Nicholas Little, an HIV prevention worker from Ottawa, has been a great supporter of this site. And today, not because I’m lazy, but because he says it so well, I’m going to quote, with his permission, a big chunk of a recent post on his own blog.

Nicholas says we need to do an about face; to turn our attention to those guys who assume they are negative but are in fact positive - and highly infectious at that - rather than continually focussing on poz guys as the problem, and by doing so, stigmatizing them.

Interesting.  Even our own community has being doing a lot of work focussing on poz guys lately. I don’t think his line of thought negates the poz prevention work that is being done in this province, and which I strongly believe in.  But it does suggest a new and highly productive avenue for poz prevention to explore further, by expanding its target audience perhaps. Anyway, here’s what Nicholas says . . .

A recent UK study shows that over 50% of recently HIV+ gay men leave UK sexual health clinics undiagnosed. FIFTY PERCENT. And of those men who also have another sexually transmitted infection (making them more infectious to others), 80% left the clinics without being tested for HIV. EIGHTY PERCENT.

This blows my mind. We waste outrageous amounts of energy pushing men who know they are HIV+ to the margins of society — straight into prison cells, in fact — while we ignore the real crisis right in front of us. Study after study confirms: too many gay men are not getting tested for HIV - especially those engaging in high risk sex who need to be tested most.

We know who our true target audience is: gay men under the false assumption that they are HIV-, who have recently sero-converted (making them more infectious because their viral load is higher) and who may also have another sexually transmitted infection (make them yet more infectious). This is who HIV prevention campaigns should be focusing on. This is who is most likely to pass on the virus.

Not men who know they are HIV+. Not HIV+ men who self-disclose about their status (the majority). Not HIV+ men who, with their partners, employ harm reduction measures to keep everyone safer (the majority). Not HIV+ men who maintain good general health (by eating well, building strong social support networks with friends, combating HIV stigma, nurturing self-esteem and getting regularly tested for other STIs, among other things).

The UK Study should be sounding alarm bells. The longer we play into the paranoia about people who know they are HIV+ wilfully infecting others, the longer this epidemic will go on. We are wilfully deceiving ourselves and paying a very high cost because of it.

Just this past weekend an Ottawa gay guy told me, I always take my own condom because I am afraid the positive guy might have poked holes in his condoms in advance. I asked him, Do you even know any positive guys? He shook his head no. You do actually. About 11% of your random hook ups are positive. About 11% of guys at the Ottawa gay bars are positive. And seriously, dude, do you honestly think these guys are sitting around in some kind of vengeful stitch n bitch poking holes in big batches of condoms? These guys have way better things to do with their time. Like grocery shopping. Like doing their laundry. Like laying on the couch missing the days when Bob Barker was the host of The Price Is Right. Because they’re fucking human beings, not vindictive aliens. They’re regular, boring, everyday gay guys like you and me. And for all you know, I AM one of those 11% of gay guys. So I’m going to put this condom on that I lovingly perforated for you at home and we’re going to fuck already.

He laughed. And we did.

You can read the full text of Nicholas’s blog post, including recommendations for the way to go forward. It’s good.  It’s here: 

 http://ickaprick.blogspot.com/2009/01/50-of-hiv-gay-men-leave-clinics.html#comments

 Thoughts, anybody?

Stigma. Some poz guys here have said they don’t experience much of it. Other have said “are you crazy? It’s everywhere!” My response is somewhere in the middle; I’m fortunate not to have to bear the brunt of it - much - in my daily life. Being out about being poz helps see to that. But I see it around me, impacting on others all the time, and I certainly see it directed at us poz guys collectively, all the time.

Often it’s because we are portrayed in the media (like in that Globe and Mail article) or even in our own community (like some of the remarks provoked by that gay.com feature) as being complacent about the risk of HIV transmission, or worse, acting “irresponsibly”.  Vectors of disease, in fact, only interested in our own gratification, with no concern about infecting others.

That’s highly stigmatizing language of course. But if we argue that kind of talk is an unfair and erroneous characterization, we’re accused of “pussyfooting.”   (I hate that term. by the way.)

Here are the three main arguments I and others make against charges of “irresponsibility”:

• most poz guys play safe
• the evidence suggests that its neg guys who don’t know they are poz, with resultant high viral loads, who are the source of most new infections
• where “irresponsibility” exists, it does so in both poz and neg guys, so concentrating on the problem in just one of those communities is unfair and unproductive.

All of these facts are true.

