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What Young Gay Men DO Know About AIDS
December 9, 2013 5:53 AM   Subscribe

[Eleven] days ago, The New Yorker’s Daily Comment blog published an essay by Michael Specter titled “What Young Gay Men Don’t Know About Aids,” in which Specter points to the increase of “unprotected anal intercourse among gay men,” claims that “the rates of HIV infection will surely follow,” and then identifies the cause of this shift as the ignorance of my generation, who weren’t around to see the AIDS epidemic for themselves. The piece is a call to arms of sort, stating the need for increased public funding for HIV/AIDS prevention, and concludes by quoting Larry Kramer’s famous 1983 warning, “1,112 and Counting.” It’s a familiar argument—one that, in my lifetime, I have heard repeated ad nauseam and, I fear, largely misses what AIDS means to me and many other young gay men.
posted by Blasdelb (71 comments total) 17 users marked this as a favorite

 
Maybe it's because I live in New York, but I feel like young gay men my age or a bit younger (20s and 30s) know a great deal about what the epidemic was like in the early 80s. When The Normal Heart was playing at the Public and then on Broadway, it was hard to get a rush/student ticket because so many young people want to know.

I do feel like And the Band Played On should be required reading for all high school students, though.
posted by roomthreeseventeen at 6:31 AM on December 9, 2013 [2 favorites]


thank you so much for pointing this out. i saw the original piece and it stuck in my craw for a reason i couldn't really parse myself. this gets to the meat of it :

...the essay, which interpellates me in its title, has very little to do with me. In this kind of discourse, gay men who lived through the AIDS epidemic are simply talking to each other while wagging the finger at the younger generation down below.
posted by nadawi at 6:38 AM on December 9, 2013 [1 favorite]


Also, the second piece is horrifying in its defense of ignorance.
posted by roomthreeseventeen at 6:45 AM on December 9, 2013 [1 favorite]


The titling trope of "What [You|They] Don't Know About X" cannot go away fast enough for me.
posted by Etrigan at 6:47 AM on December 9, 2013 [2 favorites]


Tumblr is blocked at work- is anyone willing to post a quick synopsis? I saw the original piece and would be curious about the response.
posted by Wretch729 at 6:48 AM on December 9, 2013


i didn't feel he was defending ignorance - he was saying he wasn't ignorant and still made the wrong choices sometimes, just like everyone does, gay or straight - and that maybe there are other ways forward that aren't reduced solely to "all condoms all the time."
posted by nadawi at 6:49 AM on December 9, 2013 [7 favorites]


Wretch729 - memailed you the text of the post.
posted by troika at 6:54 AM on December 9, 2013 [1 favorite]


There is a lot of room for a response to the first piece from the perspective of a member of the next generation of gay men - how HIV has lost much of its perceived lethality, and the effect that has had, how there will be so many more older gay men for this generation to have as examples of out and proud predecessors, etc. I just think the second article doesn't do much good in that regard. The author's point seems to be that he grew up knowing about HIV/AIDS, but that being warned about safe sex (along with being young and dumb) made him more likely to engage in risk-taking behaviour. I don't feel a great sympathy for his position, which seems to be that his actions can be extrapolated to all young gay men everywhere, and that rather than trying to change their own actions in the face of HIV they should just take the drugs that will help prevent acquiring it, or help deal with it if they get infected.

There might be some 'young kids today' tsk-tsking in the original article, but his response involves at least a modicum of 'shut up old man' petulance.
posted by gadge emeritus at 7:05 AM on December 9, 2013 [6 favorites]


Wow, that second essay really reads like it was written by a 22-year-old. It's the way it ping-pongs between "This behavior is self-destructive and symptomatic of a larger problem" and "Fuck you Dad I do what I waaaaant!" The insistence that having people "moralize" at him forces him to do self-destructive things is just pathetic.
posted by ThatFuzzyBastard at 7:05 AM on December 9, 2013 [15 favorites]


The “safe sex or die” rhetoric has become its own brand of moralism—a force that both young people and queer people have pushed against throughout history. 

The writer seems to still want biological facts to be fair. There is zero moral reason why AIDS hits gay men. This fact does not mean that to keep themselves and their partners safe, safe sex is not the best way to handle the issue. Its as if its okay to not deal with the increased risk via safer sex practices.

And this applies to everyone. While hetero rates of HIV infection are lower due to less anal sex and the lower rates of blood mixing in regular penetrative p in v sex, the time function of the equation is infinite and eventually everyone gets it without safe sex.
posted by Ironmouth at 7:07 AM on December 9, 2013 [10 favorites]


I feel like the tumblr essay is attempting an argument based on refuting abstinence-only sex ed, merely moved one quantum towards promiscuity. That is, he treats older gay men saying "Jesus Christ you younger versions of myself, please please wear condoms! I watched so many friends die!" the same as "don't ever have sex unless you're married." His response is the same: that's not how things work in real life so that approach doesn't work.

But I feel like he's missing a crucial qualitative difference between abstinence-only sex ed and the condoms-condoms-condoms-I-watched-friends-die refrain. One fails by ignoring real sexual behavior patterns and the other works by recognizing them but striving for an unachievable ideal. I mean, no one is saying this ("stop telling me to wear condoms so much, that's not how real teenagers screw") in straight circles, right?

The crux of Jameson Fitzpatrick's objection is that he takes offense at the tone of the New Yorker article:
[T]he essay, which interpellates me in its title, has very little to do with me. In this kind of discourse, gay men who lived through the AIDS epidemic are simply talking to each other while wagging the finger at the younger generation down below.... And never should we use public forums to shame or blame young gay men for doing what—one has to acknowledge—feels good.
I'd like to know what exactly he felt was "shaming" or "wagging the finger". Specter seemed to explicitly acknowledge that, as Fitzpatrick puts it, sex "feels good" (duh). It's just that seeing an epidemic in person is different from watching a documentary:
What twenty-year-old man, enjoying his first moments of sexual adventure, is going to be scared because, ten years before he was born, people like me saw gay men writhe and vomit and die on the streets where he now stands?
posted by daveliepmann at 7:10 AM on December 9, 2013 [4 favorites]


and that maybe there are other ways forward that aren't reduced solely to "all condoms all the time."

