In the spring of 2004, a crystal meth addict slumped into a clinic in New York with lesions and a story about barebacking with several hundred men over that year. At first it seemed like the sad same-old, the kind of case that staggers into AIDS clinics across the world every day: gay man gets addicted to crystal, belly-flops into a culture of raw sex, and seroconverts in a second. Only this case was different. This man had tested negative just six months before - but he was already showing the symptoms of AIDS. It seemed impossible: the virus takes far longer than six months to progress to its late, lethal stages. And it got worse: the virus ravaging his body was so powerful that protease inhibitors didn't work. The doctors tried cocktail after cocktail, but nothing changed. It seemed like this was a new Patient Zero, and super-AIDS - a new, more toxic mutation of the HIV virus, quicker and invulnerable to drug treatment - had arrived.
This was not an idle press scare. Dr David Ho - who had been named as Time magazine's Man of the Year in 1996 for his AIDS research - issued a warning alongside the New York City Health Commissioner that this was "a wake-up call". Tokes Osubu, Executive Director of Gay Men of African Descent, said, "This is the news we have all been fearing." But the worst did not happen. It turned out that the men Patient Zero had fucked were not contracting the same illness - this super-AIDS was not super-transmissible - and eventually he did respond to the drug T-20 and efavirenz. The alarm was switched off. We all went back to sleep.
Today, we are all loudly focusing on the danger from Proposition 8 and its foul theocratic supporters - but this slower threat is swelling alongside it in silence.
Some doctors have tried to warn against this narcoleptic response. HIV physician Dr James Braun warned a recent retrovirus conference that the transmission of treatment-resistant HIV is "a disaster waiting to happen." But the refusal to listen, the determination to keep on barebackin', shouldn't surprise us. The gay community is facing a string of HIV crises - and we are hitting the snooze button on all of them.
The culture of safe sex that emerged in the wake of the first AIDS crisis - when the disease scythed through gay communities in near-apocalyptic numbers - has now melted away. A British survey of over 14,000 gay men in 2003 found nearly 60 percent had unprotected anal sex in the past year. Barebacking has become an accepted subculture. Check out the darkroom of any club and you'll find condomless sex. Click into the chatroom of any pick-up site and there are men - both HIV-positive and negative - advertising for "raw" sex. Websites such as www.barebackcity.com attract hundreds of thousands of hits a day. For the first time since the late 1980s, HIV infection rates are rising among gay men in the US and across the developed world.
The disciples of barebacking acted as though they stand for a masculine rodeo roughness, far better than the prissy girlish fussiness of their condom-waving exes. I logged on to gaydar to ask barebackers why they played Russian Roulette with their cocks. One said, "Safe sex is not real sex, it's pretend sex. The need for the intimacy of actual skin-to-skin contact is primal." Another explained, "It's hotter without a condom. It's just so much better to feel a guy come inside you. Besides, a lot of men can't keep it up with a condom." This backed up the much more extensive survey conducted by the New York psychologist Perry Halkitis. He found that the main reasons for rubber-free fucking were that men believed barebacking was "more intimate", "hotter", "more romantic", and "more butch".
There are other, more subtle reasons for the decline in safe sex. Michael, the webmaster of 'XtremeSex', a barebacking site, says HIV is now "a minor inconvenience" and "not the catastrophe negatives think it is." Some HIV prevention experts have nervously labelled the new treatments "protease disinhibitors", because they have lulled many gay men into believing that contracting HIV is less like getting cancer and more like getting diabetes, just a matter of swallowing a few pills a day. The HIV-positive playwright Larry Kramer is incredulous at this. "I don't understand why some of you believe that because we have drugs, it's worth gambling with unprotected sex," he says. "These drugs are not easy to take. There are many side-effects. I have to allow one day out of every week to feel really shitty, to have no sleep, to be constipated, to have diarrhea, to require blood tests and monitoring at a hospital, and to have the shakes. I don't enjoy eating any more. Keeping on weight is a constant problem. I have dry mouth. I get up six or seven times a night to pee. Is a fuck without a condom worth not being able to taste food?"
