Hidden Dangers : Worried by AIDS Threat, Experts Focus On Bisexual Men Who Put Themselves, Families at Risk
Marie DeFord tells people her husband killed her.
When Doug DeFord died of AIDS in 1990, Marie DeFord was mystified: Doug was a married man, and he wasn’t an IV drug user. But when DeFord emptied her husband’s wallet soon after his death, she found two membership cards to gay bathhouses in a nearby city. Suddenly, it all made sense.
A 43-year-old mother of two from Centralia, Wash., DeFord is losing her sight from complications of the AIDS she contracted from her husband of six years.
“I had no idea my husband was bisexual--none,” she says. “He played Russian roulette with my life and lost.”
Only recently have public health specialists begun to concentrate on preventing cases like DeFord’s. In the literature on AIDS, homosexual and bisexual men generally have been lumped together. But AIDS educators say they now feel that’s a mistake.
“Most of the AIDS programs have been geared toward gay men, and we’ve been missing a lot of bisexual men,” says Susan Chu, an epidemiologist with the Centers for Disease Control in Atlanta. The CDC, which is in the midst of an ethnographic study of the male bisexual lifestyle, has recently begun an innovative AIDS intervention program for bisexual men in Seattle.
According to Chu, many bisexual men have entirely different habits and lifestyles than gay men and, as a result, have not been reached by AIDS education efforts.
It’s a deadly oversight: Heterosexual transmission accounts for the fastest-growing group of people with AIDS, and clandestine bisexuality is one culprit. To date, the CDC knows of 689 women who have contracted AIDS from sex with bisexual men. The agency also has identified 67 children who contracted the disease perinatally from mothers who had sex with a bisexual man. (Marie DeFord’s two children were from a previous marriage and so were not at risk.)
In California, Washington and several Midwestern states, just as many women are getting the virus from bisexual men as from intravenous drug users, according to a study published this year in the American Journal of Public Health.
Bisexual men who are open about their sexual practices are less likely to endanger their partners. The big public health concern is men who are married or in a primary relationship with a woman but who have sex with men secretively. Researchers say this group constitutes the majority of the male bisexual population, which is estimated at up to 6 million as a whole.
In a recent University of Illinois study, only 20% of bisexual men in a primary relationship with a woman had discussed their same-sex activities with their female partners.
The female partners of bisexual men thus are less likely to know they are at risk for AIDS than IV drug users’ partners, Chu says. Women who don’t know they are at risk don’t take measures to protect themselves, she adds.
Marie DeFord, for example, says she and her husband had unprotected sex; she never would have thought to demand anything else. “I was living in this little fantasy world,” she says. “I thought I was in a happy, heterosexual, monogamous marriage.”
Efforts to target men like DeFord’s husband for AIDS education have been delayed partly because married men who have sex with men tend to be extremely secretive and elusive. They don’t read gay publications, patronize gay businesses or join gay organizations, CDC research shows. They take pains not to be identified as bisexual or to have their wives find out about their behavior. And they decline to speak to reporters, even anonymously.
“It’s hard to do research on people you can’t find,” says Karen Hartfield, coordinator for the AIDS Education Program of the Seattle-King County Department of Public Health.
There’s an additional barrier to delivering a safe-sex message to bisexual men: Many deny their homosexual leanings and so believe, irrationally, that they are not at risk for AIDS.
A Long Beach woman who contracted the virus from her bisexual husband says: “To this day, he denies being bisexual, even though he goes from guy to girl and guy to girl.” The woman, now divorced, asked not to be named because some family members do not know she is HIV positive.
Because the bisexual lifestyle has been shrouded in denial, secrecy and mystery, the initial goal of the CDC project was simply to find out more about bisexual male behavior.
Working in conjunction with the CDC, public health workers in Long Beach, Denver and Seattle have interviewed and observed hundreds of bisexual men. They have approached their task like anthropologists, attempting to learn about codes, customs, rituals, taboos and meeting places.
The population seems to vary from location to location. In Seattle, for instance, interviewers have seen a preponderance of slightly older married men who engage in closeted bisexual activity.
In Long Beach, where three part-time interviewers have talked to 200 men at public parks and beachfront meeting places, they’ve discovered a wider range of bisexual options, says Rich Wolitski, assistant director of the AIDS Research and Education Project at Cal State Long Beach.
The Long Beach study includes men who are basically heterosexual but who are experimenting with homosexuality as means of “exploring their sexuality,” says Wolitski, adding, “There are also a fair number of men in their 20s and 30s who are not in permanent, long-term relationships but who are having sex with both male and female partners.”
One goal of the initial interviews was to discover where bisexual men meet in order to know where to deliver an AIDS prevention message. Tom Perdue, a member of the Seattle team, explains the rationale for focusing on public sex sites: “That’s the only real common denominator they (bisexual men) have.”
Denver will be next to initiate outreach efforts. If the Seattle and Denver projects prove effective, outreach will probably be expanded to other cities, says Donna Higgins, a CDC public health analyst who oversees the project.
Cevero Gonzalez parked his Toyota pickup in the shade of a tranquil Seattle park. Squirrels leaped from leaf-strewn picnic tables to rusted barbecue pits; a woman and her dog slowly promenaded on the lawn.
Gonzalez, an outreach worker for the Seattle-King County Department of Public Health, has been coming to this park three or four times a week to study the ritualized behavior of bisexual men and to talk to them about AIDS. His work, and the work of other outreach workers, is beginning to yield information about this mysterious population.
A boyish, affable man in Bermuda shorts and with braces on his teeth, Gonzalez pointed out a parked silver Continental equipped with a baby seat. A man sat idly behind the wheel. Stationed elsewhere around the large circular drive were five or six cars occupied by a solitary man.
