In a recent Calgary Herald column (Don’t count on medicine alone to cure HIV/AIDS - November 29/2013), columnist Susan Martinuk concluded that while science and medicine can treat HIV/AIDS, in her opinion we cannot and will not eradicate it, or even make any progress against it, if we don’t address the behaviours that lead to infection.
On the surface, she has a point and certainly AIDS Service Organizations in the developed countries, and some Third World countries, have spent decades addressing that through safer sex initiatives and other educational programs, often under strong adverse public reaction to such explicit programs.
However, she concludes by saying "...can we truly eradicate HIV - or even make headway against the HIV epidemic - if we continue to tell our youth it’s OK to participate in behaviours that are responsible for at least half of all cases?" This is reminiscent of much of the rhetoric coming from social conservatives throughout the 80s and 90s and, it seems to me, suggests a view that gay/bisexual male youth, who are still amongst the highest groups at risk for infection, "choose" to engage in sexual behaviours - sexual acts, in other words - that can lead to HIV infection and, ultimately, to AIDS.
It is estimated that by the end of 2011, 71,300 individuals were living with HIV/AIDS in Canada. This is a conservative estimate, obviously, since approximately 25 percent of those with HIV are unaware they are even infected as the symptoms sometimes do not manifest for years.
She quotes some unnerving figures, such as - in terms of reported cases - 48.6 percent of all adult HIV infections were amongst men who have sex with men (whether or not the individuals self-identify as gay or bisexual) and 61.4 percent of all positive HIV tests were also amongst this group. That is statistically significant and means half the men one may have sex with are HIV+ and know it. Those who don’t know aren’t even in that figure.
The Centres for Disease Control in the US reveal infections in young men increased by 22 percent between 2008 and 2010 and that approximately 92 percent of all HIV in young males aged 13 to 24 is due to same-sex sexual activity.
This of course brings home the very message ASOs have been putting out there for years; assume whoever you have sex with is HIV+ and practice safer sex. That means using condoms during intercourse. Every time.
As mentioned in last month’s column, that simply isn’t happening. Only 45 percent of the 1,500 post-secondary Albertans surveyed reported they used a condom the last time they had sexual intercourse and 67 percent reported they were not concerned about contracting a sexually-transmitted infection. The message hasn’t gotten through. The figures as revealed in media did not indicate sexual orientation.
Martinuk also says, "The numbers are clear - young, gay men have by far the largest burden of HIV infection and its prevalence is increasing, not decreasing."
This is true and is why it is so important AIDS prevention education target youth who are, or are about to become, sexually active. I would further suggest, not just post-secondary or senior high school but junior high as well. If 92 percent of diagnosed youth fall into the 13 years old to 24 years old bracket, then obviously we need to be doing some work with that age range, with education around safer-sex being introduced by probably no later than age 12. However, doing so creates a major backlash.
Given these figures, the risk-reduction models in use clearly are not effective. In amongst the messages ASOs put out there in the 80s, when I was actively involved in HIV/AIDS work, was an emphasis on how to have the sort of sex we as gay and bisexual men have with each other safely. We did not engage in telling people to stop having anal intercourse or to avoid having it, although that is an option for some men. We believed, as I still do, it was important to affirm our sexual expressions as good and important and valid, but that in the age of AIDS we all had to do them more safely.
Certainly, we as a society would never entertain the notion of saying to heterosexual men and women, oh, vaginal intercourse is a primary avenue of HIV infection and you have to stop having it. Why, then, would we even remotely entertain the idea of telling gay/bisexual men, and other men who have sex with men, to stop having the sort of sex we have and which is such an important part of our identity, just as anyone’s sexual expression is?
Contrary to Martinuk’s idea that it is not okay to tell our youth - our queer youth, in other words - they can participate in these behaviours, I believe that’s exactly what we need to say. Yes, having oral and anal intercourse with another gay/bisexual male, or any other male who is willing and interested, is perfectly okay. Absolutely! We need to affirm that over and over. However, along with that we also need to push forward the message that while sex between males is good and affirming and even healthy, one simply must do so safely and that means using a condom every single time. It is the responsibility, and again this was a dominant message of 1980s-era ASOs, of both partners to insist on using condoms unless they both know - not assume, but know - they are both HIV-negative (and free of any other STIs for that matter). To balance the two messages effectively and responsibly is a challenge, no one denies that, but it is a challenge that must be taken up by educators.
All this raises an interesting philosophical question: Do we have sex with other males because we are gay/bisexual or are we gay/bisexual because we have sex with other males? I am of the view we have sex with other men because we are gay/bisexual. That is our orientation and the sex we have is an expression of that orientation, just as having sex with a woman is the expression of a heterosexual man’s orientation. To suggest we somehow try and discourage that is preposterous.
Martinuk’s analogy of lung cancer is a bit disingenuous. She suggests that the theory of earlier testing and early treatment (combined with education, by the way) reducing the overall amount of HIV out there is in error. She says,
"...[T]his theory would suggest that we don’t discourage people from smoking, but wait until they are diagnosed with lung cancer before taking action to cure the disease...[W]ouldn’t there be fewer people who need treatment and who have lung cancer if we encouraged people to stop an activity that is known to cause it?"
Despite the legal and social advances made around issues of sexual orientation in the last few years, there still is this view within the dominant culture (i.e. heterosexuals) that our sexuality, or at least the expression of it, is some sort of ‘choice’ and, when the reality of HIV/AIDS is added to the mix, that it is somehow appropriate to suggest we - meaning gay and bisexual men and other men who have sex with men - just stop. That’s not going to happen and nor should it. Smoking is an addiction. Giving expression to one’s sexuality is not. What does need to be done, and was being done until funding and political pressure gradually suppressed it, was explicit, open, sex-affirming education.
The goal of ASOs was, at one time at least, to ‘normalize’ safer sex. That using a condom during anal intercourse was simply just something one did, as a matter of course. Not a big deal. But in order for that message to enter the consciousness of a population, the education around it has to be specific. Condom use has to be made sexy and hot and normal and in order to do that effectively, educators and other workers have to be able to distribute explicit materials and talk openly about the sort of sex males have with each other.
In addition to that, the erotic images we access, and by that I mean our porn, must consistently portray condom use. Much of it does, but there is a whole industry constructed around the ‘hotness’ of barebacking and even amongst those videos that do show the actors using condoms, the condoms just ‘magically’ appear on a cock as the top starts to fuck...we seldom see it being put on; it’s just ‘there’ all of a sudden. To me, that sends a subliminal message that condoms are secondary, bit of a nuisance, only being used because we have to not because they are or can be an integral part of hot horny sex. And porn is all about seeing hot horny sex.
So while medicine and science play an important, even crucial, role in reducing and eventually eliminating HIV/AIDs, each and every one of us also plays a role. A thin piece of latex can literally mean the difference between health and disease, between life and death.