I guess the counter point is until that day comes, condom use protects the best. Wishing it wasn't so doesn't make that truth go away.
posted by Ironmouth at 7:13 AM on December 9, 2013 [4 favorites]


I have had friends die of AIDS. Mercifully, it was not in the early 80s when these people were so feared that their bodies were put into garbage bags. Honestly, I do not think any amount of education about what happened in this country will ever be enough.
posted by roomthreeseventeen at 7:14 AM on December 9, 2013 [1 favorite]


Nadawi, can you explain what you mean by "other ways forward"? Are you saying that it's acceptable to not use condoms in some instances or are you saying that there are different ways to get out the message about condom use?

Also, I'm not that familiar with gay culture/sexuality, but it seems that coming to the conclusion at the end of the article that "teenagers are always going to have unprotected sex" is a destructive way of looking at things. What if we had that attitude about drunk-driving or bullying in schools?

Maybe I'm speaking out of turn as a straight man; is there an aspect of gay culture regarding unprotected sex that I'm not aware of?
posted by R.F.Simpson at 7:15 AM on December 9, 2013


Also, the second piece is horrifying in its defense of ignorance.

Wait, really? I thought it raised some good points that indicated anything but ignorance:

I don’t take issue with Specter’s intent—I would certainly like to prevent the second coming of an American epidemic—nor do I disagree with all of his points. More public funding for prevention education is absolutely needed, particularly in underserved communities; there has, in fact, been a rise in HIV infections among young MSM of color in recent years. But his argument that “the rates of HIV infection will surely follow” an increase in unprotected sex jumps to a quick causative conclusion without considering a number of other factors. While I think this is certainly a possible, even likely, consequence, I think there are other important questions to be asked: How many of the gay men engaging in unprotected sex today are positive and sero-sorting? How many are in monogamous relationships with a single partner? How many are taking preventative HIV medication like Truvada?

Throughout, I found that piece to be remarkably well-informed and grounded. Ignorance is not the same as realistic expectations of behavior, and from a public health perspective it's extremely naive to expect 100% health-behavior-compliance at all times. Any good solution accepts and accommodates this.
posted by entropone at 7:15 AM on December 9, 2013 [3 favorites]


The “safe sex or die” rhetoric has become its own brand of moralism—a force that both young people and queer people have pushed against throughout history.

We older gay men aren't trying to shame the younger generation. We're terrified that they'll have to live through another time when you'd turn around, ask, "Where's my friend?" and find out that they died last week, repeat again and again and again.
posted by xingcat at 7:19 AM on December 9, 2013 [9 favorites]


R.F.Simpson - that there are other solutions employed by gay men that isn't all condoms all the time. the part entropone quotes just below you discusses some of those methods.
posted by nadawi at 7:19 AM on December 9, 2013


Wait, really? I thought it raised some good points that indicated anything but ignorance:

I guess I took issue with his "I was young and so I had safe sex anyway, because everyone does" defense. It reeks of privilege to me.
posted by roomthreeseventeen at 7:21 AM on December 9, 2013


I don't think he was ignorant. He makes the point quite clearly that he knew about HIV and how to prevent it - but though he was very fearful of getting infected he still had unsafe sex anyway.

So, not ignorant. Not always smart, either. And then he complained about the tone of the original article, and assigned some of the reasoning to having unprotected sex to the moralising of the older generation. So a bit of a dick, as well.
posted by gadge emeritus at 7:28 AM on December 9, 2013


Here's the deal. Many, many young gay men are surrounded with these messages of condoms "every single time or you'll die a horrible death and you should have fucking known better."

But imagine what it's like (for those of you who aren't a young gay or bisexual man or trans woman who has sex with men). You cannot fuck up. EVER. Not once. Your sexuality from the minute you come out until the end of your life unless serious unbroken monogamy, etc. is DANGEROUS.

Those of us who lived through the worst of times, we didn't have it easy, but we didn't have this to deal with. Who are we to talk to them and tell them what they should and should not know, what they should and should not do.

The hypocrisy and condescension of this drives me right insane.
posted by Sophie1 at 7:29 AM on December 9, 2013 [13 favorites]


Ok, I understand know.

Honestly, being from the deep south and raised very religiously, I am (sadly) very ignorant about LGBT culture. When I read these articles, my first thought was, "why would any gay man ever have sex without a condom?"

Clearly this is a position of privilege that I wasn't aware I even had until I reread the paragraph you referred me to. I hadn't thought about situations where it would be acceptable to have unprotected sex between a gay couple.
posted by R.F.Simpson at 7:30 AM on December 9, 2013 [2 favorites]


i hear you on being from the south and religious - i was raised much the same way - but i was also a girl who realized i liked kissing girls, so i had to find my education elsewhere pretty early on. i think it's awesome that you're here, reading and learning.
posted by nadawi at 7:36 AM on December 9, 2013 [2 favorites]


Why do straight teenagers who know damned well that sex without birth control causes babies still have sex without birth control when they definitely don't want babies? I mean, not like babies and HIV are equivalent, but we act sometimes like it's shocking that gay men would still have unprotected sex when young people have been doing unwise things in the pursuit of sex basically forever and nobody's exempt from that on the basis of sexual orientation. Why do congressmen risk their careers to have affairs?

