Two front-line warriors for public health offer balanced assessments of risks facing gay men
By LAWRENCE D. MASS, M.D.
I’m often in South Florida, as the east coast from Miami north through Fort Lauderdale to West Palm Beach is usually described. Ten years ago, this area, even then one of the largest gay communities anywhere, was hands down the fast-lane sex capital of the world, claiming the most numerous and active back rooms in its bars. Not surprisingly, it also claimed the highest rates of syphilis and AIDS. Things got so bad that all the back rooms have since been shut down. For an area as casual about unsafe and safer sex as South Florida, that was quite a turn of events.
Meanwhile, at sex parties, which have grown steadily since the closing of back rooms in the bars, and at the bathhouses in Fort Lauderdale, one of them a beautiful, state-of-the-art spa, another trend was emerging. Barebacking is not new to South Florida or elsewhere, but it’s in Fort Lauderdale that I first became aware of what I myself might have called—before reading Michael Shernoff’s “Without Condoms”––barebacking with a vengeance. On any given night at the baths, you’re hard put to find anyone with bedside condoms. And if you bring your own, you are likely to be rebuffed. Even if you find a willing partner, you better have brought your own, because unlike the leading bathhouses in New York City, the Fort Lauderdale baths don’t provide them with your towel, or otherwise promote them. You have to ask for them. For what may be a minority but a sizable one, barebacking has become the norm and if you don’t like it, you can go shove it elsewhere.
Remember when Michelangelo Signorile, Gabriel Rotello, and others were warning about just this development—the spread of barebacking––and Sex Panic targeted them as alarmists? Well, nearly a decade later, where do we stand? Have the prophesies of Rotello’s “Sexual Ecology” turned out to be true? The answer is a simple and unqualified yes and no, as the scene in Fort Lauderdale and two new books, Shernoff’s on barebacking and Duncan Osborne’s “Suicide Tuesday, “ about crystal meth use, demonstrate.
While there continues to be ever-greater diversity, strides, and progress in our community’s approach to safer-sex and health care generally, there is at the same time no question that there are resurgences of unsafe sex and rates of AIDS and other STD transmission among gay men.
What are we to do? Real answers to these questions are to be found in “Suicide Tuesday,” Osborne’s review of what I’m going to call the crystal crisis, though his book is at pains to demonstrate the degree to which this “crisis” has been exaggerated and has invited panic. The other book, Shernoff’s “Without Condoms,” goes further than any other resource to date in demystifying the various phenomena we call “barebacking” and suggesting sober harm reduction approaches to dealing with it (harm reduction being another term for preventive medicine—drug and safer sex education, condom use, needle exchange, therapy, and treatment).
These books will fill the reader with good old-fashioned gay pride that we still have such mindfulness, soul, and commitment to service in our ranks, notwithstanding the ravages of AIDS, the assaults on all aspects of our integrity, rights, and needs from the far right, and the minimizings and denials within our community, from the darkest ages of our internalized homophobia. To this jumble of progress and obstacles comes the newer challenge of our now being officially “post-gay,” implying that to be gay-focused is to be retro.
What both books achieve, impressively, is a sober assessment of the current dangers, pointing up the panic and hysteria around them, and placing them in cool, harm-reduction perspective. Osborne, for example, calmly compares the use of crystal with that of other drugs, demonstrating that it is only one of many drugs of use, abuse, and dependence, not necessarily worse or more concerning than the others, while Shernoff discusses the complexities of serostatus and emerging compromises such as negotiated safety. Both authors discuss barebacking, drug use, and safer sex at length, concluding that there are no easy answers and that solutions must be individualized, respectful, and painstaking.
I must confess that these books changed my own thinking from sometimes grave concern about the state of our community vis a vis unsafe sex and a range of diseases, to ongoing grave concern but with much greater confidence that we are not as bad as people, including ourselves, too often tell us we are. I was also affirmed in my hope that we can continue the work of harm reduction to achieve a great deal. What front-line warriors Shernoff and Osborne are showing us is that meeting these newest challenges of crystal use and barebacking needn’t be as daunting as fear, bias, and panic would have us believe.
At its best, being post-gay means we’re not singled out as “gay,” and treated differently, which is often a good place to be. In the world of harm reduction, this means that we are increasingly regarded by sympathetic health care observers and practitioners as suitable for more generic efforts at contact tracing of those diagnosed with HIV. Although our city health commissioner and his department of health are being closely monitored by Gay City News, as they should be, there is no question but that pubic health workers will move ahead with these efforts, which have been largely articulated as voluntary for our community.
