So I am staring at my pile of pills. Two Kaletra, an AZT, two Invirase, Bactrim. Add to the mix a Claritin and a couple of Tylenol for the inevitable headaches. I will wash it down with a teaspoon of Mepron, and make sure I eat a decent meal with it, though the meds have made my taste buds interpret anything as metallic. I’m bitching, I know. Worst part? I isolated myself from anyone who might want to come over and hang out, mainly because Kaletra gives a person gas beyond my capacity to articulate. It's the worst of stuff; that's why forensic examiners dab Noxema or Menthol ointment under their nose before unzipping the body bag. It's like being an overinflated bag of humiliation... So I gag down the pills, at the cusp of feeling JUST a little better (my body’s signal that its time for more toxicity).
~ Jonathan's HIV Blog [AIDSMeds.com]
In 2003, Rolling Stone magazine caused a storm across gay America by claiming that a number of gay men - "bug chasers" - deliberately set out to have high risk sex in order to contract HIV. The article, In Search of Death, suggested that 25% of HIV seroconversions among gay men in the US may be intentional, although the writer later claimed that the figure was fabricated without his consent.
In 2006, British HIV+ journalist Ricky Dyer went undercover as an HIV "gift giver"/"breeder" for a BBC documentary, I Love Being HIV+, in which he secretly filmed numerous online encounters with "chasers" who had told him they were keen to "poz up". In reality, most of the men he met kept their ambition at the level of fantasy. Says Dyer: "Whether genuine or fantasy, bug chasers tend to fall into two main groups; 'Russian rouletters', who get off on brinkmanship and risk, and 'control seekers', who seek to eliminate that same sense of risk by getting HIV+."
"Recently I was asked if I wanted to 'breed in negative arse'. It took me a while to work out what I was being asked to do... I can't be the only person who thinks that if someone is choosing the prospect of a lifetime of stomach cramps, diarrhoea and muscle wasting over having sex with a condom, they could really do with working on their self-esteem."
~ Joe Chown [Positive Nation]
2,500 men who have sex with men (MSM) were diagnosed with HIV in the UK in 2005, the highest number since records began. Data from a recent London gay men's sex survey concluded that while HIV- men are extremely aware of the HIV risks associated with receptive unprotected intercourse, a significant proportion still do not practice safe sex for a multitude of psychological reasons, including:
• A desire for love, trust and intimacy greater than the fear of HIV;
• A misguided assumption that HIV happens to other people;
• A belief that HIV infection is not the worst thing that can happen;
• Repeated negative tests, confirming a sense of immunity;
• Fatalism regarding the perceived inevitability of becoming infected;
• The prospect of engaging in lots of unprotected sex with other HIV+ men;
• A willingness to share a partner's sero-status;
• The acquisition of attention and "victim kudos";
• The hope that having the virus will empower and make the individual a better person;
• Simple, plain excitement.
"For some men, sex without a condom fulfills a variety of deeply important needs, some of which are actually spiritual. Then there are men who have taken on the identity of the barebacker because it is their way of remaining a sexual outlaw."
~ Michael Shernoff [HIV+ gay psychotherapist]
"I [didn't] care enough about myself to prevent it happening... And perhaps, if I am really honest, I actually wanted some means of opting further out of 'normal' society that had never welcomed me... HIV was a further step away for someone already conditioned to feel like an outsider."
~ Paul Bakalite [Positive Nation]
When the crystal meth high is thrown into the equation, it can prove potently persuasive in influencing such a person to risk acquiring HIV, and during the crash period when his mind is depressive and raped of self-
worth and respect, safe sex can fall way down the list of considerations.
A 2002 study of 518 MSM in New York found that 49% blamed the rise of barebacking on "boring" safe sex campaigns and 48% cited treatments. 1,500 New Yorkers a year still die from AIDS-related illnesses, and a further 1,000 don't discover their status until already sick.
