London Times Article: Are Gay Men Complacent About HIV Infection?

HIV and the rise of complacency

Is it time to revive the ‘Don’t die of ignorance’ message of the Eighties?

There’s a scene in Jonathan Harvey’s play, Canary, in which two gay men — one young, one middle-aged — are about to have sex with each other for the first time. The younger one announces that he is into “BB” — barebacked sex or sex without a condom. His older conquest is appalled. “What if I’m HIV?” he demands. The younger man shrugs. “So what if you do give me something?” he replies. “I’ll just take pills.”

Of all the scenes in Harvey’s acclaimed drama about homosexual experience over the past five decades this one is attracting the most attention. This is because it epitomises an issue worrying many people within the gay community — a new complacency about HIV.

Many older gay men now believe that some younger ones are blasé, even reckless about contracting HIV. There’s a significant minority, they believe, who regards it as no more serious than any other sexually-transmitted disease, comforted by the availability of powerful anti-retroviral drugs and the message that it’s now a “manageable illness”.

There are even claims of some men knowingly exposing themselves to the virus thinking it “no big deal”. Critics say that health campaigners have been so concerned to destigmatise HIV that they have softened its image.

Harvey, 42, noticed the shift about five years ago, and believes that it coincided with HIV-infected people surviving for many years on combination therapy. He says that he is aware of “younger people who see unsafe sex as an option, a risk worth taking, and more enjoyable and exciting”. They “see an interest in safe sex as boring and fuddy-duddy and old-fashioned”. As the young man, Toby, says in Harvey’s play “HIV’s like an old man’s disease. It’s so last century”.

Of course, those under 23 weren’t even born when the grim tombstone public health adverts blitzed our TV screens in 1987. Most of today’s young gay men have never attended the funeral of someone who has perished from Aids. They probably cannot imagine just how much stigma there was. Life has moved on and for the straight community too. HIV has dipped beneath the radar. We vaguely assume it’s a virus that has been conquered. It hasn’t.

Within the past decade the infection rate in this country has doubled. Statistics from the Terrence Higgins Trust show that in 2008 there were more than 7,000 new diagnoses. Ten years earlier in 1998 there were fewer than 3,000. Of those new diagnoses in 2008, 38 per cent were among men who have sex with men. Roughly two-thirds of the total of infected people were male. The largest proportion of the heterosexual group is black Africans, many of whom would have caught HIV in Africa but have received the diagnosis in the UK. In 2008, 571 people died from HIV-related illness.

Many gay men believe that tougher campaigns are needed. Karl Riley, 24, a journalist who writes about gay issues says this is a “confused generation” receiving conflicting messages. Recent health campaigns have focused on how to “minimise the risks” rather than vetoing unprotected sex. Meanwhile, a culture is flourishing, fuelled by gay pornography, glamorising “barebacking”, perpetuating the message that “only unsafe sex is real sex”. Riley says: “Our generation has not lost people to this disease. We’ve had a very different experience of HIV . . . but we need to be told the top line. We need to know how many people are getting it and to have a better awareness of what HIV can do.”

It was Riley who broke the story about three young men who contracted HIV on the British set of a porn film, shot without condoms. One of them, interviewed for Boyz magazine and Newsnight said that he “wasn’t bothered he had HIV, and that being gay he always knew he’d get it”. In a debate on the issue, Time Out’s Paul Burston told of a conversation he’d had with a 22-year-old in Liverpool, who said he was more worried about catching gonorrhoea than HIV. As Riley says of his generation: “We’re not scared of HIV, and it’s no wonder. Sex education in schools barely touches on HIV and gay sex … HIV prevention charities [should] catch those who fall through the net. Yet instead of giving us a picture of what our lives could be like if we bareback, they choose to empower us.”

This new insouciance is also giving rise to wild claims, such as that some actively seek out the virus wanting to belong to its “community”. A subculture known as “bug-chasing” in which individuals pursue sex with HI- infected people has its own Wikipedia entry though most experts say there is no evidence to support it and it’s largely a myth.

Harvey, who wrote Beautiful Thing, the BBC sitcom Gimme, Gimme, Gimme and is a scriptwriter for Coronation Street, says one of the things which motivated him to write Canary was that, because most gay men don’t have children, important stories weren’t being passed down the generations. “I know all about my family from my grandma but if you don’t have kids who do those stories get passed on to?” he asks. “I’ve lived all my sexually active life knowing about HIV and Aids. There wasn’t a time when I didn’t know you had to wear a condom . . . it’s different for this generation. But the show isn’t just about this. It’s about a bigger apathy. In my day we had Thatcher and one of the benefits of that was that she made such horrible laws about gay people we all clubbed together and made a stand. It kept the community together. That’s lacking now. There’s not really a common cause to fight against.”

Is it, as some suggest, time to resurrect clunking-fist campaigns?

Alan Wardle, head of health promotion at the Terrence Higgins Trust, denies the suggestion that campaigns are too soft. “We try to give people the best information we can to make the best choice they can. But it is an ongoing challenge — there are only so many different ways you can say ‘use a condom’. We know from the anti-smoking campaigns that fear isn’t enough to stop people doing it.”

He says the number of people with HIV in this country continues to grow with groups most at risk being gay men and black Africans of both sexes. But he defends the young gay generation against accusations of recklessness. “There’s this notion that there’s a whole host of young, gay men dispensing with condoms and thinking it’s a risk worth taking but I don’t think there’s the evidence to back it up.” Though contracting HIV is “not the death sentence it used to be”, he says, “you will be putting quite toxic medicine into your body for the rest of your life and HIV is still quite highly stigmatised.”

Some think that “dread ad” campaigns are self-defeating and that the issue is too complex for a sledgehammer approach.

Trevor Hoppe, an American academic specialising in sexuality and sociology and a well-known voice in health activism in the United States, believes that public health scare tactics have in some cases caused a backlash. He says: “This isn’t the perspective of the majority of gay men, by far, but a minority who are very vocal and proud of their rejection of HIV prevention. I believe that is their right, and at the same time I think it is the product of abstinence-only, fear-mongering health promotion that laid the Orwellian foundation for such a visceral and at times militant resistance.”

Hoppe says that for today’s young gay men “Aids just isn’t their starting point for understanding their sexualities. That doesn’t mean that they are careless about HIV — on the contrary, my research with young gay men suggests that they’re well aware of HIV and do what they can to avoid contracting it. This varies geographically, of course.

“I’m shocked to discover that my students — both gay and straight — at The University of Michigan often have little idea of how HIV is transmitted. The less information they have, the more scared they are about HIV. They are a product of Bush-era abstinence-only education, and they are totally clueless. That is a tragedy.”

Some believe that another price to pay for a new HIV epidemic would be a return to the dark days of extreme prejudice.

“Gay people feel no different from straight people which is great in terms of how times have changed,” says Jonathan Harvey. “But I don’t think homophobia has disappeared in the same way that I don’t think racism has disappeared. It’s just that the gay community has become visible and strong and is answering back. But it doesn’t mean that a boy comes out of a club and doesn’t get beaten up.”

As the older man in Canary says, if the young heed the safe sex warning and stay healthy then the wretched, skeletal souls we remember from the 1980s won’t have died for nothing.