If protease inhibitors have made gay men psychologically down-grade the risk of contracting HIV, then the gay community is snatching defeat from the bubble-butt of victory. Many HIV-positive men who bareback believe they have nothing to lose, since they already have the virus. This is a deadly misconception. They can easily become reinfected with a more virulent strain of HIV that will kill them faster. Positive Nation's treatment director Robert Fieldhouse discovered his first "unequivocal" case of reinfection three years ago when a patient treated for a subtype B infection disappeared on a shagathon to Brazil - and returned with subtype C. "The real nightmare was that his previously well-controlled virus began progressing more rapidly, his viral load shot up and his CD4s plummeted," he explains. "Reinfection can mean your HIV treatment might suddenly stop working and the course of your infection changes from one that is fairly benign to one that is fast processing."
But despite this, anti-condom attitudes are rippling out beyond the barebacking subculture. The HIV-positive gay club night promoter Spike says he has seen "countless" men being shunned for insisting on safe sex in clubs and saunas. He warns: "There is a real danger that the anti-gay press and politicians will seize on these things and use them to attack the gay community. This could set the scene back some 30 years and lead to an explosion in hate crimes. The message we are sending out is that diseases like HIV and Hep C are no big deal and gay men don't have any respect for themselves."
Some of this is happening because well-meaning people have acted from the best of motives. For example, there has been a long campaign over the past decade to peel back prejudice against HIV-positive men. Adverts show them as rippling, testosterone-soaked hunks, and in US ads for protease inhibitors, HIV-positive men are shown rock-climbing, dancing and sailing. But some campaigners believe that propping up the self-esteem of HIV-positive men has actually overtaken and obstructed HIV prevention work. When the AIDS Health Project in San Francisco put up a banner saying 'Stay Healthy, Stay Negative', it was bombarded with complaints from men saying, "I have HIV, I'm healthy, how dare you say I'm not?"
The New York psychologist Walt Odets has been barracked and harangued for warning that "HIV prevention is not supposed to be about making positive men feel good about themselves, it's supposed to be about protecting HIV negative men." Sally Putnam, Nurse Co-ordinator for the AIDS Consultation Centre in the state of Maine, backs this up: "Sometimes I really think we're at fault. If you look at the advertisements for HIV drugs in the magazines, everyone is really healthy. I really wish some people could come and sit in here for a day and observe all the wasting, all the fat bellies. If we had those photos out there, maybe things would be a little different."
And there's yet another good, decent instinct that has had perverse outcomes on HIV prevention. Over the past decade, many people have fought hard to erase the idea that AIDS is a "gay plague" from the public mind. After the nightmare of the 1980s, it's not hard to see why: it was a time when Ronald Reagan's close friend William Buckley suggested all gay men be forcibly tested and HIV positive men have a warning tattooed onto their buttocks (what would it say - abandon hope all ye who enter here?). But Will Nutland of the Terrence Higgins Trust warns that, "We have definitely gone too far in de-gaying AIDS - and the result is it's created a huge funding problem and gay men aren't getting the help they need."
The British Department of Health has recently been diverting a huge amount of HIV-prevention cash to young straight people holidaying in places like Ibiza. It sounds like a good idea - don't the figures show that straight seroconversions are soaring? But if you look at the statistics more closely, you find that almost all the heterosexual HIV infections in Britain were acquired in Africa by Africans who subsequently came here as immigrants and refugees. "Everyone in HIV prevention is very reluctant to say it because we are worried about a homophobic and racist backlash, so we have colluded in this Ibiza-isation of HIV," Nutland says bluntly. "But the result is that money is being wasted targeting very low-risk straight holiday-makers, and high-risk people are not getting the protection they need."
