Treatment Issues: Newsletter of Current Issues in HIV/AIDS - Volume 19, Number 1 & 2, January / February 2005
From Gay Men's Health Crisis

In the United States, recent media attention about a multi-drug resistant HIV (the "super-bug") couldn't come at a worse time — when HIV prevention efforts are both increasingly censored and under funded. Unfortunately, many public health officials are currently relying on a one-size-fits-all approach to preventing further transmission of HIV. Abstinence is promoted over more comprehensive sex education approaches that address contextual as well as individual level factors. There is plenty of research showing the strong link between important contextual factors — HIV/AIDS stigma, homophobia, class, racism, community cohesion, depression, substance use, etc — and individual level HIV risk.

Facts:

• HIV infections with drug resistance (and even multi-class drug resistant HIV) are not a new phenomenon. In the US and in Europe 8–20% of all new infections are one-class drug resistant, and 1–4% are multi-drug resistant (it is higher in men who have sex with men).
• It's well established in large studies that although 'average' time of progression to AIDS after initial infection is 10–12 years, there are many cases where people progressed rapidly (within 2 years). Without additional case validation, it is impossible to scientifically conclude that increased viral virulence, and not host immune factors or some combination of the two, is responsible for rapid progression.
• Three conditions must be met before there is serious cause for alarm: multiple cases have to be shown to be virologically related; rapid progression must be linked to the virus itself and not host genetics or weakened immune system (i.e., due to drug use); and the virus must be readily transmitted.

Reflection:
Fear campaigns launched on the backs of gay men are not new in the 24 year history of the HIV/AIDS epidemic. What remains crucial is that we retain control over our bodies and health during these times. Men who have sex with men, gay identified or not, must be supported in our efforts to live satisfying and healthy sex lives, which must include consistent employment of effective safer sex and risk reduction strategies. We must work to reinforce as social norms in our community both sex with the minimal exchange of bodily fluids and condom use whenever possible.

For those of us living with HIV, it is vital that we have access to and adhere to treatment. For those of us who are HIV negative, routine STI and HIV screening must be a part of our regular health care regimen.

Sex while under the influence of any substance greatly increases the chance of HIV transmission because a person's ability to negotiate safer sex may be impaired. We must support efforts by men to minimize or eliminate their use of alcohol and/or drugs especially before and during sex. Treatment of addictions must be viewed as integral to our STD and HIV prevention efforts.

Dialogue:
Dialogue is also critical during these times. Whether over a dinner table with friends and family or in bed with a boyfriend or trick, we must have the difficult conversations about why we should matter to ourselves, each other and the world. Here are some questions to get the discussion going:

• Why should gay men matter to each other?
• How do we extend consideration and concern to other men with whom we have sex?
• How do we feel about our bodies as gay men and how do those feelings influence the decisions we make about the sex we have or the drugs we use?
• What motivates some gay men's abuse of crystal?
• Is self-policing a viable strategy for gay men?
• What will self-policing really mean inside of gay communities that are already highly divided by race, class, and sero-status?
• How can we promote a progressive gay men's health agenda in a socially and politically conservative environment?
• How can we respond to questions about complacency among gay men?
• What are the long term psychological and social consequences of prolonged periods of HIV vigilance?
• Where is the outrage over depictions of gay men as the embodiment of terror as government officials and some elements of the mainstream media continue to portray us, especially those of us living with HIV as walking time bombs ready to explode HIV all over the concerned public?

Action:
There has never been room for complacency or resignation in our fight to end the HIV/AIDS epidemic. We must remain deliberate in our organizing efforts. Here are some organizing principles to be mindful about as we ready ourselves for the continued work which lies ahead:

• Understand and reject HIV/AIDS stigma. Stigma can serve as the basis for discrimination. Its sole function is to exclude. Exclusion will not work as an STD/HIV prevention strategy.
• Insist that every sex act be an expression of consideration as well as desire.
• Resist urges to police other men, but instead surprise your friends, lovers, sex partners, family members, and acquaintances with conversations about sex, love, crystal use, relationships, homophobia, HIV/AIDS, racism, work, art, and the million other things that matter to you.
• Request participatory, open-ended and community-level interventions aimed at signaling to all gay men that we matter — to each other and to the world. These can range from pot-luck dinners to 12-step programs; from story-telling circles to interactive internet-based programs; from personal art projects to large scale home-grown social marketing campaigns; from reading groups to community forums.
• Demand gay sensitive, culturally relevant mental health programs, addiction services and treatment strategies for men who have sex with men.
• Establish alliances that are unexpected and that break from HIV/AIDS industry convention (civil rights groups, anti-hate crime advocates, art organizations, anti-poverty coalitions, etc.) as a strategy for addressing the contextual factors underlying heightened risk for STD and HIV.
• Work to end homophobia, racism, sexism, HIV/AIDS stigma, transphobia, and poverty as part of a broader health and wellness agenda for men who have sex with men.

Sadly, there is no cure for AIDS. Nor is there a magic bullet to prevent the transmission of HIV. If nothing else, the media attention about multi-drug resistant HIV reminds us about the seriousness of HIV/AIDS disease. We must move past the trivialization of HIV, because living with AIDS is neither glamorous nor easy. Now more than ever, we must re-affirm with dignity the many expressions of love and pride we extend to ourselves and to each other. We must continue to advocate for comprehensive and creative prevention approaches that are multi-pronged and sustained over time. In the current challenging political and fiscal environment, this will require our collective, unrelenting, and steady resolve.

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