Sexual Ecology: AIDS, and the Destiny of Gay Men.
Reviewed by: J. Roy Gillis, Ph.D., Assistant Professor, Department of Adult Education, Community Development, and Counselling Psychology, Ontario Institute for Studies in Education, University of Toronto, Toronto, Ontario.
Gabriel Rotello, a gay male journalist and former editor of the now defunct Outweek Magasine, an avant-garde U.S. gay and lesbian magazine, has written a new book chronicling the failures of HIV prevention efforts with gay men in the United States and Canada. Based on a series of interviews with epidemiologists, biologists, virologists, physicians, and psychologists working in the HIV/AIDS area, and a selective review of the social science and public health literature on HIV transmission prevention, Rotello presents his rather simplistic thesis. This thesis, evident from the book's title, is that the AIDS epidemic in gay men is a consequence of their violating the natural rules of sexual ecology. The rules of sexual ecology that gay men are alleged to have violated include indiscriminate selection of sexual partners, failure to practice serial and/or longterm monogamy with sexual partners, participation in unhealthy sexual practices such as "rimming" (oral-anal sexual contact), and failing to avoid alcohol and substance use during sex. According to Rotello, major contributors to the AIDS crisis have been the tendency for gay men to: (1) be flexible in their sexual roles and engage in both receptive and insertive anal sex, thereby increasing the rate of HIV transmission; (2) engage in receptive anal sex with many partners, thus exposing themselves to a large pool of infected partners; and (3) to be "sexual tourists" who feel compelled to sample the sexual pleasures of the numerous regions they visit in their extensive travels, thereby helping to spread the HIV epidemic worldwide.
The above litany of stereotypes and over-generalizations about gay male sexual behaviour based on the experiences of a small urban elite core of gay men is Rotello's proof of the destructiveness of modem gay male sexual behaviour. His arguments are eerily similar to those of the Christian right wing who promote the belief that AIDS is God's punishment against gay men. Simply and frequently argued by Rotello is the conviction that gay men of the new gay liberation era have too many sexual partners, and that no amount of condom promotion or safer sex education will stem the tide of the HIV pandemic until gay men become monogamous. Few of the major players in the HIV/AIDS enterprise emerge unscathed from his pointed, and at times, unfair criticisms. Community-based organizations in the U.S. gay male community, in particular New York City's Gay Men's Health Crisis (GMHC) and San Francisco's Stop AIDS Project, are treated with particular scorn. GMHC and Stop AIDS are accused of putting political correctness above the health of gay and bisexual men, and taking the easy route for advocating the use of condoms during anal sex, rather than urging abstinence from anal sex and preaching long-term monogamy.
Rotello presents the results of some interesting theoretical modelling concerning the spread of HIV infection among the gay male community which suggest that a core group of gay men practising frequent receptive anal sex with many partners, primarily in the bath houses and sex clubs, provided the necessary conditions for HIV infection to reach a prevalence of 40 to 60% among gay men in major urban centres. This is the violation of the rules of sexual ecology to which Rotello so often refers. According to Rotello, anyone engaging in intimate sexual practices with a large number of partners, especially practices such as anal sex which involve the exchange of body fluids, is doomed to experience catastrophic health consequences. In Rotello's view, the emergence of HIV (or some other type of equally serious viral or bacterial) infection in the gay male community was not an accident, but a statistical inevitability.
One of the most glaring errors in the book is Rotello's endorsement of monogamy as a useful strategy for HIV prevention among gay men. By promoting monogamy as the primary prevention message, he falls to give sufficient consideration to the fact that the incidence of HIV infection in the urban gay male community was high, even before HIV was isolated. This early prevalence estimate of HIV is known because Hepatitis B had been recognized as a serious problem in the gay male community by the late 1970s, and blood samples from sexually active gay men had been collected and frozen to study the seroprevalence and assist in the development of a vaccine. When an antibody test for HIV was patented, researchers tested the stored blood of the men and found that a majority of the gay men in the Hepatitis B trials had already contracted HIV (Hessol, Lifson, O'Malley, Doll, Jaffe & Rutherford, 1989; Stevens, Taylor, Zang, et al., 1986). Thus, as early as 1980, the probability for many gay men that the current partner they were having sex with was infected with HIV was greater than 50%. Therefore, a reduction in the number of sexual partners, unless it was to zero, was not a useful prevention strategy for urban gay men, even at the earliest recognized stages of the HIV pandemic.
