LAMBDA Volume 28: Issue 1
Part One: Demystifying the Epidemic
By Trevor Hoppe
Editor’s Note: Trevor
Hoppe is a senior Political Science major and Sexuality Studies
minor. He would like to thank Professor David Halperin from the
University of Michigan for assistance with this article.
It was an afternoon not terribly unlike many others during my summer
life in Charlotte, NC. I was sitting around having cocktails with a
few gay male friends chatting about our lives as we casually flipped
through television channels. It was just another careless Sunday of
recuperation from the previous night’s festivities. Any outsider who
happened into the kitchen, however, might describe the situation
differently. This is because sitting on the counter beside the open
bottle of white wine were gauze, a used lancet and a blood sample.
It was my blood drying in
the kitchen. I had just begun the process of testing my blood for
After picking up a commonly available testing system at the local
drug store, I planned a small, intimate get-together at my friend’s
apartment to help make such a grim experience a little livelier. I
have an intense phobia of needles, so I forced one of my friends to
puncture my finger while I looked away and took a sip of wine. It
was painless - at least physically painless. After letting it dry,
we sealed up the sample and dropped it in the mail for screening at
a laboratory far, far away. Seventy-two hours and a quick phone call
later, I learned my HIV status.
Living in a Culture of Fear
While the collection process wasn’t difficult, the time between
sending off my blood and the availability of my test results wasn’t
so easy. I get tested for HIV antibodies every six months, and every
time I convince myself that this will be the last such experience
necessary. Over and over I revisit the grainy memories of sexual
acts that fill my imagination - did the condom break, did he look
emaciated, did I have any cuts in my mouth? I meticulously review
any symptoms I may have experienced in that time. Did I have a
fever, had I experienced nausea, was I overwhelmed with exhaustion?
I convince myself that one or all of these things have happened and
that I’m “obviously” HIV-positive.
You see, like so many
Americans - not just gay men - I suffer from an intense fear of
contracting HIV and ultimately dying of AIDS. It is one of my worst
nightmares, and, like clockwork, I relive it every six months. My
trepidation is fueled not just by my own internalized homophobia
(e.g. “I’m going to get AIDS because that’s what happens to sexually
active gay men”), but also by the often misinformed and misleading
dialogue on HIV/AIDS that goes on in our country. Every media outlet
seems to spew information that targets me (and my sex life) as an
“at risk” sexual being because of the sex acts I engage in. Even
when I open up safer sex literature I am presented with knowledge
that attempts to instill fear deep in my conscious by hinting that
the HIV epidemic is growing and that I could be its next victim.
Sex, they say, is like Russian roulette. The odds aren’t good, so
you might as well keep away.
Whether the effects of
this fear are positive or negative is disputed. It is certainly at
the foundation of the recent controversy about “bug chasers ” in the
gay male community. “Bug chaser” is a newly coined term referring to
HIV-negative gay men who purposely seek out positive sexual partners
to become infected. The story goes something like this: Gay boy
engages in safe sex but always fears becoming positive. Gay boy
longs for a sexual life free from the ever-present fear of
contracting HIV. Gay boy decides that contracting the disease on his
own terms provides a relief from the constant anxiety and,
therefore, access to a more liberated sexual life. Gay boy gets
gangbanged unprotected by known HIV-positive sexual partners and
subsequently seroconverts - antibodies develop in his blood as a
result of infection. Whether scores of these chasers actually exist
is somewhat irrelevant, the story still vividly illustrates the
terror that many gay men experience in the face of the epidemic.
The unease that
accompanies these trips is certainly connected to the failure of
mainstream information sources to communicate solid scientific data
about the epidemic to the public. What are the real facts about HIV
and AIDS? Not many people know because as a culture we don’t like to
talk openly about all things sexual - especially the kinds of sex
that carry an increased risk of HIV transmission. In a media culture
of sound bites and corporate interests, dialogues on the sexual
reality in which we live are squelched.
I want to talk about what
no one else seems to be interested in frankly discussing. In part
one, I will examine the current state of the American epidemic. I
want to talk about the annual number of new HIV infections and about
trends that new infections have followed throughout the past 23
years. In doing so, I hope to dispel myths and misconceptions that,
until recently, I believed to be scientific fact. In part two, I
will explore the biology of the epidemic. What constitutes risky
sexual behavior, and how high is that risk? I will explore the most
current knowledge on that topic and, in doing so, argue that the HIV
panic that has held so many queer men’s sexual bodies captive is
largely unfounded. It’s not an easy conversation to begin, but the
knowledge is so important to surviving in our culture of fear. This
is not a conversation about AIDS worldwide. This is a conversation
about our own sexual habitat ? the United States.
A Snapshot of the American Epidemic, Trends
There are many myths and half-truths that are promoted about the
domestic HIV/AIDS epidemic. One of the most prevalent is the
commonly held belief that new HIV infections are dramatically on the
rise here in the United States. In fact, this is far from the truth.
New AIDS cases actually peaked in 1993 with 78,954 new infections
reported in that year. By 2001 that number had dropped to 24,804
cases and the statistics continue to decline. We are coming close to
a return to a number of new annual infections not seen since 1981.
Though the annual numbers of new infections have dropped since 1993,
the demographic composition of those new infections has markedly
changed over time. For example, the proportions of heterosexuals and
people of color making up those new infections have increased since
the initial outbreak. Whereas in 1981 71% of new infections were
“men who have sex with men” (MSM), this year that number has dropped
to 40%. More drastic has been the proportional increase of infected
people of color. Whereas in 1981 well over half of new infections
were white; today they represent just one-fifth of new infections.
Black people in the United States are being disproportionately
infected today by a factor of five and make up over half of all new
infections. Likewise, Hispanic populations are overrepresented by a
factor of 2 with 20% of new infections. By contrast, in 1981 they
made up 25% and 14% of new infections, respectively.
HIV doesn’t pick new
people to infect by the color of their skin, however. The changing
demographics have as much to do with social class as they do with
race and ethnicity. The virus is ravaging poor populations here in
the United States just as it is across the globe. This is
attributable to a variety of factors. One explanation is the immense
lack of knowledge about the virus within poor communities and how it
gets transmitted. If you don’t know how the virus gets from person A
to person B, you won’t know how to protect yourself against
infection. Others point to the importance of hygiene in regards to
transmission risk. Cuts, lesions, and open sores are an excellent
way for the virus to find its way into your bloodstream.
Furthermore, while more affluent communities are able to afford the
costly protease inhibitor regimen that can combat viral loads, poor
communities rarely have access to these life-extending medications.
Thus, increased viral loads make for increased levels of
transmission. Connected with this is the lack of health care for
millions of Americans, especially working class Americans. People
with adequate health care will more readily seek treatment for other
sexually transmitted diseases, and thus lower their risk of both
becoming infected via sores or lesions and infecting others if they
have already contracted HIV.
All of these factors
contribute to an unstable situation for our sexual ecology. Public
health infrastructure hasn’t adequately accounted for the changing
face of the American epidemic. HIV is no longer just about gay white
men, as it was considered in the early 1980s when it was known as
“GRID,” or gay related immuno-deficiency - though we are still
overrepresented in new infections. The trends that the epidemic has
followed can be further explained by examining the facts about
sexual transmission, which we will explore in Part 2 of this series.