November 30, 2007

Answering HIV's rising gay threat

Posted by: Chris

I posted earlier this week about a convincing trove of data showing that HIV is again spreading in larger numbers among gay and bisexual men, in the U.S. and abroad. The question remains what we -- the government, HIV/AIDS group and we gay and bi men -- are going to do about it.

Since tomorrow is World AIDS Day, there's no better time to make a few informed suggestions.

One thing is clear: The old ideas of the past, simply handing out condoms and such, are no longer working. It’s time for new ideas and new energy. If anything, the data on rising HIV infections is an indictment of the way most agencies have tackled prevention among gay and bisexual men.

For one thing, it’s long past time to trust gay and bisexual men with real information about the risk of exposure associated with particular sexual behavior. It’s criminal that more than a quarter-century into this epidemic, public health officials still keep secret the data they have on the relative risk associated with giving or receiving oral and anal sex, with and without condoms.

Armed with the better information, people will act more responsibly than they are today under the "use a condom every time" reminder. That's not to say that condoms should be abandoned. Agencies should rediscover effective marketing techniques to remind gay and bi men where they meet -- bars, clubs and online chat rooms -- to wrap it up. The TV ad I posted about a couple of days ago, produced by the government of Brazil, is an example of the kind of frankness that gets noticed.

But it’s not just about condoms. Gay men are already way out ahead of prevention efforts, adopting their own techniques like “sero-sorting” – that is, poz men having sex with only other poz men – to limit if not eliminate their exposure. We need to know what works and what doesn’t.

One thing we know works is getting tested, since men who know they're positive take meds, which makes them less contagious, and are less likely to engage in risky sexual behavior.

The JAMA report also makes one policy argument that is long overdue. The authors called for “legal domestic partnerships as a way to promote stable, longer term [gay male] relationships.” The most effective curb against gay male sexual promiscuity is to encourage committed relationships, and legal recognition is an important way of doing that.

Another is for public and private HIV agencies to help promote the alternative of dating and relationships over promiscuity; not in a preachy way, but by reminding us all how sex with love beats just plain sex any day. The Brazilian TV ad, in which parents counsel their son to take a condom on a date with his boyfriend, is another subtle example of that.

I would go one step further, and develop marketing campaigns that remind us all that good old-fashioned dating, going steady and relationships have a lot to recommend them, especially with rising HIV statistics. Most of the gay men I know who survived the worst of the AIDS slaughter in the 1980s and 90s did so because they were in relationships. There's nothing wrong -- and a lot right even beyond the safe sex context -- to remembering that lesson.

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Tags: HIV AIDS, safe sex, World AIDS Day