From: 
Don't fear the fear
The first thing I did when I walked into a room at the bathhouse was throw the condoms that were laid on the table into the trash," 32-year-old Troy Alexander, an HIV-positive former hustler and New York party boy, told me over coffee in a New York café, speaking about his life over the past three years. He was out on the scene every night with his friends, most of whom are in their 20s and early 30s, going to dance clubs, sex clubs, and the new and expanded bathhouses that have sprung up in Manhattan in recent years, and he was often doing a lot of drugs, mainly the stimulant methamphetamine, better known as crystal meth. "When guys would even try to put a condom on [during anal sex], I'd say, 'No way,' " he recalls. "Some of them were saying to me that I needed to get my head examined. But others—most, in fact—plunged right in without saying a word. I'd sometimes spend days at the club, having sex with dozens of guys. No one, none of my friends, uses condoms. Our attitude was always like, Why would you? That's utterly retarded and just worthless." There was a time when being safe was what was hip. That was back in the late '80s, when the late downtown New York street artist Keith Haring was designing safer-sex posters and AIDS groups were producing condom ads so sexy that they were sometimes banned. Now, in the midst of what seems like a full-scale late-'90s escalation of the epidemic among gay men, it is unsafe sex that is often put forth as the hot thing to do. Witness the February cover of Poz magazine, which depicted young, naked, smiling bareback activist Tony Valenzuela atop a saddleless horse, with a cover line that refers to the "boys who bareback." It was similar to a women's magazine like Cosmopolitan putting a busty blond model on the cover under the headline "The Girls Who Go All the Way." The message was clear: The boys who bareback are leading more exciting, daring, fun lives, and the rest of you poor souls are wimps and dullards, doomed to mediocrity unless you too can go as far as they do. Why has it come to this? Because one little four-letter word has fallen out of the safer-sex equation: fear. Quite simply, the fear that once was so omnipresent in people's lives—the experiences of friends' dying rapidly, the emaciated bodies walking through the gay ghettos, the obituaries filled with the names of young gay men—is gone. For this (perhaps short) moment, fear has gone back into the closet. It's true that most gay men are, at the very least, trying to be safe and would no doubt reject the bareback philosophy outright. But the glamorization of bareback sex—a glamorization fueled by the absence of fear—has a direct effect on gay men of all ages who are struggling with safer sex. They may be safe most of the time, but they have their moments of weakness. And it's in those moments when, often under the influence of a couple of drinks or buzzed on drugs, they will sometimes cling to any flimsy (and later, regrettable) excuse to forgo using a condom. The message that it's hip to go condomless and that you're a wimp if you don't isn't exactly going to help gay men maintain their resolve to stay safe. Couple that with drug ads showing HIV-positive people looking beautiful and living healthy. And add in the simple fact that many gay men today may not know of anyone who's sick, let alone someone who has died a horrible death. It's interesting to read Valenzuela's motivations for barebacking. "I come from a generation that has normalized the epidemic,'' Valenzuela, who is 30, told the Associated Press. "It's not my experience to lose half of my friends and feel the debilitating effects of the virus. I don't have a reaction to it the way people [do] who have had so much loss around it.… I wish I could say that to people and not be heard as defiant, irresponsible, delusional.'' The article paraphrased Valenzuela as saying that he "cannot help but feel that transmitting HIV to another is not that horrible of a thing to do." Troy Alexander, in the same age group as Valenzuela, also HIV-positive, also once a hustler, says he felt the same way. "Oh, I'd just go to the bathhouse and do as many guys as I could, and then later I'd take some calls and make some money and not care about HIV or about my own health—it just wasn't an issue in our lives." He has been HIV-positive for several years, has been on combination therapy for a while, and has not had any health problems. But Alexander recently made a dramatic change. He stopped hustling. He's trying to come to terms with his past crystal meth use. And he has rethought his opinions and certainly his actions concerning bareback sex. What caused the turnaround? Fear. "A close friend of mine died, and it just devastated me," he says. "It was my first brush with the repercussions of AIDS. I'd certainly never felt them before. He was just gorgeous and a great person. Carson was a waiter, but he was also a hustler. It's hip to be