The Uncertainty Principle

The word has been out for almost two years now: more and more gay men are engaging in unsafe sex. Studies from San Francisco are showing a two- to three-percent rise in seroconversion among the city's young HIV-negative men; over the past two years, studies in major US cities such as San Francisco and Los Angeles have pointed in the same direction. Meanwhile, articles in the New York Times, medical journals, and the gay press have been spreading the word that AIDS-prevention campaigns have been less than successful.There is enormous speculation about why gay men are still having unsafe sex. One possibility is simply despair: eight years ago many thought the end of the epidemic was in sight, but for many men it still isn't, even with the advances made with protease inhibitors. Another is depression: the cumulative death toll has created an atmosphere so without hope that some gay men see little reason to continue to act safely. Then there's survivor guilt: how can you rationalize the fact that men with similar sexual histories have differing HIV and health status? And denial: arguments ranging from "If I haven't gotten AIDS by now, I won't" to "If he wants to fuck me without a condom he must be negative" allow gay men the luxury of not discussing their conflicted feelings about sexual activity.At the root of each of these reasons is the idea that self-esteem -- simply feeling good about oneself and one's life -- is what motivates men to engage consistently in safer sexual activity. This is echoed in some of the newer and most persuasive prevention literature, such as the writings of Walt Odets, which hold that gay-male self-esteem is key to encouraging gay men to make logical, thoughtful, and informed decisions about their sexual practices.Yet self-esteem is innately tied to our ideals and presumptions of beauty -- which are, of course, shaped by popular culture. This is as true of the heterosexual world as it is of gay-male culture. Whether it appears in Honcho magazine or ads for Club Med, the idealized body signifies both health and happiness. And partly for that reason, the use of the beautiful male body as a symbol of sexual desire has become problematic in AIDS-prevention work.From the early days of AIDS prevention, posters and pamphlets have featured traditionally beautiful, healthy-looking men. The message: beautiful men = safe sex. The problem is, that message can easily exclude any man who sees himself as falling short of this standard of beauty. Men who feel they could never measure up to the physical (and ethical) ideal of safer sex may see themselves as failures -- thus having even more difficulty acting safely in sexual encounters.And there is another problem with these campaigns. From the beginning of the safer-sex education movement, a great deal of prevention work has used traditional advertising techniques to convey the message. Typical of this is the classic safer-sex campaign slogan "Safe Sex Is Hot Sex," which promotes safer sex as "better" or "hotter" -- a more enjoyable alternative. The idea of promoting one kind of sex as "hotter" than another is really no different from saying that Coke is better then Pepsi, or that BMWs are better than Toyotas. Such slogans don't necessarily endure over time -- indeed, they're specifically designed not to. Advertising is predicated on convincing viewers for the moment that they will be happier by simply choosing one product, one option, over another. The techniques of advertising are essentially lies that don't make a lasting impression on us. We cannot take that chance with safer-sex education.Safe-sex education has to acknowledge that HIV status is unavoidably a part of gay-male identity today. If you test HIV-positive, it means that you are carrying the HIV virus and will, at some point, come down with AIDS-related illnesses. You may also identify as "positive." Conversely, if you test HIV-negative, it means that you do not have the HIV virus and may identify as "negative."In reality, HIV-negative status is no more than the absence of a positive test result. The problem is that a negative test result quickly becomes an HIV-negative identity -- which leads many to think of it as a stable, unfluctuating status. (And with the persistent stigmatization of people with AIDS, is it any wonder that men would want to hold onto that belief?) But not only is an HIV-negative result sometimes unreliable, HIV-negative status can change and frequently does. Thus, the HIV-negative identity is a kind of myth that presents many problems in safer-sex education. Put another way, a social, emotional, and physical identity based upon HIV-negative status creates a category of wellness that simply may not exist.For many men, negotiating safer sex is a complex and confusing process, involving awareness of how HIV is transmitted, the mediation of sexual desire and physical action, and honesty (often unspoken) between parties about HIV status. With the advent of a reliable HIV test, men began to form fixed HIV-negative identities -- which has made negotiating safer sex increasingly problematic. Men have been making "informed" decisions based on knowledge that was quite possibly inaccurate, but which they didn't want to question. The intense desire to hold onto an HIV-negative identity affects all aspects of gay-male life.An immutable HIV-negative identity becomes even more problematic in AIDS-prevention work when considered in conjunction with those cultural processes that conflate beauty and apparent health. The paradigm that beautiful people are healthy people is so widely accepted in both gay and straight culture that it often goes completely unexamined. Isn't a fantasy in gay- male porn videos that the beautiful, well-built men are healthy, even though many porn stars have died of AIDS, or are HIV-positive? Isn't the subliminal (or not-so-subliminal) message of the circuit and sex-club parties that the body beautiful is the body healthy? Doesn't this conflation of the beautiful body and the healthy body carry over into AIDS-prevention work as well, with posters of gorgeous men urging us to have safe sex and stay HIV-negative?Of course, the beautiful body isn't necessarily the healthy body, and safer-sex decisions based on the presumption that it is are often ill-informed. When this confusion occurs within the mythos of an unfluctuating HIV-negative status, it further muddies the decision-making process. The cultural myths of beauty, health, and presumed HIV status consistently thwart our efforts to make informed and safe decisions about sexual activity.Recently, a friend and AIDS educator told me of a safer-sex crisis he had experienced. He'd gone into a public men's room to cruise and was standing at the urinal jerking off when a man came in and stood two spots down from him. Glancing sideways, my friend noted the man's dick, his good build, and his striking, bearded face. As he was about to make his move and go down on the man, he saw that the man's face was covered with KS lesions. My friend hesitated, but within seconds he acknowledged to himself that he was having a knee-jerk reaction to the man's obvious AIDS status. After all, my friend believes that sucking cock without ejaculation is a safe activity, and he regularly goes down on strangers without worrying about it. He realizes that many of these men may have AIDS; they might even have KS lesions not immediately visible to the eye. Why should he hesitate to go down on someone with apparent KS when he has probably, unknowingly, gone down on men with similar conditions?As he was contemplating this, a third man came into the restroom and immediately went down on my friend's prospective trick. My friend's reaction? First, annoyance that he had lost a trick; then, worry that this new man had not noticed the KS lesions. My friend realized that the physical presence of an AIDS-related illness made him question his own standards for making an informed decision -- and even question the ability of others to make those same decisions.The ability to make safe and sane decisions about sexual activity is not a simple process. We are all autonomous individuals capable of making informed choices. But we are also citizens in a world that overloads us with endlessly confusing and conflicting images, desires, and needs. Our attitudes about health, beauty, and HIV-negative identity all conspire to make our lives and our decisions seem easier: beautiful people are healthy people; healthy people always look healthy; people who test HIV-negative always stay negative. Those are seductive ideas even when we know they are untrue, and they are confusing ideas when we are attempting to make informed, complicated decisions that effect our egos, sex lives, and health. They become deadly ideas when confusion leads to seroconversion.They are also ideas that make distinctions between people who are living with AIDS and those who are not; they separate the well from the unwell, the healthy from the unhealthy. But the reality is that "well" and "healthy" are only temporary categories: if we don't get sick and die of AIDS, we will all die of something else. Humans are not very good at dealing with death and illness. AIDS has brought illness, unwellness, and death into our lives in such a visceral and undeniable way that we struggle daily to cope without despair. But if we continue to construct false dichotomies of the sick and the well, the HIV-positive and the HIV-negative, the beautiful and the unacceptable, we do so not only at our own risk, but at the risk of everyone.