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Risky business: as many gay men continue to have unsafe sex, AIDS educators take blunt steps to reduce potential harm.

Every few months hundreds of gay men gather in Seattle for an evening of entertainment hosted by any one of several local drag divas. But the event is not just another night of fabulous performances. Instead the evening, sponsored by the group Gay City Health Project, is devoted to helping gay men maintain their commitment to safer sex by strengthening the ties among them.

"We asked men what they wanted, and the most common suggestion was to build community, " says John Leonard, the group's executive director. "They've heard the messages about using a condom every time, but they said what would make the most difference was if they had a stronger sense of support from one another, if we focused more on self-esteem and feeling good about ourselves. We took that as our mandate. "

Since its founding in April 1995, Gay City has seen its budget, which is funded by government grants, more than quadruple. "It's pretty surprising because we're unflinchingly queer in our language, approach, and images," Leonard says. For example, an event about anal sex was titled "Tunnel of Love: The Greatest Hole on Earth." Discussions are often frank, with men talking bluntly -- and honestly -- about their sexual practices. To judge from the turnout, gay men like the combination of entertainment and discussion that characterizes each forum. "We've been successful at getting these really large crowds, and that's pretty unique," Leonard says. Apparently unperturbed by Gay City's explicit approach, the Centers for Disease Control and Prevention has given the group its imprimatur with a grant for a media campaign.

The formula that Gay City has developed, which is increasingly being adopted by other AIDS groups around the nation, is based on a simple Premise: The old AIDS education doesn't work. Indeed, the founders of Gay City created the group because they were dissatisfied with the efforts of the local AIDS and health agencies for whom they worked. What was needed -- and still is needed, they believe -- was something new. "In 1998 you're not going to get many people to turn out for another AIDS lecture," Leonard says. "People are over it. "

Others agree. "I think, with all the changes in the epidemic, our education efforts have to be revamped and retooled," says Scott Hitt, chairman of the White House's Presidential Advisory Council on HIV/AIDS. "What worked five years ago may not work as well today. The scare tactics of this bad disease, with our friends dying, may not be as scary anymore in light of new therapies. You always have to retool education. "

That unsafe sex is on the upswing is a widely accepted assumption but one that is difficult to pin down precisely. According to Richard Elovich, director of HIV prevention at the New York City-based Gay Men's Health Crisis, the nation's largest AIDS service organization, young gay men are becoming infected with HIV at a rate of up to 4% a year, far above rates from the late 1980s. A survey of gay clinics late last year found rising rates of venereal disease, considered a sure marker for increased risk for HIV infection. Still, no one knows exactly how serious the problem may be. "In many states they still monitor the AIDS epidemic, not the HIV epidemic," says Hitt. " It's all hearsay. "

However, no one disputes the need for effective education. Exactly how to re-create AIDS prevention is the challenge. Complicating the matter is the current discussion about "barebacking, " or having unprotected anal sex. Receptive unprotected anal sex is one of the most efficient methods of contracting HIV.

Not all gay men believe that the current guidelines for safer sex are accurate. "I think the guidelines were formulated in the mid '80s with the best of intentions, but they haven't been substantially revised since then," says "Doug," a gay man in Los Angeles who declined to use his real name for this story. "We're telling people the same things in 1998 that we were telling them in 1986. "

Doug maintains that the true risk for HIV transmission is borne primarily by men who are the receptive partners in anal intercourse. "What has become obvious from observation is that the only people who become infected are people who've gotten fucked by men who weren't wearing condoms," he says. "Can I prove it medically? I've been having bareback sex as a top for more than a year, and I've been getting tested regularly, and I haven't seroconverted." (AIDS educators maintain that while the risk is lower for active partners in anal intercourse, it is still significant.)