"Some HIV prevention experts label the treatments 'protease disinhibitors', because they have lulled many gay men into believing that contracting HIV is less like getting cancer and more like getting diabetes, merely a matter of swallowing a few pills a day."
~ Johann Hari [Attitude Magazine]
The "Lazarus effect" of combination therapies in stemming and even reversing the progression to full-blown AIDS - by blocking viral replication within existing cells at different stages in the life cycle of the virus - means that young MSM today aren't witnessing the harrowing, relentless death toll that defined the 1980-90s. Neither are they registering the impact of sustained, upfront safe sex campaigns which have all but dwindled in the wake of antiretrovirals arriving a decade ago, when AIDS agencies worldwide prematurely and recklessly hailed them as a silver bullet.
"HIV meds aren’t a cure and can be lethal themselves. Despite all the advances, someone diagnosed with HIV is still likely to die from complications associated with the virus or the meds they’re taking to fight it. That’s a message that’s not getting out there, especially to younger gay men. A 21-year-old who learns today he has HIV can expect to die in his mid-40s."
~ Chris Crain [New York Blade]
A tidal wave of complacency by the gay men's HIV sector has culminated in today's soaring conversion rates, particularly among younger MSM who naively perceive AIDS as a treatable and manageable disease, yet who have no concept of consuming a cocktail of noxious drugs at set times each day that induce, night sweats, nausea, insomnia, constipation and loss of appetite, to name a few of the side effects that are part and parcel of keeping AIDS at bay, not to mention the increased risk of developing lung, liver and heart disease and/or cancer from these toxic medications.
[See AID$ Inc. Uncovered]
"When protease inhibitors arrived in 1995, consultants hit hard and hit early. By putting their patients on triple therapy regardless of CD4 count, they thought they were treating them correctly. After five years they saw the side effects: lipodystrophy, osteopaenia, lactic acidosis, enuropathy, heart, kidney and liver problems"
~ Jon Kaiser [US HIV Physician]
HIV medications have created a further dichotomy in that the complacency that has crept in in their wake and served to undermine the threat of exposure to HIV has seen increasing numbers of MSM being diagnosed with HIV too late for such treatments to be effective. With up to 50% of people with HIV in the West aware of their status, in 2006 as in 1986 MSM are dying of ignorance, but this time around for all the wrong reasons; the British HIV Association alone estimates that 35% of HIV-related deaths in the UK are due to late diagnoses.
"Having lived with, worked with and spent an inordinate amount of time with HIV+ people, I think I've seen, heard, smelt and dealt with just about every side effect known to man and a few that I swear have not yet made their way into medical books."
~ Andrew Balkin [Plusve]
"Whenever I enter my [AIDS] clinic, no one is happy and most seem close to tears... Half of the people I chat to there say the same: 'Why did it have to be me, why do I have to live like this?'"
~ Andrew Nield [Positive Nation, June 2006]
While the last decade has seen a stripping away of negative images and perceptions of HIV+ men, at what point does a more enlightened attitude actually become counter-productive?
"You used to walk down the street and see death everywhere. People with lesions on their faces, people on crutches and in wheelchairs, if they could even go outside. I used to go to memorial services every weekend. This was a community of ghosts, and that is not true anymore."
~ Michael Siever [Stonewall]
Adverts for protease inhibitors invariably portray HIV+ individuals as rippling, testesterone-soaked sportsmen engaging in active outdoor pursuits ranging from sailing to rock-climbing. Indeed, for many HIVers who once stared death in the face, muscle-enhancing steroids and growth hormones are part and parcel of their prescribed medication, leading some MSM to naively equate HIV as a short cut to a desired physical ideal.
"All the ads in the gay press talk about how healthy, happy, active and handsome you can be if you take this new drug. Of course, it takes three pages for these ads - two for the photo of the healthy, active man and the other page for the eight-point type of horrifying side effects."
