April 3, 2005

AIDS Fighters Face a Resistant Form of Apathy

By ANDREW JACOBS

Where have all the condoms gone?

Don't try looking at the Monster, the Hangar, Starlight or Barracuda.
On a recent evening, these and more than a dozen other Manhattan gay
bars were well stocked with free going-out guides, but not a scrap of
literature about H.I.V. prevention or the perils of crystal meth. As
for condoms, the frontline defense against sexually transmitted
diseases, only one establishment stocked them - behind the bar.

As part of his graduate course work at New York University, Michael
Marino set out last winter to compare the AIDS prevention efforts of
New York and London. He was troubled by what he found. At most New
York bars, and even at some bedrock gay and AIDS service institutions,
educational pamphlets and free condoms were hard to find, if not
impossible. In London, Mr. Marino found them easily.

"No wonder things are getting so out of control here," he said.

Condoms, which still can be found in vending machines at a handful of
places, were once given away by the bucketful. While no one believes
free condoms will completely halt the spread of H.I.V., their
disappearance from bars, the equivalent of a town hall for some gay
men, is a telling indicator of how much steam has been lost in the
fight against AIDS.

Although the city health department's recent warning about a rare,
possibly more virulent strain of H.I.V. has caused a stir among gay
men, many AIDS activists hold out little hope the news will prompt
substantial or lasting changes in behavior. They point to the
continued popularity of methamphetamine, which has contributed to a
rise in condomless intercourse, known as barebacking, and the
widespread apathy in which H.I.V. is seen as a nuisance, not a
potential killer.

Compounding this laissez-faire attitude, they complain, are drug
company advertisements that gloss over the disease's effects by
portraying patients as the picture of perfect health.

Locally, at least, the statistics paint a mixed picture. The number of
new H.I.V. infections among men who have sex with men declined
slightly from 2001 to 2003, according to the most recent figures
available, although in much of the country that number has been
rising. But AIDS service providers, pointing to a recent spike in
syphilis cases and the rise of methamphetamine abuse among gay men,
fear it is only a matter of time before New York faces a new surge in
infections.

The challenge is far more complicated than handing bar patrons
informational brochures and telling them to be good, prevention
specialists say.

"Just because folks are well informed doesn't mean they'll necessarily
make the wisest choices in terms of their health," said Dr. Ronald O.
Valdiserri, who oversees AIDS prevention at the Centers for Disease
Control and Prevention. "This is true of all humanity, not just gay
men."

The reality that gay men continue to have unprotected sex has been
vexing health experts for 20 years, although the struggle became even
more daunting in the mid-1990's, when a new class of medications
sharply reduced death rates and fed the misconception that AIDS is
only about as troublesome as the flu.

And then there are those who disdain condoms. With the specter of
imminent death gone, the idea of using condoms has become an annoyance
for many. "Let's face it, sex with a condom is not as good," said Dr.
Robert L. Klitzman, a psychiatrist and professor at Columbia
University. "Sex is supposed to be an incredibly intimate moment, and
it's not as intimate when there's a piece of plastic between you and
your partner."

There is a growing sense that the traditional sloganeering about
condoms and club drugs is about as effective as birth-control
campaigns that rely on abstinence. The only hope for changing
behavior, public health experts and psychologists say, is to recognize
and address the underlying factors that propel men into risky
situations. Loneliness, alienation and self-hatred, they say, are the
real culprits that need to be addressed.

But others, describing such talk as naïve, say it makes more sense to
stress personal responsibility. Demonize crystal meth, stigmatize
unprotected sex and remind people that living with H.I.V. can be
grueling, or worse. An important first step, they say, would be to
stop running pharmaceutical ads that portray people with AIDS as
carefree and virile.

Other ideas include following the lead of the San Francisco health
department, which is seeking strict limitations on the availability of
erectile dysfunction drugs that counteract the impotence induced by
crystal meth and encourage the spread of sexually transmitted
diseases.

Many AIDS activists in New York, describing current public service
campaigns as toothless and ineffective, say bus ads and billboards
should remind people that AIDS is a devastating and entirely avoidable
illness.

Many prevention advocates agree that only a creative, ever-changing
arsenal of tactics can reduce the number of new H.I.V. infections.
They point out that it has taken years and millions of dollars to
change public attitudes about tobacco and seat belts, and even now
reasonable people lapse into old ways.

"Everyone knows smoking is bad for you, but we still print those
health warnings on cigarette packs," said Kwame M. Banks, a consultant
specializing in prevention work. "People need to hear these messages
100 times a day. That's the way these things work."