But what we've been saying essentially for awhile is that even though all classes of people do it, that gay men are especially irresponsible for not having universally adopted 100% condom use. They're not. It's not that this has to always be with us, but we need ways of dealing with it that are more than just trying to scare people into appropriate behavior, because it doesn't work.
posted by Sequence at 7:37 AM on December 9, 2013 [22 favorites]


Right. I think stuff like "Safe Sex or Die" gets seen as moralizing is because it doesn't match up with what they're seeing... They see people their age getting lost in the passion of the moment, or just being dumb, and no one dies, and they start to distrust the message.

I know I saw a similar thing with anti-drug campaigns, they rail against the dangers of marijuana, and then when they go to parties and people pass them a joint and it's no big deal, they decide that the authority there is full of it. And I've seen some people who take it too far with other recreational drugs and get themselves messed up.

Now, I mean with gay sex, it's not like there's "harder" and "softer" drugs. But I'm guessing there's a big difference in risk between two teenagers who've had few sexual partners going at it without protection, and doing the same thing later in life when people have had more partners, with people they know the sexual history of less.

I don't know exactly what the answer is, but there has to be some way of impressing upon people the very real dangers of unsafe sex while acknowledging that it's not the height of the AIDS epidemic anymore.
posted by Zalzidrax at 7:59 AM on December 9, 2013 [2 favorites]


Also, I'm not that familiar with gay culture/sexuality, but it seems that coming to the conclusion at the end of the article that "teenagers are always going to have unprotected sex" is a destructive way of looking at things. What if we had that attitude about drunk-driving or bullying in schools?

Saying that a situation exists is not the same as saying that the situation is okay, nor is it saying that we can just throw up our hands and go well, guess we can't do anything about it! It's saying that the situation exists, and that perhaps some techniques or methods of changing that situations aren't working as well as we'd like, and we should change those techniques or incorporate new ones.
posted by rtha at 8:08 AM on December 9, 2013 [3 favorites]


Thank you troika. Re: the article I don't have much to say other than I think gadge emeritus put it pretty well upthread.

I did think it was worth highlighting some of the medical details the tumblr piece mentions but doesn't go into detail about.

THIS IS NOT MEDICAL ADVICE, CONDOMS ARE STILL CONSIDERED BY FAR THE SAFEST OPTION FOR PROTECTION AGAINST HIV.

One fact that I think has a big effect on risky behavior but that is mostly overlooked in both pieces is that HIV is not the same death sentence it was through the 1980s and 90s, at least in the United States. If an HIV+ person is not unlucky enough to be in the minority of people who don't respond well to HAART and they are able to take their medication regularly then they should be able to live to more or less a normal life expectancy relatively unaffected by the disease. Major caveats: they have to take the medication for the rest of their lives, it is expensive for patients and for the healthcare system in general, it can have serious side effects (though that too is improving over time), even if they maintain a supressed viral load there can be other health consequences.
So I'm certainly not saying HIV infection is no big deal. But the consequences for someone who is infected are markedly less dire today than they were in the past. Connected to this is the fact that an HIV+ person with a suppressed/undetectable viral load is far less likely to transit the virus even if they engage in risky sexual behavior. So to speak about a return to seeing people dying in the street is pretty unrealistic. HIV is now seen as a treatable, chronic disease. Deeper discussion on living with HIV on Metafilter here.

Explanation of terms used in the tumblr piece:
PreP = PRe-Exposure Prophylaxis. See previous discussion about this on Metafilter here. Refers to various implementations of the idea that someone who is HIV negative can take HIV medication to prevent infection. Not as safe as condoms and obviously requires actually taking the medication to work.

TasP = Treatment AS Prevention, see PreP above.

PeP = Post-Exposure Prophylaxis treatment with HIV medication immediately after exposure in order to reduce risk of infection.
posted by Wretch729 at 8:15 AM on December 9, 2013 [1 favorite]


The author seems to be a fan of sero-sorting, but in practice, that tends to be "Don't worry, I'm clean," which is a really bad way to stay uninfected.

Your sexuality from the minute you come out until the end of your life unless serious unbroken monogamy, etc. is DANGEROUS.

You can hate this message all you want, but it won't stop being true. Sex is a breeding ground for viruses; always has been. Anal sex frequently involves tearing of mucus membranes, and is a ripe ground for infection. That doesn't mean one should stop having sex, or stop having anal sex. But there are more and less safe ways to do it, and if you choose the less safe way, you are choosing to be less safe, and if you choose to be less safe, you are in danger. Biology doesn't care about what you want to hear.
posted by ThatFuzzyBastard at 8:16 AM on December 9, 2013 [8 favorites]


It's unrealistic, from a public health perspective or one rooted in social and behavioral science, to expect everybody to always make a certain decision in their best interest - especially their best interest as defined by other people.

Especially young people, who don't have a fully developed prefrontal cortext and have a biological tendency to make decisions in their short-term best interest rather than their long-term best interest.
posted by entropone at 8:37 AM on December 9, 2013 [1 favorite]


Actually, we're still in an HIV epidemic, both in North America and worldwide. It's just less obvious among white gay men in the developed world, because the (now being reduced in the US, thanks stupid budget cuts!) publicly-funded availability of ARV drugs and other treatments delays overt symptoms and mortality.

Infection rates for MSM POCs and their female partners in North America are rising due to combinations of homophobia, low-information, poverty, and lack of healthcare access. South and Central Africa are being devasted by heterosexual HIV transmission - there are are areas where the infection rate for adults 18-35 is over 30%. Southeast Asia is looking at a similar infection growth rate due to IV drugs, sex work, and lack of accessible/affordable medical care.

But what young, newly out gay men see is most people look healthy and sexy, testing is free and confidential, affordable treatment is (was, ugh) available in most urban areas, and being HIV+ can prove how gay one is (I wish I was making this up). The right-wing/evangelical homophobic equation of "gay man = HIV+" is being enacted by young gay men who have never heard much else about adult queers. Bigotry and lack of fact-based sex ed kills, even though it's delayed.

