Thirty years after the Centers for Disease Control and Prevention warned about AIDS, a 21-city survey finds one in five men having sex with men (MSM) is HIV positive. Even more sobering, 44 percent of those men are unaware of their infection. And of that group, young men of color are the least likely to know their status. Do you know your HIV status? These numbers are cause for concern because they resemble peak numbers from the epidemic’s “first wave” in the late ’80s/early ’90s. Further exacerbating an alarming scenario are 8,100 people on waiting lists for tapped-out state programs providing lifesaving HIV medicines. Although Congress has bumped up funding to alleviate the strain, being on a waiting list isn’t a good treatment plan if you find yourself positive.
Simply put, we’re in trouble here, folks. Reasons for a 20 percent infection rate among young gay/bi men form two clusters: One cites low awareness, underestimated personal risk and the belief that treatment advances minimize HIV’s threat. The other revolves around discrimination, poverty, homophobia, stigma and healthcare access. And though health experts and HIV survivors and activists don’t always agree on why prevention efforts have failed or how to proceed, they do agree that action is desperately needed.
First and foremost, that begins with us, the gay community, rallying together just as we did in the early days of this disease. It’s even one of the top recommendations by the CDC on how to take hold of this rising rate of HIV infections. And the best part is we’ve done this before—successfully! When the epidemic began, gay men created AIDS service organizations that eventually grew to be funded by government grants and foundations. In those dark early days, more than 75,000 MSM were infected each year. Our collective work reduced that number to about 25,000 by the mid-’90s.
Richard Berkowitz thinks we can reduce those numbers again by taking control of HIV-prevention messages. A hustler turned activist, Berkowitz is the co-author of the first-ever safer-sex book, the controversial yet pioneering How To Have Sex In An Epidemic. He is adamant that gay men must take control of prevention for themselves, he says, because publicly funded HIV-prevention efforts will be too vanilla for political reasons.
“I really believe we’ve lost our way and then blame those who get infected,” Berkowitz says of the re-emerging crisis we are finding ourselves in. “[Publicly funded prevention messages] have not and never will talk about anal sex in the ways men can and should talk to each other.”
Berkowitz’s notions formed the premise of his 2009 documentary, Sex Positive, which takes a riveting look back at our history, beginning with the Stonewall riots through 1981, and what our gay male sexapalooza during those years may have meant. “We haven’t taken time to look at our collective past as gay men and see where we’ve maybe gone wrong with HIV prevention. We’ve missed the boat, as have government programs. Promiscuity wasn’t then and isn’t now black-and-white,” he adds. “It’s time for a new framework.”
What exactly does that framework look like? For starters, says Dr. Joseph Sonnabend, an HIV expert who’s been working on the disease since its earliest days, that means talking openly and honestly about sex. Doing prevention “right,” he adds, means health organizations embracing gay sex as legitimate.
Doing prevention right also means the sexuality of men must be celebrated and not viewed as an obstacle that has to be worked around in a politically correct way. Francisco Roque of Gay Men’s Health Crisis notes that men who have sex with men are the only demographic rising in infection rate because we “fail to celebrate men having sex with one another.”
GMHC has been trying to break down those social barriers by bringing the conversation surrounding “gay,” particularly within ethnic minority communities, into everyday life. Roque cites GMHC’s viral and subway campaigns “I Love My Boo” and “My Son Is My Life” as additional ways the gay community has begun to reclaim the conversation. “Boo” shows two guys who care enough about each other to practice safe sex, while “Son” is a message from a father that his gay son matters.
But institutional change is sorely needed, too. African-American and many other churches still play the “shame” game on homosexuality and HIV, and many experts agree that it is critical that dialogues begin within these groups. “We need to be more vocal when told ‘no’ by schools, doctors and religious communities when we want to openly and honestly discuss same-sex relationships,” says Bob Moore, a counselor to members of both the LGBT and HIV community. “Our love is as legitimate as any other consensual, affectionate relationship between adults. There are times when we need to demand, not ask, when funding is at stake.”
Organize and demand is what men did in the ’80s to create AIDS service organizations, and Moore, as well as many others, agrees that we must be visible again, this time on prevention issues. So regardless of where you find yourself in terms of HIV status, let this final statistic serve as a wake-up call for us all: Gay and bisexual men make up a small percentage of the U.S. population aged 13 and older, yet we account for more than half of new HIV infections and more than half of the 1 million people living with the disease in the U.S. What more must happen before we once again reach out and raise our voices?