Why Aren’t We Talking More About HIV?

First published at 365gay.com on October 1, 2010

You may have seen last week’s Washington Post headline, “Study puts HIV rate among gay men at 1 in 5.” [http://www.washingtonpost.com/wp-dyn/content/article/2010/09/23/AR2010092306828.html] And the story starts off grim:

“One in five gay men in the United States has HIV, and almost half of those who
carry the virus are unaware that they are infected, according to a new Centers
for Disease Control and Prevention study.”

So, here’s the sorta-kinda-almost good news: The headline is simply false.

A more accurate headline would have read, “Among gay men who frequent bars and dance clubs in metropolitan areas with high AIDS prevalence, the HIV rate is nearly 1 in 5.”

As the CDC report explicitly warns, “the results are not representative of all MSM [men who have sex with men].” The study focused mostly on bars and dance clubs in 21 cities with high AIDS prevalence. “A lower HIV prevalence (11.8%) has been reported among MSM in the general U.S. population.” [http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5937a2.htm?s_cid=mm5937a2_w]

11.8% is bad. But it’s not 1 in 5, or even close.

The sorta-kinda-almost good news is still bad, since it means that the Washington Post, and the scores of other outlets that picked up the story, are spreading a falsehood. This is grossly irresponsible journalism.

And ultimately, there’s really no good news in this story, since HIV-infection among club-going gay men in certain cities is indeed shockingly high, and HIV-infection among gay men more generally is also high—and rising.

Moreover, 44% of the HIV-positive men in the CDC report are unaware that they’re infected—which means they may spread the disease without knowing it. The percentage of those unaware of their positive status is especially high among younger men and minorities (59% among African-Americans in this particular study).

If anything good comes from these reports, it will be increased attention to this problem in our community. Frankly, it’s long overdue.

I came out in 1988—late enough that “safer sex” was part of our vocabulary, but early enough that I watched lots of people die. AZT was just becoming available, and protease inhibitors were some time off.

Thanks to medical advances, AIDS is no longer a death sentence. For this we are all grateful.

But the flip side of those advances is that too many gay men—especially young gay men—think of HIV as “no big deal.” Either that, or they just don’t think about it at all.

A fortysomething friend of mine recently told me about several hookups with twentysomething men who tried to allow him to enter them without a condom. In one case, he told the young man afterwards, “We probably should have had this conversation earlier, but just so you know, I’m HIV-negative.” To which the younger man responded, “Yeah, I assumed you would have said something otherwise.”

No, no, no! Don’t assume. Ask. (And then use a condom regardless.)

Back in the late 80’s, we learned how to have these conversations. While dimming the lights, we’d mention “By the way, I was last tested…” or while unbuckling his pants, we’d ask, “So, do you know your HIV status?” It was awkward, maybe, but awkward was better than sick.

And yes, the sickness was a lot scarier then. When I sang in the Capitol City Men’s Chorus (a gay chorus in Austin Texas) in the early 90’s, we would perform at a member’s funeral just about every season. We kept photo albums of smiling groups of friends in their 20’s and 30’s—many of whom never saw 40. It was a horrible time.

So we learned to “use a condom every time.” We got tested regularly. We took care of one another.

We worried that those infected would feel “untouchable,” and so we tempered our rhetoric. It wasn’t easy. It’s hard to tell HIV-negative people “Avoid this at all costs!” while telling HIV-positive people “You’re going to be just fine.” It was a difficult balance.

Then the drug cocktails arrived, and the HIV-positive people really were fine—sort of. They had to take lots of expensive pills that often made them sick, and they had to bear the psychological burden of being positive. But at least they weren’t dying left and right.

And so we stopped fearing HIV—especially those younger generations who never witnessed the plague. And then we stopped talking about it.

Recently a gay male contemporary of mine died of cancer. It was a rare cancer that most often strikes African children and AIDS patients. My friend was not an African child.

I don’t know whether his death was AIDS-related. I do know that none of us wanted to bring it up, because it’s “impolite” to talk about such things. But we need to talk about such things.

11.8% may not be 1 in 5. But it should be enough to break the silence.