So much prevention work is seen through clinical and political eyes. Yes, it matters that we arm youth and young adults with condoms and continue pushing for biomedical prevention tools: Pre-exposure prophylaxis, microbicides, vaccines, etc. None of this, however, matters to at-risk youth or adults who still believe that their homosexuality makes them ‘sick’ or ‘unworthy.’
The bullying, rejection and resulting low self-esteem and depression continues to fuel the epidemics of drug abuse and HIV in our community. There’s no point in giving HIV prevention tools to someone who doesn’t believe his or her life matters. Until HIV prevention efforts deal head on with the rampant issue of homophobia—both external and internal—we will continue to see waves of young gay men becoming infected.
Tim Horn, 41, HIV/AIDS educator,
President/Editor of AIDSmeds.com
New Jersey
Diagnosed: 10/10/91
judderwocky
This man is horribly ignorant. The fact is the biggest contributor to the ‘waves’ of young people succumbing to HIV is youth HOMLESSNESS. It is a WELL ESTABLISHED fact that homeless, underage youth are the most vulnerable to becoming victims of the sex trade and are the most likely to be forced to trade unsafe sex for living arrangements, shelter, and food.
The vast majority of these young people have faced violence at their homes, foster homes, and even at religious institutions that they have turned to for help. To say that its because they don’t love themselves is just heartless.
The fact is these kids have been forced to trade their own safety in order to survive. What would you be willing to give up in order to survive? My guess is you have to want to be alive pretty bad to put yourself in those kinds of situations if it is literally a choice between that or dying. This author has COMPLETELY missed the point what is scary is that he actually thinks he’s in a position to talk about this.
This is exactly the kind of thinking that plays into conservative stereotypes. Its exactly the kind of bs that comes from well moneyed, white, non profits that are so far isolated from the class issues central to the problem that they only make them worse.
BLAMING THE VICTIM? Pathetic.
Mike in Asheville
Way too cynical for me.
While Horn is somewhat correct, he misses two huge factors: 1) many many many more than not gay/lesbian youth have lives that do matter to them (otherwise, the number of suicides among gay/lesbian youth would be 50 times greater than it already is) and are in need of accurate HIV/AIDS prevention/awareness information; 2) those gay/lesbian youth who believe that their lives do not matter, as a result of rampant homophobia, need all the help and guidance that our community can offer them, to lift them from despair.
There absolutely is a reason, an excellent and important reason, to provide HIV/AIDS prevention and other relevant information for at-risk depressed and maligned gay/lesbian youth: who else is going to step up and attempt to show these kids that they do matter, their lives matter, and with regard to HIV/AIDS, here is help you need.
By showing the struggling with homophobia kids that there are many adults who do care that they overcome their predicament is what will assist them in overcoming that predicament.
As an HIV/AIDS educator, I would think Horn would be more in tune with accessing strategy that would work, and struggle to find a successful strategy until a successful is found that works.
Simply throwing your hands up and saying, there is nothing we can do, certainly is not an acceptable answer.
Marcus
You get HIV from having bareback sex,guys need to protect themsevels if not this is what will happen.Its nobody’s fault but your own.
Matthew
Great conversation starter! Men who have sex with men know how not to get HIV. The prevention models I’ve seen fall short of addressing the complexities of gay life today. We could all being doing more to support our vulnerable communities. We have generations of men who feel alienated from themselves and the world around them. People need acknowledgement and they need support. I don’t know why we wait on public funding or politicians to address our community’s issues. We as gay men, along with our allies could create new service models in our own communities. It’s not terribly difficult. If you know a gay man, take him out to lunch, ask him about his life, let him speak. Let’s share our stories honestly. Let’s model health and self-care to those around us. We don’t have to wait any more. Thanks for letting me write.
CombatWorn
Thank you for saying that.
There is no doubt that many will find your truth to be brutally honest and others will twist this to meet their needs in changing the topic. If we don’t love ourselves, no one else will and who will protect you (general public) then? No one can protect you like you and I firmly believe it starts with loving yourself, the rest will follow.
Great post!
