Editor's Note: David Douglas is a writer for beonecity.com living in NYC.
When I was asked to revisit and revise a piece I'd written on safe sex four years ago I was thrilled. I love revisiting sex as often as possible!
I also thought the timing perfect. Now you may be thinking, "Oh great--how lame--he's gonna tie this to the recent political conventions." Puhleeze! I have a little more imagination than that. Right outside of the Democratic Convention Center is where I'd actually like to begin my re-visitation.
You see, as anxious as I was to see what pantsuit Hillary would be wearing and what tie Barack would be sporting, I found one of the fringe events far more titillating. For even as the Dems began politicizing practically across the street Rolling Stone magazine and Trojan were sponsoring a Condomvention. I kid you not. With the theme "GET IT ON" and Bill Maher hosting, it was billed as a "night of condoms, cocktails, comedy and hopefully change."
O.K., so maybe that is a lame tie-in. But by the way things are going, let's hope those delegates took time to check it out (and focused less on the cocktails and more on the condoms!). After all, with the recent acknowledgement by the U.S. Centers for Disease Control that they've been underestimating the rate of new HIV infections by almost 40% for years, it's certainly time for a real national focus on the issue.
These new stats may, in fact, be just the jolt for justification the politicians need. For the first time since the death toll started over 25 years ago BOTH parties seem intent on addressing AIDS as a national crisis and on a national scale. Obama even goes as far as to say he is "committed to developing a National AIDS Strategy."
It's the kind of push we've obviously needed for a long, long time. As much as we've accomplished as a community--by those who are, like myself, virally-enhanced and those fortunate enough to have remained negative--the message of safe sex continues to elude us. This fact became painfully clear to me during this re-visitation.
Making HIV/AIDS Fun
When I wrote my original piece for HX Magazine over four years ago, the rate of new infections among gay men in New York City was surging once again. For those of you unfamiliar with HX, it's basically a weekly NYC party guide for the boys, with mostly a bar distribution--definitely aimed at a party crowd. So when the editor asked me to write a safe sex piece for their annual sex issue I was impressed. It wasn't the type of article HX is noted for. I mean, hey. Their major funding comes from hustler's ads--focusing on safe sex isn't exactly part of their marketing strategy.
It seemed routine enough and I was excited to do it. I thought, "Wow! If a party guide like HX is heralding safe sex things really must be dire." As the editor got more specific, though, my excitement cooled. "Talk about the history," he said, "Why were safe sex messages so prevalent and powerful in the '80s, why'd they wane and why are they coming back?"
Simple, I thought at first. Shouldn't be a problem. "Make it fun!" Now in the interest of brevity, I won't go into the number of times he used the word "fun" as he continued to share with me his vision for the piece. Suffice it to say, I quickly realized that what he really wanted was a party piece; something palatable to a readership that usually has a cocktail in one hand (an old-fashioned, pre-AIDS, real- thing cocktail) and HX in the other while cruising the boy across the bar. It's an audience for whom HX is more often a convenient prop than anything else. (Do any of those boys even read the articles?!)
I wasn't at all sure what to write. "Fun fun fun" kept echoing through my mind. And yes, sex is fun. Safe sex is fun. But safe sex was born of tragic necessity, and it was that same necessity that carried the message so efficiently and effectively in the early days of AIDS.
The Fear Factor
I remember those days (yeah, I'm on the other side of 40). The idea that a condom could protect you not only from STD's but also from AIDS, was just gaining steam when I volunteered with GMHC in 1984. From the get-go the idea of practicing safe sex was rife with controversy. "It's all a government plot," I remember a man telling me in a bar, "They just want us to stop having sex."
Part of me really wanted to believe him. But then I went to the hospital to see my first GMHC client. The elevator doors opened and there he stood--a man so emaciated and frail that I was amazed he could stand at all. His face and arms were covered with the bluish-purple spots of Kaposi's sarcoma. I'd seen it before--you saw it everyday back then. Still my face must have registered horrific pain. He tried to alleviate my discomfort with a stab at humor, "All I can say is, don't eat the blueberries."
Such visions kept the message of safe sex strong and viable during those initial years. So what happened?
When Fear Becomes Fatigue
When interviewed at last month's XVII International AIDS Conference Dr. David Hardy, Director of Infectious Diseases at Cedars-Sinai Medical Center in Los Angeles, acknowledged the potency of this fear-factor. "We certainly have seen success, having been around in 1983 to 1987, right after the virus and the disease was discovered. Men who have sex with men who were at risk did, in fact, change their behavior, and the new infection rate did plummet dramatically.
Having seen that happen over 20 years ago, I know that that can happen again. Unfortunately, complacency--and lack of information, the lack of knowledge, the lack of fear about what the virus can do to someone--has, I think, in large part been responsible for why this disease is starting to re-emerge..." So, am I really too healthy to be scary? (You should see me first thing in the morning!) Having never been one to steal the spotlight, though, I searched for other possible factors.
