There's one group that is seeing HIV rates accelerating: twentysomething gay men
Three decades ago, the sexual revolution skidded to a halt when the Centers for Disease Control and Prevention first reported a bizarre strain of pneumonia besieging gay men. After having decimated an entire generation, AIDS now threatens another. Today, young gay and bisexual men account (especially men of color) are responsible for the most alarming surges in new HIV diagnoses and represent the only demographic group whose rates of infection have continued to climb each year since antiretroviral drug therapies introduced in the mid-’90s gave patients hope. The highest rate of new HIV infections are occurring among black men 13 to 29 who have sex with men.
Welcome to Generation H, the twentysomething queers who’ve never known a world without AIDS and yet appear reluctant to use condoms.
Sean Strub, a veteran AIDS activist and founder of POZ magazine, doesn’t buy the argument that young gay men “don’t get it” when it comes to HIV. On the contrary, he argues that Generation H is “healthier about their sexuality—especially in self-acceptance—than any previous generation of gay men in recent history. They also are quite sophisticated. Part of the reason they turn off and don’t heed safer-sex messages is because they’ve figured out that many of those messages are overly cautious, not heeded by nearly everyone, and paint a picture of an unlikely outcome.”
Advocates and health workers are scratching their heads and asking, “Who or what is to blame for so many young gay men contracting HIV? Rebellion? Complacency? Arrogance? A desire to self-annihilate?” Maybe it’s because they’ve missed the most effective prevention program of all: funerals. “They don’t realize what we went through, but that’s human nature,” says Mark King, who blogs MyFabulousDisease.net. “If I wasn’t there, I don’t get it and I don’t have time to listen to you because I’m 26 and my friends are waiting for me at the club. And that’s exactly how we behaved. The only thing that made it different for us is that we were living in a horror movie.”
For Michael Tikili, 25, the “unlikely” outcome of an HIV diagnosis became a reality for him almost two years ago. But he sees seroconverting (becoming HIV-positive) as actually having changed his life—and not all bad. “Everyone that doesn’t have it thinks it is the worst thing in the world, but we need to stop looking at it as a death sentence because it’s not,” he says. “You can lead a healthy life with HIV.” The experience of the virus for Tikili and his friends include seeing healthy, humpy guys living with HIV, as well as six-packed models in omnipresent pharmaceutical ads touting the medications that have allowed those infected with the virus to live near-normal lives. You have to read the fine print to understand the nasty side effects of, and eventual resistance to, these wonder drugs. Nor do the ads mention how expensive they are.
James Krellenstein, 20, works at Yale University School of Medicine and founded a website about post-exposure prophylaxis, the “morning-after pill” (actually, a month-long regimen of pills) for people who believe they may have been exposed to HIV. Owing to the success of new therapies, he believes that the problem lies in safer-sex messages “framed in a shame-oriented way coming from the basic premise that you shouldn’t be having sex, and if you do so, be sure to use a condom every time for everything. It’s as if there’s something bad or irresponsible about it. People start to shut down when they hear that sort of judgment.” Critics cite the New York Health Department’s controversial “It’s Never Just HIV” campaign, which shows images like a cancer-inflamed anus. They believe the ads only make people more anxious about getting tested—at a time when nearly two-thirds of queer men 18 to 29 are oblivious of their status (according to a 2010 CDC report).
The natural response for many has been the eroticization of risk-taking. The trend, called barebacking, has become so popular in gay porn that condom-free load-shooting orgies are top sellers. But don’t swallow the media hype that young gay men are bug chasers seeking out partners with whom they might contract the virus. New research indicates that most infections among gay men take place within a relationship. A 2009 study reported that well over three-quarters of under-30-year-olds received the virus from their main sex partners. A hesitancy around or resistance to condom use, then, appears to have more to do with a desire for closer intimacy.
“It is a natural thing to want to have skin-on-skin contact and to share fluids,” says Jim Pickett who works for the AIDS Foundation of Chicago and blogs under LifeLube.org. “We allow this for heterosexuals and throw baby showers for the results of heterosexual ‘barebacking.’ But the idea that all men, all humans, can use condoms consistently and correctly every time they have sex for their entire sexual lives is crazy. It is one option, but you need to provide options to people. We need to reframe all of this so that it makes sense for the lives people are living.”
The one thing all advocates agree on is throwing out federally mandated abstinence-only sex education in public school. As for queer-specific information, forget it. Sean Cahill, who directs public policy and community health at Gay Men’s Health Crisis, believes that “we’re now entering a period where science has replaced ideology among federal policy makers. There is a lot more support and willingness for science-based HIV and more broad sexual-health education.”
Some also argue that the gay rights movement has abandoned AIDS in favor of hot-button issues like serving openly in the military and marriage. When was the last time you heard about a large contingent of young queers taking part in street action about AIDS? “For them to talk about HIV as a gay disease or a disease that predominantly impacts the LGBT community sort of flies against the sort of narrative behind the marriage equality movement,” says activist Kenyon Farrow of the leaders of gay organizations. “They are situating gay people as ‘normal’ and middle-class and white, like they are just like everybody else.” Others, however, counter that existing marriage laws are part of a matrix of societal repressions that, over time, wear away gay men’s self-esteem. For them, equal rights—including marriage equality—are ultimately HIV prevention tools.