By Michael Callen
Published in the February, 1989 PWA Coalition Newsline
© 1989 Michael Callen
For the past five years, there has been consensus within the U.S. gay community about what constitutes safer sex. But the first signs of cracks in the consensus have emerged.
The Canadian AIDS Society is making official what has been unofficial for at least two years in Canada (and Australia). Chicago’s gay paper, Outlines, quotes Leslie Wagman of AIDS Vancouver as saying, “We have been telling people that oral sex is low risk at least for the last two years. [AIDS Vancouver doesn’t] encourage people to swallow semen, but if they do, it’s a minimal increase in risk.”
Predictably, there is disagreement here in the U.S. David Winters, GMHC’s coordinator of AIDS prevention, believes the Canadian educators are “foolish.” “That’s too liberal,” he asserts in the same article. “Unprotected fellatio with ejaculation should be in the high risk category.” Contradicting GMHC, Chuck Frutchey of San Francisco’s AIDS Foundation asserts that the Canadians “are correct in saying oral sex is probably a low risk activity. Many gay men in San Francisco never gave up oral sex in the first place and yet the city has seen a remarkable decrease in transmission [of HIV].”
But it’s anal sex that is shaping up as the real battleground. Washington, D.C.’s respected Whitman Walker clinic has used $25,000 of community funds to run a horrifying ad campaign urging gay men to give up anal sex entirely–even with a condom.
”Can you live without anal sex?” asks the ad. “You can enjoy your sex life without risking the rest of your life,” answers the ad.
Strictly speaking, in none of the ads does Whitman Walker categorically say that all gay men should give up anal sex–even with a condom. However, it is quite clear from the slant of the ads that a majority of Whitman Walker’s Board believe that anyone who continues to engage in anal intercourse–even with a condom–is nuts. The following is excerpted from the policy statement passed by Whitman Walker’s Executive Committee:
At this time the Clinic believes that particular emphasis is needed not only on the extreme risks of unprotected anal intercourse but also on the unpredictable yet equally alarming dangers of protection failure through condom breakage, undetected faults, and/or improper usage. Therefore, the Clinic will in the future stress the potentially life-saving option of totally eliminating anal intercourse from sex practices. The Clinic shall continue to provide detailed instruction on proper condom usage to minimize the existing risk for those persons who choose to practice anal intercourse.
My problem is with Whitman Walker’s decision to “stress” the “potentially life-saving option of totally eliminating anal intercourse.” It would be one thing to neutrally mention the possibility of condom failure and to underscore the importance of proper condom use. I could even live with an acknowledgment that because of the theoretical risk of condom failure, some gay men have chosen not to engage in anal sex. (Although I’d appreciatesome acknowledgment that giving up anal sex entirely is, for many, a tremendous loss; I recoil at the implication of the ads that anal sex is a trifle, not at all important and easily done without.) Whitman Walker’s position can be faulted on three points:
(1) It is an equivocation. If they believe, as they clearly do, that anal sex even with a condom poses a great likelihood of killing you, they should say so outright and aggressively urge everyone to stop having anal sex entirely.
(2) It represents a failure of political will. Instead of urging gay men to pull out before they cum (even if they’re wearing a condom); instead of demanding stricter standards for condom manufacture and inspection (or even manufacturing our own condoms, as the Swiss AIDS organization has done); instead of redoubling efforts to educate gay men about the proper use of condoms; instead of demanding a national AIDS educational campaign which speaks bluntly in non-clinical language that people can understand, they have come to the same conclusion as the fundamentalists (albeit for very different reasons) and have decided to “stress” that the best solution to the problem of AIDS is to give up anal sodomy entirely.
(3) It is subtly homophobic in its logical inconsistency. It treats anal sex as inherently less important than vaginal sex. Although available evidence clearly indicates that vaginal intercourse can transmit HIV (and Whitman Walker claims to address the health concerns of gays and bisexuals), it would be unthinkable to initiate a campaign “stressing” that men and women should try to “live without” vaginal intercourse.
It’s important to make explicit a number of presumptions buried in Whitman Walker’s decision to discourage anal sex, even with a condom. Although I’m sure Whitman Walker believes they’ve made their decision solely on the evidence that passive anal intercourse is the number one risk factor for the development of AIDS in gay men, in fact, two factors must always be considered in the formulation of any safer sex recommendation: (1) the medical/scientific risk which that particular form of sexual expression is presumed to pose for the transmission of HIV/AIDS; and (2) a value judgment about the importance of a particular form of sexual expression.
I offer the following decoding of the many presumptions implicit in Whitman Walker’s anti-anal sex position:
1. HIV has been proven to be the cause of AIDS.
2. A single unlucky exposure to HIV can result in infection with HIV and, therefore, a single unlucky mistake can lead to AIDS.
