Resurgence of AIDS Can Only be Fought by Changing Societal Perceptions of Gays, Op-Ed Says

"[H]eading off the next AIDS epidemic will take a lot more than free condoms and stern lectures from well-meaning health officials," freelance journalist Andrew Webb writes in a Washington Monthly op-ed. According to the latest CDC figures, HIV infections are again on the rise, particularly among gay men. The rising numbers indicate that the "fear mongering that was public health officials' primary weapon against HIV for most of the 1990s is no longer working," Webb, who is openly gay, states.

Pressures of Society
Webb blames the rise in infections on the resurgence among gay men of barebacking -- anal sex without a condom -- which was practiced mostly "on the fringes" of gay society for most of the past two decades, but has recently become "de rigueur." Contributing to the resurgence of the practice is the "advent of new drug treatments" and a "well-articulated ideology that views unfettered sex as the defining feature of gay identity," he states. Gay men tend to define themselves through sex because they are not accepted by general society, he says. Both conservative and liberal groups seem to adopt a view that if a gay man gets HIV from consensual sex, "it's his own damn fault," Webb says, adding that it is "too facile to say that the disease is its own punishment, and that society at large bears no responsibility for its social consequences." He goes on to say that "for all the progress made in gay rights in the past decade, straight people still don't see gays as part of respectable society." In response, gay people have "developed their own vaguely defined morality and ethics ... created in response to ostracism from mainstream society," he says, adding that that morality provides for a self-centered world. The ostracism and isolation felt by many gay men also leads to "alcohol abuse, depression and promiscuity -- all of which contribute to the risky behavior that can lead to HIV infection," he adds. "Without recognizing these complicating factors in gay sexuality, public health officials' simple exhortations for safer sex will likely fail at a tremendous cost, both in human lives lost and in the public expense of caring for a new generation of HIV's victims," he states.

Effective Prevention Strategies
New prevention strategies must "emphasize responsible sex and demand that gay men consider the effect of their actions on the well-being of larger society," Webb states, adding that some have proposed measures that may even be seen as "coercive." Dr. Jeffrey Klausner, director of the San Francisco health department's Sexually Transmitted Disease Prevention and Control Services, has proposed closing sex clubs and adult bookstores and enforcing "no-sex" and "no-drug" ordinances in city bars and clubs. He has also proposed Internet-based outreach and education efforts in chat rooms where gay men may arrange to meet sexual partners. In addition, while "brainstorming on this subject," Klausner "raised the possibility of quarantining those who cannot control their infectivity," much as New York City officials quarantined "Typhoid Mary" at the turn of the 20th century, Webb states. While many of those measures may be "infeasible in the current political climate," they should be discussed, Webb says. "After all, in an environment where there are no consequences for actions that threaten the public health, it may be necessary to create some," he states, adding that a "balance could be struck between effective public health measures and civil rights." People have "long accepted the need in certain circumstances for quarantining tuberculosis patients and recently began forcing some recalcitrant tuberculosis-infected individuals to take their medications under supervision," he states, adding that "contact reporting and tracing has long been the means of limiting the damage (to individuals and the public at large) from other sexually transmitted diseases." But most importantly, HIV prevention efforts "will not take root until mainstream society welcomes gays into the fold" by legalizing same-sex marriages, domestic partnership benefits and "other measures that would allow gays to have culturally supported monogamous relationships," Web concludes (Webb, Washington Monthly, November 2001).