Public Health - Seattle King & County reports four men using meth and having gay sex with mostly anonymous, multiple partners tested positive for a similar, drug-resistant strain of HIV, the virus that can develop into AIDS. The Seattle P-I and Seattle Times report. The Internet often hastens such hook-ups. Taken together, both stories and a department press release correctly highlight behavior, but give equal or greater emphasis to condoms (still often eschewed) and testing, versus monagamy.
The choice is between emotional and sexual maturity versus serial risk-taking, immediate kicks, and HIV or even possible death from AIDS; a path which claimed, among others, the prominent deconstructionist scholar and anonymous gay sex practitioner Michel Foucault.
People make all kinds of bad choices about all kinds of things. But settling down versus serial sexual conquests has life or death implications for gay men because too often condoms aren't used and other unsafe practices are deliberately pursued for pleasure. I guess there will still be a market for e-mail services allowing gay men with HIV and other STDs to anonymously inform sexual partners of their status, post-hook up. I wish it wasn't certain public health departments providing the service, though, as that tactily encourages often-harmful behavior.
In the U.S., reported AIDS cases remain vastly the province of men having sex with men, injecting drug users of both sexes, and "high risk" heterosexual sex. The latter typically involves a partner (male or female) who has been injecting drugs; a man who has had unsafe sex with other men; or a woman who has had sex with such a man. The Centers For Disease Control reports here that through 2005, out of 947,585 total AIDS cases reported as transmitted in the U.S., 454,106 (48 %) have resulted from male to male sex; 242,006 (25.5 %) from injecting drug use; 66,081 (7 %) from both of the above; 164,850 (17.4 %) from high-risk hetero sex; and 20,542 (2 %) from other causes such as hemophilia, blood transfusions and perinatal transmission.
As long as government is going to remain in the business of HIV risk intervention, a caveat is necessary. There should be regularly updated, well designed and well publicized social surveys to determine what percentage or urban gay male populations are in committed, monogamous relationships; and what percentage engage with multiple partners (how many, how often, how often anonymously, and how safely). Granted, some of the self-reporting will not be totally accurate. A calibrated margin of error would address that concern, and the results, properly used, could help compel further behavioral shifts that public health experts urge in order to better limit HIV transmission risk.
Comments are welcome, as always. Please keep it constructive and venom-free: no gay-bashing or name-calling.
Posted by Matt Rosenberg at February 02, 2007 01:05 PM | Email ThisIf the bureaucracy is not willing to take a stronger stand on condemning bad decisions instead of dismissing them with the childish "their gonna do it anyway" mentality, then it will have only itself to blame for the mass death that will result. And in tolerating such a government, culture and bureaucracy, we are all imposing a death sentence for those who succumb to temptation over rationality.
Maybe that's subconsciously our intent?
Posted by: Jeff B. on February 2, 2007 12:55 PMIn fact, compared to other diseases that kill far more people, the spending is way out of proportion.
Although AIDS cases and deaths are declining and the disease is completely preventable, it nonetheless gets almost $180,000 in research funds per death from the National Institutes of Health. Compare that to its closest rivals: Parkinson's Disease, prostate cancer, and diabetes. All of these receive about $14,000 per death. Alzheimer's gets about $11,000..
Posted by: SouthernRoots on February 2, 2007 02:00 PM
I don't want to see anyone die (with maybe the exception of bin Laden) but government is never going to cure irresponsibility.
Posted by: swassociates on February 2, 2007 03:19 PMGreat idea! And here's another idea: Can we possibly think of any policies that could encourage such relationships? Such as the same policies that encourage heterosexual relationships -- say, marriage?
Posted by: Bruce on February 2, 2007 03:25 PMThis just shows the fundamental problem of the homosexual community. They don't know when to quit.
Posted by: Joe Blow on February 2, 2007 05:19 PMbut--the p.c. indoctrinated fears for our careers and jobs will make this untouchable for cutting funding. everyone is afraid to speak up. perhaps we need a bit of Darwin here--let the problem solve its willing participants.
trouble is, its (funding) takes from others more deserving (my view) like the truly mentally ill, frail senior citizens who paid their dues & veterans who are injured or needing help.
time to check our priorities. is this an innocent sniffle passed on a doorknob or a purposeful act done by irresponsible & selfish promiscuous participants? you be the judge.
no one wants to point out that hot potato facet of the problem. better to just "normalize" it as any other flu bug, right?!