3. Because we accept the dire predictions that a majority of those who become infected with HIV–perhaps 100%–will eventually die of AIDS or suffer “HIV related disease,” we believe every reasonable effort must be made to discourage people from exposing themselves to HIV/AIDS.
4. Although we believe that gay sex has become a deadly game of Russian Roulette, with HIV as the silver bullet, we disagree with right wing conservatives who insist that we should “stress” abstinence and/or mutual monogamy between (presumably heterosexual) virgins. Even though we admit that gay male sex might kill you, we believe some risks are worth taking–that some forms of sexual expression may be worth dying for.
5. Our formula for judging which sex acts you should risk dying for is as follows: If the presumed risk for a particular sex act is high, and if we arbitrarily judge the particular form of sexual expression to be unimportant or expendable, then we’ll recommend that you give it up entirely, rather than urge you to find ways to practice that form of sex more safely.
6. For example, although we believe that there exists some theoretical possibility that wet kissing can transmit HIV, and therefore AIDS, if both partners have open cuts, we have made the arbitrary judgment that (a) kissing is an important form of human expression and (b) the theoretical risk of getting HIV/AIDS from kissing is below some arbitrary and unenumerated threshold of risk and therefore we will not “stress” the notion that all gay men should give up wet kissing.
7. Similarly, although we acknowledge that sucking someone off, even if he is wearing a condom, poses some theoretical risk of transmitting HIV/AIDS because the condom might be defective or might not be used properly, we have made the arbitrary judgment that (a) fellatio is an important, and to us acceptable, form of human expression and (b) the theoretical risks of getting HIV/AIDS from sucking someone off are below some arbitrary and unenumerated threshold of risk; we therefore have decided not to “stress” the notion that all gay men should give up fellatio.
8. However, we believe that the risk of transmission of HIV, and therefore AIDS, posed by vaginal and anal sex are great–they are beyond our arbitrary and unenumerated threshold or risk. But since vaginal intercourse is an important form of human sexual expression, we would never recommend that heterosexuals or bisexuals abandon vaginal intercourse. We have chosen not to even address the issue of vaginal intercourse; we are only concerned with the homosexual component of bisexuality. We won’t advise bisexual men to abstain from vaginal intercourse even with a condom. Let heterosexual women fend for themselves.
9. However, since we arbitrarily judge anal sex to be a less important form of sexual expression than kissing or fellatio or vaginal intercourse, we have decided to “stress” that gay men abandon anal sex entirely because we believe that the theoretical risks of condom failure make anal sex, even with a condom, beyond our arbitrary and unenumerated threshold of acceptable risk.
I spoke with Jim Graham, Executive Director of Whitman Walker, who said that in Washington, D.C., 85% of AIDS cases are the result of gay male sex. He cited a Johns Hopkins study of 3,000 gay men and indicated that:
“100% of the AIDS cases involved individuals who took the passive role in anal intercourse. In D.C., the threat posed to men who have sex with men, in terms of anal intercourse, is very substantial indeed–so much so that this ad campaign is not a casual devaluation of anal sex. We know anal sex is the primary way in which the virus is being spread in terms of gay and bisexual men and we’ve made a judgment about it.”
Although I find a 100% admission of passive anal intercourse surprising (since it has been my experience that there is always a certain percentage of liars in every cohort), the association of passive anal intercourse with AIDS is certainly not new. It has been known from the beginning that AIDS is, in the lingo of the street, a bottom’s disease. This is hardly new information and certainly is not sufficient to justify such a radical departure from the consensus of the past five years that fucking with a condom is o.k. Some other reason must account for the timing of this departure from consensus.
I fear that a hidden reason for suggesting that gay men give up anal sex entirely is squeamishness about the asshole. The implication in Whitman Walker’s ads is that anal sex is some exotic, extraneous vice, like, say, cigarette smoking–that it is an unimportant practice in a way that vaginal sex could never be. This reeks of homophobia.
In Issue #7 of the Newsline, way back in December 1985, I blasted the Gay Men’s Health Crisis for distributing a “trick card” which urged gay men to “Try to avoid anal sex.” I wrote:
“Those who enjoy getting fucked should not be made to feel stupid or irresponsible. Instead, they should be provided with the information necessary to make what they enjoy safe(r)! And that means the aggressive encouragement of condom use!”
Dr. Joseph Sonnabend, in an interview in the New York Native long ago, spelled out the issue clearly: “The rectum is a sexual organ, and it deserves the respect that a penis gets and a vagina gets. Anal intercourse is a central sexual activity, and it should be supported; it should be celebrated.”
