Wednesday, November 02, 2005

Sex in the Age of AIDS

I have been interviewing people this summer about their perceptions of the global AIDS pandemic, among other issues, for a film that I am helping produce through 1 Giant Leap. I traveled from Durham to Dublin, Ireland, and from there to London, Paris, Montpellier, Barcelona, Mallorca, Valencia, Madrid, Lisbon, Nice, Rome, Naples, Heidelberg and finally Berlin before returning home. Along the way, I poured sweat in the summer heat and I walked a lot, stopping strangers and friends alike to ask my questions. What I learned was very interesting.

In most cases, nearly everyone had compassion for people living with HIV/AIDS and knew that the issue is a huge problem for the world. However, there were many people who described a lack of education in their societies about how to prevent this disease that is totally preventable. Unlike cancer and heart disease and many other genetically predisposed illnesses, HIV/AIDS has the potential to spread exponentially where the other illnesses seem to spread in a more measurable, even statistically predictable way. All it takes is a little knowledge, care and love for your partner and the responsibility to wear a condom to prevent spreading HIV. If you as the penetrative male wish to be even safer, wear a condom and withdraw before attaining orgasm. Many suggest abstinence-only is an option, but we know that people are driven to have sex. Suggesting abstinence-only is kind of like saying that the only way to effectively remove a stain from a garment is to cut it out with scissors. We don’t call it a gene puddle, after all….it is a gene pool, and we all seem to need to dive right in, some days more than others.

I know that it sounds very simple to say "have safe sex", but the reality is quite complex. I have furthered my research by balancing my message of prevention with a desire to get laid. Yes, I am a human being who needs human touch, tenderness and affection. This is a very thin line to skate over very thin ice. You can’t scare the living shit out of people to get them to understand the risks and consequences of HIV/AIDS and still be able to get them to make out with you. In doing this latter research, I have learned a few other things that are frustrating me.

The first is that you can break down sexual interactions online in the gay male community according to sero-compatibility issues. For example, I can show a guy my photos and then get an invitation to meet. Even if I have been careful to show my photograph AND to disclose my status online, they often do not read my profile once they have seen my photos. When I point out my status, there are several rather predictable results.

If the person who is interested in my physical appearance is HIV negative or thinks so, then by pointing out explicitly that my profile shows my HIV status as Positive ends up shooting my desire to get laid in the foot. They frequently will simply quit writing to me as if I had disappeared. It is difficult to do this research and maintain my self-esteem. Some actually do have the integrity to write me back to say that they had not seen the profile and that they are not able to take the risk of having sex with me since they are not willing to risk death for a good lay. That message, though better than silence, still reeks of "Pariah!" That doesn’t leave me feeling a whole lot better, I have to say. On the other hand, I suspect that many of these guys are having sex with others who are not open with their status or who do not know their status because they assume that everyone is negative. Times have changed since the 1980s when we assumed that everyone was positive. A fairly large percentage of the gay male community is infected and these guys do not know their status. If they haven’t been tested yet, they can claim that they are sero-negative, because as far as they know, they are not infected. Perhaps they should claim their status as not-tested instead.

The other extreme is represented by the sero-positive guys who refuse to have safe sex. I am no angel, and have not always, in every circumstance, practiced safe sex, even though I am always open with my status. In this case, there are guys who do not care if they are infected, or perhaps are already infected and figure that taking more virus into their bodies is no big deal. I can say that I have been very careful not to allow myself to be exposed to another man’s bodily fluids, but there have been occasions where despite my efforts not to share my virus, I have not been able to control the last-second actions of the people with whom I have been. Though they have been forewarned, I have to say, once you get down to the actual act of having sex, it is very difficult to stop and ask, "Do you really want me to do that?" or "Stop, don’t…well, nevermind." That kind of thing has a chilling effect on getting laid too. Frequently, the mere mention of safe sex is enough to be a deal-breaker with some guys.

I have not found a lot of HIV positive guys who are attracted to me, for whom I find an attraction as well, who choose to have safe responsible sex 100% of the time. That would be my ideal partner. There is apparently a risk, or at least the concern of a risk, of developing a super-virus that would come about by combining the wild viruses of HIV with those that our bodies cause to mutate when we take our meds. If for example, I am taking drug A and it fails, then there is a likelihood that I have a virus that is resistant to drug A. If I then have unsafe sex with a man who has a virus resistant to drug B, then I can become infected with his drug-B resistant virus and he can become infected with my drug-A resistant virus. Once the two viruses come in contact with one another, then there is theoretically a chance that they will combine to create a drug-A, drug-B-resistant strain. If we are casual partners and move on to other partners, there is the chance that a series of different strains of HIV can be pooled around in the community. The big scare, in this case, is that a super-virus will develop that is resistant to all known drugs and we will find ourselves back in the early 1980s with no way to prevent grueling death among infected people.

We need to be aware, also, of the guys who have been told that their viral load is undetectable and then have decided that they no longer need to disclose their status because they feel they can practice unsafe sex without passing the virus along. These people need counseling by a good social worker or therapist or AIDS educator. The fact is that you can still pass along the virus even with an undetectable viral load and you owe it to your partner(s) to be honest and open before putting them at risk. These guys make me angry, perhaps because I know they are out there and they are active when I am not and I "follow the rules" to the best of my ability.

This disease is not a gay illness alone. It never has been. In the early 1980s when I was infected, there were known high-risk groups that included hemophiliacs, Haitians, homosexuals and IV drug users. Today, the fastest growing demographic in the US is African-American women between the age of 25 and 44. In sub-Saharan Africa, the disease is primarily a heterosexual disease, and in these affected countries, there is nearly no infrastructure to deal with the illness. Whole segments of the population of these countries are being decimated. It is said that in some places, there will not be a middle-age. Only the very young and the very old will survive. We all have to assume that we are at risk.

Compassion is the last issue I wish to address. I was chatting with a guy one night, just to say hello. He claimed in his online information to be a nice guy. He read my profile, returned to our conversation and he said "You should have worn a condom," and then clicked out of the chat. It was such a complete insult. If the US government under President Reagan had addressed this issue by educating us about AIDS when Europe was already doing so for their citizens, I might have known to wear a condom and my life would have been very different. That was not the case, and I was infected before we knew what caused this illness. Being holier-than-someone-else is not helpful except to make the speaker feel better about his own lack of control.

We need to develop compassion for the whole world as well. Africa is under extreme duress from AIDS. There are more than 40 million people in the world infected with HIV/AIDS. Most can not afford their medications, or are in parts of the world where even getting tested is too expensive for them. We need to put more pressure on our political and business leaders to help those who can not help themselves. Did you know that North Carolina has one of the worst AIDS assistance programs in the US? If you make more than 125% of poverty level income, then you can not qualify for help under government programs. That amounts to a total income and asset level of about $11K/year. Many of the victims of this disease can not approach their faith-based charities with this issue because of moral judgment. We need secular support, not judgment.

So that is what I can share with you about what I have learned. It isn’t helping my sex life, but I won’t give up, because it is no fun to struggle for 20 years to continue surviving, to look death in the face and to return, only to be told that you can not participate in one of the most wonderful experiences as a living human being. With luck and time, I will find the right guy for a compatible relationship and this will not be an issue for me any longer. Either way, I hope to continue to educate to the best of my ability that safer sex is hot sex and that you can still protect yourself from AIDS while living a full life.

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