Tonight, Rubin has decided to get an HIV test. He’s getting it here, in the middle of a sex club. Wearing nothing but a towel, he chats with me after having had his blood drawn.
“I don’t think these people are judging me,” he says of Dr. Demetre Daskalakis, director of the Men’s Sexual Health Project (MSHP, pronounced “Em-Ship”), the diagnostic center inside the club where the testing is administered. “I mean, how could they? Look where we are. And besides, he’s cute,” Rubin says of Mike Dreyden, the porn star who’s promoting tonight’s testing. “I’ve never met a porn star before,” he admits. “And I want the DVD.” In addition to raffling off his latest release (the proceeds go to MSHP), Dreyden is giving away a free DVD sampler of porn previews to anyone who gets tested.
It’s been more than twenty-five years since the publication of Richard Berkowitz and Michael Callen’s brochure, “How to Have Sex in an Epidemic,” introduced the notion of “safe sex.” Most gay men know the message by now, but the safe-sex rhetoric no longer seems to be working. At least it’s no longer producing the intended behavior. In fact, it may be producing a whole slew of new behaviors that work to defeat the message.
The fact that sex without condoms feels better—both physically and often emotionally—is an intense temptation. Many gay men—in fact, most men, regardless of sexual preference—want to have sex without condoms and, sooner or later, most do.
Recently released reports from both the CDC in Atlanta and the New York City Department of Health confirm that new HIV infection rates are rising dramatically in certain key demographics, particularly in young men (in their teens and twenties) and men of color, both locally and nationally, even as overall rates are in decline. And those numbers don’t take into account the infected and at-risk individuals who aren’t getting tested or counseled. Additionally, other sexually transmitted diseases, such as syphilis, which were once almost wiped out are now on the rise again—a sign of risky behaviors.
The safe-sex message was born at a time of crisis when HIV was a literal death sentence. Since then, radical changes in disease treatment have (hopefully and optimistically) turned HIV into a chronic, rather than fatal, condition. An entire generation of sexually active young men now exists that wasn’t even in existence when the crisis was at its peak. Plus, legions of men who have practiced using condoms for most of their lives are beginning to seriously wonder what they’ve been missing.
One of the least-discussed developments is the fact that some men live a lifestyle where they not only prefer, but insist upon, sex without condoms. And now some of these “barebackers” have started calling bareback sex “natural sex,” implying that it is the safe sexers who are engaged in unnatural behavior by wearing condoms.
The only response we have to these developments, however, is the same, tired message: safe sex. The implied judgment of that message is that smart people always use a condom and so those who choose not to, for whatever reason, likely feel shame.
Dr. Daskalakis, who received specialized medical training on HIV in Boston, at Harvard Medical School and Massachusetts General Hospital, before founding MSHP in 2006, concedes that shame is a big part of why it’s so difficult for us to talk about sex.
“I love working with commercial sex venues, and would never say anything bad about them,” he says. “But why do they exist? One reason is that people think it’s hot to have sex with a lot of people in one place. The other reason I think, frankly, is shame. I feel like the way that we push sex—gay sex in particular, and unprotected gay sex especially—into this place of badness, whether it’s pathologized because of HIV and STDs, or pathologized because of some moral majority, I think what that automatically creates is shame and the need to hide what you’re doing. I feel like shame is still a major part of what is going on in the community.”
The shame implied by the safe-sex message makes it difficult for HIV-positive people to disclose their status or to talk openly and honestly about their medical challenges.
Dr. Richard Greene, a frequent volunteer with MSHP, tells of a med school student in his twenties who called him after a sexual encounter with a man who revealed his HIV-positive status afterward. The young student was shaken and wanted Dr. Greene’s advice as to when or how or if to inquire about HIV in regard to having sex. “And this is a med school student,” says Dr. Greene. “How is the average guy supposed to know how to deal with this?”
