[I originally intended this to be my September column, my third, but the editor became confused (I was several months ahead of schedule at that point) and printed my column on "The Gay Crusaders" first, in September. Oh well.]
Well, this is just my fourth month writing this column, and I've already been vastly influenced and educated by what I've read. I recently finished "The Gay Crusaders" (covered in last month's column, which I actually wrote after this one) and have been making good, if intermittent, progress on Larry Kramer's "Faggots". I plan to cover the latter in next month's column or shortly thereafter.
Sexual Ecology: AIDS and the Destiny of Gay Men, by Gabriel Rotello, 1997
Recently, a prominent gay activist, after returning from the AIDS Conference in Barcelona, had this to say:
"Folks, the younger generation is not getting the word about this plague (and some of the older folks are forgetting, thinking the worst is past). Everybody, get tested. And if you have any friends who think it's safe to play without a condom, yell at 'em, because it's not."
This is a sentiment that I think many of us in the gay community (I'm including myself and other bisexual identified men in this term) share - a collective anguish over the seeming inability of certain members of our community to "get it", and the failure of all efforts to date to contain the epidemic.
After reading Gabriel Rotello's "Sexual Ecology", I had one of those "aha" experiences that accompanies a transformative change in understanding of an issue: young gay and bisexual men are not stupid or deliberately self-destructive, they are simply trapped in the middle of an epidemic that makes even the occasional mildly risky behavior vastly more consequential than it would normally be.
"Sexual Ecology" highlighted the fact that studies showed that, at then current levels, seroconversion rates for today's young gay and bisexual men will result in 50% of them being HIV+ by age 50. Why is this?
The answer is simple: the "condom" code, as he describes it, simply is not effective enough; your average young gay man *knows* about AIDS, and *knows* about condoms - they *have* gotten the word. The problem is that young gay men, like everyone else, are *human*, and occasionally have lapses of judgement (helped by drugs, alcohol, and the heat of the moment) - just like young straight men. Unfortunately, the prevalence of HIV in the gay and bisexual male population makes that lapse ultimately fatal.
Something more has to happen: ever since the mode of transmission was discovered, prevention efforts (to the tune of untold millions of dollars) have been focused on saying "use a condom" -- and it hasn't worked. As Einstein said, "The definition of insanity is doing the same thing over and over again, and expecting a different result."
Many reviews seize upon the weakest parts of Rotello's polemic - his inability to effectively describe what changes need to be made to stem the epidemic, if mere promotion of the use of condoms is inadequate.
It seems to me, however, that (all controversy aside) the core thesis of "Sexual Ecology" demonstrates that what needs to be done, is simply what was already done, to great success, prior to the emergence of the "condom code": reduce the rate of partner change. This doesn't require "monogamy", it merely requires a collective reduction in the number of partners we have - and, consequentially, in the number of times we "slip up" and have unsafe sex. Rotello cites studies showing that the difference between a gradual disappearance of the epidemic, and a massive prevalence, is the difference between one unsafe partner a year, on average, and two unsafe partners. He also demonstrates, conclusively in my opinion, that the real problem isn't among the mass of gay and bisexual men, but among the "core groups" participating in massively multi-partnered sex. Rotello even highlights the core of a solution: focus prevention resources at the most critically affected groups.
The fact is that, as it now stands, if the prevalence rate of AIDS was 2%, it probably would stay there, or even gradually drop, as long as gay men as a whole maintained their current levels of caution. It is only because the prevalance level is so high (especially in "core groups"), that the cost of the occasional slip up is so great, for gay and bisexual men as a whole.
When I saw this comment, it struck me as a classic example of our collective blindness to our own humanity. I'm now thirty, and the epidemic rates of AIDS among my younger brethren horrified and baffled me... but no longer. I was never comfortable with the idea that young people just don't get it, or with the even more strange idea that young people are deliberately infecting themselves in significant numbers for status or for medical care. Reading this book confirmed my instinct was correct. The question remaining after reading it was, "Where do we go from here?"
I'd like your thoughts on this. Write me, at thomasleavitt@hotmail.com