Selfish, ignorant and immoral?

The furor arising from the recent showing of Louise Hogarth’s film, The Gift, at the Out on Screen queer film and video festival shows once again the complexities of HIV prevention.

As a panel member, I was dismayed at our lack of success in trying to convince Dan Savage and his supporters in the audience that there is a huge difference between “barebacking” and “gift-giving/bug-chasing.”

The advance publicity for The Gift suggests that the video is about intentional spread of HIV, but in fact Hogarth confuses two different phenomena. This confusion is not productive for advancing our understanding about what is going on in the gay men’s community, and it demonizes HIV-positive gay men-the vast majority of whom are repelled by the idea that they might transmit the virus to an HIV-negative partner.

Imposing shame and guilt on HIV-positive men, two tools that Dan Savage suggests should form the foundation for HIV prevention, will only serve to further shut down communication between positive and negative guys, and communication is part of what is required for effective prevention.

Shame and guilt are part of the problem, not part of the solution.

Gift-giving and bug-chasing are apparently quite rare phenomena, while barebacking is much more prevalent. Gift-giving and bug-chasing imply the intentional transmission of the virus, which is quite different indeed from accidental transmission. Prevention cannot approach these different problems with a single solution.

Those of us working in HIV prevention are not police, and we are not empowered to force people to act in particular ways. We are not empowered to hunt down psychopaths (as I think gift-givers must be) and to make them change their behaviours.

In Canadian law, however, the police themselves can indeed intervene in cases of intentional exposure to HIV. After the Cuerrier case, there is already precedent in Canadian law for criminal charges against people who intentionally engage in risky behaviours that hold the possibility of exposing others to HIV infection.

In terms of barebacking, we need to establish some definitions about what we are referring to. It’s not accurate to conceptualize barebacking as a single phenomenon. When we say “barebacking,” what exactly are we talking about? Does barebacking refer to any unprotected sex? Are two poz guys who are aware of their status, in a more-or-less committed relationship, and who choose to engage in unprotected sex, barebacking?

What about two negative guys in a relationship with negotiated safety?

Or are we referring to more-or-less organized sex parties, where HIV status of participants is known, or unknown, or assumed? The word “barebacking” needs to be deconstructed, because each of these definitions of barebacking requires a different solution.

Earlier in the epidemic, virtually all prevention work emphasized “use a condom every time.” In fact, research does show that gay men use condoms more often and more consistently than straight people. Dan Savage implied that straight people are more careful than gay men, and that is patently untrue. To that extent, HIV prevention for gay men has been successful. But the epidemic still rumbles along, and in fact, evidence is coming in that there is once again an increase in new infections.

Current discussion in HIV prevention tries to explain this increase in a number of different ways.

Some gay men have ‘condom fatigue,’ are no longer afraid of HIV because it is now viewed as treatable and have become complacent about the epidemic. We fail to protect the youngest and newest members of our community by protecting them from homophobia and providing adequate sex education. Positive gay men are ostracized from the larger gay community, are ashamed of their infection, and find it difficult to communicate with other gay men about HIV. Gay culture values youth, and therefore older gay men fail to protect themselves because the fear of gay old age is greater than the fear of HIV.

Gay culture values health and therefore encourages positive men to deny their HIV status as long as possible. Positive gay men who reveal their status find themselves sexually (and socially) rejected whenever they are honest. Untested people are afraid to be tested and would prefer not to know.

All of these possible explanations-and many others-are likely to be true, and need to be addressed for the development of effective HIV prevention programming.

But prevention programs require funding to figure out where problems exist, to identify the priorities of those problems, and to develop and deliver solutions. To date, our governments have not seen fit to make adequate financial investments in HIV prevention for the gay community. Demonizing gay men, as Dan Savage suggests, plays into the hands of rightwing governments and their supporters, who would prefer to view gay men as selfish, ignorant and immoral, and it provides the perfect environment for governments to avoid supporting the efforts of our community in developing effective responses to the epidemic of HIV.

* When he wrote this, Carl Bognar was prevention coordinator for BC Persons with AIDS Society. He is now project coordinator for the evaluation of Canada’s first supervised injection site, located in the Downtown Eastside.