Monday, 9 June 2014

PreP, Kramer, marriage and S-E-X

My little corner of the world has been a lively place lately as the debate about how to stop people from getting HIV has heated up. Here are some highlights:

- Pre-exposure prophylaxsis (“PreP”) has become the subject of a somewhat manufactured controversy as the multi-million-dollar AIDS business, the American Healthcare Foundation (AHF), stages a one-CEO operation against the idea that people should take a daily pill to avoid the AIDS-causing virus because it will discourage condom use. This campaign by AHF chief Michael Weinstein (e.g,, the full-page “Why worry?” condom ad in the latest issue of Gay City News) presumes that people need some sort of incentive to drop rubbers from their sex lives. I can confidently attest that this is NOT TRUE.

- Larry Kramer, whose AIDS-era play, The Normal Heart, was just restaged for HBO, sided with Weinstein with a typical nastygram of his own, calling people who use PreP “cowards” in a recent interview. Kramer is beatified frequently as the founder of ACT UP (to which I belong in its current avatar), but his intemperate positions are a double-edged sword: they are frequently ad hominem and polarizing. Polemics can be healthy, but as a lifestyle they’re problematic.

- Same-sex marriage is sweeping the nation. So Kramer’s “normal” hearts are being welcomed into the fold in quite a remarkable way. Gays and lesbians can form marital units and have their sexual lives recognized publicly, and it’s a pretty radical shift for our society.

So why is HIV still an out-of-control epidemic that continues to sweep gay populations nationwide? Why have we resigned ourselves to another 50,000 new infections every year to add to the million-plus Americans already dealing with it? Why can half of all young gay men look forward to acquiring HIV in the course of their lifetimes, especially if they are black or Hispanic?

Kramer and Weinstein would say that it’s because those horny homos just won’t get the message and do what they say, which is faithfully use condoms instead of running around having sex like crazy with every Tom, Dick & Harry. I am being unfair, but this characterization is very much in the spirit of Kramer’s historic critique of gay sexual mores dating from the pre-AIDS era, and it’s portrayed in The Normal Heart itself. Kramer has a puritanical streak a mile wide, and he’s not alone—lots of people are turned off by the more outrĂ© aspects of homo culture and are more comfortable with the idea of couples settling down to a recognizably mainstream existence in stable units. As Ted Olson, the lawyer who engineered Bush’s 2000 Supreme Court coup to snatch the presidency from Gore, says, “Marriage is a conservative institution”—which is why he joined the fight for it.

People who see same-sex couples lining up at the courthouse as the ultimate goal may be forgiven for wondering why anybody would need a preventive tool that anticipates multiple sex partners and ongoing risk. Maybe that’s because not everyone is the same. Or here’s an even more radical thought: maybe homosexual men really aren’t just like their straight counterparts. Who said we have to be?

The burgeoning acceptance of same-sex couples who want to form partnerships that look like traditional marriage does not automatically translate into comfort with the sexual practices that those smiling newlyweds are carrying on, not to mention those occurring outside the matrimonial suite. But those practices are alive and well, and younger guys, who don’t really focus on the risks of HIV, are engaging in them plenty. (Older ones, too.) Condom use was never universal even in the bad old days of pre-treatment AIDS, and risk levels among gay men are found to be pretty consistent in studies done all over modern gay communities around the world.

Peter Staley, another famous face from the AIDS wars of the 1980s, had a much more nuanced and sensible position about the advent of PreP:

The goal is not condoms on dicks. The goal is fewer HIV infections. So how do we get there? What’s the quickest path? What’s the path that takes human nature where it is today? . . . If somebody from my generation, the safe sex generation, can show me the cultural and advocacy path to getting gay men to return to the condom code that was developed in the ’80s, I’m all ears. But none of them have spelled that out. All they do is preach. None of them have a plan, a feasible plan, that leads us back to those norms.

It’s foolish to think that we can program people to resist the impulse for sexual satisfaction, which has proven itself pretty repression-resistant over the biped millenia. We can lament that fact, or we can see what to do about it so that people have a variety of tools with which to keep themselves healthy. Attacking those of us trying to do just that isn’t healthy debate nor does it “raise an important issue,” like New York magazine argued this week approving of Kramer’s outburst. No, it doesn’t. It is not serious. It is not helpful. It is not just. And it won’t work.

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