The Bay Area Reporter - November 5, 1999
Dale Carpenter

The news seems very bad. The anti-AIDS drugs that appeared commercially three years ago are starting to fail. Up to 40 percent of treated individuals are now developing HIV strains strongly resistant to the drugs. At the same time, there is evidence that unsafe sex is on the rise, indicating a dangerous relaxation in attitudes about AIDS. "The concern is that there will be a second wave of disease," warns Dr. John Mellors, an AIDS specialist at the University of Pittsburgh.

Or maybe the news is very good. The death rate from AIDS has been cut by two-thirds in the last three years. More drugs are on the way. At the same time, sexually transmitted diseases -- an indicator of the frequency of unsafe sex -- are well below the high levels witnessed in the sexual heyday of the 1970s and early 1980s.

Upon the recent release of 10 short French films about AIDS, a New York Times reviewer commented that AIDS-themed film projects are "pass ." Gay sex-advice columnist Dan Savage, among other prominent writers, believes the AIDS "crisis" has ended. In a banner outside its office, ACT UP/San Francisco proclaims simply: "AIDS is over."

Who's right? AIDS, which killed more than 300,000 Americans in a first wave of death from 1981 to 1996, is unlike any disease we have ever faced. Despite extensive research, we still have only a primitive understanding of how the virus attacks the body, where it resides, what the risks of particular sexual activities are, and so forth. There is no cure in sight.

There are many ways to interpret the available evidence about both progress in AIDS treatment and sexual behavior. The most optimistic rational interpretation -- the one that sees gay men making fine calculations of risk for various sex acts in an environment where the consequences of error are falling -- is certainly defensible. But when the stakes are so high, we better be damn sure before we adopt an interpretation that confirms what we badly want to believe.

What are the policy implications of a more prudent, but less optimistic, outlook? I don't think it means closing bathhouses, a clumsy attempt to substitute government mandate for personal responsibility. But we -- and by "we" I mean individuals, organizations, and even government -- must frankly tell people they're taking serious risks.

That's a daunting project. People (men especially) have always risked things for sex -- careers, families, presidencies, lives -- that they would never risk for most other things. People are capable of rationalizing almost any activity or promise or deception -- or available data -- to obtain sexual satisfaction. So any message we send to try to overcome the human willingness to throw the eternal dice for sex will have to be very tough on complacency.

We must say without equivocation that a return to the behavior that created the AIDS epidemic in America -- widespread, promiscuous, unprotected anal sex -- will either retard or negate our progress in treatment. If we make petri dishes of our bodies, we tempt the disease to find a way around even the best medicine.

Members of groups like Sex Panic! talk about unsafe sex as a mystical experience. But we must emphasize that there are other mystical experiences in life: like walking down a dark country road or engaging the mind of an author in a really good book or looking into the eyes of a baby. The tragedy is that we would risk trading a lifetime of the latter things for one episode of the first thing.

We must say even more than that, however, if the next generation is to be spared the horrors of the last. The time has come to remind our young what the disease does to a body. They have never seen their friends emaciated, or ravaged by pneumonia. Yet AIDS is still a leading cause of death for young gay men. They need to understand that.

What if, in addition to the muscled, mountain-climbing HIV-positive men featured in advertisements, they saw the other side? Let's have an honest ad campaign that shows the toxic effects of the new drugs. Maybe they need to see a few unsightly guys with "buffalo hump" and "protease paunch" -- the nicknames for the disfiguring body-fat distributions some people get on the antiretroviral drugs. The pharmaceutical companies have no interest in showing these things, but we do.

In our modern obsession to avoid offending anyone, we have been mealy-mouthed about this. It is an unforgivable disservice to our young, especially. We do not need to re-stigmatize the disease or the people who have it. But we do need to re-stigmatize the behavioral choices that transmit it.

People who have unsafe sex in an age when it will get them a fatal, incurable disease are not especially bad. They've inherited the human penchant for sexual risk. The lack of visible costs for indulging that penchant -- the only costs most people really consider -- tells them to stop worrying. They walk down the street past signs that assure them, "AIDS is over."

They haven't started dying yet and I hope they don't. But, unless we tell them the hard truth, I fear the next sound we hear will be the second wave crashing onshore.

Dale Carpenter, an attorney, is the winner of three Vice Versa awards for excellence in gay writing. He can be reached care of this publication or at OutRight@aol.com. For more OutRight, visit http://www.planetout.com.
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