I was quickly overwhelmed by the complexity of the issue. It's not just us non-progressors that led to a flurry of condom-less fucks. Sheer fatigue, psychosocial issues like low self-esteem and internalized homophobia, the U.S. government's emphasis on abstinence over prevention (that's why we're hoping those Dems checked out that Condomvention!), the escalating use of party drugs (most especially crystal meth), even the emergence of the Internet--all are factors.
The Anonymity of Online Sex
At the July 28, 2003 CDC Prevention Conference a survey of 2,934 men who frequent Internet chat rooms in search of sex revealed that 84% were more likely to have unprotected anal intercourse with men they met online. Apparently the anonymity once associated with the bathhouses and back rooms of the '70s and '80s has transferred to web-based hook-ups. Having frequented those rooms myself, I found this particularly interesting.
When I met a recent chat room date at a coffee shop, though, he did ask almost immediately, "Are you HIV?" After getting over my initial dismay at his stupidity (you have HIV, no one is HIV) I responded affirmatively. I've never seen a man chug a hot cup of coffee so fast; he must have suffered some scalding in his haste to depart. It's probably just as well that he left, then, because a scalded mouth is a compromised mouth and I wouldn't have been able to kiss the asshole anyway. Yes--I, like many of you, must consider such things constantly.
But the Internet isn't the only culprit in this resurgence of new HIV infections.
The Meth Factor
When I wrote that original piece, Craig Hayworth, then Director of HIV Services at the Callen-Lorde Community Health Center in New York City, acknowledged that new HIV infections had been on the rise for years but that the dramatic increase in crystal meth use was suddenly fueling it with frightening intensity. "Much of the data is anecdotal," he said, "But we know that almost 75% of our patients newly infected with HIV say crystal meth use played a part in their engaging in unsafe sex."
It was just such anecdotal evidence that induced Daniel Carlson and Dr. Bruce Kellerhouse to found the HIV Forum in the summer of 2003. The goal of their "grassroots prevention organization" was, according to Carlson, to "raise awareness about HIV infections, challenge deceptive messages about what it means to live with HIV, and change the ways we view and create HIV prevention."
"We realized new infections were increasing some time ago," added Dr. Kellerhouse. "When we saw no one was doing anything about it, that no one was targeting prevention, we felt we had to do something." That's when they organized their first public forum, Challenging the Culture of Disease. "At that first forum," says Carlson, "Three problems became clear. First, crystal meth use is fueling the rise in new HIV infections. That, along with the increased incidence of barebacking and the lack of prevention messages aimed at gay men in their twenties all seem to be factors."
Callen-Lorde's Hayworth agreed. "To have a real impact on reducing new infections we must rethink our marketing of safe sex messages so they reach young people while addressing crystal meth use. The message has to be constant, fresh and encompass a broader, more reasoned approach. Also, along with the CDC, we have to explore tailoring prevention messages aimed at those already infected."
As I said, that was over four years ago. A flurry of activity followed. Carlson and Kellerhouse launched two more forums. Activists Peter Staley and Vincent Gagliostro invested $6,000 of their own money placing ads along NYC's Eighth Avenue in Chelsea proclaiming, "Huge Sale! Buy Crystal, Get HIV Free!"--receiving press not only from local GLBT outlets, but also from no less than the New York Times itself. Major players in the community also finally got involved. NYC's Lesbian, Gay, Bisexual and Transgender Community Services Center began its own crystal meth campaign and the Gay Men's Health Crisis formed a task force aimed at creating a strategy to respond to the crisis.
So, what happened? That burst of enthusiastic energy was certainly laudable, but was it at all effective? Recent statistics say no. Not only do HIV infection rates continue to rise but the incidence of new STD's among MSM, especially syphilis, is now practically epidemic. In NYC alone syphilis rates soared 62% in 2007, almost exclusively in gay men. And, in a sadly ironic twist, if you're seeking help with a crystal meth problem I'd advise against going to Carlson and Kellerhouse's website. If you do attempt it (hivforumnyc.org) you'll find it's not only defunct but actually leads you to a site titled How To Make Crystal Meth!
Where Does That Leave Us?
So we return to the Condomvention. Its timing and placement right outside of the Democratic Convention Center could not be more apt. It appears clear now that, decades into the epidemic and despite all our efforts as a community, the message of prevention and safe sex lacks impact without the force of a national, comprehensive, government-sanctioned intervention.
And, as sobering as recent stats about under reporting of new infections may be, it seems it might, finally, be just the thing needed to motivate whatever new administration takes office to take decisive action. Perhaps in this case the irony of the situation might work in our favor. The indication of failure in these recent stats might, at last, lead to success.