Stigmatizing Gay Sex Again (and Again)

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I didn’t think I would like HBO’s rendition of Larry Kramer’s The Normal Heart, but I did. It got me thinking about all kinds of things, from queer kinship to care ethics. The theme that stayed with me the longest was that of intergenerational gay politics. In a particularly affecting scene in the middle of the movie, in the makeshift offices of the newly formed Gay Mens Health Crisis, one of the older members of the group (played by Joe Mantello) breaks down. It’s the beginning of the AIDS crisis, before anyone knows how the disease is transmitted or why it’s most prevalent amongst gay men. But there is reason to suspect that it is sexually transmitted, so one of the founders of the GMHC (played by Mark Ruffalo) argues that gay men should stop having sex until they know for certain that doing so is safe.

Mantello’s character Mickey loses it for a number of reasons—stress, fear, desperation, hopelessness. The particular trigger, though, is the suggestion that a gay political organization in the early 1980s ought to be telling gay men not to have sex. Mickey came of age in the 1960s, when the gay rights movement was about de-stigmatizing gay sex. His whole political being was oriented toward the goal of freeing gay love, affection, kinship, culture, and sex from vilification and oppression, and freeing gay men of the guilt and fear that stemmed from it. To have a gay man argue that gay men should fear sex was more than he could handle. He could see how letting the fear of gay sex back into their lives, into public discourse, could undo everything they had accomplished. Fear of AIDS was the weapon that the anti-gay forces in society needed to roll back the gay rights victories of the 1960s and 70s.

I think about that scene a lot. About how different generations of social movements are shaped by the particular sets of challenges and adversaries they face. About how much is lost when we fail to see ourselves in the struggles of older generations, whose victories we benefit from.

I thought about that scene when I read that the U.S. Department of Health and Human Services announced last week that it might recommend that the Food and Drug Administration “soften” its ban on gay men donating blood. Instead of being banned from donating entirely, gay men (or more broadly, men who have sex with men) would be allowed to donate blood after a year of abstinence.

The rationale for the new policy is that during a short window after someone contracts HIV (usually no more than one month), blood tests for the virus can produce false negatives. Gay men must therefore “defer” donating blood for (an arbitrary) one year from the last time they had sex, in order to minimize the odds of HIV positive blood making it through the screening process undetected.

As others have pointed out, this new proposed policy is bad for exactly the same reasons the current policy is: it screens for the wrong thing. The policy is built on the premise that gay sex causes HIV transmission, which isn’t true. HIV is transmitted by having unprotected sex with someone who is HIV positive. It can be anal sex or vaginal sex. It can even be transmitted by oral sex (though the odds of transmitting HIV that way are considerably lower). HIV is also frequently transmitted by sharing needles with someone who has HIV.

There is literally no chance of getting HIV from having gay sex with someone who does not have HIV. There is only a very tiny chance of getting HIV from having protected gay sex with anyone. If the FDA’s goal is to minimize the chances that HIV positive blood will make it through the screening process undetected, then it should screen for the behavior that actually causes HIV transmission—namely, having unprotected sex (gay or straight) with someone whose HIV status is positive or unknown.

By screening instead for gay sex in general, the FDA stigmatizes it—unjustly blaming it for causing something it doesn’t cause. When the Red Cross says that “You are at risk for getting infected [with HIV] if you are a male who has had sexual contact with another male, even once, since 1977” it is lying. Moreover, it is doing precisely the thing Mickey is so worried about in The Normal Heart—it is telling gay men (and everyone else) that they should fear gay sex.

So while some hailed HHS’s announcement as a “HUGE step in the right direction,” I thought about how Mickey’s struggles are still very much with us today.

I thought about the scene again when I read this week that Michael Weinstein is still fighting against Truvada. Weinstein is the president of the AIDS Healthcare Foundation and has something of a record of attention-seeking contrarianism. Truvada is a form of PrEP, or “pre-exposure prophylaxis,” a drug regimen which, if taken properly, prevents HIV transmission with 99% effectiveness. The World Health Organization, the Centers for Disease Control and Prevention, and nearly every AIDS organization in the country has celebrated PrEP as a game-changing AIDS prevention measure.

All of them except for Weinstein’s AHF, that is. Weinstein has called Truvada a “party drug.” Popularizing it will, he argues, encourage gay sex with multiple partners, discourage condom use, and because gay men can’t be trusted to take their medicine, it will ultimately increase rather than decrease the overall number of HIV transmissions.

Weinstein’s claims look somewhat different from the Department of Health and Human Services’, but only on the surface. At bottom, their logic is the same: stigmatize gay sex by wrongly blaming it for spreading HIV. The only difference between HHS’s stigmatization of gay sex and Weinstein’s is that HHS vilifies all gay sex while Weinstein vilifies only some of it—casual sex.

“Encouraging committed relationships in the gay community,” says Weinstein, “helps stem the virus’ spread.” That’s true, of course, if neither partner in the relationship is HIV positive, or if both are, or if one partner is and great care is taken not to transmit the virus to the other partner. The same could be said of the straight and bi communities. But casual gay sex does not in itself cause HIV transmission, and monogamy in itself does not prevent it.

What causes HIV transmission is, again, unprotected sex with someone who has HIV. (And sharing needles.) What prevents HIV transmission is protection. If you are having casual gay sex, with multiple partners, with great frequency, but you always wear a condom, the odds of you contracting HIV are extremely low. If you are also taking PrEP, the odds are astronomically low. Now, there is no evidence that taking PrEP actually discourages condom use. So if this new drug offers a powerful new weapon in the battle to eradicate AIDS, and if Weinstein and the AHF are “the nation’s largest organization” fighting that battle, why is Weinstein so vehemently against it?

Who knows. I can’t get inside Michael Weinstein’s head.

What I can say without question is that what Weinstein is doing (whatever his intentions) is exactly what HHS’s blood donation policy does. It is exactly what Mickey worried the GMHC would do if it told gay men not to have sex. It is adding a weapon to the arsenal of those who would stigmatize gay people. By connecting AIDS to people having sex outside monogamous relationships, rather than with having unsafe sex, Weinstein is reintroducing the stigma that generations of gay people fought to remove. Only instead of directing it against all gay people, he is directing it against a subset of the gay community.

The difference between Mickey’s time and now is that now some forms of gay love, affection, kinship, culture, and sex are sanctioned. Specifically, the long-term, monogamous kinds. But other forms of gay sex remain feared and vilified, and comments like Weinstein’s play into the hands of those who would see that fear and vilification continue.

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