Back to the beginning in the HIV fight
WE NEED to re-ring the alarm about HIV transmission among gay and bisexual men.
In March, the Centers for Disease Control and Prevention released statistics showing significant disparities between rates of HIV and syphilis infection among men who have sex with men and the rest of the US population.
Men who have sex with men are 44 times more likely to contract HIV than other men and 40 times more likely to contract HIV than women. They are 46 times more likely to contract syphilis than other men and 71 times more likely than women.
After miracle breakthroughs in treatment and two decades worth of increasingly sophisticated understanding about sexually transmitted diseases, how did we end up back at the beginning with gay and bisexual men so vulnerable to infection?
We’re here because we’ve watered down prevention messages. Explicit public campaigns about how to stay safe have been replaced with simplistic messages about condoms. If we have learned anything about preventing HIV transmission among gay and bisexual men in the last 25 year we’ve learned this: it’s not about condoms; it’s about dignity. As long as men who have sex with men are at a higher risk for mental illness, trauma, and substance abuse — which they are thanks in large part to the stigma attached to being gay or engaging in gay sex — they are going to be more likely to engage in risky behaviors.
We’re here because we have wasted a decade on abstinence-only sex education. A generation of young people have been deprived of honest information about sex. It’s not at all uncommon for an HIV testing site to see a young man who has been sexually active for less than a year come in for a test and learn that he is HIV positive. It is at once heartbreaking and maddening. At this point in the epidemic no one, least of all a 19-year-old just starting out in life, should be contracting HIV.
While many are tempted to blame the victim — after all, it’s not 1985 anymore — it accomplishes nothing. Wagging our fingers does little else than relieve us of the hard work of trying to better understand and influence human behavior. The difficulty of maintaining safer sex practices in every single sexual encounter over an entire lifetime is daunting.
Compare it to being told you have high cholesterol and need to eat a low-fat diet. Some who get this news are able to follow their doctor’s advice, but most aren’t. If the predictable complexities of life aren’t factored into outreach and prevention strategies, then we aren’t going to succeed in helping gay and bisexual men stay safe.
So what should we be doing? Comprehensive sex education in our schools is a must. Dollars for research into human sexual behavior and influencing habits and change is critical. We need to continue the hard work of eradicating bias. Federal and state governments must fund prevention efforts directed at men who have sex with men that are as varied and diverse as the gay community itself.
Over the last decade, the federal government’s biggest AIDS initiatives have been directed outside the country toward Africa. Domestically, prevention efforts have been increasingly focused on every community except men who have sex with men. But we now have indisputable proof that AIDS isn’t over in the gay community and men who have sex with men are particularly vulnerable to infection.
We will not rid this country of AIDS until we prioritize the needs of gay men within every community affected by AIDS, and overhaul outdated prevention campaigns to reach this population.
Rebecca Haag is president and chief executive of the AIDS Action Committee in Massachusetts and executive director of the Washington, D.C.-based AIDS Action. Douglas Brooks is vice president for health services of the Justice Resource Institute and a member of the executive committee of the National Black Gay Men’s Advocacy Coalition.