Posted by: jimmie-howya-doin on February 2, 2007 06:06 PMHeterosexual monomgamus relationship.
Posted by: JCM on February 2, 2007 07:11 PMThere are many straight people who think they're in monogamous relationships than find out otherwise. What counts is a monogamous relationship period, regardless of the sexual orientation. The other big problem is crystal meth, which destroys any inhibitions in those who use it.
This is very serious, obviously, but I do remember last year when a few of these cases showed up in New York and the media went around telling everyone this was immediately going to be a huge strain that was going to wipe out gay men everywhere. That didn't happen, and all that did happen was a perpetuation of shame and fear that only pushed those who may be affected by this disease further into silence.
Posted by: Jon on February 2, 2007 10:02 PMI do use condoms for anal but nobody out there uses them for oral, so if you want to be sexually active, you have to take that risk. I wonder how many straight readers here would really give up sex, even under these dire circumstances.
I want to find that one guy to settle down with, but my sense is that most gay guys are not looking for that. It's like we don't even realize it's a possibility. I've asked guys I've had sex with for a date, and the answer I've gotten is, "not interested in a date, but if you want to hook up again, let me know." That's the irony of the battle over same-sex marriage. Gay men want the right, even if we don't exercise it. Many gay guys don't see the potential value of a relationship; marriage rights would give us a roadmap towards monogamy. Yes, some gay-married couples would have open relationships (and in larger numbers than married heterosexuals do), but I think overall it would have a civilizing effect on us. I can't understand why so many conservatives advocate for a policy that increases, rather than reduces, gay promiscuity. It's not like we gays are going to disappear or turn straight.
Posted by: Tony on February 2, 2007 11:30 PMAre you really that stupid? You are basically saying that temporary sexual gratification is more important than long term survival.
Most straight readers here simply don't put themselves into risky situations like that. If I was having sex with female IV drug users on a regular basis, that would be pretty risky too, but there are clearly other options. Most people are smart enough to specifically put themselves at less risk when it comes to their sexual behavior. And I'm willing to bet most readers here would prefer a lifetime of masturbation to the risk of HIV death.
I can't imagine why you think you have no other options. If you can't find yourself a partner that is monogamous or at least one that uses condoms when he is with you, maybe you should consider abstinence? Or you can keep playing Russian roulette?
I sure hope my tax dollars don't go to paying for expensive drug cocktails for you if you contract HIV any more than I would want your tax dollars to pay for all my medical bills if I had a major car accident after I decided to stop wearing a seat-belt regularly.
Posted by: Jeff B. on February 2, 2007 11:59 PMWhat I'm saying is: sex is one of the basic human needs, especially for men. It comes right after food and shelter. Access to women has been a huge motivator for men throughout human history; it's a big part of what drives men to be successful and pursue money and power and status.
You write: "Most straight readers here simply don't put themselves into risky situations like that. If I was having sex with female IV drug users ... I can't imagine why you think you have no other options... "
The reason straight men don't put themselves at the same risk that gay men do is that they don't have to. The vast majority of a straight man's potential partners are not IV drug users, nor are they HIV positive, so there's no comparison. I'll note that straight men and women do have sex even when they don't want get pregnant, despite the fact that birth control is not completely effective. Not a life and death matter, but weighty enough -- and still, most people use birth control at some point in their lives and take their chances. That shows you just how important having sex is to most people. I have to disagree with your assumption that most readers here would choose a lifetime of abstinence over the *risk* of HIV death (which is even smaller than the risk of HIV infection). I'm sure some would, but an entire life without the prospect of sex is not something most men would endure willingly. Abstinence may be a fine idea for teenagers, or for periods of our adult lives (until recently, I've been abstinent for two years), but it's not a realistic long-term solution for the majority of men, gay or straight.
For what it's worth, I always use condoms for anal sex, the riskiest of activities. As for oral, I have my partners pull out before they finish. There is still risk, but it is relatively low. Not a perfect solution.
I haven't given up on finding a husband, for lack of a better word. For reasons I partly explained above, it's just not that easy in the gay community. (As Bruce pointed out, one reason is that the larger society does not support same-sex relationships with the same expectations and responsibilities as it does for straights, through the institution of civil marriage. It's an argument I wish conservatives made more frequently.)
> I sure hope my tax dollars don't go to paying for expensive drug cocktails for you if you contract HIV ....
Not to worry, I have health insurance.
