Gay Men, Sex and HIV
Dunmore Press, $39.95,
As chief censor, I recently classified The Gift, a documentary directed by Louise Hogarth about gay men’s relationships with a virus. It interviews men who “bareback”, who choose not to use a condom during sex. Some of these men do not care what their sex partner’s HIV status is and resign themselves to infection sooner or later. Others, called “bug-chasers”, actively seek unprotected sex with HIV+ men, choosing to force fate’s hand by deliberately infecting themselves. Still others, “gift-givers”, advertise their positive status or do not reveal it or lie, so that they may infect others. It had just never occurred to me that the mantra by which we lead our lives – “assume every potential sex partner is HIV+ until you have proof to the contrary” – could look so quaint in this new world of chic nihilism.
The Gift explores how it has come to pass that those at risk of infection are the same men who seek to undermine public health initiatives intended to save their lives. It uncovers a sort of bent self-justifying logic: (a) we’re all going to die anyway; (b) it’s much better to have a shorter life of passion, fun and quality sex than a longer life of fear, denial and latex; (c) we have as much right to control our own destiny and lives without state-imposed fetters as anyone else; (d) the medicines are so good now that AIDS is no more terminal than life itself; and (e) they’ll work harder to find a cure if the virus spreads more quickly.
In this world, infection with HIV is liberating. Condom “nazis” don’t get invited to the ball.
This attitude has been fed by very mixed messages. On the one hand, HIV- gay men are told how nasty the virus is and what steps they must take to prevent HIV+ men transmitting it to them. On the other hand, HIV- gay men are told that discrimination is bad, that they should not stigmatise HIV+ men, and, anyway, look at how healthy, even hunky, they all are in those ads for the new miracle drugs. The land of free speech has, of course, created and fostered this confusion, but it would be extremely naïve to think that New Zealanders are resistant to the personal and political attractions of barebacking. A quick search of two websites on 23 August revealed nearly 300 advertisements from New Zealand men looking for unprotected sex with other men.
The stated aim of Heather Worth’s book Gay Men, Sex and HIV is to describe how gay men in New Zealand have adjusted their lives and sexual practices to cope with HIV. She also examines the effectiveness of New Zealand HIV prevention and support strategies, providing an interesting contrast to the American experience shown in The Gift. To my mind, one critical difference is that New Zealand prevention strategies have always acknowledged risk by referring to “safer sex”, whereas American “safe sex” campaigns create an impossibly high expectation that results in a loss of credibility among prevention strategists when the inevitable happens. Such diminished credibility inevitably helps create an environment in which bareback culture can take hold.
Worth draws upon some astonishingly rich New Zealand research, including Male Call, a survey of 1,852 men who had had sex with another man in the previous five years; a qualitative research project, Socio-cultural Context of Sero-conversion in Men Who Have Sex with Men (Worth, McNab, 1998); a qualitative project examining how 10 gay couples negotiated their relationships (Worth, Reid, 1997); and Frayed at the Margins (Worth, McNab, Aspin, 1998), which examined how class and poverty affect HIV transmission.
The value of Worth’s book is that it translates academic statistical and sociological geek-talk into English. It would have been tempting, to avoid drowning her readers in statistics, to bandy about a few of the more interesting ones in superficial headline fashion, such as a Male Call result showing that 35 per cent of men identifying as heterosexual had highly unsafe anal sex with casual male partners, whereas only 20 per cent of men who identified as gay had highly unsafe anal sex with casual male partners. The headline for this statistic might be “Straight guys are stupid”, whereas in context a sensible strategy could be developed to cover a group of people at obvious risk.
I am not a statistician or a sociologist but I was left with the impression that Worth prefers to muster fleets of statistics to increase the chance of discovering a significant relationship at which to aim a new strategy and possibly save a life. The book makes statistical analysis seem like a voyage of discovery with a happy ending. Worth’s ability to marry cold statistics with quotes from the people providing them transforms potentially dreary analysis into very human stories.
By making the results of this research more accessible, the book also dismantles stereotypes of gay men’s behaviour, many of which are long cherished by religious fundamentalists, and sometimes by gay men themselves. For example, lots of gay men are poor. Fifty-nine per cent of rural gay men live as couples. Twenty per cent of Male Call respondents are fathers. The New Zealand AIDs Foundation’s current prevention strategy aimed at gay men who have sex with their partners and with “fuckbuddies” has drawn criticism from gay men who, despite the statistics, do not believe that partnered gay men have “fuckbuddies”, or if they do, that “fuckbuddies” should be called something else and not discussed in public.
Although Worth tries her best to humanise the research, there is something about drawing conclusions from statistics that will always make me nervous. It might be that they can never be completely authoritative. It might be that what is surveyed, how it is surveyed, and how the results are interpreted, are determined by people I have not met and whose intervention could skew the results in ways I can never know. An example of this is the meaning of “sex”. What “sex” includes is pretty central to a book about sexual behaviour. Worth recalls giving a number of people the following scenario: “You are a young man of 18 in your last year of boarding school. Another pupil puts his hand on your thigh and this sexually arouses you. Is this sex?”
I will not say whether the result was surprising or unsurprising. Either answer will affect how you read the Male Call research and Worth’s book. Yet it is surprising how often fundamental questions such as this are left out of American research reports and replaced by unspoken assumptions.
I was reluctant at first to read Gay Men, Sex and HIV for the same reason that I hated family law lectures: there was a risk (which eventuated in the case of those lectures) that I might recognise or even know some of the people who featured. I didn’t this time, but this could be the book’s main attraction for some readers. Although it is an interesting portrayal of how quantitative and qualitative research gets transformed into policy, the most significant impression left on me was one of admiration for the candour and courage that gay men have shown in negotiating their way through a minefield of sex drive, desire, love, lust, long-term partnerships, cheap anonymous sex, condoms as both saviours and symbols of death, and the virus forcing a risk assessment no one should have to make every time the opportunity for sex arises.
I must add a couple of caveats that may detract from the otherwise positive influence this book could have had in bringing a general audience up to date (or rather up to the late 90s) with how gay men are or are not influenced by the virus and by prevention strategies.
The first concerns the author, who does not appear to have cast a sufficiently critical eye over some of the charts and tables. One example is the table on p51 that purports to show how the men in the Male Call survey identified themselves. The first row shows that 80 per cent identified as “gay”, the third that 39 per cent identified as “queer”, and the second, fourth, sixth and eighth rows show percentages of men identifying as something – but what? One has to go back and re-read the text to find out. The source of the table is correctly cited in a footnote in the preceding paragraph but incorrectly on the table itself.
The second caveat relates to attribution. The author’s three-paragraph conclusion to the second chapter on pp60-61 is identical to three paragraphs on pp28-29 of Worth, Saxton, Hughes, Reid and Segedin’s Male Call, Report One (October 1997). Although Worth was a co-author of the original, I am not at all comfortable when co-authored work is appropriated by one author who fails to cite its source or let readers know the others have consented or, as in this case, fails to put the quote in quotation marks. Once Male Call goes online, lawyers may well interpret the author’s general assertion of copyright at the front of the book over work that does not appear to be solely her own as an invitation to litigate.
These problems might have been easily fixed before publication. I don’t know if there are other examples, but should there be, readers would be entitled to doubt the substantive content of the book. That would be a shame, because it might have done much to educate the general population about the intelligence and bravery of people who have lived with and responded to a disease that strikes at the heart of human relationships.
W K (Bill) Hastings is chief censor.