Website—Published Work: Facing the Third Decade of HIV/AIDS

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Facing the Third Decade of HIV/AIDS:

Can We Finally Tackle the Real Issues Impacting Gay Men's Sexual Health?

By Eric Rofes

As I watch the countless articles appear this month concerning the twentieth anniversary of HIV/AIDS, I find myself disheartened at the limited vision espoused by many of the writers. The now-familiar rhetoric romanticizes gay men’s AIDS response in the 1980s and blames current shifts in gay men’s AIDS involvement and sexual practices to either the new treatments, advertisements for the new treatments, or the so-called complacency of contemporary gay men. Health providers and activists alike—unable to consider big picture questions about gay men’s identities and desires—default to guilt tripping and fear mongering. The primary approach to education and prevention continues to be an attempt to re-create the crisis culture we inhabited in the 1980s. Absent the urgency linked to catastrophic decimation, commentators seem at a loss about what to do.

Am I the only one who’s had it up to here with bankrupt rhetoric attempting to explain a complex health challenge?

I am not an AIDS denialist. I do not pretend that gay men’s sexual cultures do not present a range of health challenges. I am simply someone who demands new and clearer perspectives on the contemporary situation. When are we going to admit that HIV disease among gay men of all colors is not going away anytime soon, and create long-term strategies to promote sexual health, instead of repeatedly defaulting to the same tired, state-of-emergency approaches which haven’t worked over the past ten years? We need a long-term approach to sexual health promotion for gay men, rather than the crisis-driven model. In the long run, such a strategy will be more effective in saving lives and increasing community health and well being, that the constant recycling of panic/terror approaches that continue to predominate.

While I have no difficulty believing that more men are sexing without condoms and that there’s an upswing in seroconversions in major urban centers, I consider the popular explanations to be more akin to misguided folk wisdom than a thoughtful vision of data-driven reality.

Many thoughtful gay men hunger for a deeper and more complex analysis of what’s going on in our communities. We no longer trust AIDS experts because they’ve shouted “Fire!” in this theatre too many times. Health advocates frequently mistake our boredom at their superficial and vapid analyses for complacency about the health of our communities. We care deeply about the well being of gay men’s communities; we are simply enraged at the repeated manipulation of statistics and emotions in the name of HIV prevention. And we hunger for vision: a new vision for HIV prevention, a new vision of gay male communities, a new vision of gay men’s health and wellness.

When are prevention efforts going to begin to tackle the big-picture issues that drive HIV infections among gay men? We know that all social problems can be addressed in one of two ways: we can attack them in a state of crisis, use guilt, shame, and just-say-no tactics, and hope they diminish; or we can look at the root causes that drive the social problem. Feminists have long argued that eliminating violence against women demands a transformation of power dynamics between men and women, a change in the economic dependence of many women on their boyfriends or husbands, and an examination of that romance and martyrdom that is inculcated in girls through popular culture, country-music songs, and gender organization in K-12 schools. If gay men are similarly to address deeply rooted challenges like HIV infection, smoking rates, or domestic violence, we too will need to go beyond the state-of-emergency model to look at the community and cultural contexts that support and fuel these challenges

Certainly some gay men respond to crisis-driven approaches to HIV prevention by practicing safe sex most or all of the time. I believe these are mostly middle-class, middle-age, educated, white gay men who operate primarily out of their intellects and truly make rational choices about what they do with their bodies. I think many researchers and service providers fit into this group. To me, these people show an extraordinary ability to avoid health risks that most of us regularly embrace: they choose rice over French fries; they never use illicit drugs or drink and drive; their few vices are indulged with moderation.

Most people do not share this select group’s ability to minimize health risks consistency in their everyday lives. While aware of the range of hazards involved in sex, drug and tobacco use, dietary indulgences, and speeding in automobiles, risk itself is not the overarching factor that guides most people’s social practices. These activities offer pleasures and meanings that many health experts ignore, deny, or minimize. Most of us don’t engage in activities, which have a risky edge because we hate ourselves, are stupid, or seek harm. Humans—by and large—are not guided primarily by the intellect. We do these things because they add something to our lives that we really want—that we truly value.

Instead of bemoaning the failures of young gay men and gay men of color to not follow our use-a-condom-every time dictates, prevention leaders must accept that fact that, for many gay men, HIV risk is no longer the primary factor driving the anal sex practices of gay men. A more complex look at the pleasures and meanings men experience from anal sex might suggest new pathways for prevention.

What’s keeping us from asking some of the difficult questions about anal sex—the primary mode of HIV transmission among U.S. gay men? After all, if we’re trying to reduce HIV transmission among gay men, we’re primarily talking about altering our relationship to butt sex. Whether we’re using HIV prevention funds to run hot advertising campaigns, organize gay bowling tournaments, present a sexual health fair, or diminish gay men’s alienation and isolation, what we’re really hoping for is a change in the ways gay men fuck one another. So rather than establish more coffee houses for queer youth or hold more forums on crystal use, let’s make a commitment to understanding anal sex in more complex ways. It might feel great to fuck or get fucked, but any sexual thrill is ultimately about much more than simple physical pleasure. And in the U.S., we know sorry little about what anal sex means to gay men, how we develop the desire to fuck or get fucked, and why many men find semen exchange to be the most valuable part of this sex act. Let’s begin to explore some core questions about anal sex between men.

