Who Would You Rather Sleep With? – Nicholas Little

When Ontario’s campaign against HIV stigma within the gay community came out last fall, some men (mostly HIV- men, but some poz guys too) reacted negatively to the campaign slogan: If you were rejected every time you disclosed, would you?

While delivering campaign materials to one of the local gay bars a few months back, the bartender cornered me and said, “I don’t like that message.” When I asked him why, he said, “Well, what is it saying? That it’s okay for poz guys not to disclose? Are they trying to excuse non-disclosure because rejection hurts so bad?”

These questions weren’t always easy to answer, and this campaign really stretched my thinking as a result. As an outreach worker with gay men, I was meant to be able to answer questions just like these.

I actually like the slogan because it is provocative and probably accounts for much of the attention that this campaign received. The success of HIV prevention campaigns aren’t measured in terms of the number of viewers reached, but rather in the appreciable ways they improve people’s lives, thereby leading to reduced HIV transmission rates. But you have to get people paying attention to, thinking about and discussing your message if it’s going to have any impact. A controversial slogan helped make this happen.

I think folks who disliked the campaign slogan felt most uncomfortable when they read it as being aimed at HIV+ men. The campaign is, in fact, targeting HIV- guys. It isn’t saying, “Hey poz guys, sick of negative assholes treating you like shit each time you stick your neck out and disclose your status? Well then just don’t bother!” Rather, it’s saying, “Hey negative guys! (or perhaps: Hey guys who think you are negative!…) We know the vast majority of you would very much like to remain HIV- and that’s a worthy goal. But a lot of you are trying to remain negative by keeping HIV+ men as far away from you as possible. And science shows that that strategy just doesn’t work. So let’s rethink things a little.”

When I’d suggest this reasoning to guys uncomfortable with the campaign slogan, the next question that typically followed was, “I don’t get it. How does HIV stigma actually put HIV- guys at higher risk for HIV?” Here’s what the campaign website says:

It is estimated that 17% of men who have sex with men in Ontario are HIV-positive. In Ottawa, it is about 11%. In Toronto, it is nearly one quarter. About 30% of HIV-positive men who have sex with men in Ontario do not know they have HIV.

Discriminating against guys with HIV doesn’t make you safer. HIV stigma and discrimination contribute to a culture of silence in which gay men find it challenging to talk about their HIV status or HIV in general.

Because [guys aren’t talking], some gay men make silent assumptions about the HIV status of their sexual partners based on beliefs they hold about who has HIV or how someone with HIV looks or where someone with HIV has sex.

When we make incorrect assumptions about the HIV status of the other guy in order to have unprotected sex and prevent HIV transmission, we can end up having unprotected sex with a guy whose HIV status is different than our own. This is when HIV transmission can occur.

Other guys would read the campaign slogan and then ask, “So what, now you want me to have sex with HIV+ guys just so they don’t suffer rejection?” Obviously, the answer is no. All men, positive or negative, are entitled to sleep with whomever they like according to whatever criteria they see fit.

But that question also belies an inaccurate view of the gay male community in cities like Ottawa. If 11% of Ottawa gay guys are HIV+ and 30% of them don’t know it, you are already sleeping with HIV+ men. If you hook up online, if you cruise at the bars and leave with a cute stranger or your regular fuck buddy, if you occasionally frequent the baths to see who’s there, if you fool around with that cute dude on your gay volleyball team, if you recently bagged that hot guy you volunteer with on Thursday afternoons – you sleep with men whose HIV status is different than your own.

And that’s totally fine. It just lays bare how important it is to employ harm reduction methods for anal sex. Yes, condoms are obviously the most effective of these methods. But sometimes the “always wear a condom!” mantra can blind us to other important ways to reduce the risk of anal sex:

• Don’t ask if he’s “clean.” Ask when he was last tested and what the result was. Better yet, if you want to know those details about him, start by offering him that info about yourself;
• Get tested for other sexually transmitted infections (STIs). STIs make HIV-positive men more infectious and HIV-negative men more vulnerable to infection;
• Use lots of lube. Tons of lube. Lube reduces friction, which reduces the number of micro-tears in the sensitive tissue in your ass. Tears are an entryway to the blood stream;
• If you know you are positive, there is less risk of infecting your partner if you bottom.
• The lining of the ass is delicate and can be damaged easily. Let your top know how hard you want to ride him once you’ve had a chance to relax the muscles in your butt. And remember that condom-less sex after fisting or rough toy-play is especially high risk;
• It’s safer to pull out before cumming. Pull out right before and watch your load spray all over his back. Or tell him how you want him to blow his load in your face;
• The longer and harder the fuck, the bigger the risk;
• Try to avoid poppers when barebacking. They dilate blood vessels in the rectum, increasing blood exposure while you fuck;
• Don’t douche right before or right after bottoming;
• Get vaccinated for Hepatitis A and B;

If you’re going to bareback, you don’t have to do it with everyone. For dudes who like the intimacy of not using condoms, get that rush with one regular guy you trust and with whom you have open communication. Use protection with the rest.
Here’s what’s forgotten by a lot of gay men I talk to: if I’m an HIV- guy at the start of 2009 and end up HIV+ by the end of the year, I will most likely be infected by a guy exactly like me… One who thinks he is HIV- and who is trying not to become HIV+ even though he already is. And then if I don’t go get tested for another 18 months, I too will be infecting other guys despite telling them I’m negative and that there’s nothing to worry about.

