Response to rising HIV divides gay community

By Stuart Eskenazi
Seattle Times staff reporter

	STEVE RINGMAN / THE SEATTLE TIMES Phil Pelino, who has AIDS, counts out his meds with nurse JoAnn Hurst at Bailey-Boushay House in Seattle. Pelino understands why HIV-positive men would hide their status from sex partners but believes there is no excuse for doing so.
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Jimmy Morrison is 24 and knows the score, having dished out HIV-prevention advice to young gay men at workshops around town. But while pausing to reflect on why he put himself at risk by having unprotected sex last year, he falters.

First he blames "the heat of the moment," insisting it did not occur to him to ask his partner to wear a condom until "it was too late." When pressed, though, he acknowledges it was on his mind from the start.

"What guided my decision was that I didn't want to have to place the burden of safe sex entirely on my partner," says Morrison, of Bellevue. "I guess I was worried about his comfort level, and it was obvious he was willing to go on without one."

With HIV-infection rates among gay men in King County once again at epidemic levels, many people — gay and straight — say they are tired of hearing excuses.

Debate over the community's expectations on sexual behavior is exposing a cultural divide among gay men, sparking a separate discussion within the gay community on its values and ethics. One side says it is unfair to condemn gay men who engage in risky sex without considering the underlying causes of the behavior. The other side wants the coddling of those whose behavior is fueling the epidemic to stop.

The manifesto To learn more about A Community Manifesto: A New Response to HIV and STDs, see www.homohealth.org

A community manifesto on HIV prevention, issued last fall by gay-community leaders and public-health workers, has placed squarely upon gay men the responsibility for their own health. The manifesto responds to sobering statistics: Newly reported HIV infections among gay men in King County increased 35 percent from 2001 to 2002 and were projected to rise an additional 16 percent in 2003.

The local numbers reflect a national resurgence of HIV and other sexually transmitted diseases (STDs) among gay men.

"This is happening because we treat one another as disposable sex objects, not as people," says Phil Pelino, of Seattle, who has AIDS and helped write the manifesto.

Public-health officials estimate that 7,250 of 8,400 King County residents infected with HIV are gay men or other men who have sex with men but do not identify themselves as gay. Based on random telephone surveys, the officials also estimate that one in seven gay men in King County has the virus.

The manifesto calls on sexually active men to always use condoms for anal sex and calls on HIV-positive men to disclose their status to prospective sex partners.

Yet some gay men — along with Gay City Health Project, one of Seattle's largest gay men's health organizations — are reluctant to embrace the prescribed standards for sexual behavior, saying the manifesto casts moral judgments upon gay sex.

Gay City follows a theory that nurturing a gay man's self-esteem, rather than joining in a chorus of rebuke, inspires him to make healthier choices. The organization appears to be paying the price for its no-fault philosophy. For the first time in its nine-year history, it lost out in its bid for a share of public money allocated for HIV-prevention programs in King County.

"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," says Fred Swanson, Gay City executive director. "That's how you solve community problems? Absolutely not. 'Just Say No' doesn't work. People's lives are a lot more complicated than 'yes' or 'no' sometimes."

No-excuses stance debated

Other gay men want their community to quit playing the victim.

Dan Savage, editor of The Stranger, a Seattle weekly newspaper that has published several stories critical of Gay City, says shaming those who behave badly, instead of making excuses for them, could help stem the tide of rising HIV infection rates. While Savage writes a nationally syndicated sex-advice column that is permissive in tone, he also crusades for individuals acting responsibly in their sex lives.

	Jimmy Morrison, 24, hasn't always followed the safe-sex practices he teaches others.

"Gay men today don't need AIDS organizations saying, 'Go for it!' " he says. "What they need are AIDS organizations that are giving the Mary Poppins message: 'Enough is as good as a feast.' There are times when you need to tap on the brakes, slow down, have less sex."

Morrison, head of volunteers for Queercore, Gay City's program for men under 30, says it is unrealistic to expect younger gay men to slow down, let alone always practice safe sex. But Morrison, who tested HIV-negative in November after having unprotected sex, vows to not make the same mistake again, acknowledging that one slip is all it takes.

The choice he made at the time seems to point to his lack of fear of AIDS. As men with HIV and AIDS live longer and look healthier, the message of restraint is lost on a generation that has not seen the pallid face of the disease.

"Personally, I don't know anyone dying of AIDS," Morrison says. "So trying to scare me into having safer sex isn't going to work. The message doesn't correlate with my reality."

At the height of the AIDS epidemic in the 1980s, gay men were terrified as they attended the funerals of friends and watched many of those still alive wither away. Fear proved to be an effective incentive to practice safe sex — and transmission rates, consequently, stayed low.