It’s 9:00 p.m. on a Friday, still relatively early by bathhouse standards. Nevertheless, approximately five dozen men—of various shapes and sizes, skin color and ages (a good portion of whom appear to be in their fifties and sixties)—draped only in towels, walk back and forth in a never-ending, circuitous parade.
It’s a solemn ritual whereby potential sexual partners scope each other out and express and deflect interest by the subtlest of gestures: a quick nod, a knowing glance, a grab of the crotch or briskly brushing up against one another.
MSHP, an affiliation between Bellevue Hospital and the NYU School of Medicine, under Dr. Daskalakis’s direction, provides free HIV and STD testing inside this club and the West Side Club, the other remaining gay bathhouse in New York City, on a rotating schedule. The organization also recently offered HIV and STD testing inside the annual Black Party, a well-attended, sexually charged circuit party that takes place at Roseland Ballroom. It is a far more euphoric setting than the West or East Side clubs.
“Working at the Black Party was amazing,” Dr. Daskalakis tells me later, when I follow up after the infamous bacchanal. “We tested higher than our capacity given staffing and space, proving that HIV prevention should work with nightlife and not against it.”
MSHP’s mission is to bring accurate information about HIV and STDs to sexually active men who have sex with men and to connect them with care. Dreyden, the porn star, discovered MSHP’s booth at the 2008 Gay Erotic Expo where, incidentally, he happened to be the poster boy for the event.
He was so impressed that MSHP was offering testing and counseling where sex was happening that he wanted to use his porn-star cachet to support it in whatever way he could: he decided to promote HIV testing by giving away porn instead of condoms. The collaboration may be the most culturally significant thing to come out of a gay bathhouse since Bette Midler and Barry Manilow played the Continental Baths.
Dreyden’s mother was a Registered Medical Assistant who didn’t shy away from frank, open discussions about sexuality with him and his sister while they were growing up. He says he’s impressed by the range of services available to HIV-positive people (he, himself, is HIV-negative), but he thinks there is a lack of services available for people who aren’t sure of their status and are afraid to get tested.
“Every time I get tested, it freaks me the fuck out. I play safe. I know I’m okay,” he explains. “But going in, filling out the paperwork, hearing about the worst-case scenario; it freaks me out. I don’t think straight people have to deal with anything quite like this.”
Dreyden is reacting to the need for a more nuanced message. The safe-sex message may have worked when the “penalty” was death, but it has proven less effective now.
Perhaps the lack of an evolved message can be blamed on eight years of flat funding for the National Institutes of Health under the Bush administration, making little money available for educational outreach, or the CDC funding only abstinence-based initiatives, rendering what little outreach was offered ineffective. Or accuse HIV medication advertising for minimizing the consequences of the disease.
Whatever the reason, the stakes for new infections have never been higher and, without a new message that addresses the reality of bareback sex, those rates are likely to continue to increase.
The culture of bareback sex is one of the most fascinating consequences of twenty-five years of the safe-sex message.
“What we suppress, expresses,” explains author, lecturer and sex educator Barbara Carrellas (www.urbantantra.org). She, like Dr. Daskalakis, was inspired to become a
sex educator in response to the great loss of life and health in the original wave of the HIV epidemic. “If you study the course of what has been a fetish over time, you discover that the essential badness and kinkiness associated with something is an integral part of the fetish.”
“The bareback community,” explains Max Sohl, a NYC-BASED producer/director for Treasure Island Media, one of the first exclusively bareback porn production companies, “is defined by men who have made the decision to seek out ‘natural sex’ and are not afraid of it. This is different from men who are practicing safe sex but ‘slip up’ for one reason or another…or men who are barebacking with their partners but practicing safe sex with men outside their relationship.”