Doug believes that safer-sex guidelines should stress that "the risk in any sexual encounter is a one-way street. We need to teach bottoms that their partner's willingness to forgo a condom doesn't mean he's willing to put himself at the same risk as the bottom. "

Some AIDS educators have gone so far as to set up safer-sex guidelines for barebacking, despite their objections to the behavior. A list in a newsletter published by the People With AIDS Coalition in Fort Lauderdale, Fla., included such suggestions as withdrawing before ejaculation and knowing the viral load of your partner. (The unproved premise behind the latter suggestion is that a low viral load would mean a lower risk of HIV transmission.) However, many AIDS educators criticize such a list as unduly legitimizing unsafe behavior.

The point of most AIDS education is not to moralize, say prevention experts, but to reduce potential harm, a technique first developed in the mid '80s. Given the fact that many men continue to engage in risky behavior, eliminating unsafe sex may be too much to expect from individuals. Indeed, stressing unwavering commitment to safe sex may be so daunting that many men might ignore such a message altogether.

"Our response in terms of HIV prevention is to reach as many people as possible," says Elovich. "That's not going to be a `just say no' message. Preaching and imperatives don't reach people."

In an effort to develop a message that gay men will listen to, GMHC has created a program called Beyond 2000, which, like Gay City, aims at encouraging open conversations among men about risky behavior. One of the most common topics is the use of drugs and alcohol among gay men and the role it plays in their sexual decision making. The agency's approach, Elovich says, is strictly nonjudgmental. "If we demanded that everyone who wants to talk about cocaine use say that they were addicts first, we'd have a lot fewer clients. "

In fact, many gay men claim that drugs enhance their sexual experiences. "I feel like every pore is coming," says one man about crystal. Others say that drugs allow them to drop their inhibitions. One man says he enjoys ecstasy because "I change from a not-that-friendly guy to someone who looks around and just feels like hugging people or telling them about myself or sliding my hands all over them. "

The first issue of Beyond 2000's magazine, b.2K, includes an extensive section on the variety of drugs gay men use, complete with warnings about the possibility of contracting HIV as well as listings of the drugs' unsavory side effects. For instance, crystal use can cause impotence, nicknamed "crystal dick," at the same time it revs up the libido, leading some men to have condomless receptive sex for hours at a time. While noting the dangers of indulging in drugs, the magazine also includes tips for safer drug use, such as drinking water to prevent dehydration while on ecstasy.

Elovich says current prevention efforts allow that the relationship between drugs and unsafe sex is much more complicated than many believe and "not necessarily causal." Drugs may not make people have unsafe sex but instead allow them to have the kind of sex they want. "The experience have with sex isn't always the way we see ourselves in the cool light of day," Elovich says. "A lot of gay men -- and men who don't think of themselves as gay -- wrap up their sex life in a way that doesn't `contaminate' the rest of their life. One of the ways to do that is to have an altered state. "

"People say they are using drugs to focus attention on the pleasures of sex, " says Rafael Diaz, a researcher at the Center for AIDS Prevention Studies at the University of California, San Francisco, who has studied the connection between drug use and unsafe sexual behavior. "They're overwhelmed by issues of homophobia and weariness, and drugs help quiet the voices inside. The condom is the reminder of all that stuff.

Unfortunately, Diaz says, not all AIDS education recognizes that complex reality. "You see these posters: GET STUPID, GET HIGH, GET AIDS, " he says. "People are not getting at the actual meaning of why people are using drugs. "

What AIDS education must do, Elovich says, is "wake people up" to the reasons for their behavior. That was the goal of a recent Gay City event on drug and alcohol use in the gay community. "We want people to discuss and clarify the role of partying in gay culture and the relationship of partying to sex, sexual decision making, and behavior," Leonard says. "Then we want to do some harm-reduction education, to say that obviously gay men are going to continue to drink and use drugs but that they need to do that in a safer, healthier way."
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Article Details
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Author:Gallagher, John
Publication:The Advocate (The national gay & lesbian newsmagazine)
Date:Mar 17, 1998
Words:1567
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