Posted by: Tony on February 3, 2007 01:26 AMThis group isn't saying things about gays they are out right screaming into a megaphone calling troops and supporters of the war red necks!!! Don't candy coat that lie lame stream media because it isn't about gays it is a ploy and who in the hell cares what these bible thumping idiots think! THEY HAVE NO RIGHT TO DISRUPT A SOLDIERS MEMORIAL!!! YOU (_O_)'s!!!
The fact that I don't need to wear a seatbelt when driving a golf cart on a golf course does not change the risk of, or warrant not wearing a seatbelt when driving an auto on the road.
Humans are volitionally conscious beings. Unlike other animals, sex is not something that we have no choice over. I agree as a male, a sex drive is always present. However, if having sex might get me killed, I have the ability to override my desires with the rational side of my brain. That's volitional conciousness or free will. Humans have to use their brains and reason to survive. And we have to do it consistently. Just because you chose abstinence for two years doesn't make the risk of your community go away.
As long as you are willing to put risk, emotion and pleasure before the more rational choices that would produce a better outcome, you are just part of the problem.
And if you feel put upon because you are gay and it's harder for you than in would be for a straight male, welcome to the world. There are other people with disabilities and others with bad luck. The world is not a fair place. What you can do to make it more fair for you is to make better choices, and beyond that, it's your own fault.
Between a bureaucracy that won't take a strong stand, a society that is far too politically correct and "tolerant" of those who make bad choices, and folks like you who continue to engage in behavior that spreads disease, it's no wonder we are going backward and not forward.
Posted by: Jeff B. on February 3, 2007 07:59 AMSecond, there is no evidence that a larger number of sexual partners causes psychological problems.
Third, conservatives need to make up their minds: do they want queer people in monogamous relationships or not? You refuse to provide the same incentives to same-sex couples to settle down as you prove opposite-sex couples, and then condemn men who have sex with men for not settling down. Mixed messages much?
Fourth, do you really think that King County Health wants to encourage high-risk sex behavior? Of course not. It is empircally shown that when providers of sexual health care condemn, monitor, unnecessarily collect data on, or otherwise harrass people who participate in high-risk sexual behavior, the rates of participation in that health care decline dramatically. Instead of assuming the moral lack of health service providers, I suggest you investigate the process by which they came to the conclusion that condemning people for unsafe sexual practices is poor policy.
Fifth, I understand your frustration with the relativism of the left, and share it. But we must be slightly more nuanced in condemning unsafe behavior. As I said, when that condemnation comes from medical providers, people who practice unsafe sex simply stop going. But people like you, like Dan Savage, like every gay man's best friend, can and should be as condemning of unsafe sex as reasonably possible.
Posted by: Travis Thomas on February 3, 2007 10:06 AMFirst, if you surround yourself with gay friends, it's a group of guys who see unprotected oral sex as no big deal. We tend to adopt the values of our peers.
Second, when a friendship starts without a romantic edge, it's unlikely to acquire one later. (Just ask straight men about whether their female friends think of them as boyfriend/husband material.) I know people who have slept with friends and even dated friends, but from what I can tell, it doesn't blossom into a permanent, lifetime relationship.
Third, can you really go back to being just friends after you've slept together? I know gay guys do it all the time, but that strikes me as creepy. I don't want to know what my friends look like naked.
Fourth, once you've pledged fidelity forever in front of family, friends and community, it's harder to jump from bed to bed (though obviously not impossible).
JEFF: I don't mean to make this personal, but you do not seem to think in terms of costs and benefits. What you see as a bad choice on my part is the result of weighing not only the risks, but also the benefits. Your accounting only considers the risks.
TRAVIS THOMAS: Are gay men only at marginally higher risk that straights? I don't think so. First, anal sex is a more prevalent activity among gays than among straights. Second, rates of infection are much higher among gay men than among straights, so gay men are more like have a partner who is infected. Controlling for crystal meth use doesn't change these realities.
I suspect that this topic has run its course, but if not, carry on.
Posted by: Tony on February 3, 2007 09:21 PMI don't care what people want to do for fun, but if I have to start paying medical for all, then screw that. We must make it illegal to do that which costs us all. If someone plays russian rullet, should we pay for anyting? NO. The same is said for having unprotected sex or having anal sex with a condom (40% success rate).
When you're in school, you have all kinds of people who tell you to drink, and smoke, and do drugs, and sleep around. You don't have to do what they say. The same is true for friends later in life. If someone tries to pressure you into sexual practices you don't feel comfortable with, just because they do the same, you don't have to go along. I know that in the gay community there's sometimes a pressure to go along, but that doesn't mean you have to go along.