So the articles in the FPP are on-target from each of the writer's perspectives. Older guys want to prevent another generation from being ravaged by the plague; younger gay men want the sexual freedom of coming out with no/delayed health consequences.

There won't be much satisfaction down the road when those now-ill slightly older young gay men have to admit at least the older guys told them so. I hope public or ACA-required HIV care will still be funded by then.
posted by Dreidl at 8:39 AM on December 9, 2013 [10 favorites]


and if you choose the less safe way, you are choosing to be less safe, and if you choose to be less safe, you are in danger

We don't live in a world where people make choices in a context of perfect information, understanding, and lack of shame and stigma (especially when it comes to sex). Real-world policy must tangle with and find ways to address that lack of perfection.
posted by rtha at 8:40 AM on December 9, 2013 [13 favorites]


From the Jefferson Airplane, a lifetime ago:

Everything you say we are
We are
And we're very proud of ourselves

posted by rdone at 9:02 AM on December 9, 2013 [1 favorite]


Rather than shaming queer men who don't have safer sex one hundred percent of the time, I think it's important that folks (especially those outside of the queer community) examine the the marginalization of queer people (in particular those also at the intersections of racial & class discrimination) and recognize how that position in society can foster (and in some cases leave no choice but) condom less sex. This article, Poor Black and Hispanic Men are the Face of H.I.V., isn't a bad place to start.
posted by kylej at 9:09 AM on December 9, 2013 [4 favorites]


“We’re not ignorant; we just don’t care!”

Seriously, though, it is good to hear what the other side of the debate is thinking. I was a kid during the height of the epidemic, and I’ve been a bit baffled myself that the message from the older men who lived through it doesn’t seem to have been getting through so well.

Honestly, if there was a way to remove the whole religion/shame angle that seems to have gotten wrapped up in it – heck, this goes for comprehensive sex ed for straight kids, too - it seems like it would be a whole different ball game.

Sure, HIV can be managed with a drug regimen now. But even if you can get the drugs affordably it’s hardly an ideal solution. I’m on lifelong drug regimens for chronic illnesses; have been since I was a kid. My insurance covers them for now (with varying copays), but if there was some way I could have prevented having to be on them by something as simple and non-life-affecting as wearing a condom during sex? I’d be dancing up and down the street right now singing “Hallelujah” fit to wake the dead. Drugs cost big money – maybe you don’t have to pay it all out of pocket, but at some point along the line, somebody does, and that cost comes back to bite all of us.

We don’t want you to wear condoms because we think sex is bad or dirty or because we don’t want you to have a good time. If you’re old enough to have sex, grow the fuck up.
posted by The Underpants Monster at 9:17 AM on December 9, 2013 [2 favorites]


That's the exact type of unhelpful advice that causes people to reject some very good arguments.
posted by MCMikeNamara at 9:20 AM on December 9, 2013 [3 favorites]


has everyone in this thread worn a condom for every single sexual event in their lives? or are their times you didn't? personally i know very few people (if any) who are 100% on condom usage. this doesn't seem like a grow up issue or "i'm gonna do what i want stop telling me what to do old man!" - more of an acknowledging what we all do and attempting to start the conversation from an honest place.
posted by nadawi at 9:22 AM on December 9, 2013 [12 favorites]


But imagine what it's like (for those of you who aren't a young gay or bisexual man or trans woman who has sex with men). You cannot fuck up. EVER. Not once. Your sexuality from the minute you come out until the end of your life unless serious unbroken monogamy, etc. is DANGEROUS.

It is true that gay men are more likely to be infected. It isn't true that every time you don't have sex with a condom you will be infected. But it is also true that unsafe sex makes getting infected with HIV more likely. The virus is a piece of nature. It has no feelings, no moral judgment, no nothing. But the nature of anal sex as a practice makes its transmission more likely, man or woman.

The problem is, unlike every piece of anti-gay crap humans put out there, AIDS affects gay men in the U.S. more than anyone else. We can't ask the virus to stop infecting people. We can only do things to make its transmission less likely.

The problem is that the bad cultural messages can get mixed up in the health message. I get that. But that doesn't mean everyone shouldn't practice safe sex and when any of us don't, to remind ourselves not to do it again.
posted by Ironmouth at 9:30 AM on December 9, 2013 [2 favorites]


But that doesn't mean everyone shouldn't practice safe sex and when any of us don't, to remind ourselves not to do it again.

But how do you make policy from this? How do you make outreach and education campaigns that work from this? I understand the "grow the fuck up!" impulse that Underpants Monster expresses, but you can't make policy out of that, as much as we wish it were that simple.
posted by rtha at 9:34 AM on December 9, 2013 [3 favorites]


There is a concept in public health called harm reduction that people should look into before telling young people to "grow the fuck up".

Harm reduction is a set of practical strategies and ideas aimed at reducing negative consequences associated with risky behaviors such as drug use and sexual behavior. Harm reduction recognizes that the realities of poverty, class, racism, homophobia, social isolation, past trauma, sex-based discrimination and other social inequalities affect both people’s vulnerability to and capacity for effectively dealing with drug-related and sexual behavior related harm.

Therefore, we use messages such as, use a condom to prevent HIV/STI infection, but if something happens and you don't, there is PEP or PrEP. Also, getting infected isn't the death sentence it used to be so getting tested and finding out your status is really important.

All of these messages need to be out there because poverty, class, racism, homophobia, sexism, isolation and other social inequalities are REALITIES and people are having survival sex and support and emotional needs and all kinds of things that are not related to "growing the fuck up" which is an incredibly condescending and privileged point of view.
posted by Sophie1 at 9:38 AM on December 9, 2013 [22 favorites]


All of these messages need to be out there because poverty, class, racism, homophobia, sexism, isolation and other social inequalities are REALITIES and people are having survival sex and support and emotional needs and all kinds of things that are not related to "growing the fuck up" which is an incredibly condescending and privileged point of view.