“It’s safe to say any male alone in his car here is not just reading the newspaper,” says Gonzalez.
The hours from 4 to 6 p.m. are prime cruising time, he notes. “The kids have already gone home from school, so they won’t be walking through the park. And it is before the hour when families come out to have picnics. It’s down time.” He adds: “These guys have everything figured out.”
An oversized yellow pickup slowly makes the circuit. The driver swivels his head to see who is at the wheel of Gonzalez’s truck, then moves on when he spies a second occupant.
Gonzalez says if he wants to engage the man for sex, he simply taps his brake lights a couple of times or gives a casual two-fingered wave. Sometimes the men have sex in their vehicles (arrests are rare), or they may agree to meet at a motel or in the apartment of a man whose wife is away.
Gonzalez, who is sometimes mistaken for an undercover police officer, has talked to about 200 men who come to this park and places like it for sex. The typical patron is white, 35 and a corporate professional. He is usually married with at least one child and says he has no intention of telling his wife or girlfriend about his park forays.
“They don’t call themselves gay; they don’t call themselves bi. They tell me this is their tension release,” Gonzalez says. “They say they’re here because they’ve had a stressful day at the office. They talk about their wives: ‘My wife is such a babe.’ They’ll go into graphic detail about their wives because they want to affirm to you that they are straight.
“They don’t consider this cheating on their wives because they are not cheating with other women,” he adds.
Gonzalez recalls he once interviewed a man in his mid-70s who said: “My wife and I haven’t had sex for 20 years. She thinks I see prostitutes.” He’s talked to a teen-ager who says he comes to the park for anonymous sex because “I don’t want people at school to call me a fag.”
Likewise, outreach workers also have talked to a number of men in the military, the clergy and high-visibility positions in business and local government who say they simply cannot afford to be perceived as gay.
Researchers say it is impossible to definitively number this amorphous population. But Jean Schaar Gochros, author of “When Husbands Come Out of the Closet,” estimates that 4 million to 6 million married men in the United States have at least occasional homosexual contact. The estimate is based in part on the Kinsey report on the percentage of married men (18%-20%) who have had homosexual encounters, says Gochros, a social worker in private practice in Honolulu.
And Tom Perdue, a research analyst for the Seattle team, says: “I’m not sure the general population is aware of the extent of this activity. We hear over and over again that the group is probably larger than people think.”
The workers have learned that bisexual men who engage in public sex protect each other from outsiders and the police, with one man often acting as a lookout for the others. There is almost no talking among participants, except in moments of danger. Sites like public parks are favored because a man caught there always has an alibi: “I just stopped in to use the restroom.”
And there’s an unspoken agreement among the players that they are there strictly for sex. “Feelings aren’t included in this environment,” Gonzalez says. “These guys are trying really hard to have only sex, because their intimacy is reserved for their female partners.”
The outreach worker’s job is to break through the men’s caution and denial to get them to talk about safe sex. Gonzalez said he usually uses an opener like: “Things are picking up tonight,” or he might express curiosity about the encounters taking place, in what he calls his “Richie Cunningham approach.”
If a man is willing to talk, Gonzalez then identifies himself as being from the health department and eases into a discussion of AIDS. He distributes health department pamphlets--small enough to hide inside a man’s wallet--containing true stories of men who have sex with men but don’t consider themselves gay. The pamphlets also include a condom and a coupon for free HIV testing. The team has distributed about 10,000 of the fliers to date.
Gonzalez says his goal is to get the men to be safer in their practices at least some of the time and to begin to consider the risk to their female partners.
“A lot of them say they haven’t been tested for HIV because it’s not gay sex they’re having--it’s sexual release,” he says.
Men included in the Seattle study said they used condoms 60% to 70% of the time when having sex with other men. But the big problem health workers face is in convincing the men to practice safe sex with their wives and girlfriends.
“A married man is not going to come home and say, ‘Let’s use a condom,’ because it’s a dead giveaway (he’s been having sex outside the marriage),” says Chu of the CDC.
Gonzalez takes pains not to pass judgment on the men for their secret lives. He attributes their behavior to “desire and desperation. They desire to be with other men, but they’re so desperate to cling to the American dream--wife, kids, Winnebago.”
Indeed, many researchers attribute at least part of the problem of closeted bisexuals to a social contract that forces people into rigid heterosexual roles.
In a more accepting climate, Gonzalez says, many of the men he talks to in the park might be openly gay or at least be able to admit to an attraction to men as well as to women.
“The stigma attached to sex with men is so strong, and the pressure to be married is equally strong,” says CDC research psychologist Lynda Doll.
She says the pressure to conform to heterosexual norms is even greater in the African-American and Latino communities. In a 1989 study reported in the American Journal of Public Health, the number of women who contracted AIDS through sex with a bisexual man was three times higher among Latino women and five times higher among African-American women than white women.
Public health workers would like to extend their efforts to include the female sex partners of bisexual men. But they have not figured out a way to reach them. Take Marie DeFord, for instance: a drugstore cashier living in a small farming and timber town and married to a seemingly straight man. How would anyone have found DeFord to warn her?
For now, Gonzalez and his colleagues believe the best way to prevent more deaths is to target bisexual men in the easiest place to find them--public sex environments. They’re aware that this decision could be controversial.
“We’re not trying to condone or encourage this behavior,” says Tom Perdue. “We want to help people reduce the risk.”
Cevero Gonzalez, watching the daily procurement dance in the park, expresses similar concern. “This is not AIDS 101,” he says. “It makes some people uncomfortable. But these men could be the transmitters to the next generation of people with AIDS--women and children. These guys are on the fringes of gay society, and they’re being missed. You do what you can.”