AIDS and Silence: The Stigma Is Killing Us

We have a problem in the gay men’s community. Our silence about the
epidemic slowly eating us away is killing us. As much as this might
sound like it is some ancient diatribe written in the ’80s, sadly it
remains the reality today.

HIV has not gone away, and, in fact, there is an increase in the
reported cases of men who have sex with men in Michigan. We can blame a
lot of things, but before we look very far, we have to blame ourselves.

Yes, the Bush administration’s fixation on abstinence-only education
has hurt us. Gay sex has not been figured into that formula, so our
lives were ignored. That does not mean we did not have a responsibility
to teach each other how to be safe.

In the early ’90s when I came out, you could not go to a gay-related
event or bar without finding a big bowl full of free condoms. I have
been to dozens of queer events, including Creating Change, in the last
year, and the free condoms seem to be gone. If we aren’t putting them
out there at our events, we are pretending that the epidemic is gone.

Barebacking or raw sex — sex without condoms — is real. It is
happening. Maybe it’s a backlash against the condom messaging that was
hammered home in the ’90s. Maybe it’s because barebacking feels good.
Maybe its because people are getting tweaked out on meth and screwing
their brains out. But until we talk about it, it will continue. I am
not saying barebacking has to end. I am saying we need to give people
the tools to talk about engaging in it in a safer manner. And that
means conceding it is real.

It also means being real about our options. Abstinence is the only
100-percent sure-fire way to make sure you don’t get infected. But it’s
also an irrational expectation to place on a community that is told on
one hand that it should abstain and on the other that its relationships
don’t matter so don’t ask the state to recognize you. Sometimes,
consciously or not, the gay community replaces intimacy with sex. All
kinds of people replace intimacy with sex. It’s part of human nature.

Condoms are certainly an effective option, but realistically, they
are not being used regularly or consistently. That’s why we are seeing
increased rates of HIV and other STIs in the gay men’s community.

There are other options. Post-Exposure Prophylaxis or PEP; and
Pre-Exposure Prophylaxis, or PrEP; work. PEP is the long-held secret of
the medical community and is used when a health care worker is exposed
to HIV. Promptly the person is put on a course of anti-HIV medications.
The course is 30 days. It has also been shown to prevent infection if
taken within 72 hours of exposure through sex. PrEP is used as a
long-term option by some and requires the use of anti-retrovirals
before and after exposures. It has been shown effective in studies.

But we don’t talk about PEP and PrEP as real options for HIV
prevention. Why aren’t gay men being given PEP options through HIV
education and prevention outreach efforts? Why aren’t doctors with
HIV-positive patients discussing with those patient’s partners the PrEP
option? Do most doctors even know about these options? Do HIV educators?

And finally we have to get real about how HIV is impacting all of
us, infected and uninfected. Rejecting a guy merely because he is HIV
positive sends the message that he should not disclose his status
again. Not getting tested and trusting your partner to be honest with
you is not safe, it’s reckless. And choosing partners who claim to be
HIV negative but can not name the date time and place they were last
tested is not reducing your risk, it’s burying your head in the sand.
Our ignorance is killing us and we are aiding it by pretending we are
not ignorant.

If you have not been tested for HIV, you are hurting the community.
If you are not talking about HIV with your partner, you are hurting the
community. If you are gossiping about someone and labeling them as HIV
positive to ostracize them, you are making HIV a bigger, nastier
monster than it already is. If you are rejecting some one who is HIV
positive, you are damaging yourself.

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  • invalid-0

    “Why aren’t doctors with HIV-positive patients discussing with those patient’s partners the PrEP option?”

    Well there is one very simple answer to this question. PrEP has not yet been proven to be effective at preventing HIV transmission in humans. Only one study has been completed so far in humans and that was to test safety not eficacy. Of the 936 women who participated in the study six women who were taking the placebo contracted HIV against two taking Tenofovir. The study authors clearly stated that these findings could not prove that PrEP worked at preventing HIV transmission.

    You are right though that we should be discussing PrEP now. Not on an individual level but in terms of policy and advocacy if it is proven to be effective at preventing transmission. If we do not start this conversation now then we will end up in the situation that we have been with PEP for more than a decade, namely health commissioners not wanting to promote it because they fear the cost of it and most importantly the red herring of “it will increase risk behaviours.”

    Inaccurate reporting about the availability of new prevention technologies to prevent HIV transmission is misleading, and ultimately, another danger to our communities.

    May I recommend the AVAC report “Anticipating The Results Of PrEP Trials”