Exporting Our Morality
As the world moves toward a global AIDS policy that will affect every heterosexual on the planet, our country is still hammering on homosexuals. Every day I watch the great river of AIDS news coverage, and on the average I still see more talk about gay risk than straight risk go floating by. It seems like moralistic anti-gay outrage is needed to fuel heterosexual AIDS awareness.
On its Web site, the CDC has a whole subpage devoted to women who have sex with women (WSW). When you follow the link, you find little of any significance. The CDC admits that it's really hard to find U.S. cases of female AIDS that have woman-to-woman sex as the sole risk factor. But they try! The agency says:
"Through December 1998, 109,311 women were reported with AIDS. Of these, 2,220 were reported to have had sex with women; however, the vast majority had other risks (such as injection drug use, sex with high-risk men, or receipt of blood or blood products). Of the 346 (out of 2,220) women who were reported to have had sex only with women, ninety-eight also had another risk -- injection drug use in most cases. Women with AIDS whose only reported risk initially is sex with women are given high priority for a follow-up examination. As of December 1998, none of these investigations had confirmed female-to-female HIV transmission. A separate study of more than one million female blood donors found no HIV-infected women whose only risk was sex with women."
Translation: After twenty years of the epidemic, there is no evidence that WSW sex is a dire health threat to the United States. So much for all those claims that "the gay lifestyle is unhealthy."
Other public-health sectors also stay obsessed with that same "medical moralism" about gay and bisexual sex. Yet our current national statistics (if we can believe them) clearly suggest that young heterosexual men are higher-risk, especially if they are black and Latino.
According to recent CDC figures, new AIDS cases declined for more populations, but the number of cases actually increased nationally among women (by two percent) and heterosexuals (by nine percent). Women account for over fifteen percent of cumulative AIDS cases nationally, and 21 percent of cases reported between July 1996 and June 1997. AIDS-related deaths among men fell by 25 percent, deaths among women only dropped by 10 percent. But AIDS-related deaths dropped much less quickly among African-Americans, Latinos, heterosexuals and injection drug users as compared to whites and men who have sex with men.
Most startling of all: The CDC estimates that nearly 50 percent of all new infections are now related to injection drug use. Fifty percent!
This being the case, why are some public-health and media operatives still so quick to go for the item or statistic about unprotected sex that includes the word "gay"?
San Francisco is a good example of a city where the Department of Public Health insists on a gay positioning for its AIDS scene, despite statistics that prove otherwise. According to the "Overview of Health Statutes," released last month by the SFDPH, there was an 83.9 percent decline in gay and bisexual AIDS cases between 1990 and 1999. So why is the SFDPH spending CDC money on a prime-time TV prevention campaign aimed at local gay men? How about using some of that money to reach the 50 percent who use IV drugs? Or those women or young heterosexual men at risk out there? A campaign like this may convince the moralistic crowd that "something is being done about the gay menace to American health," but it won't deliver the numbers that the right kind of campaign targeting drug users could deliver. Yet CDC funds are evidently available to repeat this gay campaign in other cities.
Public-health officials are sucking in their breath at reports that a new, more nasty strain of HIV is around -- one that is nonresponsive to protease inhibitors. According to the reports, one in five HIV-positive people now have the new strain. "It's a dangerous situation," said Brian Byrnes, director of education with the AIDS Action Committee of Boston. But so far the only worries I've seen in the news were about gay men catching this strain. Not about women or young heterosexual men. Or those 50 percent drug users.
Blood donations are a big flinch-point of anti-gay bias. In its masterpiece of contradictory policy, the FDA forbids donations "if you are male and have had sex with another male since 1977 -- even if only once," as Douglass Starr pointed out in the Los Angeles Times. "You can't give blood for the rest of your life if you've ever had homosexual relations with a gay man -- even with a condom -- at any time in the past 23 years," Starr went on. "But you can if it's been a year plus a day when you last had unprotected sex with prostitutes, drug users, or even with AIDS patients."
HIV-positive gay and bisexual men in uniform get the hot spotlight when they're discharged, because of mandatory testing in the armed forces.
It isn't hard to figure out that bias is driving this targeted moralism. What concerns me is the dishonesty it creates in our national life. Thanks to these examples of skewed public-health rhetoric, it is not surprising that many Americans still live in a bubble about what the "global AIDS epidemic" is. Around the world, the vast majority of those estimated 49 million infected people, who might be dying of whatever virus or opportunistic infection is killing them, are heterosexuals. Yet we still have the irate reader who dashes off a haughty letter to the Orange County Register, informing us all that "it is well-established that homosexuality is the major cause of AIDS."
In developing countries, some leaders are not buying the U.S. party line that AIDS must be positioned as a gay disease. Indeed, they must tread lightly on orientation issues, because their heterosexual male populations are fiercely hostile to any inference that risky sex equals MSM (men who have sex with men) sex. South African president Thabo Mbeki certainly noticed the curious way in which our AIDS propaganda doesn't dovetail with the rest of the world. In his now-famous letter to President Clinton, Mbeki politely said: "As you are aware, whereas in the west HIV/AIDS is said to be largely homosexually transmitted, it is reported that in Africa, including our country, it is transmitted heterosexually."
In short, we are trying to export a fraudulent morality -- a two-faced AIDS rhetoric.
The United States is underwriting more international AIDS funding than any other country on earth -- an effort directed at billions of heterosexuals in hundreds of countries. Yet many Americans are still stubbornly, defensively, grimly trying to keep that moralistic homosexual spin on AIDS at home. In so doing, they promote a reluctance by many heterosexuals to take personal responsibility for their own "morals" and their own health.
Patricia Nell Warren writes for A&U, the national AIDS magazine, where this article originally appeared.