PApaul
I never thought about it like this before. I became HIV+ 6 years ago when I was 24. I knew all about condoms but I messed up alot. I was just so insecure about everything. When i’d get picked up in a bar or someplace it felt good to be wanted and I didn’t want to be rejected if I told teh guy to put on a condom or make a stink about it. I wouldn’t make the same mistake today because I don’t have any problems speaking up for myself any more. It makes me so angry when people tell me it was my fault that I became HIV+ but I don’t think this is fair because I definitely wasn’t in my best mind when it happened. Alot of people when I was younger made me feel really bad about myself and it took me a long time to stop feeling ashamed and alone. I don’t blame myself and I think your right that homophobia stopped me making good choices. Alot of people beat up on me which made me beat up on myself. I see that now so thank you.
Scott Bonzitski
OH,…and by the way… I got/get sick to my stomach when I saw/see HIV+ people still going out with one-night-stands and you KNOW they are NOT telling the person they are going home with that they are, due to them feeling as if “I got it, why not pass it to someone else.” And YES, it IS happening…SB
Timmy
In the developed world, HIV is primarily still a gay man’s disease because in every European country and in North America, new HIV infections are percentage wise higher from men having sex with men. Unless the LGBT community starts to address wanton promiscuity and the false sense of notion that sex is fun and harmless, no amount of condoms and free rapid HIV tests will stop new infections. Check any gay porn site and first thing you’ll see is tons of amateur guys proudly displaying their bareback sessions with some random guys they find online.
There is no way one can remain STD free if they sleep with 30 guys a year after weekend club or manhunt hookups. Most guys don’t get full STD testing yearly. How can you expect them to prevent infections with high numbers of new partners? GET TESTED WITH EVERY PARTNER, NOT AFTER YOU SLEEP AND THEN SUSPECT AN STI.
the other Greg
@Scott Bonzitski: You’re a doctor? You gotta be freaking kidding. Well you should know that if a guy has sex with someone and they don’t do anal sex AT ALL, or they have anal sex WITH A CONDOM, the chance of HIV infection is so infinitesimal as to be comparable to being HIT BY A METEOR.
(Your CAPS KEY mode is contagious, I think.)
@PApaul: But I suppose there’s something to what you and Tim Horn say — if a young person lacks a sense of worth and is pestered into bareback sex, it may feel “easier” to just give in and do it. That’s very sad, because for the bottom, it doesn’t feel ANY different! (The top is just being lazy, btw – aside from being an aggressive prick.)
WillBFair
@PApaul: It sounds like you’ve come a long way. I think that admitting our internalized homophobia is the first step toward adulthood. It’s no picnic, but it’s something that most of us have to go through. It’s also an important step toward healing.
I’m just so glad for the new meds and that you can live a good life.
Don’t you ever believe any heartless bitch who says it’s your fault. It isn’t your fault. You are innocent. Best wishes, and stay on that road to maturity.
WillBFair
@Matthew: I agree. I think we should set up support structures for people in their twenties: counselling, emotional support, etc… They’re the ones who need it most, after the twelve year hate fest of public school.
Scott Bonzitski
@the other Greg – member, No one was talking about “PROTECTED” sex. Don’t try to make me appear stupid when you do so yourself. It was the bareback that was in question. Please try to keep up with the conversation/point on hand…SB
the other Greg
@Scott Bonzitski: You referred to “HIV+ people still going out with one-night-stands and you KNOW they are NOT telling the person they are going home with that they are…” etc.
The guy on the bottom can’t trust the top to be telling the truth about being HIV neg or poz, or even knowing his status for sure. The guy on the bottom has to refuse to bareback, no matter what he’s being told in the way of “disclosure.” The whole “disclosure” conversation in a bar or internet hookup is totally pointless: the point is to avoid barebacking.
ewe
I do not like this connection between a virus and low self esteem. It is not acceptable. It is propaganda started by the Bummer and now being promoted by this person. Disgraceful.
the other Greg
@Scott Bonzitski: Were you referring to patients of yours who are deliberately trying to give HIV to uninfected people? How do you “KNOW” this?
The continual moralizing tone nowadays is another part of the problem: agonized wailing about “one-night stands” (gasp!), blasts at (supposed) ’70s-style promiscuity, implications that anything less than monogamy = HIV. You may not mean to imply this to young patients, but they may be inferring it. This doesn’t mean they don’t care about avoiding transmission, let alone that they’re deliberately trying to do it.