The emerging reports of new HIV seroconversions in young gay and bisexual men (Dean & Meyer, 1995; Service & Blower, 1995) are taken by Rotello as final proof of the failure and futility of current HIV prevention and education efforts focused on safer sex strategies. He suggests, instead, that agencies and professionals working in HIV prevention with gay men focus on preaching monogamy, avoidance of anal sex, disclosure of HIV serostattis to partners, and self-esteem enhancement. This premature conclusion about the ineffectiveness of safer sex is perhaps his greatest error in logic made in the book. Clearly, some failure in such a major behavioural change with a community, as evidenced by a return to less safe sexual practices by older gay men and the lack of younger gay men's embracing safer sex strategies, is to be expected. No one expected at the onset of the HIV epidemic that a cure or vaccine would be so elusive, and that behavioural change would have to be maintained for so long and so rigorously. It is also unfair to suggest that AIDS interventions with gay men have focused solely on condom distribution, as Rotello claims. Popular HIV intervention strategies have included sexual negotiation and assertiveness training, accurate risk appraisal, promotion of abstinence and/or monogamy, self-esteem enhancement, avoidance of drug and alcohol use during sex, and communication skills training (Kelly, 1995). In fact, results of recent epidemiological studies with young gay men (Service & Blower, 1995) indicate that having unprotected sex with older gay men, a cohort with high HIV seroprevalence, rather than total sexual partner numbers is predictive of HIV seroconversion. Furthermore, studies of HIV seroconversion among older, non-monogamous gay men have found an association between unprotected receptive anal sex and the use of amyl and butyl nitrites, rather than data that support Rotello's assertion that the total number of sexual partners is predictive of seroconversion (Ostrow, Beltran, Joseph, DiFranceisco, Wesch, & Chmiel, 1993).
One comes to the conclusion from reading Rotello's book that his promotion of monogamy and committed relationships among gay men is really a moral agenda, consistent with the assimilationist perspectives of the gay U.S. Republican right (e.g., Sullivan, 1995), rather than a biological imperative derived from ecological principles. Perhaps, the "destiny of gay men" and those providing HIV/AIDS services to them should be to continue to adapt the range of safer sex strategies to the uniqueness of the gay and bisexual male experiences, with a particular emphasis on gay male youth. Rather than embrace the heterosexist attitudes of the dominant society, committed individuals and groups should strive to extend the successes of earlier HIV prevention efforts with gay men which focused on empowerment, choice, and responsibility, rather than attaining ecological acceptability. By asking the gay male community to adopt the same HIV prevention strategies promoted for heterosexuals, which are far more likely to focus on monogamy and abstinence, Rotello is recommending that successful HIV prevention strategies be traded in for strategies with a long history of failure.
Dean, L., & Meyer, I. (1995). HIV prevalence and sexual behavior in a cohort of New York City gay men (aged 18-24). Journal of Acquired Immune Deficiency Syndromes & Human Retrovirology, 8, 208-211.
Hessol, N.A., Lifson, A.R., O'Malley, P.M., Doll, L.S., Jaffe, H.W., Rutherford, G.W. (1989). Prevalence, incidence, and progression of human immunodeficiency virus infection in homosexual and bisexual men in Hepatitis B vaccine trials, 1978-1988 American Journal of Epidemiology, 130, 1167-1175.
Kelly, J.A. (1995). Changing HIV risk behavior: Practical strategies. New York: The Guilford Press.
Ostrow, D.G., Beltran, E.D., Joseph, J.G., DiFranceisco, W., Wesch, J., & Chmiel, J.S. (1993). Recreational
drugs and sexual behavior in the Chicago MACS/CCS cohort of homosexually active men. Journal of Substance Use, 5, 311-325.
Service, S.K., & Blower, S.M. (1995). HIV transmission in sexual networks: An empirical analysis. Proceedings of the Royal Society of London-Series B: Biological Sciences. 260(1359), 237-244.
Stevens, C.E., Taylor, P.E., Zang, E.A., et al. (1986). Human T-cell lymphotrophic virus type III infection in a cohort of homosexual men in New York City. Journal of the American Medical Association, 225, 2167-2172.
Sullivan, A. (1995). Virtually normal: An argument about homosexuality. New York: Alfred A. Knopf.
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|Author:||Gillis, J. Roy|
|Publication:||The Canadian Journal of Human Sexuality|
|Article Type:||Book Review|
|Date:||Dec 22, 1997|
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