I agree with you, but it seemed to me that the Tumblr writer was not someone who falls into the categories you mention there. I am willing to be wrong.
posted by roomthreeseventeen at 9:39 AM on December 9, 2013


As a young gay man, I don't think anyone is contesting the importance of safe sex; rather, it's the way the messages that are being communicated that are the issue.

First, I don't think people are giving enough credence to the impact of homophobia in these arguments - gay men are always stereotyped and stigmatized as reckless and hedonic, and gay sex as dirty, immoral and crude. So to hear the same message of gay sex being dirty both internally from the gay community in addition to the external messages we're constantly bombarded with reinforces that homophobia. I do understand the biological factors that make MSM more vulnerable and the need for prevention of HIV - but at the same time, we have to admit that the rhetoric, stigma and messages around HIV are far more overblown in proportion to any other STD. It's the "slip up once and you're dead" messages; it's the "use condoms if you aren't a selfish hedonic shallow twink" messages; it's the dramatic and emotional tellings and retellings of HIV as a plague that eradicated a generation. These messages are whether inadvertently or not, used to reinforce the idea of gay sex as dirty - unless you're, conveniently enough in line with the majority hegemony, white, monogamous and un-queer in your sexual practices.

Second, I challenge the stigmatization behind HIV. Sexual activity, like driving a car, is an inherently risky activity - and as others have pointed out, it's not always driven by rational agents or in completely informed mindsets. Thus, I think like any other STD, HIV is always on the table - the focus should be on how to minimize infection. But that doesn't seem to be where much of the talk is really going. Prevention acknowledges the inherent riskiness of sexual activity - but in current HIV rhetoric, there's never any room for slipping up once; and any HIV+ individual, regardless of whether they're treated to the point of undetectable viral load, is demonized and ostracized as "impure". Truthfully, I would find it less risky to have sex with a HIV+ guy who's on consistent treatment and has an undetectable viral load than a person of unknown status who claims to be negative - but within the confines of HIV stigmatization, that's unacceptable. As an adult, consenting person, I get to set my own parameters and assessments for risk - and I'm honestly sick of being babied around and told to "grow up" for not making risk assessments that fall in line with that of the older gay generation.

The rhetoric around HIV is furthermore used to accuse young gay men of being reckless and shallow. But in reality, I would argue that as a population, we're far, far more educated on HIV awareness and prevention than much of the older generation was when they were facing their epidemic. How could we not be? It's constantly drilled into us - words like PrEP/PEP, viral load, serosorting, are all thrown around casually.
posted by Conspire at 9:41 AM on December 9, 2013 [6 favorites]


I have friends who engage or have formerly engaged in sex work. Several of them are trans women who sleep with men, most whom regularly get tested for HIV and insist on condoms in their work.

But, there's this one trans woman, who does not know what her HIV status is. Doesn't care to know. I've talked to her a couple times about it. But, she just does not want to know. I've tired to talk to her about her reasons for not wanting to know. She doesn't want to deal with it or acknowledge it at all. She doesn't want to think of herself as 'unclean' or 'dirty' or something like that. Or to think that there's anything at all wrong with what she did (and no longer does, as far as she tells me).

Not that I really care that she did sex work in the past, mind you. A lot of trans women turn to sex work as a source of income because of a society that actively discriminates against them in traditional workplaces. It's a shitty situation, but I can understand they're doing what they have to do to survive.

Which is why I guess I don't understand why someone doing that kind of work wouldn't want to know their HIV status. It is a matter of survival after all. Doing shitty stuff to survive, just to become sick or possibly die from something that's readily treatable is the stupidest fucking thing in the world. And I don't know how to convince her of that. Maybe she'll change her mind as she gets older (she's barely in her twenties), or maybe when right set of circumstances forces it.

But, in a way, I guess I can understand the behavior, both hers and the one described in the FPP. We take risks because maybe we're 'horny, reckless and defiant' or maybe we're doing it just to survive. That risk is always going to be there, and it's not going away easily. Maybe we can and should act to mitigate that risk some, even if we can't completely prevent it quite yet.
posted by yeoz at 9:41 AM on December 9, 2013 [2 favorites]


I am wondering if anyone has done a study of HIV negative men and what messages have been effective in keeping them that way.

I recall a recent article (but couldn't find it) about how some services, such as housing and treatment for homeless people, may be more available to HIV+ people, and this may serve as an incentive to seroconvert.

I have my doubts about PrEP - wouldn't someone who has trouble wearing a condom every time have trouble taking pills every day? And what are the health consequences of taking the medication? Also, more money for pharmaceutical companies.
posted by larrybob at 9:52 AM on December 9, 2013 [1 favorite]


Also, more money for pharmaceutical companies.
Well, on that note, you can get an Indian generic for Truvada for ~$127 a month.
posted by yeoz at 9:58 AM on December 9, 2013


I am wondering if anyone has done a study of HIV negative men and what messages have been effective in keeping them that way.

It would be pretty hard to make a causal connection, since there are a lot of other variables.
posted by entropone at 9:59 AM on December 9, 2013


"I probably wouldn't take [PrEP] because I know HIV medications are very strong and if you don't have to take them why would you? And I'm healthy, so why would I do damage to my body to protect myself but I still got a chance of getting [HIV], when I can just use a condom and continue what I've been doing?"

Weighing Risks of TDF/FTC PrEP Side Effects in People Without HIV

posted by larrybob at 10:00 AM on December 9, 2013


"I probably wouldn't take [PrEP] because I know HIV medications are very strong and if you don't have to take them why would you? And I'm healthy, so why would I do damage to my body to protect myself but I still got a chance of getting [HIV], when I can just use a condom and continue what I've been doing?"

