By 2017, 16,000 Philadelphians will be dying of AIDS. This is not an exaggerated statistic, this is not a conservative estimate, and it is not information propagated by an advocacy organization. Rather, this breathtaking number comes from the Philadelphia AIDS Activities Coordinating Office, or AACO. Under the direction of Mayor Michael Nutter, AACO works cooperatively with worthy non-profit organizations, like the progressive and forward thinking and sex positive Gay and Lesbian Latino AIDS Education Initiative, in order to figure out what the reality looks like on the ground for those living with HIV/AIDS, how many people in Philadelphia have HIV/AIDS, and how to best deliver services to the HIV/AIDS population throughout the city of brotherly love.
For the past thirty years, HIV/AIDS has systematically murdered an entire generation of good men and women. Thousands of our brothers and sisters have perished, their immune systems succumbing to the utter devastation wrecked by HIV, most dying of otherwise benign pneumonia infections or other opportunistic infection. And, the ancillary infections, the burning shingles, the eye infections, the loss of teeth, and the thinning of hair continue to torture thousands of Americans today because of the lack of wide availability of antiretroviral medication that can, if used properly and adhered to over 96% of the time, both ensure the HIV+ live long, vibrant, and high-quality lives and simultaneously neutralize the HIV+ population from being able to transmit the virus, even when they have sex without a condom.
Thankfully, Philadelphia is quizzically progressive when it comes to availability of HIV medication, and there are no waiting lists or bureaucratic mazes to navigate, like in Georgia or Louisiana or Ohio, lines essentially allowing the HIV+ to slowly die because of governmental inefficiency. Yet, because of scientific ignorance in the early days of the epidemic, the horrific side effects of early and outdated treatment like AZT, continued stigma propagated by misguided prevention efforts, and the reckless disregard of the HIV- population, who still stubbornly keeps infecting itself with HIV, 16,000 Philadelphians will be dying of AIDS by 2017.
Since I was a boy, I have been bombarded by organizations like the Gay Men’s Health Crisis, liberal interest groups, and corporate-financed condom campaigns telling me that condoms will protect me, that having sex without a condom will kill me, and that, so long as I use good judgment, put on a condom, and be a good boy, I will be “safer.”
“Safe” or “safer” or “protected” sex is probably the most pernicious of stigmatic implications that is still commonly accepted as shorthand marketing, even in the most thoughtful and HIV friendly campaigns and organizations. Notwithstanding its widespread use, the term must be recognized for what it truly is: the modern incarnation of the conservative mantra of “abstinence only” and, as such, undeserving of serious or thoughtful digestion by adults.
Condom campaigns have not adapted to the reality facing Americans. If they were effective, then I would not be writing this right now. Rather, I would have been protected against HIV infection, the rates of HIV transmission would not continue to go up every year, and thousands of Philadelphians would not be estimated to be dying of AIDS in the next decade. Nevertheless, all of these facts are true: I am HIV+, HIV infection rates are on the rise, and thousands of Philadelphians are estimated to be dying of AIDS in the next decade. We must recognize that condom campaigns have failed miserably to be relevant to the world in 2013.
Now, I am not saying that condoms are wholly ineffective. Rather, condoms are an incredibly effective barrier method against most sexually transmitted diseases and infections. In fact, if used properly, condoms, no matter how disgusting the latex ones smell or how much they all inhibit male erections, can help prevent HIV transmission. But, the fact of the matter is that abstinence is even more effective. Yet, we as a society have, at least the thinking parts of society, recognized that abstinence only education is unrealistic, behind the times, and, paradoxically, leads to higher rates of teen pregnancy and HIV infection. Even so, the stubborn fact is that condom campaigns contain precisely the exact same moralistic and well-meaning but sniveling inefficacy as abstinence only.
This is a grossly inconvenient fact; after all, it goes against the decades of intellectually dishonest and disingenuous fallacies affirming, without ever taking into account actual human behavior or sexuality, that condoms are just as fun as sex without a condom (they aren’t,) that condoms are sexy (they aren’t,) and that condoms are effective at reducing HIV infection rates (they aren’t.) Otherwise, there wouldn’t be an entire pornographic movement devoted to the absence of condoms, we wouldn’t have teenage boys pleading with their female counterparts “to just put the tip in,” and we wouldn’t be seeing HIV infections on the rise. But, all of these things are true; therefore, the logical conclusion is that condom campaigns are woefully ineffective and, paradoxically, leading us down the path to greater destruction, higher rates of HIV infection, and internalized self-loathing and stigma manifest in the idea that most HIV+ people, either knowingly or unknowingly, possess.