This important distinction is most evident in the world of gay, bareback porn. Few people consider “vintage,” or pre-condom porn (porn made before the HIV crisis, mostly in the 1970s and’80s) bareback porn, even though the performers don’t use condoms. It isn’t the lack of condoms alone that makes porn, or sex for that matter, bareback. It is the conscious lack of condoms in the face of the safe-sex message that generates the essential “badness,” the excitement and the fetish.
“I believe,” continues Sohl, “that the labeling of ‘bareback’ porn is a creation of the gay community. What I do is document real men having real sex—that sex just happens to not involve the use of condoms. When I started working with Treasure Island in 2003, you couldn’t find a bareback video in any store in New York City.”
Sohl notes that adult video stores now stock huge sections of the formerly illicit material. “It went from being a taboo, underground, fetish genre with a niche audience,” says Sohl, “to topping the gay DVD charts in sales and rentals.”
It’s not just in porn; a random sampling of several online sex hook-up sites (including Craigslist M4M personals)—filtered for key words such as “bareback,” “BB” and “raw”—turns up dozens of listings. Few of them mention HIV status.
Even GAYVN (pronounced “Gay Vee Enn”), the industry magazine that covers gay porn and hosts one of the most highly visible porn awards ceremonies, has had to make concessions to bareback’s growing popularity. Up until very recently, the company had not acknowledged bareback porn or allowed any of the bareback movies to be nominated for awards. But a recent switch in management to a new editorial staff that believes its job is to document the trends in gay porn without moralizing and pressure from the advertising department to sell ad space to bareback companies has changed that.
“We have to contend with it,” says GAYVN editor-in-chief Harker Jones. “Bareback porn is no longer a fad.” GAYVN tried, in 2008, to create and implement a set of what they considered responsible standards (such as mandatory STD testing) by which bareback porn companies could become eligible for award nominations this year. But the landscape became too difficult to navigate, and the venture was abandoned.
Shame and fear of judgment is also what makes it difficult for HIV-negative people to ask their physicians serious questions about the risks of unprotected sex or for physicians to know how to properly respond.
Tyler, an acquaintance of mine, revealed that he often engaged in sex without condoms. His recollection of the conversations he would have with his doctor, a physician with a large gay practice, prior to seroconverting (becoming HIV-positive), are disturbing.
“He would ask me if I was using condoms all the time, and I would say, ‘No,’ and he would say, ‘Well, you should.’ And I would say, ‘I know,’ and that was that.”
The unfortunate result, then, is that most people only learn the real consequences of seroconversion after they have converted, and it’s too late to make an informed choice.
Since seroconverting, Tyler has become an avowed barebacker. He loves having sex without a condom. He has performed in bareback porn, he escorts and only uses condoms at the direct request of clients (he never offers), and he is currently in an open relationship in which he and his boyfriend almost exclusively insist on bareback sex with other men. They rarely disclose their status (both positive) and are almost never asked. Tyler has also maintained a healthy T-cell count, so it would appear the consequences haven’t been so dire.
So, I asked him whether the “privilege” of being able to have all the bareback sex he wanted outweighed the disadvantages of having HIV. “No,” he said, “definitely not. It’s a booby prize. I’d rather have my health.”
“Doctors think they know that people with HIV are going to live, hopefully, happier, healthier, longer lives, with maybe a few extra pitfalls along the way,” says Dr. Daskalakis, “but that’s based on conjecture. We haven’t yet had a generation of people with HIV living full, average life expectancies. Serious medical complications are likely to develop, and side effects from the meds can be severe and debilitating in their own right. Even under the best of circumstances, an HIV diagnosis means that you are likely to have to see a doctor regularly for the rest of your life and all that entails.”
Shame often compels people to act in secret. Later at the West Side Club, I spoke with Chris, another MSHP test client. He is an unassuming guy in his early thirties with a wholesome, Broadway chorus boy look about him. He’s supposedly been in a monogamous relationship for four years but has repeatedly had bareback sex outside of the relationship. Although he has recently come clean to his boyfriend about the sex—and has entered a 12-step program for sexual compulsion—he hasn’t been able to admit to his partner that the sex he had was not safe. “I’m afraid of his reaction. I mean, I put his life at risk.”
