PERSPECTIVE ON AIDS : Safer Sex Has to Be Forever : If human behavior triggered the epidemic, human behavior could quell it. But that calls for permanent changes.
Gay and AIDS activists, even at the risk of providing fodder for homophobes, need to examine how AIDS developed, and the reason is soberingly simple. Researchers are virtually unanimous in believing that if AIDS were cured tomorrow and we returned to the ways of the 1970s, the whole nightmare could easily happen again.
Scientists are confident that what can be amplified by one form of human behavior can be prevented by another. Among the most critical contributions the gay community has made in responding to AIDS has been the invention and promotion of safer sex, which remains the most important means of preventing HIV transmission today. Overcoming great resistance, gay men and lesbians--after a period of adjustment--reacted with remarkable decisiveness, effectiveness and often nobility to the challenge of safer sex. The most impressive evidence of this was a subsequently lowered rate of HIV transmission in places like San Francisco, where the epidemic was at its peak.
But an important reason for examining the genesis of the epidemic itself is to lay the framework for prevention on a macro scale--not individual cases, but of AIDS II: the Sequel. Researchers have already identified several microbes capable of spawning deadly new plagues if the conditions of the 1970s are re-created, starting, most obviously, with HIV-2 and the cancer-causing HTLV retroviruses. Now drug-resistant forms of tuberculosis and sexually transmitted diseases have evolved, making these infections harder to treat, especially for those with HIV. There are probably many others--rare, death-dealing microbes--unnoticed as HIV was long unnoticed, eking out a meager existences in the global bloodstream. Waiting.
Yet as we move into the second decade of AIDS without a cure in sight, many cannot resist the siren song of unsafe sex. According to the San Francisco health department, the rate of newly infected gay men recently doubled in the Bay Area, with many cases among young gay men. Epidemiologists say the same thing is happening in other gay communities.
Focus groups have elicited several explanations for the relapse, including fatalism, survivor guilt and a desire to join what some bizarrely consider a culture of heightened meaning among the HIV-positive. But a significant reason gay men gave investigators was the belief that safer sex is just too stressful, even unnatural, to maintain for very long.
“Safe sex is not incorporated naturally into a life,” a Bay Area man told reporter Jane Gross of the New York Times recently. “OK, three years; OK, five years; OK, eight years. But the rest of my life? No. That’s not possible.” His view is widely echoed even by many who practice safer sex but who look forward to the end of AIDS not just for personal salvation or the salvation of their friends but so that they can return to the multipartner practices of the swinging ‘70s.
Perhaps ironically, those practices are now becoming more popular within lesbian circles even as AIDS rises among women. Yet the lesson of AIDS, or at least one lesson of AIDS, is that until all viruses have been defeated, the kind of gay sexual activism that has contributed to AIDS remains incompatible with survival. If gay men in particular are to survive, the real challenge of liberation will not be to resist that lesson but to organize around it.
Even if such a major readjustment is possible, many would view it with deep suspicion. Historian Martin Duberman cites powerful arguments against accepting any seemingly moralistic, anti-sex lesson from AIDS: “The powers that be have always used epidemics in order to reinforce moral lessons. And epidemics, because they involve so much terror, are very good enforcers of the code.”
True enough. But in the past, the powers that be did not know the facts about plagues. It is one thing for moralists to misinterpret epidemics as God’s wrath and use such interpretations to suggest tattooing gays. It is quite another for rationalists to explore the interlinked mechanisms of epidemics and provide resulting knowledge that can be applied to prevention and protection.
To be effective on the individual level, we have learned that safer sex has to be every time. The history of AIDS indicates that to be effective on the macro level, it will have to be all the time, for all humankind. And not just for the duration of the epidemic. Forever. Or at least until the viral world has been vanquished.
