HIV Prevention 101: Consider The Context
Friday, May 9, 2008 In response to yet another "I just can't understand why the fags can't be responsible and use a condom every time", article on the topic of our failed HIV prevention strategies, consider this my response.
Though I should offer a warning. If you are the type of individual to steadfastly ignore the evidence in front of you, and instead retreat to a position of relative emotional insularity, this may not be the read for you. As it tends to begin at the place we currently are. I know, what a novel concept.
After twenty six years of a disease, there are some things we can say for sure, and we can be totally at peace with the facts of those assertions. Lets look at a few, shall we?
Shame, blame, and moralizing ridicule may be wonderful tools to aid in ones perception of personal importance, however as a prevention method for a global pandemic, they actually do little to help. Many argue, myself included, that they may in fact make the problem worse, by helping to set up dynamics of entrenched and marginalized sub culture, where what eventually manifests as norms in response to unrelenting persecution, are examples of discordant personal and community responses to crisis.
What else have we learned from twenty six years of a plague that has affected the gay community on a scale similar to war time? We have learned that people are going to continue having sex in the face of a crisis, or under threat of death, or even with great personal risk. In fact, under these circumstances, many will have more sex than they would in normal conditions.
Another lesson from the past quarter century of public health and epidemiological data? Abstinence is a rock solid theory on the prevention of HIV, but, like Communism, it just never really works out as planned. Uganda, for example, has been heralded as the modern example of "old fashioned values at work". President Bush gave an unprecedented figure in the high millions to help in that countries fight against HIV. With of course, a catch. That condoms be used as only a third line resource; never a first or second line intervention.
In a country where well over fifty per cent of its female victims acquire HIV through a non choiced sexual encounter, either rape or prostitution out of necessity, the public health professionals would have told you that approach was a recipe for disaster. It was the correct assumption. The last stats for the region show HIV infection rates to be up by more than 86%.
I'm going to propose something radical. Radical as in, like radical feminism, relating to the root. Read it twice if you so require.
If we expect a community, an individual, or a planet for that matter, to respond appropriately in the time of extra ordinary circumstance, then it would be a logical extension that we offer that culture, community, individual, and planet, a standing in society that mandates equality. That is humanity 101, and is central to the human nature of moral individuals.
This point is so key in this crisis, I cannot understand why we have not been dealing with it from the start. The gay community of the early eighties was a young and a culturally immature community. It was also less than five years out of the era which saw Anita Bryant and the Briggs initiative, teachers fired from their positions for being gay, landlords, employers, even stores, routinely deny service to gays and lesbians. Untold examples of families rejecting their gay and lesbians sons and daughters, brothers and sisters.
July, 1981
Consider what happens when, cruel irony being the bitch that she is, makes her entrance:
Bringing with her a new, fatal in all cases, very disfiguring gay cancer.
It happens to target a community not accepted in most ways by a very fearful, hostile and intolerant greater society.
Add on a good fifteen years of unrelenting death.
Don't add in a cure, because there was none.
But please, add in more death.
Add in grieving and more grieving, eventually experienced as a learned art.
Entire circles of friends - gone.
Cut to 1996.
For the first time since this crisis began, people start to whisper about hope.
The whisper turns into an official announcement.
New medications.
People stop dying in massive number.
And, like human beings are known to do, people react in very human ways.
Many say thank God, I can now forget for a while.
Many see the beginning of an end they dream, hope, and pray for.
And a few, see it for what it is....
Cruel Irony: Act II
Rinse, repeat.
Cut to 2008. Well, what do you know? We have a prevention crisis in the gay community!
Now, please ask yourself: Is it not possible that the dynamics I describe very briefly above, could have helped in part to create a less than optimal environment in which to self advocate for personal health? Or, a less verbose way of saying it; the past two and a half decades have been one hell of a twisted mind fuck for an entire community. It has known more loss, with an equal amount of non acknowledgment, than most people could ever conceive of.