+Because my life partner is HIV+ and condoms sometimes break
+Because I'm a sex worker and sometimes using a condom can cost me needed money or my safety
+Because I'm in an abusive relationship and I can't get out right now and I don't know my partner's status
+Because sometimes I get too drunk and "things happen" but I know I'm protected anyway
+Because I'm a crystal meth addict and I can manage taking my PrEP but I'm not ready to be in treatment
+Because I think my partner may be cheating on me
and on and on and on.
posted by Sophie1 at 10:05 AM on December 9, 2013 [10 favorites]


I have my doubts about PrEP - wouldn't someone who has trouble wearing a condom every time have trouble taking pills every day? And what are the health consequences of taking the medication? Also, more money for pharmaceutical companies.

Well, it depends. I'm not always a completely rational agent all the time. I might be too drunk to negotiate a condom; I'm pretty small and I'm Asian so it's possible that not all my encounters will be completely consensual; it could just be in the heat of the moment that I neglect to use a condom. So understanding my own fallibility, why not make my preventative decision to a safer, more rational, controlled time of the day as opposed to a moment where I might not be in a rational state of mind and might not have full control over the situation?

I see it as a lot like birth control pills; yes, PrEP has side-effects, but it's always a cost-benefit situation knowing that you are a population at disproportionate risk for HIV. So I think it's up to the individual to weigh the costs and benefits? I find it very, very weird that condom use is pushed overwhelmingly past any other form of safe sex and HIV prevention. It's not always the best and most convenient choice for an individual, and it's not a completely infallible method as well, especially if it's not used properly - in some respects, condom use has become synonymous with moral sex. So to me, it honestly feels like a lot of it is policing of sexuality - there's only one "moral" way to perform sex and that's with condoms exclusively. And that honestly intersects with a lot of the other "gay sex is dirty and immoral" messages that gay men are constantly bombarded with, so it's pretty easy to see why a lot of the younger generation is honestly just fed up with it.
posted by Conspire at 10:09 AM on December 9, 2013 [5 favorites]


The Tumblr essay is useful because it's honest. It's also conflicted and troubling in some ways, just like HIV in the American gay community really is. I think straight people have no understanding of just what it's like growing up gay in the shadow of the plague. It's a constant weight, a burden, a spectre. There's been a lot written about this, if you want one quick read try this Ask Metafilter question.

One thing that particularly rankles me here is straight people kneejerk saying "you don't use condoms for sex? OMG that's terrible!" I'm astonished at how many straight people regularly have sex without condoms. Good thing! Or we'd have far fewer babies. But not just married couples trying to get pregnant, all sorts of more casual / serially monogamous straight people I know have unprotected sex. And there's no moral panic.

One thing I'm particularly curious about: anal sex has been largely normalized for young straight Americans, both as a fun/new thing and as a way to avoid pregnancy. Do straight people always use condoms for anal sex? Has there been any measurement of increase in HIV transmission in heterosexuals because of increased anal sex?
posted by Nelson at 10:10 AM on December 9, 2013 [7 favorites]


Which is why I guess I don't understand why someone doing that kind of work wouldn't want to know their HIV status.

Because things like depression and anxiety are comorbid, and I would be incredibly surprised if someone doing sex work for survival reasons didn't have depression and/or anxiety. We see questions on the green every day from people suffering from those conditions who can't bring themselves to tell their professor or boss or parent or partner that they are having trouble dealing with stuff. And, if you don't have good access to health care, or if going into the one clinic in town that provides competent care to people with HIV means that everyone knows your business, or if (as recently came up in a different, horrifying thread about HIV) you live in a state that criminalizes not disclosing your HIV status to potential sex partners - well, then not getting tested may seem like a totally rational choice.
posted by rtha at 10:14 AM on December 9, 2013 [3 favorites]


I also disagree with the "safe sex or DIE" attitude. Obviously counterproductive. But I don't see how having safe sex as a GOAL is inconsistent with harm reduction. Yes, occasionally you don't meet your goal. That doesn't mean the world ends, but that also doesn't mean you throw your hands up and stop trying to meet your goal.
posted by The Underpants Monster at 10:26 AM on December 9, 2013 [1 favorite]


interpellate
verb (philosophy): To address (a person) in a way that presupposes a particular identification of them; to give (a person) an identity (which may or may not be accurate).

Learning something new every day. Don't think I'll be using it much myself, though. Don't want to come across as a pompous ass while I'm dissing someone else for implying that I'm a pompous ass.
posted by alms at 10:33 AM on December 9, 2013 [1 favorite]


That doesn't mean the world ends, but that also doesn't mean you throw your hands up and stop trying to meet your goal.

Who is saying that here? I'm not seeing anyone here saying that. Part of harm reduction is meeting people where they are, not yelling at them for not being where you think they should be. Not getting everyone onboard with 100% safer sex practices 100% of the time doesn't mean you give up; it means that whatever strategies you're using are inadequate for some portion of the people you're trying to reach, and you need to figure out why, and for whom, and re-work them. And since you cannot guarantee for any human behavior 100% compliance, you also have to figure out how to work with those who cannot or will not comply 100% of the time for the rest of their lives.
posted by rtha at 10:39 AM on December 9, 2013 [3 favorites]


So I don't really have much of an opinion on the pieces presented, but I did make an interesting connection.

But imagine what it's like (for those of you who aren't a young gay or bisexual man or trans woman who has sex with men). You cannot fuck up. EVER. Not once. Your sexuality from the minute you come out until the end of your life unless serious unbroken monogamy, etc. is DANGEROUS.