Isn't it better to admit that AIDS is still disproportionately a problem for gay people and Africans and risk the venomous poison this might unleash? The alternative is to let innocent gay people and Africans contract HIV and die because the prevention funds were wasted on people who were never at risk anyway: isn't that the real betrayal?
It is particularly important to funnel new funds towards young gay men, Nutland says, "because we have a whole new generation with no memory of seeing their friends die and a very different experience of HIV." The UK Gay Men's Sex Survey in 2003 - commissioned by the Terrence Higgins Trust - found that one third of 20 year-old gay men do not even know the most basic facts about HIV transmission. Some 51 percent didn't know that HIV is more likely to be passed on if he or his partner has another STD; 31 percent did not know that water-based lubricant reduces condom failure; and, incredibly, 14 percent did not know that HIV is more likely to be passed on if a man ejaculates inside his partner. This is the deadly legacy of the Thatcher-Reagan calls to not teach about homosexuality in the classroom, lest they (somehow) "promote" it.
But there is another female cause of rising HIV infections among gay men, and she comes by the cutesy name of Tina. The drug crystal meth used to be known as "redneck cocaine", because a hit cost as little as a Big Mac in rural America. In the late 1990s it began to transfer onto the gay circuit party scene in the US, where its versatility was attractive: crystal can be drunk, snorted, injected or inserted anally (it's known as a 'booty bump'). Today it's used by a quarter of gay men in San Francisco, according to some surveys. Tina (also known simply as cystal, or ice) is a fuck-drug: it makes it possible to have sex for hours, even days, and users often say the difference between sex with crystal and sex without is the difference between Technicolor and black and white.
The problem with Tina is it simultaneously makes you incredibly horny and melts away your rationality and cautiousness - a recipe for bareback sex. Mel, a man who contracted HIV while addicted to crystal, explains, "If somebody wants to fuck you without a condom, you just don't care. I did things on crystal I would never do sober, like being gang-banged and doubled-fucked." He's not alone: New York's Collen-Lorde Community Health Centre has found that two-thirds of their patients who tested HIV positive since June 2003 acknowledged crystal use as a factor in their infection. And it's not just the horniness of gay men that has made it spread through our world. Neva Chaupette, a clinical psychologist, explains: "The drug is especially attractive to people who have internalized homophobia. If you're conflicted about expressing yourself in a gay manner, crystal not only gives you control, it just wipes that away."
But crystal meth, when it is twinned with the constant sexual availability of the internet, is a guarantee of rapid HIV transmission. As one journalist puts it, "The internet has turned out to be a higher-risk environment than any bar or bathhouse. Men who meet online are more likely to use crystal, more likely to be infected with HIV, and less likely to use condoms."
In this environment, the potential for a mutated super-AIDS virus to spread is phenomenally high. Viruses are constantly mutating: even today, HIV positive men are immune to at least 35 percent of the available protease inhibitors. A situation where we have central group of men infecting and reinfecting each other through barebacking, with the most virulent and vicious strains of the virus spreading, almost creates a petri dish for incubating the HIV virus. Any mutation will be spread with astonishing speed. Gabriel Rotello, author of Sexual Ecology: AIDS and the Destiny of Gay Men, explains, "You can't have a core group of people having sex with large numbers of people without amplifying any sexually transmitted disease that enters the system. I don't have any doubt that a resurgent HIV epidemic will hit the gay population in the near future." But he believes "people are not going to modify their sexual habits in ways that are difficult or unpleasant until they see their friends dying again. And to me that's just an unbelievably depressing thought."
