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HIV Rates May Soar in the Future

In a disturbing article in, researchers at the University of Pittsburgh are expecting HIV rates to skyrocket in North America and Europe in the future.

The report projects that while only 1 in 12 gay men were infected in their 20s, 1 in 4 of this generation will be HIV+ when they turn 30 and 58% of these same gay men will be HIV+ at 60! The projected stats for people of color are even more grim. On the whole, HIV rates have been rising at about 2% per year since 2001.

While projections like this tend to be on the high side, it is still cause for serious concern. This study is like a tornado watch--the tornado may not happen, but the conditions are right for it to happen, so watch out.

In 2006, twenty-five years after the AIDS epidemic first made its appearance, I still hear things like: "Can you get it from kissing?" or "Can you get it because some cum got on my chest?" or "you look healthy so you don't have to use a condom with me." After hearing comments like these, I have to conclude that a major part of the problem is widespread mis-education.

It is often said that "this isn't the '70s" and so we have to just accept that the sexual landscape has changed. We can no longer have "carefree" sex anymore, some say. Use a condom everytime, HIV prevention specialists say. And they are right--indeed, the sexual landscape has changed and if you are going to have anal sex, USE A CONDOM.

But what HIV prevention specialists also have to take seriously is that this is also not the late '80s and early '90s. Since 1996, anti-retroviral drugs have significantly prolonged the lives of people who are HIV+. Furthermore, the antibody tests have become far more sensitive and now, with the fourth generation antibody tests you can actually know whether or not you are positive only six weeks after a risky encounter! The CDC still recommends three months, but in the state of Massachusetts, six weeks is considered definitive.

With the window period for testing getting smaller, the antiretroviral drugs getting more effective and side-effects becoming more manageable, we may be seeing more incidents of unprotected sex because people are becoming more relaxed and experimenting with new ways to keep themselves safer--e.g. serosorting. People are using "trial and error" to negotiate the changing effects of HIV. But unfortunately, with a lot of "trial" comes a lot of "error" and the rate of new infections continue to rise. That means that there does need to be some leadership and guidance from prevention specialists.

Unfortunately, many of our prevention specialists are still acting as though this is 1988 or 1992 when they need to be ahead of the population at large and creating prevention strategies that take into account the new HIV landscape. "Use a condom every time" is no longer an effective message. The same idea needs to be expressed differently and with some understandings of the complexities of people's lives.

Some say that in the old days (late '80s, early 90s) the fear of getting sick and dying was what kept people in line. So, the logic goes, if we want to stop the spread of HIV, we have to recreate that fearful environment. As a result, some prevention specialists are intensifying the use of fear-mongering and scapegoating to deal with the problem. A recent prevention ad aimed at the black community with the picture of a black man in the crosshairs asking, "HIV: Have you been hit?" is a great example of what's wrong with some HIV prevention strategies. Many critics commented on the ad's most egregious and blatant outrage--racism (as if blacks can only understand the language of violence and guns). The other problem with the ad is the very insinuation that HIV positive people are like snipers! It only reinforces the stigma associated with HIV and encourages people to do the very opposite of what the ad suggested--that is, get tested. Who wants to find out they're a potential sniper?

Fear and scapegoating do not promote testing or safer sex; they produce guilt and shame--which lead to lies and infection. Instead of resorting to fear tactics we need to take on the issue of HIV prevention holistically and address the various social, economic and psychological dynamics that are at the root of the epidemic. That may mean that we reevaluate things like social priorities (what government money gets allocated where), the political and financial priorities of the LGBT movement, etc.

First, it is clear to me that even twenty-five years after AIDS first hit, many, many people simply do not understand how the virus works. Everyone needs to understand that HIV usually means a significant reduction in quality of life--even with anti-retrovirals. Thanks to the pharmaceutical industry's advertising campaigns, the imagery of people who are on HIV-meds is skewed and unrealistic.

Also critical is that people know how HIV is transmitted without obfuscation and fear-mongering. The fact that people are paranoid of infection because they gave someone a blowjob is indicative of widespread mis-education. Sometimes transmission statistics are unclear, but we need to be as clear as possible and allow people to make informed choices.

Second, and most importantly, many prevention campaigns assume that people care enough about themselves to actually take steps to protect themselves. Most of the campaigns say, "Use a condom" and the subtext (and sometimes even the overt message) is if you don't use a condom you're stupid or evil. That's the wrong message. People make mistakes sometimes. Others get to a point in their lives in which they no longer want to live because they feel that their lives have no value--so why would they take steps to keep themselves safe? Some desire so much to fit in or to be loved and accepted that they put the desires of others over their own safety. As someone who works with HIV-positive people, I have heard all of these scenarios multiple times. To say "put on a condom" or "practice safer sex" to people who are hurt and alienated is putting the cart before the horse.

Is it really that inconceivable that people don't take steps to protect their own life if they believe that their life has no value, or they believe that their life isn't going anywhere? I have never seen an HIV prevention ad that says things like: You're special. Your life does have value. You are loved. You're not a slut, you're a good person.

