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.
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10 Comments
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Thanks for this thoughtful piece, David.
Jeeze, when the first rumors of a strange illness began circulating in San Francisco in the early 1980's (I first heard of it by rumor in 1982) I would have never been able to imagine that 26 years later, we'd still be looking at condoms as our best line of defense.
But we are. And we need to find a way as a community to successfully battle fatigue, frustration and anger and deal with that.
Brynn Craffey | September 20, 2008 6:03 PM
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(Oh, and may I say, what an idiot that coffee-shop guy was!!!)
Brynn Craffey | September 20, 2008 6:04 PM
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Thanks, Brynn, I appreciate the comment. The coffee shop episode has me writing a humorous (at least I hope it is) piece about HIV disclosure. Look for it at BeOneCity.com - hopefully in a couple of weeks. (If I ever stop procrastinating.)
Take care.
David
David Douglas | September 20, 2008 6:45 PM
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I think one of the key issues, in addition to the failure of governments at all levels to fund sex-positive prevention campaigns by gay men, for gay men, is that we as gay men have not used the incredible creativity we regularly use in hooking up to develop compelling and persuasive campaigns.
By "compelling," I don't necessarily mean overly dramatic and fear-inducing. I do mean that the typical HIV prevention campaign is boring, not reflective of what is going on in the lives of gay men and is designed more to not offend the genteel sensibilities of heterosexuals.
There is also a real need for prevention technologies beyond condoms that give men more options in having safer sex. I do understand that we are a long way away from microbicidal agents to prevent HIV, but that does not make the need for them any less urgent.
Some years back there was brief blip called "prevention activism" that aimed to focus on bringing the energy and creativity of direct action activism to HIV prevention. Unfortunately prevention activism and the groups associated with it crash and burned in short order.
We can definitely use some of that energy and creativity now to focus on the problems around HIV prevention and helping guys to have sex in the ways that they want that is also healthier.
Michael Crawford | September 21, 2008 3:38 PM
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What ever happened to some of the prevention activism, Michael? Do you have any of the history?
Bil Browning | September 21, 2008 10:16 PM
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Well, Bil, Michael Crawford and David Douglas might supply you with some details about how the "prevention activism" movement developed on the East Coast ...
... but as for Los Angeles, where I was living at that time in history, you might want to ask Bilerico contributor Patricia Nell Warren to put you in contact with her publishing partner, Tyler St. Mark, who helped create one of the first prevention campaigns in the country, the "Mother Cares" campaign funded by Los Angeles County Health Department.
Briefly, the campaign featured a short, matronly figure simply called "Mother" (played by actress Zelda Rubenstein of Poltergeist fame) who would urge her "sons" to "Play Safely" ... and similar clever euphemisms, such as appearing holding an umbrella and saying something like, "Mother wants you to be sure you put on your rubbers" (Groan! ... that pun has to be as old as the condom itself!) The campaign was well-received in L.A. and achieved national attention. See Tyler St. Mark's bio here.
Another unrelated L.A. prevention campaign was more graphic: it featured simply a totally nude attractive young man in low lighting, seated probably on the edge of a bed, with a full erection and a condom over it. The caption read, "Dress for the occasion" --- obviously, this poster appeared only in the bars and bathhouses.
Another L.A. footnote: Shortly after the identification of the HIV virus, the premier gay-lesbian political action committee in southern California, the Municipal Elections Committee of Los Angeles (MECLA) called for the area's bathhouses to close voluntarily. The backlash from the gay male community was so devastating that MECLA's finances never fully recovered.
A. J. Lopp | September 22, 2008 2:58 AM
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The idea of Condom Fatigue actually speaks a lot to me. There are people who know to use condoms, they know why, but they still don't. They're often people who lived through the 80's and 90's and used condoms the whole time and, for whatever reason, stopped.
Honestly, and I hate to say this with the present company in the comments, a lot of people of that generation loooooooooooove to tell me that those folks just don't exist. Everyone over 40, to them, uses condoms all the time because they lived through the worst years of the epidemic. The fact that the last time I was in the US only one man in that age group that I slept with volunteered a condom w/o me reminding him 1-5 times is, you know, something to be ignored.
But I'm kinda tired of being told what I see and what I don't see.
Alex Blaze | September 22, 2008 6:06 AM
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Thank you for this piece from an HIV+ person. I think this perspective--especially a glimpse into the types of everyday discrimination that HIV+ people experience--has been lacking from the conversation.
All too often it seems to me that the safe sex message is being shouted by HIV- people who seem to disdain anyone who would be "stupid enough" to have unsafe sex. They seem to be looking down upon all HIV+ people, especially young people who have probably seen safer sex messages all their lives and thus should have known better. That tone will not, in my opinion, succeed in helping anyone to make safer sex choices.
I think that tone is a big contributing factor into why HIV+ people generally don't discuss their disease. It's easy now, thanks to improved treatments, to simply blend in. Why stick our heads above the crowd and endure the discrimination and lowered opinions of the negative people around us? While we may be loud advocates for treatment research funding and other abstractions, it seems we rarely share our personal, daily experiences of living with the virus.
I wish there were more concrete suggestions for improving the success of the safer sex message, other than "better marketing." Unfortunately, though there are far better informed people than me racking their brains for answers, it seems to be an extraordinary quagmire.
I believe that, rather than focusing on altering the safer sex message, it would be worthwhile to investigate the effect of treating the underlying problems. I think a decision to have unsafe sex is often caused by low self-worth. The same goes for the decision to use crystal meth. If we can't find successful new marketing campaigns for safer sex and against drug use, perhaps we should instead treat depression, internalized homophobia, LGBT teen homelessness, and those similar problems which often precede and enable the bad decisions.