There’s nothing necessarily wrong with one-night stands; they can be fun and pretty harmless (in moderation) as long as there’s no barebacking. Anyway, plenty of happy gay couples met in rather sleazy situations, and all friends must meet somewhere the first time.
Not all young gay men are interested, YET, in settling down into a relationship. Not everyone wants or needs a relationship. That’s perfectly okay, as long as they don’t bareback.
jason
The best prevention tool is to refrain from promiscuity. It’s hard to do this in a male-male paradigm, however. Men are hard-wired to be constantly horny. In an environment where men mingle socially with men, that horniness factor is multiplied.
This is one reason why the stigma against male-male sexuality was invented – ie to prevent men from turning the mainstream into a highly promiscuous cesspool. The stigma against male-male sexuality was essentially invented to curtail the power of the male sex drive in recognition of the fact that this power drives men towards sex with anything that moves. It recognizes that most men are capable of bisexuality.
It is not coincidence that the gay male social scene is segregated from the mainstream. Women demand that this must be so. It helps to separate male-male sexuality away from “polluting” the mainstream. Women consider male-male sexuality a form of pollution.
It is also not coincidental that female-female sexuality is glamorized but male-male sexuality isn’t. Again, women are largely to blame. Women contribute to this double standard because they make money out of it and they also use it to pull the superiority card on men. Women WANT the bisexual double standard to exist.
Andy
@ewe: @the other Greg: @ the other greg: I’m still trying to figure how someone with a “doctorate in physiology” has “patients”. I’m probably better off with that distraction, as I’d hate to devote energy to wondering why a “physiologist” might be so simplistic as to think it is ethical or effective to shift the burden of prevention to the poz partner.
(sighs) looks like its another post from the KKKweerty.
I do agree with Ewe. Its kind of obvious that there is a connection between low self-esteem and poor condom adherence. Just like there’s a connection between low self esteem and pretty much ANY destructive behavior. Horn’s description of a relationship between HIV and “bullying” seems like a sad attempt to pander towards a seronegative population that demands constant regard for its own feelings of persecution above all else. I wonder what kind of conversation we’d be having if someone tried to link racism and smoking. I also worry that this is sort of thing contributes to the perception that people with HIV only get that way by being grossly self destructive.
steve
@ewe: I do not like this connection between a virus and low self esteem. It is not acceptable. It is propaganda started by the Bummer and now being promoted by this person. Disgraceful.
Just because you don’t like it or see it, there is a connection between the virus and low self esteem. Here’s my story. Few years ago during a phase of deep depression and low self esteem I let the guard down and stopped insisting to use condoms with my occasional partners. That was the stupidest thing I have ever done in my life and I paid for it because I got a somewhat manageable STD but thankfully not the HIV virus. Needless to say that was a wake up call. I did not realize how low I had sunk emotionally and psychologically because of lifelong issues accepting being gay, until I had to go to an STD clinic for strange and painful symptoms I never experienced before. If it wasn’t for sheer luck my story could have been much different and sadder, because of the consequences of living one’s life with the HIV virus, which we all know is not a death sentence anymore but it is still not something most people would want to bear. Now there must have been some study about the gay men who get infected during sexual intercourse with other men and the reasons why they choose to have unprotected sex. That same study would be the necessary foundation for an effective campaign against HIV/AIDS and it is probably something, that I assume, Tim Horn is aware of.
steve sydney
This guys rambling reinforces the fact that many people ignorantly perceive HIV to be a ‘gay’ persons disease.
HIV doesn’t discriminate and therefore treatment, education and prevention should be given to all no matter what.
Tim Horn
I’d like to start by saying that the above quote was from a much longer interview with Queerty. Maybe the longer interview would have helped frame my argument a bit better – or maybe not. But I do want explain my point here a bit more carefully.
My argument is that prevention efforts in the United States are not going nearly far enough to empower young men who have sex with men – the particular population I was asked to comment on by the Queerty editors – to use condoms and negotiate safer sex. And I believe that a central component of empowerment, for many gay and bisexual men, is providing the tools, resources and support to overcome internalized stigma, an undeniable consequence of being raised and coming of age in a largely homophobic society.