Until we decide that we are ready to treat HIV as something that involves social, psychological and political dynamics, the spectre of rising infections will continue to haunt us.


Laurel said...

Good post. I haven't read the Advocate article yet, but I agree with you that the message needs to keep up with the times, and a postive, affirming standpoint would be a welcome change. I've been aware of HIV/AIDS from the outset, and I've noticed two things. First, it is often forgotten that new people enter into the pool of sexual beings each and every day. So, some pamphlet dropped in a school library 5 years ago won't be in the right place at the right time for today's newbie. Education has to be comprehensive and ongoing. Second, the non-gay population is still hugely ignorant of the potential consequences of their own behaviours. The message needs to get out there that the disease, unlike certain people, doesn't discriminate.

Gerry Scoppettuolo said...

Brian: I think the old days of fear mongering are really over, and have been over for a few years. As much as I disagree with much of how state-funded programs are rolled out, truth is the CDC will only underwrite programs that have scientifically shown to be effective. Some of these, like the MPOwerment Project for young gay men and Popular Opinion Leader, are actually exciting and driven by the consciousness of those effected.

On the other hand, the CDC and the Massachusetts Department of Public Health, especially in its HIV counseling and testing programs, often demonstrate how the needs of communities at risk are irreconcilable with the "state" in the formal sense (after Lenin, "State and Revolution").

In the region where I work (Cambridge, Somerville, Malden, Medford, Everett, Revere etc) there is not dime one being spent on HIV prevention efforts for people of color, regardless of transmission factor.According to MDPH no agency in that area applied for programs deemed worthy of funding in 2003. Hence, no programs.When programs of this type are proposed by funded agencies, they are disallowed because they were not originally sought and "not in the contract" or contracts are defined so narrowly, that excellent programs are squashed before they can see the light of day. But this is the history of funding for HIV in the U.S..

First, the government did nothing for years. Next, affected communities, desperate when people started dying like flies, took actions of their own, creating their own programs.Finally, in 1995, the CDC started funding communities through state public health departments, targeting funds to agencies representing affected communities. No agency, no funding.

The "state" represents the interests of the rich and has only conceded any HIV funding after years of consistant and uncompromising political organizing and fighting back by people ith HIV and their allies.This is the only thing that works in the current environment. What is needed is the organized activity of people like you and me, in concert with HIV positive people, is action.

Gerry Scoppettuolo,

Brian Rainey said...

Hi Gerry:

I agree that outright fearmongering is unpopular, but I do believe that it does still exist (hence the Philly poster with "HIV: Have you been hit?"). Some people really want to revive fear to deal with what could be a serious problem in the next decade--rising HIV-infections.

If it isn't outright fearmongering, it is often preachy, moralistic rhetoric with lists of "thou shalt nots" and "thou should nots." There is little discussion about social realities of people's lives (as you noted when you said the CDC rarely funds outreach for POCs).

One thing that disturbs me, that I did not mention in the post, is the suppression of sexuality in the LGBT community. As marriage defines LGBT politics and community, it encourages suppression of alternative forms of sexuality which are embarrassments to the powers that be in the LGBT community.

There is an expectation of monogamy in marriage, but as is often the case, there is not monogamy in marriage (people have always had affairs--yes, even in the '50s). Promoting the fiction and false image of marriage, which our LGBT leaders seem determined to do, could lead to lies and dishonesty.

Global AIDS is spread in the context of heterosexual sex--emulating heterosexual marriage is certainly no answer to the HIV crisis. In fact, it may make it worse. Being honest about people's REAL sex lives is a far better solution.

Anonymous said...

Hmmmm...makes one wonder what the attraction is to being "gay", doesn't it?

And I thought that this wasn't a problem among homosexuals? You know, it is the BEHAVIOR that is to blame, and not society.

But seriously, I hope that the problem goes people turn from homosexuality to do what's right.

Brian Rainey said...

Anonymous, not only are you a cowardly, ignorant piece of shit, your reading comprehension skills are below kindergarten levels (no offense to kindergarteners).

I addressed this point in the last post. HIV rates are rising on the whole, not just among gay men. The highest incidences of new infections are among largely STRAIGHT women of color. Globally, AIDS affects heterosexuals more than gays.

It's people like you who continue to poison minds with ignorance and stupidity that contribute to the problem.

Anonymous said...

Your intro shows your hatred.

