Syphilis rates among gay and bisexual men are up all around the country. Rates of new HIV infections among men who have sex with men are also rising. And this week, The New York Times ran a front page Metro section story about the epidemic of crystal meth addiction spreading throughout New York’s gay community.
Clearly, against a backdrop of ever-growing complacency among gay men, and Americans generally, about the risks of AIDS, something very serious is amiss. Perhaps the most significant, and troubling, question raised by this deadly combination of complacency and risky behavior is whether AIDS prevention groups are equal to the task of grappling with this increasingly complex social intervention challenge.
Ronald Valdiserri, a top prevention official at the Centers for Disease Control and Prevention, offered a sobering answer to that question this week in an interview with Gay City News.
“My personal opinion is the answer to that is no,” he said.
Gay men on the ground, in New York and elsewhere, clearly share Valdisseri’s concern. In November, Dan Carlson and Bruce Kellerhouse, saying they were alarmed by the lack of prevention messages being aimed at their peers, organized a town meeting at the LGBT Community Center to give vent to the alarming trends in risk behavior they were seeing and hearing about around them. A standing-room-only crowd of hundreds turned out up to an hour early for the event.
In Seattle, where recent studies have documented dramatic rises in HIV infection rates and in syphilis, a group of gay men came together to issue a community manifesto on HIV prevention, which emphasized the responsibility gay men have for their own health. The manifesto urged gay men to always use condoms for anal sex and said HIV-positive men should disclose their status before having sex.
“Transmitting HIV knowingly is an act of violence,” the manifesto read.
The Gay City Health Project, one of Seattle’s oldest and best respected prevention organizations, however, rejected the thrust of the manifesto. Fred Swanson, the group’s executive director, was quoted in the Seattle Times complaining, “The manifesto says you are either a good gay or you’re not, and if you’re not a good gay, you’re not worthy of our time.”
But the CDC is clearly sharpening its pencil about which prevention efforts are worthy of its time––and money. A recent request for proposal it circulated for the distribution of $49 million to community prevention efforts spelled out important new measures of performance and accountability bidders must meet in order to win grants. Valdiserri said he is not sure prevention groups have yet absorbed the new reality involved in federal funding decisions.
In fairness, it should be noted that the CDC is responding in part to stepped up pressure from the right wing, particularly conservatives on Capitol Hill. As some prominent AIDS leaders have pointed out, some of the conservative criticism is based in an ideological preference for abstinence-only efforts and an aversion to frank discussions of sexuality, especially when it involves gay men.
Yet without falling prey to conservative efforts to impose a political straight jacket on prevention, AIDS advocates must acknowledge that the demand for accountability is legitimate. Roland Foster is a Congressional staffer who has done a lot of the heavy lifting for Mark Souder, the conservative Indiana Republican whose House subcommittee has been a thorn in the side of federally-funded prevention programs. Yet, it is hard to argue with his recent written statement to Gay City News that “with the failure to reduce HIV rates over the past decade, new prevention approaches are clearly needed… We will expect outcomes, including actual decreases in HIV/STD rates and reductions in risk behaviors, to demonstrate that the program is effective.”
AIDS prevention groups and the gay community generally have developed an enormous amount of expertise in the past two decades about what can work and what won’t, buttressed by an in-depth understanding of at-risk communities. But unless the leaders of those groups and of our community are willing to name the stubborn problems of risky behavior in our midst and confront them creatively in high profile fashion, they will be unable to assume the mantle of responsibility they bear.