What we don’t deal with so well, perhaps, are the exceptions. We know some poz guys out there struggle, have slip-ups, have self-respect problems and are saddled with a host of factors which make their sexual health, and even that of others they have sex with, not a top priority in their lives. Not unlike some neg guys, in fact. For poz guys, the added impact of stigma doesn’t help, in fact it’s at the root of many of the problems poz guys face. But it strikes me that we poz guys are slightly reluctant to acknowledge that those problems do exist in the poz community and that they sometimes manifest themselves in risky behaviours, like fucking without condoms. It happens. It’s better, I think, to acknowledge that than to sweep it under the carpet.

It’s also helpful, and perhaps even essential, to acknowledge that we can do something about it.  In my next post, I’ll talk about what I see as some of those ways. But in the meantime, I’d be interested in what others think. Do we poz guys hurt ourselves by suggesting we all practice safer sex, all the time, that the problem is solely in the neg community, not ours, that it’s all about testing, or in the other ways we routinely deflect criticism?

And if there is a problem out there, how do we deal with it?

We’ve talked here a lot about the law lately, and how it sucks. So much so that I’m tired of talking about it - for now. So let’s talk about non-verbal communication instead.

Sounds like for everyone who’s fessing up with “yes, I’m poz“, or ” I’m really, really negative” (even though they don’t know that for sure) there’s a bunch of us who, because of stigma, drop hints about status instead. Certainly on the internet (”safe sex only“), but also in the real world.

All of which is not good news for me. I don’t get hints very well. Which is likely why I stay waaaay too long at parties. Or consistently don’t get my partner the christmas present that he really, really wanted.

Sounds like I’m not alone, though.  When it comes to sex, not all of us are getting the hints or interpreting them the same way. A new study out of the University of Windsor and ACT suggests codes are being used by guys who think others understand them, particularly in a barebacking context, but that those codes aren’t necessarily being understood by their partners. Crossed wires, in other words. You can read highlights of the study here: http://www.aidsmap.com/en/news/E07C1E22-00BA-40D9-99EE-64C6E46D7F5A.asp

Two quotes from that research relate to men who’ve  had non-verbal communication about unprotected sex:

“Several positive men described non-verbal interactions where a failure to introduce a condom or to halt a penetration is understood as informed consent. One said : “Well you start doing it, if they don’t stop, then you keep going“.”

And “discussing saunas, several HIV-positive respondents expressed the view that: “If they start to fuck you [without a condom], you probably figure, well, unless he’s an idiot, he’s probably positive himself.” However none of the HIV-negative interviewees mentioned this.”

Now these comments are from a barebacking subculture where researchers suggest “there is a worldview in which all present were adults who fully understood the risks they were taking“. That may not be the real world all of us operate in, where the concept of protecting each other is, if not universal, at least well established. But even in the real world, it strikes me that if condoms are on the table - or not - before the fucking starts, it sort of speaks volumes. What it says, though is less clear.

I’ll be the devil’s advocate here. Given that it’s sometimes difficult for poz guys to talk about their status and even some neg guys would rather have root canals than bring the topic up, is “hinting” about your status better than nothing at all? Or is it a complete waste of time? And are guys picking up clues on serostatus from things like location - bathhouses have “a reputation” for instance - or even from the way people look?

And what’s your experience of communicating in code, giving out or picking up signals, on the Internet or in the dark? And does it ever work?

It’s exceedingly weird, in my view, that poz folks are being charged - and convicted - for having what strikes me as consensual sex. Of course the courts have ruled it’s not consensual when there is no disclosure and where there is “significant risk” of transmission. It gets complicated when we look at what constitutes “significant risk” but what’s clear, I think, is that fucking without a condom would qualify. (For more on this go here : http://www.hivstigma.com/law.php )

We get emails here on HIVstigma.com. One reader was horrified that we would bring this legal angle up, and certainly didn’t like the language we’ve used to describe the law. Much too insensitive, was his view. (I don’t agree, but I’m honestly sorry that he was hurt.)

I guess what we didn’t express was that spokespeople for the HIV community don’t like the fact that poz sex is being criminalized.  Not an appropriate intervention, stigmatizes poz people, counterproductive, acts as a deterrent to testing, they say. I happen to agree. And if the courts don’t stigmatize poz folks enough, the press certainly does. ‘There is no excuse for the wanton, reckless, self-indulgent behaviour ” is a typical reaction. It’s worse if you’re a woman.

We can debate this at length - and I will, if you want - but let’s bring this argument to the real world. Sex is fun, but it can be a complicated business, and so can how, when and with whom we disclose. The courts say that criminalization is necessary as a deterrent, in effect a systemic attempt to force us poz folks to disclose. But I want to know whether you think the prospect of going to jail is starting to enter in to the decision-making equation.  Of anyone.

So my question to you - and this is directed at poz guys in particular, is: do you think the law on disclosure - admittedly perhaps not well understood - shapes gay men’s decision making in any way at all?  Is it becoming a factor in whether or not they disclose and/or what kind of sex they have?

