There's an interesting article in the current GQ about the HIV/AIDS epidemic that asks some pretty interesting questions. It's a good reminder about where we are when it comes to finding a cure or a safe vaccine (not very far), considers the possibility of never finding anything better than condoms to fight the epidemic, and discusses current AIDS prevention policy.
Here's a part of the lengthy article from right after it mentions a Swiss study that showed that some positive people could bareback without risk of passing along the virus:
Did this good news touch off celebrations here in the United States? Hardly. The Swiss study went largely ignored in the media. What's more, powerful AIDS groups rushed to condemn it. Project Inform, a national HIV clearinghouse, decried the findings as a threat to the condom code. So did a number of other groups, many of which issued stark warnings, calling the Swiss report "dangerous" and "misleading." The World Health Organization issued a joint statement with the United Nations AIDS office reiterating the need for "correct and consistent use of condoms." They share a concern that ordinary people will misinterpret the recommendation and put themselves at further risk. "Scientifically, it makes sense," Ward says. "Sociologically, it doesn't."
But these responses seem to miss the point. The problem isn't condom knowledge. The problem is condom burnout. After a quarter century, people are demanding a new approach.
I'm not an expert in either the virus or epidemiology, but much of this article spoke to my experiences and those of the gay men around me. Especially moving attention away simply from passing out information about condoms, since I know many, many gay men who are well-informed of the risks of sex without condoms and know how to use one that still bareback:
And the reason for these increases? Gay men are no longer abiding by the one commandment that dominated gay life for decades: "Use a condom every time." In survey after survey, gay men say they have stopped using condoms. "I think the last rubber gay guys used in this town was in 1985," Michael Petrelis, an AIDS blogger in San Francisco, joked when I asked him about this trend. Most young men whom I spoke with said they have sex without condoms, though few would admit it on the record. A 20-year-old Korean student in New York told me he's used condoms in the majority of the 150 or so sexual encounters he's had, but he also makes exceptions "if I really like him or feel a kind of love or something." He acknowledged this didn't really make sense, but he isn't HIV-positive yet, and he was sure he'd make exceptions in the future. A 26-year-old Bronx native, whom I spoke with one night as he lingered on Christopher Street in the West Village, spelled out an epidemiologist's (and a girlfriend's) nightmare. "If it's my baby mama, I never use them," he said. "But if it's with a guy--sometimes in the heat of the moment you lose your focus."
Gay men say they feel cheated out of the full pleasure and intimacy of sex, and many have come to perceive condoms as emblems of a still hostile world, imposed on them by a culture that continues to stigmatize gay sex. "To use a condom every time you have sex, for the rest of your life?" says Daniel Siconolfi, of New York University's HIV-prevention think tank, the Center for Health, Identity, Behavior, and Prevention Studies. "That's a very, very big burden. That's a lot to ask of somebody. And it's not being asked of anybody other than gay men."
Indeed it is. That doesn't mean it's wrong to ask that it be imposed, but we should at least be able to recognize that many, many gay men see a life of using condoms each and every time as a burden and a loss.
The author goes on to take on some of the more... "grassroots" approaches to fighting the epidemic (he uses that word, I think it only applies if these techniques worked). He discusses sero-sorting and dosing up on HIV meds before having sex to create a barrier to transmission. While there isn't much to say that these actually are reducing transmission, it does stand as proof that there are people who are looking for an alternative to condoms all the time.
Currently we don't have a big-picture solution other than abstinence and condoms, and many people are going to forgo either of those when they're looking for sex.
I'm interested to know what others thought about the article.