Instead of telling gay men, "Always use a condom," we need to address the reasons so many men don't. When we have new generations who didn't watch their friends die horrific deaths from AIDS now dismissing condom use as "political correctness," and serious writers claiming that "hedonism" is what drives reckless sexual behavior, it's time for a reality check.
Since the beginning of the AIDS epidemic, there have been gay men who scream "homophobia" anytime attempts are made to get them to behave like responsible adults who actually respect themselves and their partners. They have conflated liberation and license, convinced they are entitled to do whatever they want -- whenever, wherever and with whomever -- and woe to anyone who dares to burst their delusional bubble.
These guys believe they can "party and play" -- gay shorthand for using crystal meth (usually) and having sex (frequently unprotected) -- with impunity, or that it's up to HIV-positive guys to eliminate themselves from the dating and sex pool because they (we) are "unclean." Basically, this type of gay man believes it's others' responsibility to behave responsibly, that anyone who gets between him and what he considers his "freedom" is "the enemy."
Well, self-hate never came so prettily packaged as it does when it's got a chiseled face, an expensive haircut and washboard abs. Self-destruction never looked so appealing as when it wears the mask of words like "party" and "play."
Let's be frank: Gay men don't account for 78 percent of all new HIV infections among men in this country because we are hedonists. We don't make up 63 percent of all new HIV infections in this country because we are having "natural" sex. Sorry, but it's not natural to believe such statistics are acceptable.
But it is what happens when we confuse "horny" with "lonely." It's what happens when we don't want to admit that being called "sissies" and "fags" all our lives still hurts, that we still bear deep scars from being bullied as kids, that maybe we've taken the messages we constantly receive about being "different" to mean we are broken and unlovable.
Ron Stall, a medical anthropologist and director of the University of Pittsburgh's Center for LGBT Health Research, has identified four intertwining, synergistic epidemics, or "syndemics," of psychosocial health conditions among urban gay and bisexual men: childhood sexual abuse, partner violence, depression and drug use. Together they lead many of us to engage in behavior that puts us at risk for higher rates of anxiety, depression and alcohol and other substance abuse, and at greater risk for HIV infection found in our community.
The good news -- and it is very good news -- is that the vast majority of gay men do not abuse drugs or engage in high-risk sex. Stall pointed in an interview to his study of gay men's psychosocial health problems. Of 812 men who reported one problem, 11 percent had recently engaged in high-risk sex -- as had 23 percent of the 129 men reporting three or four problems.
Clearly, these men showed evidence of resilience by the fact that 89 percent with one problem, and 77 percent with three or four problems, hadn't been driven to engage in high-risk sex -- unprotected anal intercourse, to be precise. Stall told me, "We were able to show that guys who do the best job of resolving internalized homophobia [or 'self-stigma,' as researchers are calling it] are the least likely to have current victimization, substance abuse and compulsive [high-risk] sex."
What this means is that to be effective, HIV prevention and substance abuse interventions need to build on gay men's resilience, to be "strength-based." As Stall put it, "We're so focused on risk factors to the point that we forget about resilience. It seems to me a smarter way to go would be to look at the guys who are thriving in spite of the adversities, how they pulled that off, see what the lessons learned are, and apply that to the interventions we already use and have developed."
Put in layman's terms, Stall said, "Getting a population of people not to hate themselves is good for their health. This is not rocket science."
Clearly, most of us get beyond the condemnation, ostracism and rejection we experience and survive and thrive as out, proud and resilient gay men.
Others of us (and I will admit I was one) don't honestly confront the demons that hound us until something like an HIV diagnosis makes us question how it could have happened. That honesty can lead to some painful places. In my own experience it meant finally admitting that watching all my friends die while we were young exacerbated the loneliness that was already far too familiar. Would I have been putting myself at risk -- calculated risk, but risk nonetheless -- if I had been able to fill that loneliness with the love of one man instead of anesthetizing it with what is rather creepily called "survival sex" with multiple men?
It's foolish and ignores the high prevalence of HIV among gay men to claim it's our "right" not to use condoms, that unprotected intercourse is nothing more than "natural" sex. It's also foolish to ignore the impact of the psychosocial "drivers" of our behavior, to pretend we are merely free agents whose choices about sex and drugs are driven by sheer pleasure-seeking -- and not too often by things like depression and loneliness.
In this Pride Month, how about if we do something worthy of truly proud, resilient gay men: stop looking at condoms and safe sex as "unnatural" but as simply what proud, healthy gay men use and do because we respect and value ourselves and one another.
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