a hustler, you know. It's where it's at right now, and we were all doing it. But what I saw in the hospital was horrible, not hip. I was there over Christmas, and I watched him wither away. "I tried to get a bunch of people to come visit him, but they wouldn't leave [the bathhouse]. They kept saying, 'Oh, I don't feel like going to a hospital. No way.' " The last thing he'd want to do now, Alexander says, is pass on HIV, and he's committed to maintaining his own health, protecting himself from infections of all kinds. Contrary to what some writers—in particular, those who support the bareback crowd—have said, fear does work in changing behavior. Absent fear of disease and dying, what, after all, is the incentive for staying safe? Some of these same writers have done everything from distorting studies about unsafe sex and HIV infection to claiming that protease inhibitors are working just fine and will continue to work, rejecting increasing evidence to the contrary. As far as they're concerned, fear won't work because there's nothing left to fear. Others have acknowledged that HIV transmission is on the rise, but they reject fear outright, claiming that terrifying gay men doesn't go far toward making them safe and only turns them off. They say the softer, sexier sell goes a longer way. But the truth is, fear has in the past worked dramatically well even when it wasn't implicit within HIV-prevention messages. Prevention has often focused on hot, healthy bodies, often even depicting images of sexy, muscular HIV-positive men. This was important not just for negative men—to eroticize safer sex—but for positive men as well in order to build self-esteem at a time when HIV-positive people were being ridiculed and stereotyped. It's partly this impulse that was the genesis of Poz magazine, and the publication's success speaks to the need for validation and hope that it fulfills among many people with HIV. But apart from the ads and the magazines like Poz boosting our morale, we were always surrounded by real life—the dying friends, the gaunt faces, the painful coughs and lesions. There was a balance in all of our lives: on the one hand, images that built the self-esteem of positive people and made safer sex more sexy and desirable, and on the other, real-life experiences that were much to the contrary. And that was enough to both promote safer sex and keep people very afraid of ever becoming infected. Now, however, the balance is way off. All we see—in ads for safer sex,
in HIV-prevention materials, in ads for protease inhibitors, even in TV
programs about people with AIDS—are handsome, healthy people. After
years of activism and education efforts, people with HIV have
But we weren't counting on the downside to that victory. Because we've had some successes in both public relations and medicine, the reality of sickness and death has become abstract and removed for a whole new generation of young adults. It's not gone, but it is hidden: The culture of hope has completely overtaken the fear, pushed it out of sight, below the surface. Even among those who are infected, a code of silence has developed,
as if the culture of hope forbids any contrary voices. People don't talk
about their complicated drug regimens. People often don't let others know
about the disfiguring and painful side effects they may be experiencing;
they're almost embarrassed about them. People don't mention it when their
viral loads go up and their T-cell counts go down; the last thing anyone
wants to be is a "protease failure." As long as
So perhaps prevention should now go in the other direction and bring the balance back. Perhaps prevention should be about fear. Maybe if, instead of just seeing hot bodies having sex, people saw and read about the difficult drug regimens, the hunchbacks, the fat deposits, the soaring cholesterol levels, the nausea, and the diarrhea, it might make them think more about staying safe. Maybe if people saw, through prevention efforts, real-life stories of those for whom the drugs don't work, people who are desperately trying everything to no avail, there might be a change in behavior. Maybe if people saw in safer-sex campaigns how those infected with drug-resistant strains of HIV spiral downward quickly into sickness, it might affect their decisions around bareback sex. Maybe if prevention highlighted gay men like Troy Alexander, young people who used to bareback but who had a real-life tragedy dramatically change them, there would be fewer people like the old Alexander tossing out the condoms at the bathhouses. As protease inhibitors continue to fail and drug-resistant strains of
HIV spread, we're heading back in a frightening direction. It would be
tragic if it once again took death en masse of countless gay men for us
to realize the immense value of making real the horror of AIDS. Just as
we earned the right to hope, maybe it's time we learn the need to fear.
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