First, how much of anal sex for gay men is related to our complicated relationship to masculinity? Few researchers have wanted to open this Pandora’s Box, but I’d argue that a population of men who either grew up being persecuted for not fulfilling proper gender roles, or as adults are considered to be “not real men,” carries with it an intense need to come to some kind of peace with masculine ideals. For many men, sex is a place where we play out a range of gender issues. Do we feel more traditionally manly when we fuck a guy good and hard? When we enjoy another man penetrating us deeply and powerfully? Does climaxing inside a man’s butt—skin-to-skin—satisfy a need to feel like a “real man”? In what ways does anal sex satisfy some men’s need to experience masculinity in a way that mutual masturbation or oral sex does not? Since gender plays out differently in different ethnic cultures, what is the relationship between white, Black, and Latino masculinities and the practice of anal penetration?

Second, how many of us are sexually turned on by cozy romantic moments and sweet, gentle men and how many of us are aroused by activities, partners, and articles of apparel that seem transgressive? What role does the forbidden play in the erotic impulses of a population that embrace an identity (loving other men) that is itself transgressive? How successful have we been as a community at eroticizing condoms or mutual masturbation? Why do the best selling gay porn videos and magazines feature police officers, truck drivers, and muscle-bound athletes, rather than male nurses, accountants, and modern dancers? How much demand is there for videos exhibiting only masturbation activities, compared to those capturing butt fucking, with or without condoms? Until health promotion workers come to grips with the powerful role that transgression plays in the sexual imaginations—and sexual practices--of many gay men, they will continue to naively inspire new and taboo desires for precisely those activities that carry risk. I might not have even been thinking about eating a cookie, but once you tell me to keep my hands out of the cookie jar, all of a sudden, I’m overwhelmed with a desire for that chocolate chip wafer.

Third, it may be time to confront head-on the generational component to anal sex among men? Several studies have turned up a problematic finding: a large portion of the infections occurring in gay men under the age of 25 may well be a product of sex with older gay men who are seropositive, including many middle-age men. What’s this about? Because of social taboos surrounding sex between people of different generations, we have very little research about the interpersonal dynamics and sexual negotiations that occur between adults of different ages. While we know that gay male cultures—like mainstream cultures—are socially segregated by generations, we also know that numerous sex cultures offer opportunities for erotic contact that cuts across generations. How can gay communities that have yet to critically examine the daddy/boy dynamic (inside and outside of the leather scene), the ageism visited upon both young, old, and middle-age gay men, and the powerful age-based attractions and revulsions that weave their way into our desires, tackle sexual health and sexual risk between men of different generations? And how can we do this in a helpful and analytical way, rather than in a judgmental and divisive manner?

This final point seems key, as gay men remain in the midst of an ugly and divisive sexual civil war that’s raged for the past five years—through the debates on circuit parties, Sex Panic!, and now barebacking. Horizontal hostility and personal bullying among gay male activists, organizers, journalists, and public officials is approaching an all-time high. Shame and approbation are being marshaled big-time as gay men point the finger at one another’s sexual practices and erotic fantasies. The Radical Right doesn’t have to take the time to entrap gay men, expose our sexual practices and kinky web sites: we are doing that work for them!

I believe many gay men hunger for an alternative and healing vision of gay community, vastly different what exists currently in the queer public sphere. While creating a community that embraces health and wellness seems critical to all of us, during a time when queer community sites, public sex spaces, and bookstores and publishers focused on gay literature are evaporating in a shifting economy dominated by corporate and real estate interests, it sometimes seems as if the very foundation of community life has been stolen out from under us.

As we face the third decade of AIDS, let’s expand our work beyond our efforts to find a miracle cure or vaccine and address core issues that impact the sexual health of gay male communities. The small, pioneering gay men’s health movement could offer a powerful alternative to the easy answers, sexual shaming, and superficial ways in which gay men’s health issues are addressed and our cultures are interpreted.

Gay men building this movement are motivated by continuing concern about HIV/AIDS, but also additional health challenges, such as mental health, addiction, cancer, and heart disease. We embrace a big-tent vision of the community, founded on our belief that healthy people emerge from a healthy community context and that HIV transmission will diminish as community wellness increases. Hence we aim to build a multi-racial, multi-issue movement that favors long-term solutions over quick fixes, brotherhood over violence, and a focus on the assets of our communities, rather than our deficits.

In 2001, over a dozen regional gay men’s health summits are taking place throughout the nation, not only in New England and San Francisco, but in Utah, Delaware, and rural Georgia. To me, these activities represent precisely where our resources should be placed during the third decade of AIDS. Continuing to focus narrowly on HIV transmission will not work in a world in which reasonable gay men understand AIDS very differently than we did two decades ago. But creating powerful broadly based gay men’s health promotion activities ultimately will impact HIV transmission.

Not only has what it means to have HIV changed radically in the past two decades, but what it means to be gay, to be a man, to be African-American, to be young have all shifted dramatically. Continuing to employ crisis-moment tactics during an era when most reasonable gay men experience HIV as awful, but not the end-of-the-world, will prove increasingly ineffective as time passes. Let’s roll up our sleeves and address gay men’s health in a long-term, sustained, and thoughtful way.

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Eric Rofes is assistant professor of education at Humboldt State University in California and the author of Dry Bones Breathe: Gay Men Creating Post-AIDS Identities and Cultures (Haworth, 1998). He can be reached at eerofes @ aol.com