 |
|
|
|
|
By Eric Rofes
"S.F. HIV Rate Surges," proclaims the banner headline on last Friday's
San Francisco Chronicle. The article spotlights results from the San
Francisco's five voluntary HIV test sites indicating a rise in the
percentage of people testing positive from 1.3% in 1997, to 2.6% in 1998,
to 3.7% in 1999.
One epidemiologist ominously notes, "These are sub-Saharan African levels of transmission.We may have squandered an opportunity to extinguish this epidemic." The director of a local research institute insists prophetically, "This is a harbinger of what is going to happen all over the country. What happens in the HIV epidemic usually happens here first." Linking quotations from health department officials, medical experts in the Centers for Disease Control, spokesmen for local AIDS organizations, and AIDS activists, a consensus of doom emerges: it's time to declare a new state-of-emergency for San Francisco's gay men. This story and subsequent wire-service accounts and articles in the San Francisco Examiner, New York Times, Washington Post and dozens of other daily papers inspire a number of questions. Has the HIV epidemic in any other U.S. city actually followed the trajectory of San Francisco, a city where a higher percentage of gay men have been infected than in any other U.S. city and where needle exchange has limited infections among addicts?
And is the reference to AIDS in Africa simply a strategic device intended to tap into stereotyped jungle-visions of disease-infested Africans hence inspiring plague terror among San Francisco's gay men? Yet before one can even ask these questions, San Francisco's AIDS leaders divert our attention in the articles and, attempting to explain the upswing in new infections, point their fingers directly at gay men. A spokesperson for a local AIDS group cites "a disturbing trend toward complacency." The research institute director argues, "There's a sense that the drugs have taken care of the problem." He then insists "There's a responsibility issue here," and identifies HIV-positive gay men as the culprits. One prominent activist angrily concludes, "The very thing that makes this happen is stupidity, ignorance and arrogance." None of these articles quote anyone willing to finger the city's HIV prevention organizations that receive millions of dollars to reduce HIV transmission; none critique the health department's master plan for preventing HIV among gay men. Instead, blame is directed unequivocally at the gay male population. This crisis/blame response by AIDS leaders suggests that they see themselves in the position of trainers to recalcitrant gay men. Such a response reminds me of some elementary school teachers' reactions to their students' poor grades on statewide achievement tests: "What do you expect? Do you know what their parents are like?," or "She just really isn't very bright," or "He is simply too lazy to do well in school." Rarely do teachers-who are paid to facilitate student learning-acknowledge their part in student failure. Instead they prefer to point the finger, deflecting attention from themselves onto individual students. Is blame necessary when an urban center faces a health threat? What would it mean if health officials in San Francisco responded to this new data by saying, "We know that gay men in our city face a huge challenge and we are committed to working in partnership with them over the long-haul to diminish HIV transmission"? What would it say about their relationship with the gay male population of San Francisco, if the AIDS leaders told reporters, "Our research and program design may have not moved swiftly enough to meet gay men's changing experience of the epidemic. We've all got to put our heads together and consider new strategies appropriate to the shifting environment"? Would it be possible for an AIDS researcher to tell the media, "We know that asking some gay men to never again have unprotected intercourse is not realistic. For most people, changing sexual practices and altering sexual meanings does not occur easily or quickly. We are committed to working with gay men as they forge their own paths through this very difficult challenge"? Yet the viewpoints that were captured in these recent articles simultaneously sidestep and exacerbate a formidable challenge of which everyone is aware, yet to which no one wants to admit: a wide chasm has opened between rank-and-file gay men who patronize the city's bars, dance parties, sex clubs, and chatrooms and the city's AIDS and public health leadership.