Still, when it comes to H.I.V. and AIDS, some wonder whether it is
time for a new strategy. Perry Halkitis, a psychologist at New York
University who studies the relationship between drug use and sex,
believes that many gay men who engage in risky behavior are grappling
with profound mental health issues.

"People are not taking risks because they're stupid, or because they
wake up one day and say, 'I'm going to take a risk today,' " Dr.
Halkitis said. "They do it because the sexual risk fulfills a need, or
somehow makes them feel better about themselves."

He and others say any successful fight against H.I.V. must deal with
depression, substance abuse and low self-esteem, problems that studies
have shown affect gay men at disproportionately higher rates.

"Many people might argue that as a community, we suffer from
post-traumatic stress disorder because we're so ostracized by
society," Dr. Halkitis said. "Being rejected by family, by our
churches, and these days by our government most certainly has an
impact."

That emotional fragility has been compounded by the trauma of the
1980's and early 90's, when sickness and death permeated the lives of
so many. Peter Staley, a veteran AIDS activist, said it was no
coincidence that some of the first people in New York to pick up
crystal meth habits have been men 35 to 45 years old.

"We are the long-term survivors who watched friends die, who never
thought we'd live to have a midlife crisis," said Mr. Staley, who is
H.I.V.-positive and himself a recovering meth addict. "Then the new
medications came along, and suddenly everyone returned to their old
lives and people moved on to other issues, like gays in the military
and gay marriage. Where was the communal processing of the emotional
hell we had just gone through? I think as a result we're a deeply
scarred group."

While such scars can lead to substance abuse, psychologists say the
internalized homophobia and deep-seated feelings of low self-worth are
just as powerful. That is where the allure of crystal meth kicks in.
Those who have used the drug say it tends to blot out feelings of
vulnerability, boosts self-confidence and imbues them with a false
sense of connection to strangers.

Then there are the "bug chasers," H.I.V.-negative men who actively
seek infection. Although such men are thought to be few in number,
mental health experts say the phenomenon reflects the intense
alienation that many gay men feel. Louis Pansulla, a psychoanalyst who
runs gay therapy groups in New York, said younger men, in the
generation that missed the darkest days of the AIDS crisis, believe
that infection will win them membership into a clique, albeit one
coping with a dreaded disease.

"It's almost a longing to belong, even though it's a completely
unconscious thing," he said.

Michelangelo Signorile, the host of a gay-themed talk show on Sirius
Satellite Radio, takes a less nuanced view: "If everyone in your group
is beautiful, taking steroids, barebacking and H.I.V. positive, having
the virus doesn't seem like such a bad thing."

It is for that reason that Michael Weinstein, president of the AIDS
Healthcare Foundation, believes the disease is due for an image
makeover. He cites a hard-to-miss ad in last month's Out magazine that
is embedded with a tiny audio chip and features two robust men on a
beach. Opening the magazine sets off the trill of a ringing phone and
a man's voice essentially saying he is having too much fun to worry
about his chronic illness. Mr. Weinstein has asked the ad's sponsor,
Bristol-Myers Squibb, to stop using the ad for the drug, Reyataz. A
spokeswoman said the company was re-examining its advertising
campaigns.

"People are in such denial about how serious H.I.V. is," Mr. Weinstein
said. "Unfortunately, the best prevention is seeing people die."

Of course, frontline prevention workers hope to avoid a new wave of
deaths. At Gay Men's Health Crisis, prevention workers are planning a
series of events that seek to promote "connectedness and community."

Others are creating antidrug messages that masquerade as packets of
meth that can be dropped on dance floors. A series of subway ads
unveiled by the state for the first time shifts responsibility to
those who are already infected.

And then there are people like Daniel Carlson, a former marketing
executive who became so disgusted by the number of men soliciting
unprotected sex online that he and a friend started a group to combat
the prevailing ethos about sex and drugs. In the past two years, the
group, H.I.V. Forum, has organized a half-dozen town hall meetings on
crystal meth and unprotected sex that have drawn packed houses.

"I know it sounds touchy-feely, but if we could just emphasize a
little bit more community and brotherhood," Mr. Carlson said. "We have
to decide whether we're going to be selfish or whether we're going to
care about one another."

				***

One has to think that in America after 20+ Years of spreading a deadly
disease that killed hundreds of thousands, homosexuals would have a
clue with regards to the damage they're doing. I think it's obvious
that they do understand, it's just that they don't give a fuck. Yet
they demand that society in general tolerate them with out question
and stand aside while they make a free slide into mainstream America
with homosexual marriages and the whole nine yards!

Homo-promiscuity....LAISSEZ LES BONS TEMPS ROULER



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