This thought process is leading us to more pain and anguish in society. Specifically, newly HIV+ folks or folks who refuse to get tested feel that had they acted in a more Trojan-sponsored way, they would not be in the predicament in which they find themselves. Therefore, they might as well bury their heads in the sand, not get a confirmatory HIV test after an initial positive result, that is if they got tested at all, and they might as well let themselves die unnecessarily and infect many more people along the way (because of not going on antiretroviral treatment which can, again, stop HIV transmission even more effectively than condom use). After all, if they had been good little boys and girls, and they had lied to themselves and others that condoms were just as fun and sexy and easy as bareback sex, then they would not be the embodiment of God’s divine judgment, the inevitable coda to immoral or “reckless” behavior.
And, some less than thoughtful folks in the HIV- community sustain this ludicrous notion with their obscenely hurtful and idiotic insistence that they are “clean and want to stay that way,” even though most of them put their tongues unprotected into the anuses of other men.
In fact, the most laughable component of this cycle of stigma and moral fantasy is the idea that “safe” sex exists; considering a good number of LGBT folks don’t even engage in anal sex, condom campaigns are basically tone deaf to their behavior, too. And, the CDC has had to routinely point out, must to the consternation of organizations and entities that “know best” for us, that condoms do absolutely nothing to protect against oral sex transmission “herpes, syphilis, gonorrhea, genital warts (HPV), intestinal parasites (amebiasis), and hepatitis A.” “Clean and want to stay that way,” indeed.
Right now, the LGBT community has an opportunity to confront the reality of sexual health in the 21st century. And, thankfully, a good number of LGBT writers and activists have started to push back against the unrealistic schoolmarming of condom campaigns, most notably Jake Sobo in California, Mark S. King in Georgia, and me here in Philadelphia.
Rather than squander our precious little resources on the corporate endorsed stealth consumer campaign of condoms, we should be focusing on making HIV testing as routine as a flu shot, on wide availability of antiretroviral treatments at low or no cost, and we should insist that anyone who is HIV+ immediately go on ARV treatment and never miss a dose. For instance, two weeks ago, I ran out of my HIV medication while visiting my parents in rural Pennsylvania. Rather than accept this as just part of the inconvenience of having to live with HIV, I made obtaining my medication priority one, hopped on a bus, and traveled sixty miles to obtain my pills. After all, I cannot engage in the behavior I detail in my writing without the inherently necessary adherence to antiretroviral treatment, otherwise I am just being a reckless misanthrope.
Never missing a dose, adhering to treatment precisely as described, candidly discussing our HIV statuses, recognizing that, if an HIV+ person is on ARV he has no chance of transmitting HIV anymore than the earth has a chance of being bombarded by a meteorite (which we saw this week is still scientifically possible albeit astronomically unlikely), are all necessary components of sex positive, life affirming, and effective methods to realistically stop HIV infection. Throughout all of this, the use of condoms is incidental and, just like abstinence, should take a back seat to acknowledging that part of being an adult is taking risk, managing this risk’s potential impact through practices like serosorting partners (where HIV+ men seek out specifically other HIV+ men as sexual partners), using lots of personal lubricrant (which reduces tearing and, therefore, blood to blood contact during anal sex), and talking openly about the sexual needs, desires, and behaviors of our modern society.
Until we recognize that condoms are just as effective as abstinence only in regards to stopping HIV infection and must be a small part of an overall broader and more comprehensive approach to sexual health, we will be looking at more HIV transmissions, more people dying of AIDS, and more young men and women feeling like they did something wrong by simply engaging in behaviors that are morally neutral and, frankly, human and natural. And, until we stop expressing this disingenuous shock and umbrage that a majority of gay men prefer sex without condoms, we will tragically be sustaining this cycle of stigma, HIV infection, and, inevitably and wholly unnecessary, untimely death.
This article first appeared on Josh’s own blog here.