OK, let’s sort something out right now... It isn't positive guys who bareback with positive guys who are making the HIV problem worse.
1) If people who haven't been tested for HIV, and suspect that they may have been exposed at some point to the virus and have a duty to disclose their HIV-positive status to new (and indeed former sexual partners), then this will not get people to come forward for testing in the first place, indeed it will be a barrier to choosing to get tested. Instead those who are infected, won't get tested at all, won’t know they are HIV-positive and will keep having unsafe sex and infecting other people ‘officially unknowingly’ and living in ignorance. If people are known to be HIV-positive then medical intervention can reduce their viral load and infectivity with the use of effective anti-retrovirals. But people need to feel safe enough to come forward for voluntary testing for this to work. If society and the law stigmatizes people with HIV further, the problem becomes an even more invisible one, with people who may suspect they are HIV-positive preferring not to be tested for fear of legal repercussions and criminalization.
2) If a duty is put on an individual who is HIV-positive to disclose their status then it could lead to creating a false sense of security. For example, two people get together for sex. One assumes they are HIV-negative, the other person who knows they are HIV-positive doesn't disclose, so the HIV-negative person thinks, "Well, they haven't said anything, so they must be HIV-negative". As much as the safer sex message is driven home, people do take risks when they make the assumption that it is safe to do so. It is human nature, but assumptions can be dangerous things to make.
3) Safer sex is a dual mutual responsibility. All of us need to take responsibility for safer sex, and for ourselves - as well as anyone else involved in sexual activity - irrespective of HIV status, known or otherwise. One-third of people are estimated to not know they are HIV-positive, a frightening statistic. However, I can speak from personal experience that I have been HIV-positive myself for nearly 21 years. I always disclose my HIV status to someone before engaging in sexual activity – out of choice rather than any sense of duty. My partner of four years was HIV-negative when I met him, and is still HIV-negative now. My ex-partner of five years before him is also remains HIV-negative. Sero-discordant relationships do work and are possible when both parties take responsibility for themselves. Safer sex works, and to create a two-tier system that is discriminatory towards those that are HIV-positive is frankly dangerous.
If society is to follow the course where we perpetuate this kind of discrimination by firmly putting the duty on those who are HIV-positive to disclose their HIV status to new potential sexual partners, then a new argument emerges. What about the one-third of people who don’t know? What about them. Do we move towards a course of mandatory testing for all? Such efforts would have to be an ongoing programme of testing for everyone. There would be nothing to stop someone from becoming infected a day after they had a negative test result, not to mention the cost involved.
By creating an environment that is as comfortable and safe for people to voluntarily be tested for HIV we stand a much better chance of getting people who are infected on treatment and preventing them from infecting anyone else with the virus. We live in a time when things have changed from the mid 1980s to mid 1990s. Today we have treatment that can actually reduce the viral load to undetectable, rendering a person virtually, if not completely non-infectious. No longer are people with HIV (who are on treatment) the ones “spreading the virus”, today it is the “great untested” that are causing new infections. Let’s make it as easy as possible for them to seek testing and treatment, but not though discrimination, stigmatization, or criminalization, but through a safe, non-judgmental and caring environment and society.
Sunday, June 26, 2011
A quick history of bareback sex between men over the past 30 years
The emergence of the HIV virus in the early 1980s, and subsequent HIV prevention and safer sex campaigns by both HIV organisations and UK government health departments saw a marked change in the behaviour of many gay men. Whereas before condoms were something that one furtively bought at the cinema or with some embarrassment at the chemists, and solely for prevention of pregnancy between heterosexual couples, they were given a new function. To prevent HIV transmission between men who have sex with men and given out free at GUM clinics, and also in gay bars, saunas and sex establishments. The message was; whoever you have sex with always use a condom. Although described as safe sex by many, it is better described as “safer sex”. Even the best intentions and precautions may not be 100% risk free, for example when a condom splits or slips off.
