80's Nostalgia

Human immunodeficiency virus (HIV) digital artwork. Maciej Frolow/Photodisc/Getty Images

When I look at the current state of HIV/AIDS education and activism, I frequently end up missing the 80's. I'm nostalgic for the days when there were ACT UP posters everywhere and it felt like the American gay community was really making a push towards prevention and keeping people safe. I miss people being loud and proud and vocal while trying to change the world. For a while, it seemed like we might be able to really make safe sex the norm, and really do a number on the human immunodeficiency virus.

Then things changed.

The important thing to remember is that AIDS is not a gay disease. Worldwide, the vast majority of cases are spread by heterosexual intercourse. So why, in the U.S., are gay men still so disproportionately affected by the virus? It seemed like we might be able to get that problem under control, but as the urgency of the safer sex messages faded so did many lasting elements of behavior change.

What happened? A number of factors seem to be involved.

  1. Men don't like getting health care. In general, U.S. men are far less likely to seek out medical treatment then are women. This means less preventative testing, including screening for HIV. It's possible that gay men may be even worse about this than heterosexual men, because they may not have a woman willing to pester them.
  2. Homophobia puts people at risk. Gay men may be leery of disclosing their sexuality to their doctors, for fear of judgment, but they also may have other difficulties getting information about HIV prevention and safe sex due to the prevalence of homophobia in society at large. Fear of being identified as gay, and persecuted for their sexual orientation, can keep men away from not just testing but from the educational material they need to learn about risk and safer sex. Now that the initial phase of the epidemic has passed, activists aren't being as "in your face" about education, which means that homophobia-mediated silence about gay health issues is often the rule of the day.
  1. Complacency about HIV makes it hard to motivate young men to protect themselves. Thanks to advancements in treatment, for many people AIDS is becoming a disease that you can live with. Although it's wonderful that AIDS is no longer a death sentence, the fact that it's beginning to be seen more as a chronic illness than a deadly plague may contribute to making younger men somewhat complacent about practicing safer sex and reducing their risk.
  1. Biology isn't destiny, but it also isn't helping. The per-act risk of HIV transmission is higher for anal sex than it is for oral sex or vaginal intercourse. That means that people who engage in anal sex are at higher risk of getting the virus from an HIV positive partner than people who don't. This isn't only a risk for gay men, but it is a significant risk for many of them.

It's frustrating. I had a conversation with a friend the other night where she suggested that it would be more likely for a miracle to happen and all STDs to vanish from the earth than for the whole population to make lasting behavioral changes and reliably practice safe sex. I don't want her to be right. Which, I suppose, makes the real question this:

How can we motivate people to take the risk of STDs, including HIV, seriously, without simultaneously stigmatizing them?

I continue to feel like the only way that we might even have a chance at lasting change is to work to make sex, and sexuality, an acceptable topic of discussion and to discuss safer sex as the rule, not the exception.

People rarely hesitate to ask someone to cover their mouth when they cough. It shouldn't be that different to ask your partner to cover their genitals during sex.

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