But as more has become known about HIV transmission and as new multidrug "cocktail" treatments have transformed AIDS for many from a horrific way to die to a manageable disease, fear no longer can be counted on as a deterrent to risky sexual behavior.

Pelino, 67 and diagnosed with full-blown AIDS in 1986, is still alive because of the drug cocktails. But he is quick to debunk the vigorous images of people with AIDS, such as those depicted in drug-company advertisements. He says he spends less time climbing mountains and more time sitting on the toilet because of side effects from the drug cocktails.

"I've been at death's door five times," Pelino says. "It's not fun."

Bathhouse event canceled

Gay City's idea to invite young gay men to a bathhouse to teach them how to stay HIV-negative sent a strong signal to King County officials that the organization's philosophies were out of sync with their own.

The annual workshop was to take place last October at a Capitol Hill bathhouse — a club where men have sex, often anonymously and sometimes without condoms. As incubators for the transmission of HIV, bathhouses may seem like logical places to bring a safe-sex message — except Gay City targeted promotions for the event to "sex-club virgins."

Tipped off by The Stranger, County Executive Ron Sims pressured Gay City, which canceled the event. Dr. Alonzo Plough, director of Public Health — Seattle & King County, says the bathhouse event implicitly normalized the very things Gay City is supposed to be trying to prevent.

Gay City's approach toward health is aimed at offsetting a history of oppression in which others have cast judgment or shame upon gay men. Founded in 1995, the organization goes to great lengths to celebrate gay sex. Its phone number ends with 6969, a not-so-veiled allusion to a sex act.

"Part of nurturing self-esteem is saying, 'Hey, being gay is great,' " says Swanson, Gay City's director. "The work we do is shamelessly gay. We don't plan events worrying about whether they are acceptable dinner conversation for a 64-year-old straight man in Bellevue."

Critics, however, say Gay City's slant gives impressionable gay men mixed messages about healthy sexual behavior and community norms. Gay City's HIV and STD information phone line, for example, ends with STUD (7883). A poster in Gay City's new HIV-prevention media campaign reads: "Anonymous sex doesn't give you HIV. Unsafe sex does."

Savage, a co-founder of Gay City before becoming one of its most vocal critics, says such organizations are obliged to call out those whose behaviors endanger the community's health.

"They need to start telling gay men the things that gay men don't want to hear," Savage says. "There are some lost gay men out there who want and need guidelines on what is expected of them, so they go searching and are told, 'Everything goes, and the more reckless you are, the gayer you are.' "

When sex is a crime

Intentionally exposing or transmitting the HIV virus to another is a form of first-degree assault in Washington state. King County has never prosecuted anyone under the law, though other counties have.

The King County manifesto's most controversial line is: "Transmitting HIV knowingly is an act of violence." When Jim Blodgett read that line, it caused him pain.

"It's an act of stigma, confusion or shame," says Blodgett, 49 and HIV-positive for nearly a decade. "Rarely is it an act of violence."

Blodgett says he is just now beginning to deal emotionally with his HIV status. In the past few months, he also began selectively disclosing his status to sex partners.

In two instances, sexual contact was low-risk, yet each partner sought reassurance from Blodgett afterward that he had not infected him.

"I felt pretty crushed," says Blodgett, of Seattle. "Why even tell anybody? Why go through this hurt, these fears, this feeling of rejection and stigma all over again? Why is the responsibility for keeping others safe all on my shoulders?"

Questions such as his have fueled a blame game between HIV-positive and HIV-negative men over who bears more responsibility for protecting men from the virus.

"If I tell you I'm negative, I could be lying or just not know my status," Blodgett says. "If you are going to base your behavior on something that someone tells you, then you are a fool.

"I never have tried to figure out who the bastard was who infected me, because it doesn't matter who he was. I was the bastard. I am the only person who can infect me."

Savage is sick of hearing excuses from HIV-positive men who do not disclose their status — and tired of those who say condemning them is victimizing the victim, especially in an age where HIV-positive men enjoy healthier lives.

"If you're physically healthy enough to fly to Mexico and go to the gym, then you should be emotionally healthy enough to hear, 'Knock it off' ... and 'That's wrong,' " he says.

As a person with AIDS, Pelino has more empathy for the emotional baggage of HIV-positive men. But like Savage, he does not want to hear excuses.

"You disclose your HIV status because you feel better about yourself for having done it," Pelino says. "You do it because you are a man, not a petulant child."

While he would prefer sex without a condom, he says using one is among the many compromises he has had to make in life.

"I also understand that it's difficult to reveal your status upfront because you do get a lot of rejection. And I do.

"You know what? Too bad."

Stuart Eskenazi: 206-464-2293 or seskenazi@seattletimes.com

Copyright © 2004 The Seattle Times Company