Some may ask why the intense detailing. Because, it shows that our community response to this crisis is not the norm. The actions people counter with, are, in many ways, only adding to the problem. Whether it be the right wing fundie, or the puritanical gay man still not over his sexual shame who harshly condemns, or the "not a care about anybody else in the fucking world" methed out party boy who has unprotected sex with everyone from Toronto to San Fran. Our responses culturally, and our responses personally, are often making this situation worse.
Strange? Ironic? Evil? Flagrant disregard for life? Suggesting a lack of humanity? Hardly. What these responses demonstrate, are the textbook markers and clinical identifiers of community acquired post traumatic stress disorder. Reacting out of the range of what "should be done", is an entirely normal response given the current context.
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Reader Comments (16)
No we aren't ready, because to do so would mandate that we explore areas "outside of our comfort zone". It is easier to employ moral posturing and finger pointing, than it is to search for root causes or solutions. No, we are not ready, and never will be. We would rather throw condoms at people and say, "it's your own fault if you get sick!" or "Abstinence=Health". It's time we get ready, but I am pessimistic about the response. With Big Pharma's pretty pictures of healthy boyz taking HIV meds, our youngsters are lulled into believing sero-converting isn't as bad as they were lead to believe. We are pressured to bury our heads in the sand from all sides, and we as a community have caved. It's a sad state we are in.
Fuck yeah! Al, thank you for saying this. Really.
Excellent post and I couldn't agree more with what Tater said about the ads showing gorgeous men living active and healthy lives while sending the message that being HIV+ is just a tiny inconvenience. Media and Pharmaceutical company LIES. Nowadays it's all about money going into someone's pockets. HIV and AIDS have become cash crops and money makes the world go round. Personally, I think unless you were there the first time around and lived through those very dark days, you just aren't capable of understanding. Maybe it's time they hauled that quilt out again?
this is the first time i have ever read your blog. you have done nothing less than sum up my life over the past twenty six years. please never stop saying this it is too important. hopefully someone one day will listen. thank you allan.
Wow. When you actually stop to look at it like that, like how it actually plays out in the lives of people within a community, it is a wonder we have done as well as we have with prevention. And that is the ironic part, we have never been very well.
Thanks for posting this Al. I don't want to sound kiss ass, but I really learn a lot from your site and I appreciate the perspective. You are a very decent guy. (though it helps that you're cute)
Shame, blame, and moralizing ridicule may be wonderful tools to aid in ones perception of personal importance, however as a prevention method for a global pandemic, they actually do little to help.
Right on, and exactly said.
Thanks for this post, Al.
Hard truth, uncomfortable to consider, but vitally important. Vitally. This points out where we are with what problems we face. Are there solutions? Possibly.
What do you know about LifeLube? Some of the stuff I've read there sounds pretty sane. There might be some viable solutions to this problem in the discussions on that website. http://www.lifelube.blogspot.com/
Hey Java,
Thanks for the comment. Yeah, Lifelube is one of the only sane, real, and effective voices out there on the landscape of prevention. I've been reading and linking them for a while now. You are right in that some of this is hard to hear, but as you say, it is vital. Otherwise, what are our options? Not again, thanks. We don't need an Act III!
Oh honey. Tears in my eyes as this is so true and I really know how much you make sense here, in so many ways. I think my tears are because in my heart I know Tater is right about the outcome, despite what we do.
Speaking from this single straight girl who has lost an incredible amount of friends, and knows that experience is not even close to over, this is just so, so tragically sad.
"Discordant reactions"????
Yes, bug chasing and no condoms for as many multiple doses of semen man can take in their rectums is just so much of the right approach now isn't it. Honestly you people, the sky is blue, the earth is round and right is wrong. And anal is wrong!!!!
Well hells-bells! If it isn't our resident right-wing-fundie spouting her brand of crazy.