Shame also drives some people to lie. Keith seroconverted in what he understood to be a monogamous relationship and, to this day, his ex-boyfriend claims to be HIV-negative. Keith did have sex with a few other men toward the end of his relationship, so he admits he might have been exposed then, but what little sex he had outside of the relationship was safe. He only barebacked with his boyfriend. “I remember once seeing what I thought was an STD on him, but he denied it. I mean where would it have come from? We were monogamous. Sometimes I wonder.” Keith has gone to the other end of the spectrum and now insists on disclosure and wearing condoms. “But I see guys online on hook-up sites all the time,” he says, “who list themselves as HIV-negative when I know for a fact that they are HIV-positive because we’ve disclosed to each other and had sex. For a fact.”
It appears people simply aren’t getting and sharing the information they need to make informed choices about their lives and their health. Knowing your HIV status is only the first step.
“Make no assumptions about anything,” says Carrellas. “Do not assume that people hold the same values as you or even define something in the same way you do. Not even monogamy. People can have vastly different interpretations.”
Carrellas proposes a model along the lines of safe, sane, consensual, risk-aware sex in place of the safe-sex message. “It’s a model from the kink world,” she explains, “whereby someone can say I am aware of certain risks and I am willing to play with this much risk, but not that much risk. Gay men were the sexual adventurers of the twentieth century, and they had some great skills prior to HIV. Negotiation was one of them. You really had to know how to negotiate back then if you wanted to play with the leather boys. You had to be able to name your desires, set your limits and talk about it. We could use a return to some of those truly queer roots.”
Carrellas is talking about honest, genuine sexual negotiation. “We may not all be able to agree on how safe we want to be collectively,” she says. “But if we can’t agree on being safe, sane and consensual with the people we are playing with, we’re in real trouble.”
It’s the minimum we should expect. Everyone is entitled to make informed choices about their lives and take the associated risks they are comfortable with in their own pursuit of happiness. And we’re not simply talking about the health risks that HIV-NEGATIVE people assume in the absence of negotiation.
HIV-positive people also assume great psychological risk when th
ey lie or misrepresent themselves to potential sexual partners. It’s bad enough when people make decisions without being adequately informed or aware of the degree of risk they are assuming. But when the best available public message about that risk is not strong enough to overcome the attraction of the behavior and, worse, actually generates the sorts of feelings and behaviors that keep accurate information underground, it’s a genuine tragedy.
One of Dr. Daskalakis’s goals with MSHP is to facilitate dialogue among and between men who have sex with men who are not necessarily socially connected and to integrate those men into the larger community.
“It’s always the ‘dirty dog’ that goes to the bathhouses and causes a problem,” says Dr. Daskalakis. “But that dirty dog is often married and has children. The complexity of this is so great that anything we can do to bring it into the light, anything, we should.”
That brings me back to where I started, the middle of the East Side Club on a Friday night, talking to Rubin. He’s stepped away to get his results and his free porn sampler and to ask whatever questions he has of Dr. Daskalakis and his staff. It’s a good twenty minutes before he learns his result. He’s negative.
Rubin recedes back into the dim hallway and takes his place in the ritual dance surrounding us—one more anonymous face.
What he does with this new information is up to him. As it should be.
Piece of Ass
Monica Shores
It was my fault for bringing up the sex toy for dogs. In retrospect, that was what started it all. But what else should I have responded with when one of Brian’s cats jumped on the back of the couch and began laying her claws and teeth into my hair in what can only be described as a near-abusive seduction?
“Wow, look at her go,” Stacey said, wineglass in hand. “Peaches, you better calm down.” Calming down, however, was the last thing the cat had in mind. She kneaded aggressively as her purring increased.
Best Sex Writing 2010 Page 17