ESPINOSA: On HIV, don’t repeat history

Gay men of the Gay Ivy: We are a generation that’s come of age in the wake

of half a million Americans lost to AIDS. Since that devastation, what was once a certain death is now a manageable disease. We are a generation that knows HIV, and we know how to protect our partners and ourselves.

Despite this hard-won knowledge, HIV transmissions among men who have sex with men, or MSM, are on the rise after years of decline. and now comprise the majority of new infections. Almost half of college-aged gay men will be HIV+ by age 40. For black MSM, the number jumps to 57 percent.

While these numbers are startling on their own, what sounds the alarm is that we’ve seen them before. In San Francisco. 20 years ago.

History is repeating itself.

To reconcile these statistics with the current state of HIV prevention and education, a group of about 30 Yale undergraduates, graduate students, alumni, faculty and local activists met this month. The workshop revealed that those spared the early, darkest years of the plague also missed the critical lessons that succeeded in slowing its spread.

Questions that once protected a man’s health have become part of an online hookup culture, flattening once-valid concerns into cheap phrases that no longer bear the urgency under which they were initially created. On apps like Grindr and websites like Manhunt, men post profiles complete with their status, most recent test date and acronyms like “DDF” and “neg UB2.” People ask, “Are you clean?”

Degrading language aside, serosorting — when HIV- men only partner with HIV- men, and HIV+ with HIV+ — doesn’t really make sense. A negative test result is not a license to have unprotected sex. A gap of months separates the time you are infected with HIV from the time a test will reveal you are positive. In this gap, your viral load is greatest, which means you are more likely to infect others. Any protective effect of having unprotected sex with negative partners is cancelled out by this potential, untestable increased virality.

Safeguards exist to prevent possible exposure. Yale students seem generally unaware of PEP and PrEP: post- and pre-exposure prophylaxis, respectively. The former, if administered soon after exposure to the virus, can dramatically lower the likelihood infection. The latter, if taken daily before exposure to the virus, will do the same.

But attributing this rise in transmission to just misguided health choices misses a deeper issue. To paraphrase art historian Douglas Crimp, a chronic illness is abstract until it’s not. As young people, the reality of living with HIV — the regimen of daily medications, their side effects, and frequent doctor visits — is far beyond our imagination.

Culturally, the conversation has deviated from the health crisis as well. The Gay Rights movement, galvanized by AIDS, has turned to assimilationist advocacy for gay marriage, relegating mortal crises as secondary. Placing HIV transmission alongside other epidemics facing our community — the violence and victimization of gay men, the burden of depression and heavy use of alcohol and other drugs — it is no surprise that young gay men, already four times more likely to commit suicide than their heterosexual peers, might value and protect their bodies less. To address the crisis of rising HIV transmission, we need to make these social and mental health issues as important and visible as the push for marriage rights.

Silence, violence and stigma that feed this shame and misinformation are reproduced at all levels of public and private life, but schools and universities should be the exception. “Light and truth” should be an imperative, not a motto. Yale must foster open discussion and remove all barriers to quick and easy testing for HIV and other STIs. Half of Yale’s gay male students are in peril, and Yale has taken no apparent action to specifically focus on HIV.

We must share knowledge and reject historical amnesia. We must speak frankly about sex before, during and after. Assume everyone you sleep with is HIV-positive, use a condom, and explore nonpenetrative sexual practices. Our hope lies in our rejection of the statistical fate that awaits us should we choose to do nothing.

Richard Espinosa is a 2010 graduate of Berkeley College and an incoming student at the Yale School of Art. The Yale AIDS Memorial Project (YAMP) contributed writing. 

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