Before the advent of anti-retroviral treatment and our new found ability to manage the progression of HIV, people were becoming sick. Many gay men saw their peers, friends and loved ones die to the ravages of AIDS. The visibility of the destruction that the virus could cause instilled a fear in the community that was the main motivator behind the majority practicing, or at least with the intention of practicing safer sex and condom usage. They were driven by not only the natural human desire to avoid infection, in the same way that one recoils from someone with the flu, but also the equal need to have an intimate experience or sexual relationship, whether a one night stand, or something longer term with another human being. For some there was resignation and surrender to the virus, once infected and discovering that they had tested HIV-positive. Some threw safer sex to the wind and stopped practicing safer sex at all. Sometimes they did this without telling the person they were having sex with. Anonymous liaisons with strangers in dark rooms and saunas for some didn’t require any explanation and indeed they seemed like places where the topic of being HIV-positive and safer sex was difficult, even seemingly inappropriate. In other words they didn’t see the point in safer sex when they were already infected, and if someone wouldn’t take responsibility for themselves, then who’s duty was it to instigate safer sex?
The pre-anti-retroviral generation, and by that I mean those who were sexually active before the advent of drugs which could manage the HIV condition lived in a very different time to those who were to become sexually active after anti-retrovirals started to be used successfully. They were the dark days of the HIV-pandemic. Every gay man knew that people were dying, and no one, including the medical profession knew how to stop it.
The late 1990s and this started to change. The deaths of people with HIV became more infrequent, indeed people with the virus seemed almost miraculously to start getting better. Like Lazarus those who had been occupying hospital beds on dedicated HIV wards started to have to face the fact that they were going to live, almost as difficult as coming to terms that they were going to actually die. HIV organisations had to shift their priorities. Rather than offering people with the virus support to continue living independently for as long as possible, or indeed offering support, and palliative care, to those in the final phase of their lives, the focus had to change. Projects promoting healthy living with HIV, and back to work programmes for those who had been signed off sick for many years and financially dependent on the welfare state started to come to the fore. There then occurred something that many hadn’t considered. HIV and those with the virus started to become invisible. The sight of sick people, with skin lesions, the emaciated, elliptic thrush on the corners of their mouths became no more visible to a large extent. Anti-retrovirals surpassed the expectations of many, even the medical profession who thought that such ability to manage the virus would be years away. Those with HIV became difficult to spot and almost seemed to vanish. Anyone could be forgiven for thinking that HIV wasn’t a problem anymore, and so emerged the post-anti-retroviral generation. Attitudes started to change. If one was unlucky enough to become infected with HIV, then all you had to do was take the tablets, right? The young and ‘newbies’ to the gay scene started to believe that HIV was something that only affected older men, those who used saunas for sex and the promiscuous. HIV wasn’t something that would happen to them, would it?
The post-anti-retroviral generation were not alone in the change of attitudes. The pre-anti-retroviral survivors of the pandemic , (at least in the developed countries of the world, I acknowledge that HIV to a larger extent still leads to AIDS and kills many, who don’t have access to treatment), started to ask different questions of their potential sexual partners. Whereas those with HIV, who admitted their status and found that the person they were speaking to was also infected often made the decision to have un-safe sex in an informed and consensual way in the past, there was again a shift in the questions asked. Now people admitted their HIV-positive status, then the question arose as to whether they are on anti-retroviral treatment, and finally what level is their viral load? Was it undetectable? Based on the answers to these questions a decision is made, almost like a quick risk assessment, as to whether condoms would be dispensed of or not? The presumption being that a low or undetectable viral load means that transmission of the virus, or another strain of it is less likely. Indeed a risk worth taking for some.
This blog will look at the new era of HIV, anti-retrovirals and condom use amongst gay men today. It will examine new research and thinking about risks, as well as the criminalisation of HIV transmission. It will explain the human psycho-sexual need that many have that can affect decision making about sex. It will also document the failure of HIV organisations in the UK, and indeed globally, to keep up with scientific opinion in the light of new research and how they don’t want the gay community to know about it for fear of their safer sex campaigns being undermined.
I admit that this blog will be controversial, a lot of people are not going to like it, but in keeping with the old message about HIV in the late 1980s and early 1990s, “Ignorance = Death”. We must face the reality of bareback sex between men who have sex with men. This blog aims to explore it, in all it's raw detail.