This isn’t about “blaming the victim.” In fact, I blame the federal government. Despite the fact that the majority (57 percent) of new infections in this country are among gay and bisexual men and MSMs are 10 to 30 times more likely o get HIV than are heterosexual men and the population at large, way too little comprehensive prevention programming is reaching MSM populations. And when the CDC reports that fewer than 8 percent of MSM surveyed in 15 cities are receiving group-level HIV prevention services and that only 15 percent receive individual-level interventions, that means that up to 92 percent of all MSMs at risk for HIV aren’t receiving even the most basic services.
And how can we even begin to design programming that allows frank discussions about sexuality and identity as they relate to HIV when there has been such a tremendous legacy of rear and resistance in the federal government (and by extension, in academic research exploring gay- and sex-positive messaging and programming). Yes, a lot of this fear is cultural, but when we still have things like the Helms Amendment on the books – which forbids the use of any federal prevention program and evaluation dollars for anything that might be considered “promoting” sex or sexual behavior outside of heterosexual sex within marriage – it’s no wonder that we haven’t gotten very far in addressing in the underpinnings of HIV risk among gay and bisexual men in this country.
And while I may be taken to task for this, but recent efforts by the CDC and other agencies to paint HIV as an “equal opportunity virus” has come with problems. It’s well intended – anything that addresses women at risk and helps destigmatize HIV as a “gay disease” is essential. But here, the approach was more about capitulation and not about confronting stigma and prejudice against all stripes of MSMs. And what we’ve been left with are startling statistics that homophobia is still rampant in the U.S., HIV prevention dollars going elsewhere and rising HIV rates among gay and bisexual men.
HIV transmission is not just about behavior – promiscuity included. It’s also about the social and structural context of the behavior. As a colleague, Walt Senterfitt, of the Community HIV/AIDS Mobilization Project once wrote: “They are also about the social and structural context of the behavior, about the vulnerability and resilience of communities and populations, about individuals living in communities having the awareness, tools and support to protect themselves and their partners. Homophobia is itself a major risk factor, as well as part of the risk context or vulnerability, for HIV transmission among MSM and, indirectly, for sexual transmission from men to women.
Back in 2008, then director of the CDC, Julie Gerberding, testified before Congress—in an effort to scale up the domestic response to the HIV/AIDS epidemic—that “If we don’t address the underpinnings of the problem, we’re never going to get where we need to be as a nation.”
I honestly believe that homophobia has had a profound impact on our lives and our ability to negotiate safely for our lives. And, unfortunately, I’m still not seeing any serious efforts to deal head on with the issue of homophobia in HIV prevention programming.
Mike in Asheville
@Tim Horn: Thank you for sharing more than we were given in the short snip.
Based on the snip, it certainly appears that you were saying that there is nothing to do and that the young, depressed and bullied, are doomed to a fate of HIV/AIDS without any recourse. Yikes, what an awful thought/vision.
What would be helpful, particularly as you point out that there is such a lack of leadership from government, is telling (and selling) us the ideas and concepts that HIV/AIDS educators such as yourself are promoting to make a change.
My friends were dropping like flies, had already lost my cousin, I was HIV+, and there was no government response at all. It was not until 1988 that the surgeon general’s report of HIV/AIDS was sent to every household in America.
The attitude changed when ActUP started acting up. No, of course ActUP did not get new legislation lobbied for and passed, that was HRC’s job. But ActUP brought the awareness that government was failing and gained a sufficient public response that gave heavy-weight status to the movement to force government into action. Alas, that action has not been sustained, and in many ways, is devolving.
So, Tim Horn, what are the plans/ideas? How do we all help? While the parents/family and community surrounding these kids have kicked them to the street, literally and figuratively, we as a community should not be so ready to let that just happen. These kids are not disposable — they are kids who deserve every bit as much the right of pursuit of happiness as every other kid. So let us help.
WillBFair
@Tim Horn: Thank you so much for this. It was obvious back in 1981 that, in their non response to hiv, the community were acting out internalized homophobia. But as with all people with emotional issues, they don’t respond to logic on related topics.
It’s been thirty years of listening to the community’s circular bulls—. Please note the endless excuses and subject changes above to see how the community avoids discussing prevention. And it’s been frustrating, to say the least, trying to get people to set community standards to stop the spread, including emotional support structures for the twenty something crowd, who need it most after the twelve year, public school hate fest.
I disagree with you on one point. It’s not entirely the government’s fault. We as a community need to step up, recognize our own and others’ internalized homophobia, and create the support structures to heal each other from self hatred.