Many gay men might appear to be unconcerned about AIDS when they actually are seething with hostility at the ways health authorities-including AIDS organizations and gay male AIDS leaders-seem expert at manipulating gay men's emotions while appearing clueless about the complicated factors that might contribute to their sexual practices The lock-step consensus within San Francisco AIDS leadership may explain why a range of dissident views about HIV/AIDS may be afforded an ever-widening audience among local gay men. After a decade of annual proclamations about a second wave of HIV hitting the local gay community, last week's panic seems like a tedious rerun and the attempt to terrorize us back into the bomb shelters of the mid-1980s falls flat. Gay men are well aware that the factors contributing these days to unprotected sex are complex and rarely are new infections the result of a deficit of intelligence or a lack of information. By defaulting to simplistic categorizations of newly infected men as dumb, drugged, or deluded, AIDS leaders risk deepening gay men's alienation from the very public health authorities they should consider as their primary partners in prevention. San Francisco cannot afford to let the gap widen between its gay male populace and its public health leadership. Sound-bite analyses of complex social phenomena might succeed at convincing policy makers to maintain AIDS funding levels, getting soccer moms to participate in the AIDS Walk, and encouraging journalists to devote front-page space to AIDS. Yet they might also deepen gay men's alienation, not because most gay men want to see AIDS funding decreased or because they don't value AIDS prevention, but because they expect health officials-especially AIDS leaders in San Francisco--to exhibit a deeper and more respectful understanding of gay male cultures and sexual practices. They don't want finger-wagging father figures or guilt-trippy Nancy Reagans as health authorities; they want AIDS leaders who will work with them as equitable and respectful partners in promoting gay men's health. Unlike some AIDS dissidents' response to this latest alarm, I believe there is reason for concern about the health and wellness of local gay men. But I don't believe a frenzy of press releases and a melodramatic response to data trends do anything more than intensify the problem and diminish the credibility of the city's health establishment in the eyes of gay men (and others). Nor do I believe pathologizing our sexual practices while parallel practices between men and women are discussed cautiously and empathetically, does more than rekindle many gay men's long-standing (and merited) distrust of medical science. In the past six weeks, I've been alerted to three distinct "alarming new epidemics" sweeping over gay male communities. First, the Gay and Lesbian Medical Association sounded the alarm on a "club drug epidemic", highlighting a "severe increase in the abuse of methamphetamine, ecstasy, ketamine, gamma-hydroxburyrate (GHB) and nitrates (poppers)" by gay men. More recently, the web site GayHealth.com announced "New Epidemic Threatens Gay Community," highlighting Dr. Stephen Goldstone's study showing a "startling increase in anal cancer" in gay men. And now our AIDS leadership and mainstream media declare that San Francisco's "long-feared and often predicted new wave of HIV infection is here." I have come to believe that gay men are either the targets of an outbreak of epidemic panics on the part of medical authorities or the codependent victims of a public health system deeply addicted to crisis approaches to public health. Gay men do not need a new state-of-emergency declared-about drug abuse, anal cancer, or HIV/AIDS. Nor do we need to pretend that significant health challenges do not threaten some of our subcultures. We need a broad, multi-issue gay men's health movement that reaches beyond HIV and values our cultures and our lives while working with us over the long haul. We need a movement that will support aggressive research to explore the factors that contribute to some gay men's risk-taking behavior and examines the value we place on sex, health, and our lifespans, while refusing to stigmatize us because our priorities may diverge from heterosexual norms. We need a movement that recognizes not only our risk-taking but also our determination and resilience in the face of adversity. Gay men have proven ourselves capable of impressive accomplishments. Not only have we altered sexual practices and contained the spread of HIV in a manner unheard of in most other populations, but, working with lesbian, bisexual, and transgender colleagues, we have dramatically shifted the social position of homosexuality in America in a single generation. We have proven ourselves capable of inspiring profound social and cultural transformation. By continually marshalling terror, drama, and panic as tactics intended to grab our attention and chasten or redirect our desires, health advocates do us a disservice. By forging respectful partnerships with rank-and-file gay men and working in meaningful ways with our diverse subcultures, AIDS leaders might diminish the credibility gap that has emerged and again enjoy success at mobilizing mass community action. Eric Rofes is a professor of education at Humboldt State University and the author of several books on gay men and HIV, most recently Dry Bones Breathe: Gay Men Creating Post-AIDS Identities and Cultures (Haworth, 1998). He has spent twenty years as a gay men's health service-provider, policy-maker, and community activist and is working as part of a six-member collective organizing the Gay Men's Health Summit, July 19-23 in Boulder, Colorado. The author is solely responsible for the perspectives offered in this piece but thanks Chris Bartlett, Jim Mitulski, Jim Baxter, Kirk Read, and Crispin Hollings for insights and editing assistance. Gay Men's Health Summit 2000—July 19-23, Boulder Five hundred people from around the nation are converging on Boulder, Colorado from July 19-23 to participate in Gay Men's Health Summit 2000, an effort to coalesce a broad range of advocates, service providers, policy makers, and researchers committed to creating a powerful movement promoting gay men's health. Participants and presenters don't share similar perspectives on current HIV trends, syphilis outbreaks in Internet chatrooms, or circuit party drug use, nor do they embrace one viewpoint regarding gay men's sexual cultures or sex practices. What they have in common is a commitment to moving beyond a piecemeal, crisis-driven approach to gay men's health and creating a bold and sustained approach to improving community wellness. The Gay Men's Health Summit takes place July 19-23, 2000 at the Regal Harvest House Hotel in Boulder, Colorado. For registration and program information, contact (303) 444-6121 or summit@bcap.org or visit the web site at www.bcap.org. |
Eric Rofes 
© 1997-2000 BEI