Not just us

Growing evidence that HIV transmission is on the increase among gay men in Toronto has made many of us at AIDS service organizations (ASOs) revisit our role in fighting the spread of HIV.

What leads to unsafe sex among gay men? What are gay men’s attitudes today towards unsafe sex and HIV prevention education? How much responsibility should AIDS organizations shoulder?

I sat down this month with a group of men who do HIV prevention work in Toronto to have a conversation about these issues.

Though scrutiny of ASOs is always necessary, there was a feeling during our conversation that ASOs should not be our sole focus of HIV prevention. In order for our communities to fight AIDS, the sense of ownership for fighting the epidemic must remain rooted throughout our communities.

“It’s not just us,” says Peter Ho of Asian Community AIDS Services. “We don’t own AIDS. Everybody has a part to play, not just ASOs.”

We talked about the important role that all community institutions play in fighting the epidemic. There are many other social service organizations and community institutions which address the mental and social health needs of gay men. Programs like the David Kelley Lesbian And Gay Community Counselling Program or services at the Centre For Addiction And Mental Health, create opportunities for gay men to seek out all kinds of support. Others, like the Italian social group Avanti, black men’s group AYA, the outdoors group Out And Out or the Toronto Bisexual Network, function as vital support systems for men in our community.

Community businesses, like bathhouses and bars, could also play a larger role than they are now.

Among the ASO workers I talked to, there was frustration expressed at the lack of clarity around the recent University Of Toronto study that got so much press this summer. According to press accounts, there has been a doubling of HIV rates among gay men in Ontario since 1999. But that is not a claim that can be made based on the study.

“We need clarity on the studies,” says Trevor Gray, who’s with the Black Coalition For AIDS Prevention. “We need to put it back to the University Of Toronto and ask for an explanation.”

In reality, the study was taken from HIV testing data, and was based on gay men who repeatedly tested for HIV. It’s impossible to generalize to the entire gay male population based on this specific sub-group. Until Until we can better understand the circumstances by which these men became infected , we won’t know how this information can be of use in shaping the direction of our HIV prevention efforts.

Zavaré Tengra, from the Alliance For South Asian AIDS Prevention and the Hassle Free Clinic, says the media needs to be more responsible about reporting information about HIV.

“If a study shows that this year five people got HIV and next year eight people got HIV, the media will declare, ’50 percent increase in HIV amongst people,’ without providing any real context,” says Tengra.

The gay media in particular, needs to do a better job at challenging community norms which contribute to HIV infection. I can’t tell you how many times I’ve heard gay men talk about the images they see in the gay media, and how that places pressure on them to look a certain way. Media images of buffed, hairless, white men contribute to an oppressive climate. I’m not suggesting that the media is the cause of gay men feeling lousy about their bodies, but I do think it’s a contributing factor.

Many ASO workers have heard from gay men about heat-of-the-moment sex, where, despite good intentions, unsafe sex just happens.

“We need to break that down,” says Vaughn Fitzpatrick of the AIDS Committee Of Toronto. “What does that mean exactly, ‘heat of the moment’?”

It can break down in several ways. Gray says that people who are in vulnerable situations, like being recent immigrants, are the mostly likely to engage in unsafe sex. Gay men might also conclude they are not at risk for HIV. If they believe that gorgeous, buffed men can’t have HIV, or young men can’t have HIV, or that they can’t get HIV as long as they are the top, then they may take risks.

Similarly, if they don’t believe that HIV is a serious infection, or will likely lead to death, they may be more likely to take a risk. The perceived success of new HIV medications may have an impact.

“Men don’t feel the fear of death as much as they used to, Fitzpatrick says. “Some feel a cure is not far away or that HIV is manageable. There’s no immediate danger.”

One possible way to counteract this belief is to present real experiences of living with HIV today. Rather than trying to scare gay men into using condoms, we could present the full spectrum of what HIV infection can mean. The reality is that we are no where near a cure, and HIV treatments, while enabling many people with HIV to prolong their lives, are no picnic to live with.

We also talked about the way in which unsafe sex among gay men is viewed both inside and outside our community.

“If a gay man is doing all he can to avoid HIV and uses a condom every time, but then one time slips up,” says Fitzpatrick, he gets labelled a failure. “Yet no other community has the level of condom use that we have.”

Many outside our community view unsafe sex within our ranks as either pathology or deviance. But many healthy and responsible gay men sometimes have condomless sex. The disdain many people feel toward men who fuck without condoms is a barrier to the kind of open and honest reflection we need to maintain community health.

Like many others, the people I talked to questioned the benefit of current prevention strategies.

“I sometimes wonder if handing out condoms is a waste of time,” says Tengra. “Is it really as effective as it could be?”

“I think we can do prevention without a condom and lube,” says Humberto Carolo, who works with ACT and is a member of Viver, the Portuguese-speaking HIV/AIDS coalition. “It’s important but not the only way. If we provide a space for men to come and talk about issues, that’s HIV prevention. If we do something that supports empowerment, feeling good, that’s prevention…. We’ve got a lot of information about HIV, but what hasn’t gone away is racism, homophobia, youth unemployment and youth kicked out of their home onto the street.”

Ho says HIV education needs to be looked at in the long term. As an example, he said that Asian Community AIDS Services has worked for years with Asian men in Toronto’s bathhouses and bars. In the early days, it was difficult to find Asian men willing to have a conversation with an outreach worker. But after years of work, Asian men are much more confident in approaching an outreach work at the baths.

Increasingly, ASO workers are agreeing that not everyone can be targeted as a single group. We know that the people most at risk for HIV are people who are socially and economically marginalized, such as recent immigrants, poor people, women experiencing violence, men from ethno-cultural communities and unemployed or street-involved youth.

This has many implications. For some gay men, coming out is a time when they are vulnerable to HIV. But coming out and declaring your sexuality is not a universally applicable idea for all men who have sex with men. For some communities, the notion of a gay identity is foreign. While things like same-sex benefits might unify part of the community, it’s not an issue that unites everyone.

“There are a lot of people in the black community who are not there,” says Gray. “They deal with racism and poverty.”

There’s been increasing focus recently on the role of people living with HIV in curbing the spread of the epidemic. Yet placing the heavier burden of responsibility on people living with HIV may actually work against HIV prevention.

I’ve heard from gay men with HIV who say that they already feel they carry the burden of responsibility when it comes to using condoms. I’ve heard guys talk about feeling angry and frustrated that there is this expectation that they will always practice safer sex. People forget that a person with HIV is just a person, capable of playing safe or of taking risks just like everybody else. If as a community we build a norm that men with HIV will protect their partners from the virus, then guys will assume that the person they are with who is not using a condom must not have HIV. Guys already make this assumption, and it’s risky.

If HIV prevention is just targeted at people who don’t have the virus, the lives of people living with HIV – who need support to avoid other strains of HIV and other infections – are seriously devalued.

If we are to succeed in the long-term at fighting this disease, we need to come together and work across many fronts. Our community is comprised of a range of institutions, all of which have a role in fighting HIV.

The AIDS Committee Of Toronto and several other AIDS organizations will host a community forum on AIDS prevention on Tue, Oct 3 at the 519 Church Street Community Centre, starting at 6:30pm. For more information, call (416) 340-8484, ext 261. TTY/TDD (416) 340-8122.

James Murray is ACT’s gay men’s community development coordinator.