When I said friendships can form relationships, I didn't mean you had to sleep with your friends (although seeing my friends naked doesn't really bother me). What I meant was that when you develop that close emotional bond with people, then sometimes, that does lead to love. If you want to date a person without having to focus on sex, then there are probably dating websites along those lines. There are more and more gay men who have broken away from the idea that sex has to be a major part of all their relationships from the start.
Posted by: Jon on February 3, 2007 11:03 PMWhat Tony calls benefit is a fleeting surrogate for value. Real value.
Marriage is not a cure-all, nor a guarantee of anything. If one wants to remain in a long term relationship, the key is value. Marriage is only a contractual construct, and what matters, as with any contract is not the words, but the underlying value to both parties. I married my wife, not because of any religious dictate, or sense of community, or what anyone else thinks, or for some immediate or even long term sexual gratification. No, I married my wife because I value her ideas. I value our shared conviction that two people form a strong force for raising children. And we both value each other for our work ethic, our willingness to put reason before immediate emotional gratification, and many other share opinions, etc.
Long after the immediacy of any relational gratification fades, there is no substitute for real value in any relationship.
If Tony's overriding value is sexual pleasure and conformity to the expectation that condoms are not worth the inconvenience for the transient sexual encounter, then he will suffer double. Both in terms of exposing himself to possibly deadly risk, and in terms of failing to understand that short term pleasure is only a diversion from the real pleasure of a relationship based on deeply shared values.
But the biggest misconception that Tony faces is that the values of his peers are something that he should adopt. Always make decisions for yourself, and then recheck every decision. Human survival is dependent on good choices.
The relevant point here is that groups of friends of gay men who take a strict "safe sex" approach rather than a "safer sex" one do not exist. (The few guys I know of who take a strict approach are married and/or deeply closeted; they are trying to protect their partners. Oddly enough, the wildest, most unsafe guys also seem to come from this group.)
My other point is that if you limit yourself to potential partners who take a strict approach (e.g., condoms for oral), you've reduced your pool to almost no one who is available for a relationship. Good luck finding someone in that tiny demographic who meets all your other relationship criteria, such as romantic compatibility, personality, finances, age, mutual attraction, etc.
Jeff thinks that I'm "failing to understand that short term pleasure is only a diversion from the real pleasure of a relationship based on deeply shared values." But I've made it pretty clear that I do desire a monogamous relationship. No need for a speech on its merits, I'm already convinced.
Jeff and katomar seem to think that I'm arguing that's in inevitable that gay guys adopt the lax attitudes of our friends. But my comments about values and peers were prompted by Jon's suggestion that I turn to friends as a source of potential partners. My actual view, as I laid out above, is that Jon's advice is poor, in part because friends make lousy lovers, and in part because (gay) friends are lousy role models, as a group. I'm not convinced that having gay friends is a likely mechanism for meeting a partner interested in safe (rather than safer) sex.
In any event, this topic isn't about me and my life. I was only trying to offer some insight from the inside about why gay guys, as a group, practice "safer sex" rather than "safe sex." If you want to continue to believe that you have solutions to a specific problem about which you have no first-hand experience (gay dating), go right ahead.
Posted by: Tony on February 4, 2007 12:07 PMThat depends on who the gay friends are. But I guess we will agree to disagree.
Posted by: Jon on February 5, 2007 02:36 AMGo figure...who's doing the most damage?
Posted by: John Bailo on February 5, 2007 09:34 AMHowever, I hate that my community uses it as a political tool-- a crutch to lean on when it suits best, one that can easily be tossed aside when declaring it as "everyone's disease".
When it comes to AMERICA, gay men have aids. Sure, other people do too, but there are a lot more gays out there than drug addicts who share needles.
HIV is no longer a death sentence- with proper treatment, like the early notice i had, you can live a long healty life. The doctor's tell me I wont even NEED meds for another decade.
So, allow me to stand up and tell my own community this- unsafe sex is retarded, and you do it at your own risk. few people get HIV by a REAL accident... the government should assist to the extent that's proportional to other diseases in this country, IF THAT. the fact that a disease that is a result of irresponsible behavior, unlike cancer for instance, should for no reason get so much attention and money.
If we, the gays, REALLY want equality, let's hold ourselves accountable for our actions and then maybe the heterosexual world will start seeing us as equals.
Posted by: michaelUW on February 6, 2007 03:41 PM