At least that's what it looks like to this 33 year old, as I look back nearly every day and ask myself, "what would have worked?" I'm an educated, fairly intelligent guy, but I'm afraid all the billboards in the world wouldn't have made the difference.
Christian | September 22, 2008 1:53 PM
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Alex: I'm obviously a member of "that generation" and I for one will not deny for a second that there are men in my age group who don't want to use condoms --- I run into them all the time! I would say the percentages here are about 50/50 --- half the guys might walk away if I insist on a condom, and the other half assume condom use as a matter of course.
Christian says:
Another footnote in L.A. history involves the sensational movement initiated by a woman by the name of Louise Hay, who attempted to do exactly what you point out, Christian.
In the early 80's, Louise Hay was a metaphysical counselor who had recently moved from NYC to LA. She started a metaphysical healing support group with a small handful of men with AIDS in her living room --- and by the end of the 1980's, she was holding Wednesday night gatherings that attracted literally thousands every week. Her weekly "Hay-ride" gatherings, in the West Hollywood park across Robertson Blvd from the Pacific Design Center, were phenomenal.
Hay's philosophy proposed that all disease is caused by the mind --- not in the sense that one imagines that they are ill, but meaning poor psychic attitudes toward oneself and life results in somehow attracting or self-generating disease.
Louise did not in any way discourage patients from following their doctor's treatments, but also taught that almost everyone, and PWA's in particular, need to consciously work on a program to improve their self-love, self-respect, and self-acceptance. She is famous for her "mirror work" in which her counselee is tutored to look in a mirror and repeat an affirmation such as "Allen (or Alex or Christian or whoever), you are wonderful and I love you just the way you are." Louise Hay herself claims to have cured herself of cervical cancer using a rigorous program of dietary de-toxification and psychological exercises that included such mirror work.
Obviously, such teachings only attract a particular type of individual who is open to such a philosophy --- many thought that Louise Hay was a bunch of bunk. And some accused her of doing harm by causing people to invest hope in a form of magic-thinking mysticism.
But the story of Louise Hay and her 1980's Hay-rides demonstrates something very important: Not only is there the clinical theory that low self-esteem plays a major role in HIV tranmission, but also there is a sizeable element of the GLBT and HIV-affected population that hungers for guidance in their quest to improve such self-attitudes. OTOH, how much of Louise's following were individuals who were willing to "grasp at straws" spiritually at a time when the medical offerings were so uncertain, ineffective, and bleak?
The effectiveness of HAART anti-retrovirals eventually brought the Hay-rides to an end. A similar movement whose time appears to have come and gone is The Advocate Experience, the program of weekend workshops that originally focused on empowering gay men and lesbians to come out of the closet, but later did a lot of work related to HIV/AIDS similar to Louise Hay.
I think the demise of such programs is regrettable, because I believe there is, and always will be for the foreseeable future, a need for programs that psychologically empower us against the prejudices, denouncements and moral accusations of the society around us. Yes, the younger generations have more open attitudes about gayness and sexuality in general, but I also believe that they, and possibly most humans, have unhealthy life attitudes that can be traced to inadequacies, trauma and mistaken attitudes we learned during childhood. Few of us reach adulthood with the feeling that "I am wonderful, I am good enough, and I love myself." Too many of us still have a little voice inside, formed by our parents, teachers, and the images of society around us, that whispers constantly, "I'm not good enough."
So in closing, yes, Christian, I would enthusiastically applaud and encourage a program along the lines you suggest --- but it is a daunting undertaking, and inevitably it will be met with a certain amount of criticism.
[I apologize for the length of this comment, but I feel that the complete treatment of this very important point justifies it, and I hope that the Bilerico moderators and many readers will agree, or at least be tolerant.]
A. J. Lopp | September 22, 2008 3:05 PM
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P.S. Christian also says:
Adding to this "quagmire" is a very critical Catch-22 when government funding is involved: In order to market safe sex, an ideal program will emphasize that safe sex can be "fun and sexy" --- just as the HX editor wanted Dave Douglas's article to do.
But unfortunately, such a program cannot encourage safe sex without also encouraging sex itself --- and even today, this is still very politically dangerous.
One early HIV prevention publication in L.A. was Mother's Handy-Dandy Safe Sex Guide that began by having a cover featuring a sexy, muscular, hairy Latino man in a jock-strap, slouching so that his crotch was toward the camera and his hand poised on his thigh as if he was about to self-pleasure his own Ground Zero. (God, was he hot! He was my type, and I still remember that photo as if it were yesterday! The producers of that piece really did a great job pushing the buttons they wanted to push!) Inside, the little booklet gave very graphic instructions on safe sex, illustrated with drawings and a few actual photographs, using the most common conversational sexual terms --- the publishers did a fantastic job, it was exactly what the L.A. street crowd who didn't make it into Harvard really needed. The booklet also appeared in Spanish.
Next thing we know, every California state legislator had received his/her own copy of Mother's Handy-Dandy Safe Sex Guide --- and a heated debate ensued in Sacramento about whether county funds should be used to produce "pornography" and encourage young men to have sex with each other, whether it is safe or not.
In the end, that territory proved to be politically untenable, even in California, and a general atmosphere descended that tacitly concluded that Mother's Handy-Dandy Safe Sex Guide had overstepped its license. So ... What level of frankness will conservative politicians tolerate? What language is appropriate when you are reaching out to populations that can barely read? Government-funded HIV prevention programs walk this tightrope balancing act to this very day.
A. J. Lopp | September 22, 2008 3:50 PM
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