Required Reading

Wow.

This is amazing. Some of the most profound and thought provoking writing I've read in years. Thanks to Guy Baldwin for writing it. And thanks to Diabolique for sending it.

It sure puts the emotional rollercoaster ride that defined my interactions with Marlboro Sir this past winter. And, it is surprisingly close too a talk I delivered at the Harm Reduction Conference in Seattle in December of 2003.

In fact, I think I'll publish my talk here on SingleTails. I thought about doing that a year and a half ago, when I wrote the thing. But I didn't. Y'see, I had just left (professionally speaking) Mondo Harm Reduction, and had a somewhat high profile political job, and that required a bit of discretion. it wouldn't do for my then-boss' conservative colleage to learn that his chief-of-staff was having sex Nushawn Williams style, would it?

But, the chances of this getting back to the guys at the sanding table are vanishingly small. So here goes. Hope you like.



I’m here to talk about barebacking. Specifically, penetrative anal sex—often called fucking—without a condom. Barebacking is a phenomenon among gay men—self-identified, sexually active gay men—and that’s the group that I feel qualified to talk about, since I am one. There’s lots of hype in the press about barebacking. It’s madness, suicide, insanity. Much despairing and wringing of hands among the punditocracy. And it’s rampant. There are websites devoted to gay men seeking bareback sex. From its advent in the public mind about five years ago, it spread like wild fire. It’s been blamed for the sudden spike of new infections—particularly among younger gay men—in several urban areas.

And it’s a real thing. My ‘exhaustive research’ indicates that nobody is using condoms any more. But, other than all the gnashing of teeth, I don’t hear a lot of discussion about it. Any discussion beyond, “If it ain’t spit, it ain’t love.” And that’s why I wanted to do this presentation here, before an audience steeped in the theories and practice of harm reduction, where I think I might have a better than average chance of sparking some intelligent conversation around the issue.

How did this all start? Let’s begin at the beginning.

Imagine (or remember). It’s 1986. Ronald Reagan is half way through his second term. AIDS activism and self-help in the gay community are doing amazing things. And you’re terrified. Every other week or so, you go through your address book crossing out the names of people who are dead. When you don’t hear from someone for a few weeks, you assume the worst. Is that nagging cough a respiratory infection, or the onset of PCP? Where did that bruise on your thigh come from? Maybe it’s KS. AIDS—the plague—saturates your existence. The books and magazines you read, the conversations you have, the art that you take in—it’s all about AIDS. So you’re worried. Or maybe terrified is a better way of putting it.

But here’s the thread out of the labyrinth: Use a Condom Every Time. If you didn’t live through it, there’s really no way to describe how the advent of ‘Safe Sex’ affected gay men. After years of pleasure being equated with death, all of a sudden, you could have sex again, if you followed the rules. And sex during this time was pretty great. Love was made manifest: “I’m using a condom because I care about you.” Even from strangers.

It’s important to note that Use a Condom Every Time came from gay men themselves. And, at the time, it worked incredibly well. For the first time in the history of epidemiology, there seemed to be a way to prevent the further expansion of an epidemic. Stemming the spread of infection through behavioral change was actually something that had never been done before. The textbook approach was quarantine, although even this was never been shown to be effective. In general, one would let the epidemic run its course and do your best to care for the afflicted. But, widespread behavioral change was successfully bringing down the rates of new infections among gay men. And this was astonishing.

So marked was the success that much self-satisfaction ensued. We’d done it. We’d beaten it. This success and self-satisfaction obscured the fact that this was not the only approach available, and there was no talk about a ‘Plan B.’ Unfortunately.

I remember back in 1989, when I was living in Philadelphia, I attended a sort of speak out hosted by the then-nascent ACT UP/Philadelphia. Jane Shull, a local activist, and one of the smartest people I’ve had the pleasure of knowing, spoke about HIV prevention. Her remarks had an almost surreal quality. I don’t think any of us knew quite what she was talking about. She took us through a brief primer on psychological motivation. She explained how all of us are usually motivated by self-interest: warmth, food, shelter, ego gratification. It’s ongoing and lifelong, and we can pursue long-term goals with these motivations. Fear, she said, was a strong motivator, but it was short-lived. You’re afraid of the bear while you’re walking alone in the Canadian woods. Once you’re on the plane home, you’re not fearing the bear any more. Jane worried aloud that HIV prevention was playing on fear motivations. I don’t think anyone came away from there thinking that a serious re-evaluation of HIV prevention interventions was called from. It was 1989, and the bear was always right behind us.

But now the bear has become part of the furniture in our lives, and most of us also have an assortment of lions and tigers that we have to contend with. Fear doesn’t do it any more.

