Scientific Evidence, and the Value of Listening

BY NATHAN RILEY | Queerty, the tart blog on matters gay, recently demanded to know from its readers, “Is It Wrong to Refuse to Have Sex With HIV-Positive Men?”

That challenge grabbed my attention. The Queerty query was posed as part of a discussion of the work being done by Trevor Hoppe, a graduate student and HIV activist who questions the practice of sero-sorting, which many gay men at least believe they engage in when picking sexual partners. The strategy is based on the hope that by avoiding sexual contact with people who know and will say they are HIV-positive, one will reduce the risk of infection.

But Hoppe believes it offers a false sense of security. He works to promote good health, but also to avoid marginalizing the poz person. Using condoms offers effective protection, so sex with an HIV-positive person is altogether reasonable.

Yet, exclusion seems to be increasingly endorsed by New York City’s health department. In its news release marking World AIDS Day, the very first recommendation for protecting yourself is: “Have one partner who is HIV-negative, in a mutually exclusive relationship.” After voicing this retreat from common sense scientific reasoning, the health department returns to the real world, counseling monogamous couples to “regularly get tested together” for HIV and STDs. This advice is sound. Professor Perry N. Halkitis, director of the NYU Steinhardt School’s Center for Health, Identity, Behavior and Prevention Studies, says that 60 percent of gay couples stray (meaning, of course, that 40 percent truly are monogamous).

However, even if the city is reminding partnered gay men that it pays to play it safe even within a relationship, its advice clearly sets poz men apart — and, in its emphasis on having a negative partner, undoubtedly reinforces the false sense of security that by avoiding positive men honest about their status, you’ve done all you need to do to remain uninfected.

After having my curiosity tweaked by Queerty’s post, I started discussing it with friends. Reminding me that the topic often engenders acute sensitivity, some responded almost reflexively, saying a person has the right to choose or not choose whichever partners they desire.

Which almost goes without saying.

But others did see an underlying morality in the question.

“I see no problem at all” with having sex with poz men, answered Terrence Green, who recently arrived in New York from Jacksonville, Florida. “There is nothing wrong with poz men. It is like saying, ‘I wouldn’t have sex with a black man.’”

Will Rockwell, the editor of $pread Magazine, written by and for sex workers, is particularly thoughtful about health matters and assumes that many of those he works with are infected. He has been in two long-term relationships with poz partners, and consistently practiced safe sex with each. He has never made sero-status an issue.

My physical trainer, Richard, has poz partners. The first time he knowingly had sex with a positive man, he recalls, he experienced qualms for a few minutes until his anxiety was overtaken by confidence that he had protected himself. On another occasion, a poz partner told Richard he had forced him to reconsider his aversion to sex with HIV-negative gay men.

Will and Richard bring a measure of deliberateness to their sexual choices, but I have other friends who bar hop, often while using drugs. They typically avoid discussions of sero-status with potential partners. They insist they would never knowingly have sex with a poz person, but readily admit they have done it unwittingly.

This Don’t Ask, Don’t Tell policy is also followed by a friend who has AIDS. He doesn’t talk about his status on a one-night stand. If a relationship develops, he becomes more open. Either way, he uses protection and also believes his infection is under control — as gauged by his viral load — making him an unlikely source of transmission.

In my totally unscientific sampling, most people said they avoid talking about sero-status for the most part. That finding coincides with Halkitis’ research among high-risk demographic groups, many of whose members say they often feel lonely. Over and over, these men say they don’t feel comfortable discussing health issues with new sex partners.

The health department, in its December 1 release, pointed to an “alarming trend” among gay and bisexual men between 13 and 29 years old, with “a rapid increase in actual [new] infections — from 551 in 2004 to 706 in 2008,” which it ascribed to “risky sexual behaviors.” But, as Halkitis points out, the community’s risk profile is more complex, with Latinos and African Americans at greatest risk of sero transmission through their 20s, but whites sero-converting in higher numbers as they hit their 30s.

Minority youth, Halkitis noted, face not only the challenges of coming out, but often issues of poverty, unemployment, and even homelessness as well, creating an instability that complicates their sexual decision-making. Youth of color also, more often than others, have sex within their age, racial/ ethnic, and socioeconomic circles, magnifying increases in infection among them. White gay and bisexual men apparently have better success practicing safe sex while young, but something in their behavior choices apparently falters over time.

Halkitis’ approach emphasizes the importance of treating each risk group with empathy for the backgrounds of their lives — an essential component of any prevention effort aimed at harm reduction.

The best news on World AIDS Day was that every STD clinic in New York City now administers the PCR test, which can detect the presence of HIV virus within two weeks or less from the time of infection — a fraction of the time that the body takes to develop the antibodies that are the markers for the original test. This is very welcome news. In the immediate aftermath of infection, when people often develop flu-like symptoms, their viral load goes through the roof, and the chance they will unwittingly pass HIV along to a sexual partner is at its greatest.

According to the health department, 90 percent of men who have sex with men are negative — though that number is only about 75 percent in Chelsea. Getting the much smaller number of men with HIV onto anti-viral drugs will significantly reduce the chances that their proportion of the population will grow significantly.

Scientific evidence should always be the bedrock of HIV policy and personal sexual behavior. We would all do well to also remember that in carrying out prevention work, it is always better to listen than preach.