The gay community is particularly ill-equipped to deal with these looming crises: the rise of bare-backing, a new and ignorant generation, the growth of Tina, and the deadly prospect of super-AIDS. Peter Staley, a veteran AIDS activist and recovering meth addict, explains why: "The whole basis of our community is very libertarian. The gay liberation movement's primary focus has always been fighting against those who are trying to tell us how to live our lives, so we're very reluctant to tell each other how to live our lives. And rightly so. But I hope our community only takes that so far. For example, if we had been completely libertarian during the height of the AIDS crisis in the 80s, there would have been no pressure on some gay men to make other gay men use condoms all the time. That was our greatest hour as a community - when we started helping each other, and started expecting that we take care of our own. Now, here we are again, faced with a situation where the health of many gay men is under serious threat. We need to start helping and pressuring each other again."
If we want to avoid a renewed crisis, we have to do something that is temperamentally very difficult for gay people: we have to restigmatise bareback sex and make crystal meth socially unacceptable on the gay scene. For a community whose whole purpose has been stripping away stigma, this will be wrenching - but the alternative may be another mass culling of the gay population. We should not offer disapproval for prurient, puritanical reasons derived from the rotting crrcass of Judaeo-Christian 'morality'; it's simply as a matter of collective survival. As the playwright Jeff Whitty puts it, "I don't care what kind of sex anyone has. That's up to them. But we have a problem. And we need to start dealing with it more responsibly if we don't all want to die. How many times does that message need to be sent?"
Some campaigning gay groups in the US want to launch an aggressive, full-on campaign against callously risky behaviour. Groups like ACT-UP - one of the first to fight for awareness of AIDS in the first crisis - have mooted tracking down anybody who is deliberately engaging in risky behaviour sabotaging them before they can infect somebody else. This would mean infiltrating websites, turning up at "pos parties" (where men bareback) to ruin them, protesting outside barebacking clubs, and more. Charles Kaiser, historian and author of 'The Gay Metropolis', argues, "Gay men do not have the right to spread a debilitating and often fatal disease. A person who is HIV-positive has no more right to unprotected intercourse than he has the right to put a bullet through another person's head." Ana Oliveira, head of Gay Men's Health Crisis, says, "It makes a community stronger when we take care of ourselves, and if that means we have to be much more present and intervene with people who are doing this to themselves and others, so be it."
Larry Kramer is just as emotional, and he believes tolerating the rise of barebacking makes gay men complicit in a slow-motion massacre. "From the first moment we were told in 1981 that the suspected cause was a virus, gay men have refused to accept our responsibility for refusing to listen. Starting in 1984, when we were told definitely it was a virus, this behaviour turned murderous. I have recently gone through my diaries of the worst of the plague years. I saw day after day a notation of another friend's death. I listed all the ones I'd slept with. There were a couple hundred. Was it my sperm that killed them? Have you ever wondered how many men you killed? I know I murdered some of them. I just know. Has it never, ever occurred to you that not using a condom is tantamount to murder?" The British Crown Prosecution Service reinforces this message: four HIV-positive people have been convicted in the past year of "biological GBH" for having unprotected sex with people without informing them of their HIV status. "I cannot understand", Kramer concludes, "how, life having been given back to us again, you treat your life with such contempt."
It will be painful for us to deal with these questions. It will seem judgmental and cruel to seek to stigmatise barebacking and crystal. Many people will demand to know: isn't that kind of finger-wagging judgement precisely what we in the gay community are running away from? We will have to reply: aren't we also running away from a disease that nearly killed all of us just twenty years ago? Is it really acceptable that 4,000 people are seroconverting in this country every year? We all know that many gay men pick up knives and slash their flesh in an epidemic of self-harm. But has it occurred to us that the gay community as a whole might be collectively doing the same thing by normalising the madness of barebacking, of crystal meth, or downplaying AIDS? Of course we don't want to distract energy from the fight against Prop 8's vicious proponents - but if we don't deal with these issues, rising HIV levels and the possibility of super-AIDS will deal with us.
Martin Luther King said, "Our lives begin to end the day we become silent about the things that matter." For the gay community, this is no longer just a metaphor.
Johann Hari is a writer for the London Independent. To read more of his articles, click here.
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