~ Here Magazine
Some campaigners argue that propping up the self-esteem of HIV+ men has served only to overtake and obstruct HIV prevention work. "HIV prevention is not supposed to be about making positive men feel good about themselves," says New York psychologist Walter Odets. "It's supposed to be about protecting negative men."
"AIDS prevention messages had not weighed the needs and experience of HIV- men specifically, choosing instead to broadcast a generic "play safe" themed tailored to avoid offending men who were HIV+. Other language in the AIDS liturgy seemed to dangerously minimise the impact of HIV and failed to state plainly that being HIV- is better than being HIV+."
~ Duncan Osborne [Author, Suicide Tuesday]
In San Francisco, Stop AIDS Project was vehemently attacked by politically-correct AIDS organisations and community health groups for its upfront, non-sugar coated but truthful 2002 HIV Is No Picnic campaign - a series of posters depicting the ravages of AIDS, including lipoatrophy (above) and crix belly - while more recently the city's AIDS Health Project was bombarded with complaints for displaying a banner proclaiming "Stay Healthy, Stay Negative", due to the slogan's implication that HIVers are not healthy.
"I really wish people could come and sit in here for a day and observe all the wasting, all the fat bellies. If we had these photos out there, maybe things would be a little different."
~ Sally Putnam [Nurse Co-ordinator, AIDS Consultation Centre, Maine]
During the early years of the disease, MSM who displayed AIDS symptoms were often made to feel alienated from the rest of gay society. Today, in large coastal cities around the US, being HIV+ is the status quo and HIV- men can find themselves marginalised and even excluded from the HIV+ mainstream; a form of reverse social stigmatisation that is prompting some to deliberately dispense with precautions and become infected simply in order to conform to the so-called "norm", or fraternity, of HIVers.
AIDS service agencies are run by committees largely comprising HIV+ men, so it is reasonable to surmise whether the interests of HIV- men have been sufficiently, or even impartially, represented in recent years.
"If the owners of unsafe sex clubs are like tobacco farmers, the policy wonks at GMHC and the libetarians of ACT UP are like tobacco company spokesmen - all AIDS doublespeak and no common sense."
~ Gabriel Rotello [Author, Sexual Ecology]
Politic correctness and the reluctance to risk offending HIVers has stymied honest, truthful and open debate about AIDS to such a degree that the rising tide of transmissions can be leveled squarely at their collective failure to convey appropriate and effective messages that are designed, above all else, to ensure that negative men stay negative. A recent London HIV campaign by GMFA (Gay Men Fighting AIDS) around condomless sex, for example, was roundly condemned by health professionals and HIV- and HIV+ men alike for resembling an HIV+ recruitment exercise for HIV-
"So long as a campaign is directed at those genuinely at high risk of infection, there's nothing wrong with employing harder-hitting tactics to induce a bit of fright. If that protects health and saves lives, then frankly, the end justifies the means, and we shouldn't shy away from it."
~ Peter Gill [Author, Body Count: How they turned AIDS into a Catastrophe]
"95% of HIV+ people would not care if an advert implied it's dumb to fuck without a condom, or that saggy arses and diarrhoea stink and will ruin your lovely gay image - whatever it takes to deter someone going through what they went through!"
~ Ricky Dyer [HIV+ journalist]
Says Louise Hogarth, director of the 2003 documentary film The Gift, which explored bug chasing and "gift givers": "I want to see less death out there and more life. No one really knows anymore what it means to get HIV. Herb Ritts died but nobody mentioned HIV. There's great denial. We in the gay community have almost made it positive to be positive. People don't discuss their status, and when they're negative they're kind of ashamed, but when you're positive you're out and proud."
Doug Hitzel, who features in Hogarth's film, moved to San Francisco when he was 19. "He was too young to get into bars, wasn't a bodybuilder, and the one community he was accepted into was the barebacking community," she continues. "You weren't allowed to reveal your status, and if you asked to use a condom you were told to leave. Doug was gay but totally accepted it in his high school. His family supported him. It was the gay community that was the problem."