When rubbers hit the road: HIV infection among gay men is on the rise. This time, it will take more than condoms to stop it

Washington Monthly, Nov, 2001 by Andrew Webb

FIRST THING MOST MORNINGS, WHILE it's still dark, before I swing my legs out of bed to get ready for the gym, I reach for the phone and call one of the many dial-a-boy phone chat services that cater to gay men. On these lines, I leave a message describing myself and what I'm looking for, and then listen to others' messages. If I hear one I like, I can send the originator a private message or initiate an online chat with him. Judging from the number of other men accessible on these lines, there are a lot of gay men who are looking for sex, titillation, or (like me, most times) just the chance to hear another man's voice as a balm to loneliness before getting up.

Most of the men who call say they do it because they're feeling a little randy. But if that were the only reason for calling--given the time or the money involved--it would be smarter to take the Joycelyn Elders approach to lust and avoid the hassles and cost. No, my guess is that despite denials, most of these guys are as lonesome as I am and want not only the eroticism which goes with sex, but the human contact, if only for a few minutes or hours.

Alas, this loneliness sometimes leads me, and I suspect many others, to take risks I know I shouldn't take. By this I mean having unprotected anal intercourse. I'm not proud to admit that the last time I did this was just last month.

My excuse? I don't have one.

For two years, I actually lived with an HIV diagnosis, and then was granted a reprieve: I wasn't HIV positive after all. (The county health department, apparently, had given me someone else's results.) During those two years and the four that followed, when I worked for an HIV study run by the University of California, I gave dozens of talks about HIV's causes and effects, read mountains of literature, talked with experts on HIV, and became extremely knowledgeable.

When I go in for my irregularly timed HIV antibody tests, public health workers tell me multiple sex partners and unprotected anal sex are the surest routes to HIV infection. "It only takes once," they caution. They know I know that. Yet occasionally--only a dozen or so times in over 15 years--I still slip. In retrospect, I see that the public health community's message, focused almost solely on encouraging condom usage, was bound to fail over time, and that my (and others') slipping into unsafe sex practices, however rare, was inevitable.

There have always been gay men who refused to practice safer sex, but between the advent of AIDS and the late 1990s, barebacking--anal sex without a condom--was mostly practiced on the fringes of gay society. Plenty of evidence suggests, however, that over the last few years barebacking has become common, if not de rigueur, among gay men in general.

Certainly, the advent of new drug treatments has contributed to this trend, as has the loneliness that seems inherent in gay life. But those factors don't explain everything. Also driving the increase in barebacking is the peculiarly amoral nature of the dominant gay culture, which springs from a well-articulated ideology that views unfettered sex as the defining feature of gay identity. As a result, heading off the next AIDS epidemic will take a lot more than free condoms and stern lectures from well-meaning health officials.

In June, the Centers for Disease Control and Prevention (CDC) released preliminary data from a seven-year, seven-city study of 15- to 22-year-old gay men that showed an alarmingly high incidence of unprotected anal sex--41 percent of respondents. CDC researchers have also found disturbing increases in the percentage of men under 25 reporting multiple sex partners, and of men having unprotected sex with multiple partners who don't even know whether their partners are infected. Researchers estimate that the increase in unprotected sex among gay men is rising exponentially: 50 percent in the last two years.

The effects are already apparent. The estimated number of new adult-adolescent AIDS cases diagnosed in the United States sharply decreased between 1996 and 1998, thanks to a concerted public health effort. But those gains have almost ground to a halt. The estimated number of new AIDS cases decreased by only one percent between 1998 and 1999.

There's reason to believe that gay men, and not intravenous drug users or other high-risk groups, are driving this change. In 1999, San Francisco researchers reviewed the results from about 9,000 people who had been tested in area clinics. Among the most recent infections, not a single woman who was tested turned up positive, nor did any IV drug users--except those who were gay. Those with new infections were gay men, mostly white, and in their thirties.

Clearly, the fear mongering that was public health officials' primary weapon against HIV infection for most of the 1990s is no longer working. It's no surprise, really. After all, condoms may offer protection against disease, but they hardly protect against the other things that drive us toward risky behavior--like loneliness, a simple human emotion that gay men probably understand better than most, and the one thing that usually prompts my own lapses.