Return of the bug chaser: a controversial documentary on gay men who seek HIV infection gets its U.S. premiere, renewing a national debate about unsafe sex and AIDS.

What does it take to get gay men to confront the realities of unsafe sex and AIDS? As HIV infection rates rise and ignorance about the disease grows, blunt anger and sensational media stunts are becoming the responses of choice.

When Louise Hogarth's controversial documentary The Gift first appeared at selected film festivals last year, it was quickly labeled sensational. The movie profiles two young gay "bug chaser"--HIV-negative men who seek out the virus flint causes AIDS--and a group of others who engage in "barebacking" (anal sex without a condom). It sparked a widespread debate about the unsafe sexual practices of gay men.

Now, as part of an evening of documentary programming called "Know HIV/AIDS" on February 2, the Sundance Channel has given the movie its long-awaited U.S. television premiere, and the debate is heating up once again. It's a debate, Hogarth says, that gay people need to have, and not because she believes bug chasing is a growing trend. "I used bug chasers and gift givers as a hook," she explains. "I think it's very peripheral behavior. I want people to think, Gee, I'm not a bug chaser, I'm not a gift giver, but I'm having unsafe sex in a community that may be 50% infected. What am I then? It opens a discussion about a behavior that is denied or at best sheepishly admitted."

Some gay and AIDS activists don't see The Gift that way, however. They have criticized Hogarth's approach, arguing that it is sensationalistic and potentially harmful because it draws attention away from the extensive work being done to reach out to at-risk groups of gay men. In seeking funding for the film, Hogarth was turned down for several grants and shunned by almost every major AIDS organization.

She found support, however, in Michael Weinstein, head of the Los Angeles-based advocacy group AIDS Healthcare Foundation. "It's not important that bug chasers are 1% or 2% or 10% of the population," says Weinstein, whose organization contributed $10,000 and some office space to Hogarth's project. "What's important is, it's part of a continuum of an acceptability for unsafe, sex. We have lost safe sex as a community norm. We can be concerned about malting people feel bad, or we can be concerned about protecting our community."

Weinstein, Hogarth, and others cite recent reports showing dramatic increases in HIV infection among young gay men. A Centers for Disease Control and Prevention analysis of 102,590 people in 29 states found that HIV diagnoses increased 17% among gay and bisexual men between 1999 and 2002. At a public forum in New York City in November, Tony award winner Harvey Fierstein, a Hogarth supporter who praises her resolve amid strong opposition to the film, cited the latest statistics and asked why there was such a dearth of safe-sex messages for gay men. Many young gay men still seek inclusion through sex, he says, and it leads to irresponsible behavior.

And irresponsibility is key to rising HIV rates, says Manuel Rodriguez, director for Positive Action for Living Safely, a program run by AIDS Project Florida. He suggests that Hogarth's film isn't enough if it doesn't educate people about responsibility. "The whole issue of responsibility must be addressed all the time, everywhere," he says. "A follow-up or an educational piece should follow the screenings [of The Gift]. [HIV-positive people] have the gift of knowledge. The gift of knowledge is invaluable."

But the level of responsibility that men who have sex with men associate with that gift of knowledge may vary greatly. When asked what his responsibility to a sexual partner is, Mark, an HIV-positive gay man from Texas who declined to reveal his real name, says it doesn't go further than disclosure. "My responsibility is to let them know [I am positive] and let them make their own decision since they are an adult," says Mark, who cruises Interact chat rooms for sex. He believes gay men "shouldn't be worried about HIV anymore," because medical care "has it under control."

It's precisely that attitude and ignorance about life with the disease that AIDS activists say they are trying to address, some with increasing bluntness. In Seattle the MSM/HIV/AIDS Taskforce, a coalition of health officials, gay men, and AIDS activists, recently released "A Community Manifesto: A New Response to HIV and AIDS" in 2003 in response to rising rates of STD infection in Seattle and surrounding King County. The manifesto pulls no punches, calling on men who have sex with men to be more responsible and arguing that disclosing HIV status doesn't grant permission to practice unsafe sex. The manifesto even goes so far as to say, "Transmitting HIV knowingly is an act of violence."

Quinten Welch, a member of the Taskforce and an educator consultant for Public Health of Seattle and King County, describes the "act of violence" statement as "pretty strong and pretty harsh," but, as is the case with Hogarth's film, he says it was designed to start a discussion on "ethics and responsibility, that bad word we never talk about."

And create a discussion it has. On the manifesto's Web site many gay men, both HIV-positive and HIV-negative, have applauded the manifesto for trying to say something new. Others have been far less enthusiastic. One respondent wrote, "Whether or not barebacking is 'acceptable behavior' is for the individual to decide. For you to mandate what is and is not 'acceptable behavior' is ludicrous."

Welch argues that as the AIDS crisis matures, new factors come into play, whether it's the rise of crystal meth addiction or younger men not being able to conceive of AIDS as a health threat. "It's a very complex issue that people aren't willing to go to because we are a sound bite society," he says. "We're trying to drag people kicking and screaming toward these very complicated issues."

For her part, Hogarth thinks the issue couldn't be more simple. "Just tell the truth," she says, adding that ads for anti-HIV drugs often fail to paint an accurate picture, including their sometimes-devastating side effects. "Let's have an ad with a man wearing diapers," Hogarth suggests. "Do you think any gay man would want to get that disease? Why isn't the truth being told?"

Lisotta is a freelance writer based in Los Angeles.