This article appeared in the Toronto Star on July 13, 1996.
by Lynda Hurst
Any gay man can describe the scenario.
You're young and in love, or just in lust, and there's this amazing person you've met who's telling you he really likes you, that he's not infected, and that he'll, you know, lose his erection if he has to wear a condom.
He's young too, so you figure the odds are slim he's been infected with HIV. AIDS is an old man's disease that got the gays who were making whoopee in the early 80s, right? Nobody your age, at least nobody you know, has died from it and just this once, or maybe it's the second time, can't hurt. Not you, you're young. So you have another drink, and let go...
Sexual arousal coupled with he invincibility of youth.
A potent combination whenever they meet, and they meet, whether society likes it or not, all the time - even among those who risk death from the encounter.
By now, after eight years of widespread, multi-million-dollar public education aimed at halting the spread of sexually transmitted AIDS, unprotected-sex-equals-unsafe-sex was supposed to be a mantra, particularly in the gay community. But it isn't.
Condoms aren't often welcome in the sexual Russian roulette of the bathhouses or back rooms of gay bars, not always feasible in the first throes of what may or may not become a serious love affair.
Men who have sex with men account for four out of five of the estimated 16,000 AIDS deaths in Canada since 1982. If anybody has a stake in changing the manner, if not the orientation, of their sexual activities, it is young homosexuals who practice anal sex.
Yet something seems to be blocking the message.
At the international AIDS conference in Vancouver this week, a leading Dutch researcher stated bluntly that a new "generation of gay men is being destroyed by HIV."
Studies from around the world show that the age of HIV infection is dropping. In Canada, it's down to an average of 23 from an average of 32 in the early '80s. While AIDS cases have leveled off, there are still 2,500 to 3,000 new HIV cases annually, meaning that another wave of AIDS deaths is looming on the horizon unless a still-elusive cure is found.
The conference heard that a recent Vancouver study of 256 gay males aged 18 to 30 found that one in four had had anal sex - the most high-risk of all sexual practices - with a casual partner without using a condom. A San Francisco survey of 425 men found that 32 per cent had had unprotected anal sex. Of greater concern was the fact that while only 18 per cent of men over 30 had had unsafe sex, 43 per cent of the men under 30 had done so.
The findings may dismay public health workers, make the straight world shake its head in bewilderment, but they don't surprise John Russell, a training officer at the AIDS Committee of Toronto.
He takes a deep sigh and says he's aware "this kind of high-risk behavior make people crazy. Young gays know what can happen if they don't use a condom, so how does it happen that they don't?"
Well, there is knowing, and there is believing. Ask a smoker who's still puffing under the weight of overwhelming evidence that cigarettes cause terminal lung cancer. Ask a pregnant teenager who thought she'd be okay just that one time.
"Sex is a powerful force and young people think that what could happen to them 10 years from now isn't real," says Russell. "It's not like, there's the 401 at rush hour and you don't cross it because you can see what will happen to you right away."
Dr. Miles Cohen, a Toronto psychiatrist with a large homosexual practice, says the younger men he sees genuinely feel AIDS is an older man's disease. "A wave of complacency after all the vigilance may be happening," he speculates, "because a lot of young gays think if they stick with their own age group they'll be okay. They think their generation is safe."
It's a dangerous illusion. Infection isn't a question of who you're having sex with (let alone his age) but what kind of sex you're having.
Today, health administrators and the gay community emphatically make that distinction; it's not certain types of people who spread AIDS, it's certain types of sexual behavior. But they resisted that emphasis in the past, says Toronto psychiatrist Dr. Irvin Wolkoff, and what should have been explicit to any male growing up gay or bisexual in the '90s has, it appears, been left dangerously unclear.
Wolkoff, who helped pioneer anonymous HIV testing, was a member of the Toronto doctors' directorate in 1988 when the first education programs were being mapped out. It frustrated him then, and infuriates him now, that the key prevention message was shut down from the start.
"No one had the honesty to say to people whose behavior was high-risk, there is no safe sex, just safer sex. No one would say, 'Don't let anyone ejaculate into your body, particularly your rectum,' because that is where the highest risk for trauma and blood-fluid interface is, and HIV cells can pole vault in. We might have saved some lives and a lot of grief if this had been said."
