Washington Blade - June 2, 2006
Joshua Lynsen

In the months before the HIV outbreak, when Dwyer lived in Los Angeles, he lived a "wild lifestyle" with a lover who owned the city's first leather bar.

All that changed in June 1981, when the Centers for Disease Control & Prevention in Atlanta reported the first cases of a rare pneumonia in young gay men. Those reports marked the official beginning of the HIV and AIDS epidemic.

"For men who had never faced problems in their lives because they were gay," Dwyer said, "HIV certainly gave them something else to think about."

Dwyer, now 52 and a Baltimore resident living with AIDS, said the outbreak and continued threat of infection taught gay men the importance of taking precautions.

Because a life with AIDS, Dwyer said, is a life laden with challenges.

"You need to play it absolutely safe, regardless of what other people say," he said. "The rational way to go about it is to treat everyone as though they're HIV positive."

Despite recent medical advancements in treating HIV, the disease remains a grave concern among gay men. It complicates the sexual decisions they make, and forces them to strike a balance between affection and apprehension.

Dr. Philippe Chiliade, medical director of the Whitman-Walker Clinic in Washington, D.C., said most gay men understand the threat that HIV poses.

"The vast majority of gay men," he said, "even young gay men, know what is safe and what is risky."

Despite the danger of infection, Chiliade said, some men continue to make risky choices.

Some refuse to wear condoms. Others let drugs or alcohol impair their judgment. And a few, Dwyer said, intentionally seek infection.

Dwyer - who was diagnosed with HIV about 20 years ago and progressed to AIDS in 1990 - said these men don't truly understand the disease.

"It's one thing to say it can be treated," he said. "It's another thing to say you've got to live the rest of your life chugging pills."

Choosing abstinence

Dwyer, who takes about 15 HIV-related pills daily, said a number of men have unhealthy attitudes.

"For a number of people, it doesn't occur to them that they can become infected," he said. "And there are a number of people out there in a fantasy world - or reality - who are looking to become infected."

Dwyer said men who desire infection do so with a certain resignation.

"Some of them are under the impression they're eventually going to get infected, so they might as well go ahead and do it," he said. "Some of them have an overly sexualized idea of what it is. Others see it as a treatable disease, so they think it's not that bad."

Chiliade said that Whitman-Walker doctors, many of whom specialize in HIV and AIDS care, have seen such patients, known as "bug chasers," though such cases are rare.

"There is a group that just doesn't care," he said. "We hear a lot about that group, but I think that group is very small."

Chiliade said more men have healthy attitudes and engage in safe and protected sex. Some even choose sexual abstinence to help stop the spread of HIV.

Researchers at the Rand Corp. recently found that a significant number of HIV-positive gay and bisexual men are choosing to be abstinent, at least temporarily or even long term.

According to the national survey of 1,339 people who were HIV positive, 11 percent of gay or bisexual men said they chose abstinence after their diagnosis.

"We didn't know much about this topic before we did the study," said Laura Bogart, the study's author. "We knew that people with HIV are more likely to be abstinent than those without HIV, but we really didn't know what the extent was."

Gay and bisexual men who chose to be sexually inactive were most likely to do so out of "a perceived responsibility to protect others," according to the study.

Chiliade said abstinence is a safe but problematic option for HIV patients.

"I will not recommend that to my patient, but if that's what the person wants, that's fine," he said. "I don't think that's healthy."

Chiliade said patients should have healthy sex lives, even after diagnosis, to maintain a general wellness. He noted that any intercourse must be done responsibly, ideally with full disclosure.

"I'm not sure how realistic it is to ask people that are HIV positive to inform their sexual partner," he said. "It's easier to say than to do."

Matthew, an HIV-positive 29-year-old gay man who lives in Washington, D.C., said he revealed his HIV-positive status to his partner about two months into their relationship. The revelation came before any sexual encounters.

"He came over to me and he said, 'Thank you very much for telling me. I'm sure you were very nervous telling me, and I'm glad that you did,'" Matthew said. "I'm really lucky in that he really cares about me and is willing to build a relationship with me despite the fact that, for some people, being HIV positive can be a stigma."

Matthew, who requested his full name be withheld because his partner is not openly gay, said that positive experience set the tone for a relationship that continues today.

"We both care about each other a great deal, and we didn't want to rush into anything," he said. "We wanted to be conscious of the fact that it's a big deal. It's a delicate situation."

A recent study by Ohio State University researchers found that Matthew's experience is common.

The study found that among HIV-positive gay men who share their health status with their sex partners, fewer than 6 percent of those surveyed regretted that decision. About 64 percent of HIV-positive gay men who participated in the study indicated they informed their partners.

Julianne Serovich, lead author of the study and chair of Human Development & Family Science in Ohio State's College of Human Ecology, said regret occurred less often than researchers expected.

"The results don't say that men were supported by these people, but somehow they've come to accept the reaction that they got, and they don't experience regret about it," she said. "Even if it wasn't a positive experience, they still don't regret that they did it."

Life after infection

But these decisions come after infection. And doctors and patients alike agree that gay men should do everything they can to avoid that.

"If you are HIV negative," Dwyer said, "I would want [you] to stay HIV negative, based on what I know of the wonderful side effects and the havoc the disease can wreak in your everyday life."

Now on his fourth HIV drug mix, Dwyer said sexually active gay men need to understand that one moment of pleasure can cause decades of pain.

"I've had pills to treat the side effects," he said, "and I've had pills to treat the side effects of the pills that treat the side effects."

Although medical advancements have helped to treat HIV, no cure is imminent and experts are still unclear about whether the treatment will allow a relatively normal lifespan.

"I would hope that treatments and medical advancements will continue to improve," Matthew said, "and this disease will continue to have less and less of an impact on our daily lives."

Chiliade said given the medical advancements that have occurred during the past 25 years, it's reasonable to think a cure will be found within the next 25 years.

"I think that when you look over the last 25 years, there were major improvements," he said. "We hope that in 25 years, we will know much more."

But absent that, doctors and patients said, gay men must continue to use caution and protection.

"It would be great if there was a cure," Matthew said. "If that doesn't happen, I would just hope that people are more responsible in their sexual lives."

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