On everything else, you’re golden. Thank you, thank you, thank you for your help on this issue.
Tim Horn
Mike:
I think we, as a community, need to think much more proactively about the underpinnings that continue to drive the epidemic among (largely young) gay and bisexual men in this country. While homophobia is by no means the only underlying factor involved – it’s also a serious consequence of racism, xenophobia, women’s oppression, transphobia and other socioeconomic factors – I honestly do think it is a huge underlying issue to contend with.
There’s certainly some literature on the subject. For example, a 2008 paper published by Simon Rosser, PhD, of the University of Minnesota School of Public Health and his colleagues, made a clear case that internalized homophobia/stigma/homonegativity is associated poorer mental and sexual health outcomes, both of which have been tied, time and time again, to substantial increases in HIV infection risk. (Source: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2605286/)
For me, there’s no argument: The homophobia so many of us experienced growing up or as adults can’t simply be reduced to being either transient aggression or indifference. Homophobia undoubtedly leads to all sorts of downstream events, notably leaving some of us feeling powerless when we absolutely need to feel most powerful – putting on condoms and safer sex negotiation notwithstanding.
Personally, I wish I was better at advocating and protecting myself when I was younger. But I wasn’t, probably because I went from being an adolescent with serious self-esteem issues because of who I was, to a highly sexually active adult, without first coming to the realization that my life is no less valuable than anyone else’s and worth protecting at all costs. Is my comment above a projection of this? Sure. But there’s no shortage of research (and other comments above) suggesting I’m not alone in this.
Where I think we need to go from here:
1) There’s no way we’re simply going to be able to treat our way out of this epidemic. Yes, one recent study found that keeping viral load undetectable was associated with a 96 percent reduction in transmissions, at least among heterosexual couples in stable sero-discordant relationships. Basically, it’s some of the best HIV prevention data we’ve ever seen. But it’s not going to be easy duplicating this rate in the “real world,” where roughly 1 in 5 people living with HIV don’t even know they’re infected and 1 in 2 people living with HIV aren’t in the regular care they need. The one thing that we need to push for is continued funding for the study of, and programming for, at-risk HIV-negative individuals. If we were to move entirely toward programs focusing on “prevention for positives,” funders – notably the CDC – will basically be saying that the future of the epidemic is entirely our cross to bear. As if we’re not already seeing this with HIV criminalization cases across the country.
2) Agencies like the Department of Health and Human Services — embodying the CDC, National Institutes of Health, etc. — need to start seeing homophobia and its sequelae as public health problems, with funds and multifaceted plans in place to address the problem.
3) Work closely with regional government and non-government agencies involved in HIV prevention work – yes, most are funded with CDC money – to ensure that they’re not simply looking at the epidemiologic data involving new HIV infections among MSM, but also consider the various factors driving these numbers, including the always unpopular and politically-fraught issue of homophobia, and the need to address them on a local level.
4) Challenge federal and state laws that reinforce homophobia and stigma and stymie research and studies designed to explore “best practices” for at-risk gay and bisexual men.
5) Keep pressure on schools, on both a state and local level, to end gay-related bullying and provide supportive counseling and other services for sexual minority youth, with the understand that homophobia can have long-lasting effects on physical, mental and sexual health.
6) Bring LGBT key opinion leaders—those who have been working, with success, on efforts to end homophobia in schools and other establishments—to the tables with HIV prevention leaders, to further explore the various associations between homophobia and HIV and ways to combat both head on.
Those, of course, are just a few ideas. To get much more involved in prevention advocacy, I highly recommend connecting with the HIV Prevention Justice Alliance: http://www.preventionjustice.org/
j
@PApaul: I just wanted to tell you how brilliant you are. 🙂
Huge
There’s also the issue of youth and the naive perception of invulnerability. It doesn’t matter what kids are taught so much as what everyone else is doing, fitting in, standing out and taking risks.
I had self-esteem issues like most other gay youth, was sexually active with other boys starting in puberty, had my first post-grade-school sexual experiences during the 80s AIDs epidemic, and knew enough from the newspapers and community at that time to be careful. Still, in one of my first real boyfriend experiences where we ended up living together, I dropped my guard thinking I was relatively safe (being monogamous), and ended up becoming positive nonetheless. Had nothing to do with low self-esteem; rather complacency and living more in the moment than thinking about the future.