Extremely powerful message, written with brutal honesty. (Al, not ocountymommy) Many pertinent points, written realistically.
As a straight female with enough of an experimental sexual history, I've tried to follow at least what the media has put out there about this pandemic, since the year it hit mainstream media in 1982. At the time it was labeled as a supposed "gay disease." I knew even back then that to suggest it was only acquired by gays was hogwash. And that anal sex is NOT the only source of transmission.
I developed an unnatural fear of acquiring this disease, based on my sexual behavior. I'm talking nightmares, anxiety attacks, and just downright paranoia regarding the chances of getting it. I read everything I could (and could understand) regarding HIV infection and the eventual treatments of this pandemic.
My point (communicated in a round-about, verbose way) is that, even with the over-the-top fear of this sexually transmitted disease, my sexual behavior was not affected by the threat of it. To suggest abstinence as a means of controlling the number of new cases is not only unrealistic, but due to the fact that we are sexual beings, is nothing more than a fairytale.
The damaging. misleading propaganda was the suggestion that the anti-retrovirals all but eradicated this disease. That led to a lackadaisical attitude toward safe sex. I know these powerful medications have been a Godsend to many people. I'm also aware that not everyone can take them without debillitating side effects.
It is extremely sad that the pharmaceutical companies (if they didn't encourage it, they didn't discourage it) allowed for the public opinion to be one of, "if I get it, I'll just take the meds."
We can only hope intelligent discourse will change that opinion.
3T
PS. Took a percocet for my neck; sorry if I rambled on, Al.
"and right is wrong"
Leave it to the sparkling wit that is ocountymommy to even get her poorly thought out and lame analogies wrong.
Ditto 3T's excellent point. I also knew all the things to do, to say, to think about with HIV, and do you think that kept me safe for most of my sexual encounters. Sex is, like it or not, not really something that takes to rules well. Anything to do with prevention needs to acknowledge that fact first and foremost.
Thank you for a very well thought out and informative blog entry. I am old enough to have experienced the era before AIDs was recognized for what it is today. We honestly didn't know in the beginning this was a sexually transmitted disease process and the patient information was at best, scattered across this country without any central location to compile and analyse the data.
I lost too many friends to this disease and besides "ocountrymommy's" unshakeable belief that it is the gay person's fault for catching this, she couldn't be farther from the truth. I suppose it is easier for her to handle this terrible disease by blaming the person who is unfortunate enough to acquire it. She prefers to live in a Jerry Falwell time warp and no amount of truth or facts will persuade her. Let her go, she has to deal with her own ignorance daily and I wouldn't wish her life on anyone. It's a sad life indeed, if one has to live it self-righteously judging and pointing fingers at others. How inferior she must seem to be to need to pontificate and judge others who have this disease. I wonder where diabetes or cardiac problems fall on her list of condemnations?
In any event, this administration has failed to recognize that education and a ton of money aimed towards testing and enough of blaming a person might be another start to finding a way to end this disease. How many years did it take former president Reagan to be able to even say the words AIDS or even the word gay in the same sentence? Towards the end of his tenure he was able to find some compassion for only a small group of persons who had AIDS. From his perspective,they were hemophiliac children, of "no fault of their own," acquired this disease, and everyone else who had it, got it because of their own damned fault. I blame him for not seeing where this disease was going as he sat purposely, ignoring the problem only because he thought gays were the only group catching this disease. A lot of precious time was wasted because something medical became a political tool. Now, it seems as though people have moved on and do not want to know anything more about AIDS or the people living with it. Hopefully, there is "change" on the horizon in the US and we will actually begin to see a "Kinder and gentler nation" after January 19th, when we finally rid ourselves of our spoiled idiot of a president.
Sorry for the ramble, as you brilliantly summed up the subject.
Sick! How you can say it discordant responses to crisis. Big words for fucking depravity. I no a few "gay" men who went out and got it because they thought the HIV in the come was going to feel even better than the regualr come. SICK!