Furthermore, Use a Condom Every Time contained the seeds of its own destruction. Then, and subsequently, no one was abiding by this 100% of the time. Because if you think about it, how would that be possible? Use a Condom Every Time. Think about that. Let that sink in. From now until you’re pushing up daisies, every time you engage in physical intimacy with anyone, you’re going to have a latex barrier between you and your beloved. And at the time when it was promulgated, to do it ‘right’, don’t wait until you’re actually sticking it in, As soon as you’re hard, put the condom on.

This is a really important point I want to make: the big issue here is pleasure. It’s all about pleasure, and claiming your pleasure. Life, liberty, and the pursuit of happiness. You can’t come between someone and their pleasure. And, the pleasures of sexual intimacy are some of the most important in life.


Absolutely there is risk-taking involved. But, consider the context. We’re talking about love and fucking. When is there ever not risk involved in these pursuits, to whatever degree? It cannot be eliminated entirely. When you fall in love, you know you’re taking a risk. A really, really big risk. You’re putting your life on the line, every time. But that, of course, is one of the things that makes it so wonderful. You can’t separate risk-taking from love and sex. We all know that. And we’re used to doing it.

The first chinks in the armor, the first cracks in the edifice of Use a Condom Every Time—to my mind—occurred in the early nineties. Suddenly, there was great debate about blow jobs. Did you need to insist that he be wearing a condom when you went down on him? Good question. Was there risk of infection there? Gay men who were HIV positive and who had never taken it up the butt came forward to say that indeed there was. I remember going to a forum at the Lesbian and Gay Community Center in New York where attempts were made to inculcate in we forum attendees how giving and receiving blowjobs with a condom could be ‘hot’ and ‘fun.’ None of us, I don’t think, were convinced. It’s like eating a banana through a plastic bag. It’s a miserable experience. And here’s a crucial thing: I’m willing to bet that all of us, attending that forum, were not using condoms for blowjobs. So there was disconnect. The prevention message was: use a condom every time. But we weren’t doing that. And, some of us who were breaking the rules were persisting in testing negative. That raised the question, at whatever level of consciousness: could I have my cake and take it out of the box, too? “My Community” was telling me ‘no,’ and I was going to say ‘sure.’ Unfortunately, there wasn’t a lot of room to talk about this. We towed the party line, did something completely different, and didn’t talk about it afterwards.

About this time, there was a sort of ‘Second Wave’ of prevention messages to which gay men were subjected, that seemed intended to eliminate any and all loopholes we might have been exploiting. What about if you’re in a monogamous relationship? Well, unless you were with your beloved every moment of the day, you couldn’t be sure if he was being monogamous or not. So, best to just Use a Condom Every Time. And, we were asked to look at instances of ‘unsafe sex’ as though they were highway collisions: what were you doing at the time? Were alcohol or other drugs involved? How can you prevent this in the future?

And then, barebacking broke out into the open. Gay men were having anal, penetrative sex without condoms. This was cataclysmic.

Or was it.

What if I’m negative, and I’m the one on Top? Is there a risk if my partner, the bottom, is positive, that I could be exposed?

What if I’m negative, and I’m the one getting it, and my partner is a longtime fuckbuddy of mine who I know well, and I know that he’s negative?

What if I’m positive, and I’m on the receiving end. The jury seems to be out as far as the re-infection with a strain of HIV that might be immune to the drug regimen I’m on.

What if lots of lube is used, and the penis is pulled out before the load is shot?

Or what if my boyfriend is positive, but his treatment regimen is working really well for him, and his viral load is undetectable?

I don’t know if a lot of gay men are asking themselves these questions, and what answers they might be coming up with, but I do know one thing: using condoms now is the exception, rather than the rule. Or when condoms are used, it’s as a last ditch effort, such as: my boyfriend is positive, and I’m negative, and he’s not on any meds, so he has a detectable viral load, so when he fucks me, we use condoms.

In answering these questions, and weighing these relative risks, there is basically nowhere to go for information. You won’t find it anywhere. Believe me, I’ve looked.

This presentation started to take shape in my mind several months ago when I went to take the HIV antibody test. Of course, there was the requisite pre- and post-test counseling session. When I hit the sidewalk, after finding out that I tested negative, I was really pissed off. I had asked some of the questions that were roiling around in my head. I didn’t get answers. I got a referral to the Harm Reduction Counseling Group run by the organization. I got an intervention.