Dr. Thomas Frieden, the health commissioner, summed up his perspective in a major editorial in the leading journal of medical studies and opinion, the New England Journal of Medicine, this past December 1: “Although stigma and discrimination on the basis of sexual orientation continue, advocacy has resulted in substantial progress, including anti-discrimination statutes in many states and increasing numbers of jurisdictions that recognize the rights of domestic partners. The world has changed in the past 25 years, and approaches to HIV prevention must also change. If we fully apply public health principles to the HIV epidemic, we can improve the health of people living with HIV infection and prevent tens of thousands of people in this country from becoming infected with HIV in the next decade.”
Nothing in Osborne or Shernoff is out of synch or in disagreement with this approach. In fact, it’s my impression that “Suicide Tuesday” and “Without Condoms” will be great aids for health practitioners aiming to apply Frieden’s public health guidelines to help those still struggling with unsafe sex and drug use.
Just as we had to learn the long, hard way that there is no such singular, circumscribed thing as “homosexuality” or “gay sensibility” or “gay community,” the reality being that all such terms are plurals, Shernoff and Osborne show us that we must do the same with barebacking and crystal. Yes, crystal is a real problem that needs to be addressed, but it’s not any one monolithic thing. Effective measures to address crystal use must take their place alongside efforts aimed at other drugs of use, abuse, and dependence—alcohol, cocaine, and designer drugs. Approaches to crystal must be differentiated for different subpopulations and individuals.
Likewise barebacking. Different people are barebacking for different reasons in varying circumstances, not all of them diabolical. Not every barebacker is like [Bearyrnz2bpoz : need to be married to HIV, to be born-again into the brotherhood]. And even someone like [bearynrz2bpoz], as Shernoff demonstrates, is not necessarily psychotic, criminal, or evil. His choices might make a degree of sense for him not immediately apparent to the rest of us. If we have our wits about us and keep calm, these dedicated observers of contemporary gay health tell us, we may discover a real person there, one who can be guided and from whom we can learn.
What do we do about private acts that have social consequences? Smoking may be a personal choice but it affects public health, indirectly if not always directly. Barebacking and crystal use are private acts and likewise affect public health, indirectly if not always directly. In Thailand, drug trafficking is a capital offense; witness the recent hanging of a convicted Australian. In Castro’s Cuba, people with AIDS for many years were remanded to concentration camps. There is a broad range of public health responses to public health problems. Hopefully, we will continue to champion and do the hard work of implementing those that are most humane, which, again hopefully, will also prove to be the most effectual.
“Suicide Tuesday” and “Without Condoms” are testament to this approach and belong on the shelf of anyone interested in the state of the gay union—past, present, and future—and in state-of-the-art harm reduction and preventive medicine.
Alas, however, after the consistent level headedness of what seemed such a valuable read, comes a concluding statement from Osborne that left me with Kafkaesque doubts about my own perceptions. Persuasively, Osborne concludes that we must turn our attention away from panic-mongering in the greater society to targeting and helping those who are still struggling. He then notes that this would not be easy, that government priorities would have to change so that issues of prevention, along with those of treatment, can be better addressed. More than fair enough. Now, here’s the zinger: “Such a demand would come after years of neglect of public health funding by government when the priorities, certainly of our national government, are skewed toward aiding the richest [again, more than fair enough] and funding programs to counter terrorism, a phenomena that, in fact, poses no threat to the vast majority of Americans and a minor threat, if any at all, to just a few.”
In perspective, Osborne, who is an associate editor for this newspaper—which recently featured a Pulitzer-quality series on homophobic atrocities in Iran by Doug Ireland––is saying that by comparison to AIDS, terrorism is a minor concern and threat. The argument that AIDS is a much greater threat than terrorism is not without merit; in fact, it has great merit. But to imply that giving any priority to the threat of terrorism is foolish because it’s “only a minor threat, if any at all, to just a few,” is, first of all, to undercut Osborne’s own argument that we need to expend greater resources on what he has taken such pains to point out is a comparatively small minority of gay men still struggling with drug use and unsafe sex. By his own argument, if these are problems of only a very few, why should the rest of the world, even the gay world, be so concerned?
Now, that said, is there anyone out there who thinks that terrorism “is only a minor threat, if any at all, to just a few?” Well yes—Tony Kushner and Michael Moore, for starters. The double-think I’m left with is the same feeling I have when I watch the demagogues on Fox News carrying on about the so-called “War on Christmas,” while at the same time being among the very few to accurately capture the seriousness of the Iranian call for the annihilation of Israel.
If told I had to solve the problem of terrorism by using the principles of harm reduction otherwise so well captured by Osborne and Shernoff, I’d propose that we not ignore or belittle the problem, nor try to relegate or dismiss it because it doesn’t affect the majority as much as some other things might seem to. Rather, I’d follow Shernoff and Osborne’s approach to gay men’s health—and recommend that we assess it accurately, and give it the respect, sober attention, and resources it deserves.
GAY MEN AND THE CRYSTAL METH SCARE
Carroll & Graf Publishers
179 pages, $13.95
GAY MEN AND BAREBACKING
371 pages, $31.95