As events unfolded, it would seem that I no longer have the choice to move on at an appropriate time somewhere on the horizon. As even as I continue to create what's next for me, there is a large part of me that would rather just leave the paradigm of HIV prevention and do something that is a complete departure. But this lacks honesty; I've not yet fulfilled all that is in my heart around gay men's health and wellness. Which is fortunate, considering that my mind has not yet released itself from thoughts and considerations about things that would make a difference for gay men. As I think of it, I am more convinced that HIV prevention matters, maybe more now than ever.
Shortly after I moved to Colorado, I was asked to deliver brief remarks during Denver's 2006 World AIDS Day Rally. I began with remembrance; remembering friends past, fellow soldiers in the fight against AIDS, my best friend....my mother. I talked about medical advances and the changes that we've seen since the beginning of the epidemic. I talked about complacency and fatigue; about the weight of losing an entire generation of men. I shared my thoughts about the state of HIV prevention.
...'If our deepest intent is to positively impact the AIDS epidemic in our communities, we must be willing to rethink everything we know about HIV prevention. We must be willing to shift the paradigm and inquire into the context of people's lives. We must abandon prevention models that are ineffective and be willing to speak truth to power.... We must have the courage to be controversial, not for the sake of controversy, but to advance the science of HIV prevention in a way that is meaningful to those whom we hope to serve."
These years later, as I read these words, I am reminded that this point of view is not simply my own perspective. These words, informed by men who shared their thoughts and perspectives for nearly 20 years, are reflective of a central truth. This truth is so true, that we all know some version of it. Health departments across the country bemoan increasing rates of HIV infection among gay men. Likewise, local HIV prevention planning groups struggle to identify effective programming for gay men. Prevention needs assessments mirror themselves year after year. HIV positive men speak of isolation, stigma, fear and ignorance. HIV negative men seem to be making their own choices around HIV risk while the mainstream HIV prevention apparatus remains conspicuously silent. What all these truths tell us is that the nature of HIV prevention for gay men has changed. And, those of us who care about HIV education, prevention and intervention for gay men must keep up with these realities. This is one point of view and may not be a global truth, but it is the view from the cheap seats.
I really don't have to look far to have an opinion about HIV prevention. As a 46 year-old, Black gay man who is HIV negative, I know what it's like to live for more than 25 years in the shadow of an seemingly unending epidemic. And while its true that I've spent more than 20 years as a champion of prevention, I've spent more than my share of time out of integrity with this truth. I have been on so many sides of the gay experience that it makes my head spin.
I've been the guy who is up for three days chasing the party. I've been the guy who has posted bail for my friendly dealer. I've been the guy at the club that everyone wants to know because I have direct hookup with the best pill in town. I was always a friend of the DJ, and have danced away entire weekends. I've been the guy who has spent so much time on line cruising that I used to call it working a shift. And I've been with so many guys that I call it doing my part for world peace, one man at a time. I've had a profile on Bareback City, spent entire weekends in compromising positions, and party and play..... my understanding is not academic.
I do not own being negative as something that I've done. In fact, the math speaks volumes. This is how I know that the very nature of risk gives rise to risk. I knew that I was making conscious choices about risk and had even developed some interesting thoughts about risk reduction in the chaos of a mansion filled with tweaked out party boys. At some point, I'd even resigned myself to contracting HIV. I had considered how I'd explain it to my colleagues. Once, as I was waiting for my test results, I'd even planned a weekend of partying in Palm Springs. When the result returned negative, I remember being crestfallen.
Even at this time in my life, with all the insanity going on, I met some of the most amazing gay men. Perhaps it may have been their circumstance that allowed such an unvarnished glimpse of the beauty and dignity within gay men. At a time when most would have said that I had fallen the furtherest away from my own values, I found such a wonderfully authentic community of men. I witnessed great acts of kindness and compassion among men who were deeply mired in their own various and sundry addictions. I used to love the after hours scene and would often be found with a small group of guys talking about our lives and whatnot. Among these disparate boys and men, I continued to see their remarkable humanity and a generosity of spirit that I think inhabits all gay men. I also saw exactly why HIV prevention efforts would most likely elude this part of our community. And even if there were programs to reach these men, none would dare go that deep into the community to talk to them.
These men inspired Tribal Revival, a five-year project to address club drugs, methamphetamine and poly-substance use among gay men. Our novel approach was to ask gay men what they wanted from their high and then asking them if they were getting that. Most often, these men were not getting what they wanted from being high and through harm reduction approaches and motivational interviewing techniques, we proposed that we could create new social norms around club drug use unprotected sex. But even then, our approach was contextual.
What I've learned over these years is that love, unto itself, is healing. From my perspective, AIDS is no longer the big, bad boogey man that it was back in my earlier days. I would argue that the collective silence around HIV/AIDS in our community has less to do with denial, indifference or even pathology; it may be that we've made an uneasy peace with AIDS, each in our own way.
Consider that gay men are making all manner of independent choices, including if, when or with whom to use a condom. What if, similarly, gay men are making fully informed choices when choosing to use any kind of drug. Can it be possible that gay men are rejecting traditional prevention models because they are perceived to be moralistic, over simplified, or that they don't fit our own picture of our lives. Is it possible that younger gay men just want to be free and live lives of their own making, even if those lives look much different that what was possible a generation ago? Do we have room in our concept of risk to honor the couple that considers all the angles and then make an informed choice to have condom-free sex? How does the collective mourning and losses of the AIDS epidemic rest in the hearts of older gay men? And what of the men who have simply given up, and have exhausted their desire to stay HIV negative. We can really go on and on, but all of these scenarios include a host of contextual factors that may give occasion to high-risk behaviors. But programs that simply focus on behaviors will rarely create enough relatedness to have open conversation with these men about the context in which their risks occur. Even those who may disagree must concede that behavior rarely occurs without a context. And this is why HIV prevention still matters for gay men.
I have yet to see a health department give grants to gay men to support our emotional wellbeing simply because they are concerned about the overall health of our community. And I've not seen social research firms breaking down the door to study how wellbeing affects the choices we make in our lives. Local planning groups don't convene to assess how social and political isolation impact the psyche of gay men, nor are they interested in how survivor guilt and fatigue rest in the hearts of gay men my age. I love my colleagues, but I doubt that without the imperatives of a sustained response to AIDS that we'd get together and explore how to promote healthy social networks. I am doubtful that the Colorado legislature would have allocated tobacco tax settlement monies simply to have gay men have meaningful interactions with one another. I've yet to attend a national conference on gay men's sexual health or gay men aging with grace and ease that was not associated somehow with HIV. Those things that impact our lives on a daily basis in profound ways have no standing onto themselves; it is the lens of HIV prevention that directs funding in these areas. Without exception, programs funded to reach gay men are in fact attempting to shift behaviors through contextual means. Just not enough.
"...We must lead our communities through inspiration and passion. We must stop asking folks to feel sorry for us, and instead inspire them to partner with us....We must speak to each of our communities in its own voice and ensure that cultural competency extends beyond race, but embraces culture, sexual orientation and age. If we embrace each of our communities just as they are, loving them and accepting them as perfect, whole and complete, our acceptance will pave the way for their participation."
And that, my friends, has HIV prevention being relevant and contextualized in such a way that that gay men can find a place to simply be ourselves and let our our collective and individual wounds begin to heal within the context of community. HIV prevention matters.
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