Until the vast majority of Ottawa and Ontario gay guys are going for frequent HIV tests (whether they think they need to or not), trying to push positive guys away and stick to the supposed negative guys will not keep you safe. In fact, the very men who take more sexual risks may also be the ones least interested in getting tested.

Why? What is fueling this dangerous feedback loop that results in more and more gay men living with HIV? The causes are multiple and complex, but two stand out in the current Canadian context. The first, stigma, is tackled head-on by this recent Ontario campaign. The more prejudice and bias that exists against people living with HIV, the greater the stakes in going for a test and learning you are positive – especially if you know you’ve been taking risks.

The second factor is both borne of and exacerbates the first: more and more Canadians are being sent to prison for not disclosing their HIV+ status before sex, whether or not their partner is infected as a result. Shocking cases like the first-degree murder conviction of Johnson Aziga , an HIV+ man who knowingly exposed eleven women to the virus, elicit strong reactions. Most people agree that such acts of willful harm against others deserve redress.

But once the media frenzy settles, we must acknowledge that these cases are as rare as they are abhorrent. The vast majority of HIV+ people go to excessive lengths to protect all of their sexual partners, the first among them being regular medical care to keep their viral load undetectable. Careless media reporting on non-disclosure stories, such as Margaret Wente’s recent Globe and Mail cover story, leads to an escalation in stigma against all HIV+ individuals instead of just the anomalies like Aziga. It also means that gay men now risk not only social stigma but also possible criminalization should they learn their status. Our urge for (and obsession with) punitive retribution, therefore, only creates barriers to more men getting tested without any discernible public health dividend or guarantee to negative folk that their status is any more secure that it previously was.

Bill Ryan , a Montreal-based HIV researcher, educator and activist, writes:

While all men, positive and negative, have a responsibility to practice prevention, there is an added responsibility to knowing that you are positive and the ethical responsibility to do no harm to another. Of course, the way this is handled in prevention campaigns, media messages and among us plays, positively or negatively, into the necessary promotion of being tested and knowing your status. Handling this issue wrongly will only discourage people from being tested.

To me, the fact that this campaign slogan provokes controversy is evidence that Ontario gay guys are out of touch with what’s actually going on in their bars, baths and beds in 2009. Despite their assumptions, they don’t actually know who is positive or who is negative and they don’t know how many of their friends and lovers fall into each category. They don’t know about viral load and its effect on transmission and they don’t realize that 5 to 6% of guys they sleep with who say they’re HIV- are actually HIV+ but don’t know it yet.

The current challenge for outreach workers like me is to bring gay men up to speed with the reality of HIV in Canada in 2009. It is a reality spelled out succinctly by Elizabeth Pisani, epidemiologist and author of last year’s critical look at HIV prevention strategies, “The Wisdom of Whores ”:

The fear attached to sex with positives is deeply misplaced. People who know they are positive in Canada get pretty adequate care — they are highly likely to have controlled viral loads and to be not all that infectious. The people who are most likely to be infectious are precisely those who don’t know their status and who are increasingly unlikely to want to find out. Therefore, disclosure is a red herring when it comes to staying negative. If people know they are infected, they are relatively safe to sleep with – whether or not they tell you about it.

With or without condoms (I choose with, but it’d be no different without): I would rather have anal sex with an HIV+ man whose viral load is undetectable than I would with a man who tells me he is negative, sleeps with a few guys each year, every so often fucks without condoms but hasn’t been tested for quite some time.

And you?

Nicholas Little is an Anglo-Albertan who decamped to Montreal sometime in the late nineties “to learn French and be gay”. He now lives in Ottawa, Ontario, where he is an HIV outreach worker in bathhouses, bars and online chat rooms. In 2008 Nicholas helped found POWER (Prostitutes of Ottawa-Gatineau Work Educate and Resist), an organization of current and former sex workers advocating for recognition of their labour, Charter and human rights. In September 2008, POWER organised the first ever rally for sex worker rights on Parliament Hill. You can follow Nicholas’ blog at http://ickaprick.blogspot.com

Comments from old site:

Submitted by peripheries (not verified) on Thu, 05/07/2009 – 21:53.

“HIV is not cool, it spoils the mood, it’s not right to talk about it, it’s a turn off.” With so much fear and so many reasons to avoid getting infected one wonders why so many people and particularly young ones, still resist condoms, particularly in the West where they are available.

Altogether, ignorance, prejudice, and stigma add to the contradiction that despite HIV becoming a chronic disease manageable in the developed world with a one-pill-a-day treatment (which does not mean it is an easy life at all), the virus and talking about it still remain a taboo. Combined with young people’s lack of awareness on HIV in the developed world, this is more than an indication that something has gone and is going very wrong with HIV prevention and reproductive health education.

Submitted by don warner saklad (not verified) on Thu, 05/07/2009 – 13:17.

“Let’s get tested 2GETHER B4 we have sex, for A VARIETY of STDs.” Sexual health checkups reduce ambiguity and can be like anything else POTENTIAL sex partners do together.

How widespread is the phenomenon?… of the strategy of “Let’s get tested TOGETHER BEFORE we have sex, for A VARIETY of STDs.”

What evidence is there of failure?… of the strategy of “Let’s get tested 2GETHER B4 we have sex, for A VARIETY of STDs.”