All that gay men who are grapping with these decisions have as resources are common sense and their own experience. In other words, empirical evidence. And, this is not to be discounted. How do we know HIV can’t be transmitted by the female anafoles mosquito? We know that it can’t because in areas where there is a statistically significant portion of the population that is HIV positive and lots of mosquitoes, you don’t have universal HIV infection. As with bumblebees, which according to the laws of physics should be incapable of flight, science really has no idea why mosquitoes can’t be vectors of HIV transmission, but they do know, because of empirical data, that they aren’t.

What does this mean for we, who labor in the fields of HIV prevention? So has the moment passed? What can we do now? What hope is there for effective HIV prevention education for gay men?

The moment has passed. There’s nothing we can do. There’s no hope for a new message?

Why?

There is no longer motivation for the target audience to listen. Not only has HIV become a common place, but the rarity is people dying. Of the four funerals I’ve been asked to attend over the past two years, two of the fatalities were from heart attack, one was from cancer, and one from diabetes. I do not mean to minimize at all the challenges facing someone who is living with HIV, from the rigors of adherence, the agonies that are euphemized as ‘side effects,’ to the numerous miscellany of ailments that plague people whose immune systems are seriously out of kilter. But, HIV is no longer perceived as the death sentence it once was. HIV prevention has used fear as the motivator for behavioral control, and we’re not afraid anymore.

And, the HIV prevention ‘industry’ no longer has standing or credibility among self-identified, sexually active gay men. “Use a Condom Every Time” has done damage. No one is going to listen to that message, or whatever clever, innovative spins we could put on that message now.

So all hope is lost? Not a bit. When I was working at the Lower East Side Harm Reduction Center, I was fond of correcting folks who would say, “Needle exchange is preventing the spread of HIV.” This is wrong. Check your messianic motivations at the door. Our participants are preventing the spread of HIV. All we do is provide the tools. Our role is passive, theirs is active. Individuals weigh benefits and risks and make choices as to what they presume to be are their own best interests, assessing conflicting and overlapping priorities.

So, too, with gay men.

Forgoing condoms is an affirmation. It’s like burning your bra. (I know that in Second Wave Feminism, there was actually very little, if any, bra-burning that went on, and that it was largely media hype, but I still like the analogy.)

Leaving behind condoms does not mean that we’re spreading HIV willy-nilly. It’s not madness. Are rates going to increase? Yes. Yes they will. Opiate overdose is statistically higher among heroin users than among people who do not use heroin. It’s not risk free, but then again, neither are most of the best things in life.

And there are responsibilities involved. Bidding a fond farewell to latex barriers means that you need to get information from your partners (“I’m negative. How about you?”), make choices, and take responsibility for those choices. Just like life.

Not using condoms means that you’re a grown up. That no one is going to tell you how to live your life and love your man. You’re making those decisions for yourself. And you’ll stand up and take your punches.



And what about the increase in infections? Well, we’re still new at this. There’s a learning curve. But, I’m confident we’ll get there. And as long as the simple majority of gay male sexual couplings do not involve HIV transmission—either because of critical assessment of the risks involved or by dumb luck—then the overall sero-conversion rates will continue to decline over time.


So what’s the lesson I want to impart for folks working with people whose primary risk is needle sharing?

Simply this. Listen to yourself? What are you saying to your participants?

“Always use a clean set.” Oh, really? I’m splitting drugs with my boyfriend, we’ve both been testing negative forever for HIV, and we’re both Hep C positive so it’s not like we’ll be breaking new ground there. Yeah, we could go through the trouble of backloading, but why bother? Especially when we’re both feeling dope sick.

It is never a good strategy to tell people what to do, even when you have their best interests at heart. It’s about pleasure, and when you ask people to forego pleasure, then you’re offering them a new opportunity for pleasure: the sublime joy of being bad, of breaking the rules and getting away with it. Here’s a better idea: Give them their works, answer any questions they have, make sure they have the opportunity to become experts at getting off, and shut up. Trust that they’ll be making good decisions, just like we all do.


Thanks so much.


So that's my presentation. It is titled, "Barebacking???!! The Failure of an Abstinence-Based HIV Prevention Intervention." It was reeeally well received. The room was packed. Tragically, it was on the last day of the conference, and it was folded into a panel discussion. I went first, followed by two women who worked with youth around sexuality issues. My fellow panelists launched into their presentation immediately after I finished speaking. When they broke people up into groups and passed out big sheets of paper and magic markers for brainstorming, there was protest that nobody wanted to do brainstorming, everybody wanted to talk about my presentation. Although I was secretly gratified by this, I did my best to be a civil panelist and said something about our presentations being fundamentally linked, and that I thought what they had to say was important.

If any discussion ensued, it was on the plane on the way home. Alas.

---