MMatt, you perfectly illustrate the conflicting impulses that are often at work in the gay male community, which is what I will call The Best Little Boy in the World Syndrome vs. The Sexual Outlaw Syndrome. Although these are not discreet categories without a LOT of overlap, I think they are helpful conversational frames. On the one hand you have the good little gay boys who were picked on growing up for being different who become huge overachievers just to prove that they are beyond perfect.
You might be surprised to realize that these kinds of guys are VERY vulnerable to crystal addiction, because they typically are Type A personalities, the kind who proudly say they "work hard and play harder." So they may try crystal one weekend and they love the way it makes them feel and the next weekend they do it two nights and they "play hard" and a few more weekends of this and the post-crystal crash hits em hard on Monday morning so they do a bump to get them through the work day and they get EVEN MORE accomplished at work than they usually do, so they do another bump to keep the crash at bay and before long, these guys who have prided themselves at always being at the top of their game, academically, professionally, etc., are in the grips of something they can not stop doing. I mean, changes happen in their bodies and they literally can not stop doing it.
Now, the part of me that is interested in public health, knows that 70% behavior change is basically unprecedented in such a short period of time. It's never going to be enough for The Best Little Boys in the World, like you MMatt, however. Larry Kramer comes from that POV too, as exhibited by his tendencies to always say we are "the best, the brightest, the smartest, the richest..." as if saying so makes that true of all of us! And you can feel his palpable rage at the Sexual Outlaws. What else could inspire the vituperative exhortations to "tell gay men to stop having sex!" The Very Best Little Boys in the World would, of course, but they don't exist. Real men have drives.
The impulse on the other hand is that of The Sexual Outlaw, which I take from the name of a very great book by John Rechy. This is the part of the gay male character that, particularly in the '60s and '70s, said, "You think I am immoral and disgusting and have no rights, well, I'll show you! I'll do things you're even scared to think about." This impulse does not particularly dovetail with "Good little gay boys always behave THIS way..." and often inspires the opposite behavior. That's why a lot of the barebacking imagery evolved with an "outlaw" sensibility. What's wilder than a bucking bronco in the Wild West that you ride bareback, I ask you? It's as untamed and risky as a rodeo, but has quite an exhilerating rush!
As for the oral sex debate, let me illustrate the difficulties of talking about it with the sort of discussion point that ElTico makes that is really bad public health discussion: "Your friends that swallow/bareback are EXTREMELY lucky."
Wellllllllllllllll, conflating unprotected oral sex with unprotected anal sex, lumping them together that way, is the sort of thing Larry Kramer does all the time. It's innacurate, unhelpful, and can actually encourage risky behavior. If a person thinks of both of those things as equally risky and he swallows once after years of not doing so, he might say, "Well, I've done that, I might as well do the other now since I probably got HIV...."
Let's look at it as a continuum of risk. (Now, I know this is not an easy answer, but as I have been trying to say through my posts here, the easy answers never really look at the complexities of people's lives and how they navigate these complexities.)
By far, unprotected anal sex is THE riskiest sexual activity. Of course, for it to BE risky, one partner has to be HIV+ and one has to be HIV-. Unprotected anal sex with two HIV- partners has no risk. This seems obvious, but in the popular imagination, whenever two men engage in that, it seems as if people believe spontaneous infections can happen.
Oral sex is BY FAR less risky than anal sex. Unprotected, of course. A long term study out of San Francisco, called the HOTS Study (I can't remember what it stands for but "oral transmission" is in there), of serodiscordant couples (one is poz one is not) showed that there were NO seroconversions as a result of oral sex. None. Some of the guys DID swallow.
But what about all those self-reports of guys who say they were infected that way? Well, there still is a taboo about talking about what we really do when we have sex, and saying, in 2005, that you let some guy penetrate you without a condom is still a very very difficult thing to do. It's amazing, if not statistically impossible, how many HIV prevention/education workers who seroconverted in the 1990s report their only risk as being oral. But certainly, that would be a group that would have great diffculty in being honest about the kind of sex they had and in what conditions because if ANY Best Little Boys in the World should "know better," it's that group!
What we have to do is decide how much risk we ourselves can live with. If unprotected oral without swallowing is as risky as driving a car every day (which is stastically pretty risky), would that be tolerable to you? If swallowing is as risky as eating a diet heavy in meats and carbs, is THAT okay to you?
I too know somebody who claims to have swallowed all through the epidemic and claims he is negative. He too knew for a fact that he has swallowed from poz guys. Well, as luck would have it, I ended up in an "environment" where we shared some space where I could actually watch his behavior. There was a guy who obviously had been on the treatment protocol for a while and therefore exhibited physical characteristics, and the guy I know did not swallow. When the other man left I said, "I noticed you did not swallow." He replied, "Well, I don't when the guy OBVIOUSLY has HIV." So it was interesting, because my point in telling that story is that what we say we do is often very different from what we actually do. How we assess risk and the things that influence that assessment vary from day to day.
Bottom line, unprotected anal sex with a partner whose status is different from yours is BY FAR the riskiest thing you can do. Nobody in your doctor's office is going to tell you that unprotected oral without swallowing is risk-free, but I think most of us can admit that if it was that easy to transmit HIV that way, most of us probably wouldn't be here typing on this website.
THE bigger problem right now, is crystal meth. Most health centers that work with men who have sex with men will tell you that most, if not all, new seroconversions right now are found after a person comes in to deal with his crystal addiction.
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Updated On: 2/15/05 at 05:14 PM
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