It IS a problem in the homosexual community, and a BIG one. There is hope...there is help...there is another way to live your life.

alex said...

anonymous, your ignorance shows your hatred.

yes, it is a problem in the queer community, but it's also a huge problem in every other community. as brian pointed out, the highest incidence of newest infections are among straight women of color. half of all people infected with HIV are women. everyone is at risk. while this is an issue that the queer community faces, to see it only as a queer issue is harmful to both the queer community and to straight people who think they aren't at risk.

you also assume that a disease is linked to our sexual orientations rather than our sexual behavior (which very clearly gestures back to the days of GRID, Gay Related Immune Deficiency, which conflated the two). it doesn't matter who you're attracted to. if you're engaging in risky behaviors, e.g. sharing needles, having sex without condoms or lube, having multiple partners without getting tested, etc. you may be at risk for contracting HIV regardless of your sexual orientation.

to ignore this hurts queers and straights alike. so, anonymous, i recommend you stop hurting us all and actually take a look at what HIV/AIDS has done in our world.

Anonymous said...

I'm not at risk from sex, or needles, or multiple partners.

Why is that? It all comes down to choices, except in the rare case where someone gets HIV through transfusion or through the birth canal, or some other way.

Why call me ignorant? Does that mean that it is no longer a large problem in the gay community? Maybe homosexuals need to take a look at their risky behavior and it's association with the spread of AIDS/HIV. Stop telling me that it isn't a large problem in the homosexual community, because it is. And stop running from the truth with your spread of hatred for that truth, it makes you look like you really don't care about the problem, you only care about your agenda.

Gerry Scoppettuolo said...

Hi Brian: yes, preachy sexulaity should be avoided at all costs. We strive for this in HIV prevention with risk reduction messages that never judge, even if we hear things that are really hard to hear from brothers like: "I'm HIV positive and I don't care if I infect the other guy, it's his responsibility to be safe".

This continued fight over marriage equality, "approved sex", shaming of sex etc., is something I can best understand with a Marxist analysis: compulsory heterosexuality, the traditional family structure, etc are outmoded concepts that have outlived whatever usefulness they may have had in previous times. Sexuality, the family, legal systems etc change over time and correspond to the material conditions prevailing in a given period and the ascendancy of whatever ruling class is then oppressing the people.

The traditional family, and compulsive heterosexuality are outmoded forms, but not outmoded, however, for the rich who must have the traditional family and its rules of legal inheritance to assure the proper transfer of wealth from one generation of the rich to their inheritors. Imagine what might happen upon the death of Bill Gates, Warren Buffett etc if there was not a way for them to pass on their wealth. What would happen to this wealth, which has been stolen off the sweat of dawn-to-dusk microporcessor factory workers in Indonesia or in Wall Street speculation and stock ownership? Maybe we, the workers and oppressed, might demand that it be given back to us!

It is not for merely "moral" reasons that Lou Dobson and the Family Research Council and their corporate backers are engaged in fighting the LGBT community, this is merely the outer dressing that conceals the really violent struggle at work, the struggle for who shall control society, the handful of the rich or the great masses of workers and the oppressed.

Sometimes the viciousness of this struggle takes a blatant form, like the crucifixtion of s Matthew Shepard, or the bashing of a drag queen or a transperson on the streets of Boston. Genderqueer rebellion against traditional gender roles is a direct challenge to traditional family heterosexuality and the economic systems for which it was created centuries ago.

But we as queers, gendervariant and more freely sexual, cannot overcome the powers arrayed against us without an analysis of the oppression and the commitment to unite with the rest of the oppressed in a mighty struggle to overthrow the rule of the Dobsons, the Bushes, Wall Street and the Pentagonthat is killing us and our brothers and sisters here, in Palestine and Lebanon ans in so many other places where cluster bombs fall and workers struggle to survive on below-poverty wages.

One opportunity to join this struggle will be happening at 4 pm Tuesday the 29th at Dudley Commons in the one year anniversary of the Katrina Disaster. This rally is being called by the extremely gay-friendly Rosa Parks Coalition - There will be queer speakers joining in with all the other speakers.

Gerry Scoppettuolo

Anonymous said...

Yeah, homosexuals are so poor! Damn the Bush administration and all of his supporters on the far right!

Wes said...

There's just one thing about your post that bothers me and I'm hoping that I just misunderstood you. You said:
"The fact that people are paranoid of infection because they gave someone a blowjob is indicative of widespread mis-education."

I'm a former health educator and you, in fact can transmit HIV through giving someone a blowjob... I'm concerned that even people who post on these subjects assume they know everything when in fact they are still allowing themselves to be at risk for contracting and spreading HIV. I should also say that I'm a gay guy who is very concerned about his fellow 20-somethings who continue to give out head like pez and expect no consequences for engaging in such risky behavior.

Mark D. Snyder said...

As far as I know there is only 1 documented case of HIV being spread through oral sex.

Oral sex is considered low risk for the spread of HIV (higher risk for herpes, etc.), but yes it is still a risk.

Also I have to ad that I think expecting guys to use condoms while sucking dick is unrealistic.

Brian Rainey said...

Hi wes,

I am aware that there is a theoretical risk from oral sex, but most of the research now indicates that it is a very, very, very low risk for HIV. Several doctors have said the same thing to me. There are high risks for other STDs, however, including the very incurable herpes simplex virus-2. I was talking about paranoia related to HIV-infection.