But it wasn't, and not just because people were squeamish at that degree of explicitness or because of blinkered concern for gay sensitivities, though both played a part, Wolkoff says. Mainly, zeroing in on high-risk behavior was never on because of the not-unreasonable fear that "if you targeted gays for prevention you would, literally, target them. Some lunatics on the right would do them harm."
Thus, he argues that political concerns took over from practical concerns as health administrators tried to quell the over-all AIDS hysteria. That meant, at first, saying that AIDS was low-risk (you didn't get it from toilet seats or shaking hands). And then, suddenly, saying that it was high-risk - everybody, straight or gay, was equally vulnerable, whatever their sexual habits.
"So we ended up with the angelic, 16-year-old blonde girl on the TV ads, saying 'No glove, no love.' Fine, but she wasn't likely to be involved in a high-risk behavior like rectal sex."
Dr. Don Sutherland, acting director of the HIV/AIDS bureau at the Laboratory Centre for Disease Control in Ottawa, doesn't dispute some of the charges.
"In hindsight, we could have been wiser about prevention in high-risk activities," he says. "But educating the whole population was the goal, not stigmatizing this one group."
Wolkoff, however, is also scornful of some political activists in the gay community, for whom, he says, protecting the rights of gays has been more important than preventing transmission.
"I've hesitated to say this in the past, but it's sad and dangerous that there are some misdirected activists who are more concerned about shaping images for the gay community than in prevention education."
Steve Martindale, coordinator of the Vancouver study of young gays, says the two aren't mutually exclusive. But, more to the point, while there have been "gaps" in the wider public education, they've been closed as much as is possible inside the gay community itself.
"There is explicit, gay-specific material out there, in the bars, in the magazines, at counseling agencies," he says, "and that has been enough for some people to change their behavior."
But he's quick to add that "if you don't live in an urban centre or if you're not 'out,' you are not accessing it." At best, you're only seeing the more generalized, non-gay-specific public campaign.
Even if prevention education was perfect, you still wouldn't entirely eliminate transmission because you're dealing with a complex human psychology, Martindale says. Indeed, his study found that those who had unprotected casual sex were twice as likely to have been sexually abused in the past, to be alcohol and drug abusers, and to be suffering from depression.
All those factors are linked, he says. Lacking self-esteem, many young gays lack the motivation to protect themselves or others, or simply think there's an inevitability to AIDS no matter what they do.
Like other studies in the U.S., Martindale's found that young people who have high-risk sex are usually marginalized. "They're poorer, they've been abused, they're disempowered. They may not even discuss condoms with a sexual partner - they always let the other person decide the perimeters."
Martindale meets with a lot of parents of gay youths, trying to instill in them an awareness that their sons need their love and support, that the self-image they take with them out of adolescence will determine the kind of lives they're going to live.
But, like other activists, he has heard all the standard rationalizations from young gays: "It's an old man's disease," "I can tell who's HIV positive and who's not," "I know people who have anal sex and they're okay."
He likens them to smokers clinging grimly to the fact that they all know of someone who lived to a venerable age despite a chronic cigarette habit. Sure, the attitude defies reason, says Martindale, but he understands it.
"People keep asking, why are young gays doing this? Well, basically, it's because they want to have sex that is natural, and latex isn't natural. But to a lot of people, the whole idea of gay sex is unnatural, so they don't understand why using a condom is what makes it so for gays."
Public education is probably never going to get past fear of gay stereotyping or, conversely, gay promotion, never beyond anything but half-hearted explicitness.
As David Marshall, director of advocacy for Positive Youth Outreach, points out, when he goes out to the public schools, he "can't talk in a way that seems to be promoting same-sex lifestyles or I'm out. At the Catholic schools, I can't say the word condom."
In the '90s, with a new generation of gay men, there is clearly more to promoting safer sex than just preaching condom use. Inside the gay community, activists are trying to fashion an approach that takes into account all the complexities of human nature, especially in the fearless young.
"We're entering into a second era with this disease," says John Russell, "and coming to understand the complex psychology of high-risk behavior. We have to teach young people that discussion is the key."
Specifically, he adds, that means teaching them how to negotiate safer sex with their partners. The sooner, the better.
For more information, contact:
Bonnie Devlin
Vanguard Project Coordinator
608 - 1081 Burrard Street
Vancouver, BC, Canada, V6Z 1Y6
Tel: (604)806-8306
Fax: (604)806-9044