I highly recommend Richard Posner’s excellent book, “Sex and Reason,” for a non-hysterical approach to the issues of safer-sex and reducing HIV transmission. The issue has been troubling me after the dumb Rolling Stone “bug-chaser” hysteria. One of the worst elements of that piece is that it sensationalized and polarized an important issue: how we manage to reduce HIV transmission in an era where an HIV diagnosis is nowhere near as scary as it used to be. The reason I admired Posner’s book is that he assumed that men seeking sex are actually rational beings. They measure costs and benefits and change behavior accordingly. Hence the amazing decline in HIV transmission in the mid 1980s. Hence also the slow shift back since. Or take a less fraught analogy. Let’s say that science found treatments that reduced the rate of fatality from lung cancer due to smoking by, say, 80 percent. Let’s also say that these treatments became progressively easier to tolerate. What would you predict would happen? More to the point: How would you conduct a public health message that still credibly warned against the risks of smoking? That’s the question we need to explore. And it’s not an easy one.
STAYING AFRAID: What to do? With HIV, insisting on abstinence for life is a non-starter for the vast majority of gay teens and adults. Falsely scaring them with empirically false statements about death rates is also counter-productive – it merely undermines the credibility of the authorities. Sexual segregation between HIV-positives and HIV-negatives has some advantages in creating a firewall between the two groups, but in time, it has apparently only further decreased fear of HIV. The pozzies look great, seem in good health and no longer live in terror of getting the disease. Some degree of “HIV-envy,” while not as pathological as “bug-chasing,” and if only because having it means you can’t be scared of getting it any more, is still a real issue. Again this problem strikes me as close to insoluble. I’ve been HIV-positive for ten years now, and my immune system is healthier now than when I got infected. I look better than I did when I was negative, have experienced deep spiritual and emotional growth as a result of my HIV experience, and live every day now with a vigor and gratitude I never felt before. I’m just one of thousands of productive, healthy people with HIV who are daily – albeit unconsciously – transmitting the message that an HIV diagnosis is no calamity. Having been a beneficiary of the solution to HIV, I am now unwittingly part of the problem.
THINKING POSITIVELY: Some structural changes would help, I think. Encouraging monogamous or more stable relationships through marriage rights would clearly have an effect, but probably only with time and in the next generation or two. (This is something, of course, that conservatives who say they want to reduce HIV infection admantly oppose.) Going around exposing people’s private failings and trying to stigmatize people with HIV may satisfy a few puritans on the right and left but I doubt it would make much difference as a whole. It also merely encourages gay men never to talk publicly about these issues for fear of being subjected to gross violations of privacy. (Tell me about it.) And then we have the simple and unavoidable fact that we are asking people to be extremely careful in a sphere of life where fantasy and passion rule. This isn’t just a gay issue. It’s a human issue. We have almost universal access to contraception, for example, and still sky-high numbers of unwanted pregnancies and abortions. Sex is messy and dangerous. But it’s also one the greatest and most exhilarating gifts our nature has given us – and free societies respect the freedom to explore it. Resolving that paradox is an impossibility as social policy, and always has been. But ameliorating it must be within our reach. So how? I wish I knew. Or do we have to get used to a certain level of HIV-infection the way we have become used to herpes, and every other sexual disease which has affected mankind, gay and straight, for millennia?
The Dish 