So, I'm not at all trying to equate AIDs with sexual violence, but when I was growing up the fear of male-perpetrated sexual violence was pretty much instilled at me at every turn, constantly, by my father (who of course was terrified of me getting hurt and saw it as an attempt to protect me.) And eventually, those repeated messages of BE AFRAID BE AFRAID BE AFRAID NEVER EVER SCREW UP YOUR LIFE IS ON THE LINE lead me to some pretty weird places in high school and early college and I'm still overcoming a lot of that conditioning.

I've never thought about the fact that young men who have sex with other men probably endure something similar. There has to be a better approach. I'm not sure what it is, but if experiencing that constant bombardment of "SCARY!" is anything like my dad's loving attempts to instill caution in me, it has got to be incredibly burdensome and psychologically exhausting and sometimes you do stupid stuff because you just can't shoulder being afraid all the time.
posted by WidgetAlley at 10:41 AM on December 9, 2013 [10 favorites]


To me, the elephant in the room here is sheer physical pleasure. It's obviously one of the main motivators for people having sex in the first place, and the sad fact is that sex with a condom on is, for most men, *considerably* less pleasurable than sex without it. (Especially before you learn techniques to enhance the pleasure of condomified sex, like putting a drop or two of *good* lube inside the condom as well as outside, and experimenting with different brands and materials and thicknesses of condom until you find the one that feels best to you -- but even then, the sensation is less pleasurable, for most.)

So, the harm reduction path this suggests to me is a massive campaign of education on the art and science of sexual pleasure, so that more pathways to extreme pleasure are on the table for everyone and therefore unprotected sex is less attractive. But that will not happen, for the same reason that pleasure hasn't come up yet (a-hem) in this discussion: the dreary utilitarian and puritanical underpinnings our social discourse still demands of "serious" matters.
posted by slappy_pinchbottom at 11:12 AM on December 9, 2013 [1 favorite]


PrEP also suffers from problems of adherence. iPrEx showed a 44% reduced acquisition risk of HIV with daily oral FTC/TDF PrEP (among men who have sex with men). The study concluded basically that the more often you took the drugs, the greater the reduction in HIV risk; people taking the drug tablets daily had a 99% reduced risk, 4 tablets/week was associated with a 96% reduction, and twice a week was 76%. People have been looking into topicals (like gels), which have the potential for fewer side effects, but those still have adherence problems.
posted by Comrade_robot at 11:38 AM on December 9, 2013


i'm 46 and i identify far more with the second link than the first. i didn't grow up in a big city, i didn't have to watch all of my friends and loved ones die and the whole of my life as an actively sexual human has unfolded under the threat of HIV/AIDS. i can also count on both hands the number of people who i've known over the years who are positive, which is not a very high number when you think about it.

fuck yes to the comment by Sequence above.
posted by Conrad-Casserole at 11:46 AM on December 9, 2013


As an adult, consenting person, I get to set my own parameters and assessments for risk

That's not exactly true. Your risk is more than your risk, it is the risk of every sexual partner you will have and their sexual partners. So there is a public health aspect to this.

The real problem isn't the gay males frustrated with this kind of essay, however. The thing that creates this type of reaction to the NYT episode is that homophobia tinges even gay responses to the health issue. (Both writers are gay). This means that a person responding to safe sex messages is either responding to homophobia, or responding to things that sound and feel like homophobia because they are targeted at the gay community (as the group with the largest risk out there for getting AIDS.).

The fact is we need more people, gay and straight, using safe sex practices. It is our modern world, with world-wide transportation, less linked kin groups and modern sexual practices that makes sexually-transmitted diseases far more spreadable (what's the scientific word for that) than before.

The toughest part is gay males do have a higher risk and the facts of nature can seem to be another bit of homophobia provided by the world. Dumb religions call that God's will. I call it a sad fact of life that has nothing to do with being gay, but more having to do with the fact that a sex practice that for practical reasons is more common in the gay community happens to create easier routes of transmission of blood-borne sexually transmitted diseases. None of this has any moral dimension in the objective world, but sadly provides a pseudos-scientific basis for false moral arguments against homosexuality.
posted by Ironmouth at 12:01 PM on December 9, 2013 [1 favorite]


But that doesn't mean everyone shouldn't practice safe sex and when any of us don't, to remind ourselves not to do it again.

But how do you make policy from this? How do you make outreach and education campaigns that work from this? I understand the "grow the fuck up!" impulse that Underpants Monster expresses, but you can't make policy out of that, as much as we wish it were that simple.


My thought is this--you focus on (1) testing; (2) messages that work in situations where one's judgment is going to be clouded by their desire to do what their bodies are programmed to do. Testing makes you more aware. And awareness messages linked to the positive aspects of sexual behavior are critical--things that focus on this is fun, let's play safe.

We are usually not affected by shaming at the time of the actions we take--only after the fact. And shaming has the perverse power to make people abandon all hope and not take any precautions. So more of a "If your gonna do it, wrap it first!" kind of thing and not "YOU WILL DIE IF YOU DON'T DO THIS" which is incredibly ineffective because the fact is that the likelihood of getting HIV from a single sexual encounter is probably not that high and is no doubt not 100%.
posted by Ironmouth at 12:07 PM on December 9, 2013


has everyone in this thread worn a condom for every single sexual event in their lives? or are their times you didn't?

Thanks for asking the obvious question that's hanging out there, nadawi.

I'd answer that as "yes." I could hedge that and say that I'm a white man, have only had sex without a condom within the course of a monogamous relationship, that hormonal birth control was used, and that both partners tested negative for all STDs prior to the relationship.

But I'd be lying. As a white man, not in poverty, who doesn't have sex with other men, I'm at a really low statistical risk for HIV, along with a lot of other diseases. I'm not the one who could get pregnant. So not using condoms sometimes has happened, although I'm not particularly proud of it.