Neg Guys? What’s your take on this?

I’d like to think this is a safe space to discuss these issues freely. But I’ve deliberately chosen to raise the question using the third person. So poz guys in particular, please feel free to do the same - and don’t say anything here which might incriminate anyone. OK?

I’m off to Oshawa tomorrow for a conference for people living with HIV. I’m talking to them about what we attendees gleaned from the International AIDS Conference in Mexico City earlier this year. In particular, lots of stuff on viral load and what being undetectable means to poz guys. And lots of stuff too on whether treating us early on, in order to reduce our viral load - perhaps on diagnosis even - is an acceptable prevention strategy. (I have real concerns about that, how about you?)

But Mexico City also addressed HIV stigma head on. Clearly it’s a universal problem. Here’s a photo I took of a huge march there addressing it:

The march was thousands strong. Would we ever get that number here? Certainly in Mexico, the commitment to tackling HIV stigma was strong. They seem to get it. Even the Mexican president spoke up against stigma.  Haven’t heard a word from Stephen Harper on the topic yet - sounds like a “when hell freezes over” kind of thing to me.

Anyway, Brian from this site also took part in the march. Somewhere on the internet there’s a picture of him bare-chested doing so. Perhaps if we ask him nicely he’ll share that here?

Anyway, following the Oshawa gig I have almost two days of meetings in Toronto about poz prevention. Later, since I’m in the big city, I’ll be hitting Church Street with my partner for Halloween. Not in costume, as it happens, but feel free to say hi. Or boo. Or whatever people say on Halloween these days. (Can you tell we don’t get out much?)

So I’ll be offline until the weekend. In the meantime, here’s another little example of how folks around the world tackle stigma, proving I think that we can address difficult topics in fun - and funny - ways. Because dancing condoms are funny, at least in my book. And that’s just the start:

http://uk.youtube.com/watch?v=44IFYB1icx0

I’m not sure whether “Never forget me, I am Nirodh, I am the condom friend ever useful to you” would cut it as a slogan here in Ontario. But it’s clear our Indian colleagues are working very hard to overcome the stigma associated with condoms in that county. Any folks from the local Asian community want to chip in and comment on that?

And if (what’s wrong with you?) you don’t like the Indian condom ad, here’s one I’m guessing will appeal to every gay guy in town. True, it has nothing at all to do with HIV, but it DOES have A LOT to do with the assumptions we make. May not be safe for work!  Enjoy.

http://uk.youtube.com/watch?v=VmxCnvP_40E

I think one of the problems with safer sex is that it’s become waaaaay to closely connected with condom use. Sometimes the two seem almost inseparable. What’s up with that?

My negative partner was checking out this very web site the other day with his usual eagle eye and stopped at the first question posed by one of the strippers in the Explicit Truth section. (You do know we have strippers, don’t you?) “This answer doesn’t make sense” he said. (He never really did have an eye for strippers. I don’t know what’s wrong with him!)

Here’s the question and response that he’d zeroed in on:

 Q: Gay guys are abandoning condoms, True or False.

A: False; Whether we have HIV or not, most of us play safe most of the time. In a 2005 study, 70% of guys reported sex lives with little or no risk of HIV transmission.

That answer is a bit of a non sequitur, so I’m guessing it won’t be just my partner scratching his head on that one. I’m sort of OK with that, though; thinking is always good in my book. But I’m not so OK with the implication that safer sex equals condoms, as if the two terms are interchangeable. That’s clearly not the intent here, I know. In fact this site has a good little section that explains what safer sex can be. You can see that here: http://www.hivstigma.com/safer_sex.php   It’s a far more inclusive list than just condom use, and rightly so.

It’s my take that condoms are a bit of a dog as a prevention methodology. Attempts to eroticize their use as a prevention strategy work for some, but clearly not for others. Some guys will tell you that sex feels better without them, that they kill the mood, that they turn Mr Big and Tall in to Misterr Softeee. BUT, despite all this, a tribute to our collective good sense I think, they are still a staple of every gays guy’s night-stand . More often than not they’re used when they need to be used.  Or - and I think this is important - many guys find other ways to reduce risk. Collective pats on the backs, folks!

But I do wish we had something better for what some see as our prime defence against HIV. In the mean time, I think it’s productive to question whether condoms are the be all and end all of safer sex.

And while we’re on the subject of finding new prevention technologies, I’ve read a lot about circumcision lately. Don’t get me started about that . . .

By coincidence, I put up a photograph in my office yesterday. (We’re in a new home and still in the decorating phase.) It’s a photo I took at the International AIDS Conference in Toronto of the work of a Brazilian artist who works entirely with condoms. She makes fab dresses out of them, in fact. I like the way how she sees condoms in an entirely different light to the rest of us  . .  .  .  .