How Does The Normal Heart Beat Today?

Three decades ago, gay men gathered in anger and fear wondering their way through the plague's darkness. Their journey followed a 12-year period of unbridled sexual expression, from the Stonewall Riot June 28, 1969 to the June 5, 1981 announcement by the Centers for Disease Control and Prevention of an immune disorder affecting gay men that eventually became known as AIDS.

Even if the men who gathered in the 1980s wanted to prevent what was happening they had no idea where to begin. Edmund White shared in our Violet Quill interview: "The truth is that gay liberation was sexual liberation. We were told in Larry Kramer’s living room in 1981 by Dr. [Alvin] Friedman-Kien that until they knew more about the AIDS epidemic we should just stop having sex. We all looked around at each other, the 100 or so guys there, as though he was mad."

HIV infection is preventable today. HIV-positive and HIV-negative men can have whatever kind of sex life they choose — from online hookups to marriage in states that allow it. Positive and negative men can safely have sex with each other. There is no reason not to have a fun sex life if you're a gay men of any age or HIV status.

There is every reason to get tested, and, if infected, to get into care. If you're infected, there is every reason to stay in care. Treatment works and prevents infection.

Given all the good news, should HIV infection rates for gay men provoke a collective heart attack?

"We're working as hard as we can and still it's not enough to control the virus," says University of Pittsburgh researcher Ronald Stall, Ph.D., M.P.H. He is director of the university's Center for LGBT Health Research.

Stall's research indicates that the rate of HIV infection among U.S. men who have sex with men is 2.4 percent.

"That's high," Stall warns. That means if nothing changes 40 percent of gay men by the age of 40 will be infected. If the current trend continues, Stall's data shows that 50 percent of African-American men who turned 18 in 2009, and who have sex with men, will be HIV-positive by age 35.

In 2011, the CDC says men who have sex with men as a percentage of new cases increased from 63 percent to 65 percent.

Speak For Yourself
Mark King, founder of My Fabulous Disease, recently produced Negative, a short video of younger HIV-negative men speaking about how they organize their thoughts around HIV. The HIV-negative men speak only for themselves.

"They are not a scientific sample," King explains. However, they do represent "a community filled with fear, confusion, and a real skepticism about what to believe and what their boundaries should be."

Some of King's subjects also represent a growing disparity.

Today's infection rates among younger gay and bi men are alarming, King notes.

"For young black gay men, this is catastrophic because they are less likely to have regular access to care and treatment," he says. Less access to care is one factor in what Stall calls "syndemics," which means two or more diseases added on to other negative factors that all gang up on individuals and communities to make everything worse.

When limited access to health care combines with poverty, joblessness, violence, substance abuse, limited information on HIV and STD transmission, and homophobia, the affected populations are overwhelmed — regardless of skin color. The combined negative results reflect a social justice issue in the broadest sense.

Overwhelming syndemic factors create little chance for men to access information about HIV.

"The fact that someone might be wrong about their HIV risk isn't as important to me as allowing them to express their perspectives," King says. "If we don't allow them that opportunity without judging them, why should they listen to what an HIV prevention person has to say? Respect them enough to shut up and listen, and then you might get somewhere."

Stigma based on misinformation or lack of information also plays a role in fueling HIV infection. Big, bad communities aren't the only stigmatizers. Gay men now actively stigmatize each other by advertising themselves as "clean, discreet, DDF" (drug and disease free). Such selfie ad text is surprising since most new HIV infections occur within primary sexual relationships, not hook ups (although that occurs). That means one or both partners in a primary relationship (including everything from your husband to your fuck buddy, this week’s boyfriend, or rebound guy) do not know their HIV status. So much for that theory of HIV prevention. If orange is the new black, is uninformed and untested the new gay when it comes to HIV?

Looking back to the first Gay Men's Health Summit in Boulder, Colorado, in 1999, our goal of not allowing HIV to be the defining measure of gay men's health seems like a lost battle. With such currently high infection rates among younger gay and bi men, HIV is the defining health issue our time.

Following the first of several national summits, I and other volunteers participated in multiple city events where gay and bi men grappled with aspects of their lives that if dealt with honestly could perhaps reduce HIV infection rates. We focused on addressing our assets rather than only our liabilities. Historically, homosexuality has been characterized as one of three things, none good: an illness, a crime, or a sin. We were, and still are by many, viewed only through the cruel prism of pathology. Our goal then, and now, is to address these barriers. Being gay isn't a problem unless you suppress it with institutional and familial homophobia and ignorance. HIV is a virus that can be prevented. Nevertheless, when homophobia combines with lack of HIV testing caused by limited access to health care, we create the syndemic situation to which Stall refers. We end up with high rates of HIV infection in communities already challenged on economic and other quality of life factors.      

Fact is that HIV-positive men can have as much sex as they want. HIV-negative men can have as much sex as they want. They can even have sex with each other. Our responsibility involves making time to learn how not to get infected with HIV and other STDs and how not to infect others. Positive men not in treatment and negative men like those in King's video can only learn how to protect themselves and others if their communities embrace them as valuable human beings. Ignoring the multiple factors that affect the lives of so many younger gay and bi men will insure high HIV infection rates.

Will There Be Action? 
It's not about "What don't these kids know?" It's about those of us who have survived (positive or negative) sharing what we've learned about the virus. We also must help our gay brothers out of poverty and despair.

It is about what 30 years of science has taught us: that HIV treatment reduces the risk of transmission.

It is about addressing a social justice issue. Younger gay and bi men of color, data shows, have fewer sex partners and practice safer sex than other populations. The fact that these men live in more concentrated and economically compromised neighborhoods accounts for higher HIV infection rates, especially with all the other hardships encountered.  

Yes, there is hope, but will there be action? Will we mount efforts today to fight the syndemic aspects of growing HIV infection rates among men in compromised communities? Will a play be written in the future about the courageous efforts of those who survived and then linked arms with younger men to bring an end to this epidemic?

"Let's not give up," Stall concludes.