Before the advent of anti-retroviral treatment and our new found ability to manage the progression of HIV, people were becoming sick. Many gay men saw their peers, friends and loved ones die to the ravages of AIDS. The visibility of the destruction that the virus could cause instilled a fear in the community that was the main motivator behind the majority practicing, or at least with the intention of practicing safer sex and condom usage. They were driven by not only the natural human desire to avoid infection, in the same way that one recoils from someone with the flu, but also the equal need to have an intimate experience or sexual relationship, whether a one night stand, or something longer term with another human being. For some there was resignation and surrender to the virus, once infected and discovering that they had tested HIV-positive. Some threw safer sex to the wind and stopped practicing safer sex at all. Sometimes they did this without telling the person they were having sex with. Anonymous liaisons with strangers in dark rooms and saunas for some didn’t require any explanation and indeed they seemed like places where the topic of being HIV-positive and safer sex was difficult, even seemingly inappropriate. In other words they didn’t see the point in safer sex when they were already infected, and if someone wouldn’t take responsibility for themselves, then who’s duty was it to instigate safer sex?
The pre-anti-retroviral generation, and by that I mean those who were sexually active before the advent of drugs which could manage the HIV condition lived in a very different time to those who were to become sexually active after anti-retrovirals started to be used successfully. They were the dark days of the HIV-pandemic. Every gay man knew that people were dying, and no one, including the medical profession knew how to stop it.
The late 1990s and this started to change. The deaths of people with HIV became more infrequent, indeed people with the virus seemed almost miraculously to start getting better. Like Lazarus those who had been occupying hospital beds on dedicated HIV wards started to have to face the fact that they were going to live, almost as difficult as coming to terms that they were going to actually die. HIV organisations had to shift their priorities. Rather than offering people with the virus support to continue living independently for as long as possible, or indeed offering support, and palliative care, to those in the final phase of their lives, the focus had to change. Projects promoting healthy living with HIV, and back to work programmes for those who had been signed off sick for many years and financially dependent on the welfare state started to come to the fore. There then occurred something that many hadn’t considered. HIV and those with the virus started to become invisible. The sight of sick people, with skin lesions, the emaciated, elliptic thrush on the corners of their mouths became no more visible to a large extent. Anti-retrovirals surpassed the expectations of many, even the medical profession who thought that such ability to manage the virus would be years away. Those with HIV became difficult to spot and almost seemed to vanish. Anyone could be forgiven for thinking that HIV wasn’t a problem anymore, and so emerged the post-anti-retroviral generation. Attitudes started to change. If one was unlucky enough to become infected with HIV, then all you had to do was take the tablets, right? The young and ‘newbies’ to the gay scene started to believe that HIV was something that only affected older men, those who used saunas for sex and the promiscuous. HIV wasn’t something that would happen to them, would it?
The post-anti-retroviral generation were not alone in the change of attitudes. The pre-anti-retroviral survivors of the pandemic , (at least in the developed countries of the world, I acknowledge that HIV to a larger extent still leads to AIDS and kills many, who don’t have access to treatment), started to ask different questions of their potential sexual partners. Whereas those with HIV, who admitted their status and found that the person they were speaking to was also infected often made the decision to have un-safe sex in an informed and consensual way in the past, there was again a shift in the questions asked. Now people admitted their HIV-positive status, then the question arose as to whether they are on anti-retroviral treatment, and finally what level is their viral load? Was it undetectable? Based on the answers to these questions a decision is made, almost like a quick risk assessment, as to whether condoms would be dispensed of or not? The presumption being that a low or undetectable viral load means that transmission of the virus, or another strain of it is less likely. Indeed a risk worth taking for some.
This blog will look at the new era of HIV, anti-retrovirals and condom use amongst gay men today. It will examine new research and thinking about risks, as well as the criminalisation of HIV transmission. It will explain the human psycho-sexual need that many have that can affect decision making about sex. It will also document the failure of HIV organisations in the UK, and indeed globally, to keep up with scientific opinion in the light of new research and how they don’t want the gay community to know about it for fear of their safer sex campaigns being undermined.
I admit that this blog will be controversial, a lot of people are not going to like it, but in keeping with the old message about HIV in the late 1980s and early 1990s, “Ignorance = Death”. We must face the reality of bareback sex between men who have sex with men. This blog aims to explore it, in all it's raw detail.
Subscribe to:
Posts (Atom)