We can go on about statistics, risk, what would be the responsible action that'd fit moral obligations, but the fact of the matter is that people aren't always rational and often make emotional decisions regardless of how strict and rational they are on their best days.
posted by mikeh at 12:10 PM on December 9, 2013 [2 favorites]


My thought is this--you focus on (1) testing; (2) messages that work in situations where one's judgment is going to be clouded by their desire to do what their bodies are programmed to do.

Ironmouth, do you have experience with HIV/AIDS issues or with LGBTQ communities? I'm not an expert, but as a a young queer man who these public health campaigns are often directed to, these are largely the messages they're already sending. As other folks have noted, HIV/AIDS is highly stigmatized, criminalized, and further complicated by the realities of poverty, homelessness, sex work and racial discrimination. Though these are valuable messages you're advocating for, it's unfortunately not that simple.
posted by kylej at 12:50 PM on December 9, 2013 [4 favorites]


Mark S. King's piece is a much better response to the first link, I think.

"Our AIDS tragedy isn't simply an annoying mindset in our social lives. It stands in the way of embracing exciting new developments in HIV prevention. New understandings of what it means to have an undetectable viral load, or the breathtaking breakthrough of pre-exposure prophylaxis (PrEP), have been unfairly maligned not because the science isn't convincing but because we're too attached to the mythology of condoms. We idealize their usage and efficacy, when nearly half of gay men are not using them consistently and never have.

If you follow this thinking, gay men who don't use condoms are doomed heretics unworthy of new prevention strategies. Let them eat cake. Just don't "waste money" on PrEP.

Perhaps in the end we are simply victims of our own success as advocates. We successfully entrenched the immediate, mortal danger of HIV, the shameless inaction of our government, and the profit-driven, opportunistic role of the pharmaceutical industry. Anything that veers from that narrative, especially for those of us who lived it, feels like betrayal. Yet here we sit, in an age that confounds so much of the horrific truths of decades past.

The 1980s are history. They are not a prevention strategy. The war as we once knew it, the one Lesley and so many others fought so valiantly, is over.

May they rest in peace"
posted by gingerbeer at 2:36 PM on December 9, 2013 [8 favorites]


What is the "mythology of condoms"?
posted by Asparagus at 2:58 PM on December 9, 2013


I think that the 'myth' that gingerbeer's talking about is acting like condoms are the only tool, rather than just a reasonably but quite broadly effective one. I still think it's one of the best, which is why condom use gets harped on so much.
posted by Zalzidrax at 3:13 PM on December 9, 2013


We are usually not affected by shaming at the time of the actions we take--only after the fact. And shaming has the perverse power to make people abandon all hope and not take any precautions.

But isn't that pretty much how we achieved the massive drop in smoking in the last thirty years? It was really bad, and a lot of people complained about "moralizing" anti-smoking messages, but ultimately, moralizing worked. Well, that and a lot of "sin tax", I suppose.
posted by ThatFuzzyBastard at 3:17 PM on December 9, 2013


Better education and outreach, too. Not to mention fewer and fewer public places where smoking is allowed. And that's not something you can enact in law regarding sex. We tried that (see: sodomy laws enforced only against gays, sometimes, in some places), and it doesn't work. And nicotine use is not exactly analogous to sex. And! Shaming a population for [specific action] when that population is already shamed, stigmatized and legislated against may not have the effect one desires or anticipates.
posted by rtha at 3:39 PM on December 9, 2013 [4 favorites]


Better education and outreach, too. Not to mention fewer and fewer public places where smoking is allowed.

Exactly - I've never heard of a single person who gave up smoking out of "shame;" they gave it up because it got too inconvenient or too expensive, or their loved ones got too worried about their health.
posted by The Underpants Monster at 7:15 PM on December 9, 2013


their loved ones got too worried about their health.

Right, exactly. Their loved ones telling them "that's really unhealthy and it worries me and I wish you wouldn't do that." You can call that not shame if you like, but how is that different from "unprotected sex is really unhealthy and it worries me and I wish you wouldn't do that"?
posted by ThatFuzzyBastard at 8:00 PM on December 9, 2013


You can call that not shame if you like

Thanks; I plan on it.
posted by The Underpants Monster at 8:14 PM on December 9, 2013


Loved ones of all kinds are generally going to have a much harder time talking to their child/sibling/good friend about sex. Do you do this? Do you check in with your friends who you know are sexually active, and ask them if they're engaging in risky behaviors, ask if they're practicing safer sex? When your friend tells you about a date they had recently, do you immediately tell them you hope they're using condoms/dental dams? What if it's your sister, or your adult child? You can say "people should" but people are generally not, and among the reasons they're not is that we don't talk about sex like that (depending hugely on the relationship, of course), and when it comes to gay male sex especially and specifically, well, even in these less barbaric times, a lot of gay people come from families who taught them to hate themselves for being gay.
posted by rtha at 8:38 PM on December 9, 2013 [3 favorites]


"I mean, no one is saying this ("stop telling me to wear condoms so much, that's not how real teenagers screw") in straight circles, right?"

lol wut
posted by klangklangston at 10:43 PM on December 9, 2013


"Loved ones of all kinds are generally going to have a much harder time talking to their child/sibling/good friend about sex. Do you do this?"

"'Sup, bro, you baggin'?"

And there really isn't a clear expression of risk out there in a lot of the moralizing messages: 50 per 10k? Five times riskier than vaginal receptive sex, sure, but doing some back-of-the-envelope calculations, if you're in the highest risk group (MSM), your risk of dying of AIDS is just a little higher than dying in a car accident (about 12 per 100k to 10 per 100k).

Don't get me wrong, I support seat belt laws and safety features on cars, but giving a "biology doesn't care, you're in danger" message is just not an effective way to get people to stop speeding.
posted by klangklangston at 10:58 PM on December 9, 2013 [3 favorites]


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