For a gay organization to attempt to reduce gay porn to the level of a snuff film is deeply offensive. I’m not aware of a single instance of the transmission of HIV which resulted from watching a video. And this ad sides uncomfortably with the Andrea Dworkin/Cathrine McKinnon school of fascistic feminism which asserts, without proof, a direct link between what we see or read and what we do. Again, it underestimates the intelligence of its audience.
Let us also acknowledge that it is a convention of gay porn videos, antedating AIDS, that the top always pulls out before he comes. And my suspicion is that actors who make porn films and are willing to be fucked without a condom are not doing so for the first time on camera. Thus, to ask “how many times [have] we actually see[n] another porn star becoming infected with the AIDS virus [sic]?” is meant to conjure up images of nubile, HIV negative virgins being infected for the viewing pleasure of sadistic voyeurs and the profit of death-dealing producers.
My guess is that what we’re probably seeing in gay porn films is two HIV+ individuals who, after all, are practicing coitus interruptus. Safer sex guidelines have yet to directly address the relative risks posed by such a situation. Is it settled that precum efficiently transmits HIV? Which is safer: letting someone come in your mouth without a condom or getting fucked with a condom? It seems the socially and officially sanctioned answer will now depend on whether you live in British Columbia or the District of Columbia.
Porn videos have been instrumental for many of us in easing the difficult transition from what we proudly called the “pig sex” of the ’70s to the necessarily self-conscious safer sex of the ’80s. If we couldn’t do it ourselves, at least we could watch it and remember–and fantasize. And isn’t it a troubling double standard to urge the gay porn industry to “insist on videos which show safer sex with condoms” at the same time that you’re urging gay men to “consider living without anal sex”–even with condoms? To be logically consistent, shouldn’t Whitman Walker’s ads urge porn films never again show fucking–even with a condom?
There is a pressing need to formulate a threshold of risk for anal sex. A recent Rolling Stone article provided interesting risk estimates for heterosexual vaginal intercourse. The following estimates of risk concern the likelihood of a woman getting HIV (not necessarily AIDS) from a single session of vaginal intercourse (presumably involving ejaculation by the male):
|Man is definitely HIV infected,||does not use a condom||1 in 50||You have about a 1 in 50 chance of being killed in a car accident sometime in your life|
|Man is definitely HIV infected,||but uses a condom||1 in 5,000||You have about a 1 in 5,000 chance of being killed in a car accident within the next year.|
|Man is in risk group, but may or may not be HIV infected.||Without a condomWith a condom||1 in 1,0001 in 10,000||You have about a 1 in 1,000 chance of dying in a motorcycle accident within a year if you are a motorcyclist.You have about a 1 in 10,000 chance of dying in a plane crash for every 100,000 miles you fly.|
|If the man is not a member of a risk group:||Without a condomWith a condom||1 in 5 million1 in 50 million||You have about a 1 in 5 million chance of being struck by lightning within the next five monthsYou have about a 1 in 50 million chance of dying during the next three months by being hit by an airplane falling out of the sky.|
While anal intercourse appears to be dramatically more efficient for the transmission of HIV than vaginal intercourse, the odds enumerated above are nevertheless useful. There is apparently a 100-fold reduction of risk through condom use. If in addition to wearing a condom the active partner pulls out before coming, there would be a further significant reduction in risk. If Whitman Walker had done some homework–if they provided some sense of the degree of risk posed by anal sex with a condom–then we might be capable of making a reasoned choice about whether or not to give up anal sex entirely. That they have not bothered to do so suggests either a disregard for the intelligence of their audience or a squeamishness about anal sex which is unconnected with its theoretical risk for the transmission of HIV.
But in fairness to Whitman Walker, I do believe that the primary motivation for this misguided anti-anal sex campaign is a legitimate concern for saving lives. (As Jim Graham defensively pointed out, Whitman Walker gave away 145,000 condoms last year.)
The process of approving safer sex guidelines is like the FDA drug approval process; it has a tendency towards conservatism. As the Heritage Foundation (of all groups!) has observed, the FDA has no incentive to approve drugs. There has never been a Congressional investigation about why the FDA failed to approve a drug. But there have been many Congressional investigations which punished the FDA for approving a drug which proved to have harmful side effects. In other words, like the FDA, guardians of gay health will always err on the side of caution. For example, rather than admit that oral sex is actually reasonably safe, U.S. AIDS educators would rather thousands of gay men suffer unnecessary guilt and anxiety over performing oral sex than risk being sued by the one individual who gets HIV from the exclusive practice of oral sex. What’s missing from the calculations is a fair assessment of the emotional and psychological importance to individuals of particular forms of sexual expression.
It seems to me that in the United States, we’re loath to admit any scientific evidence which suggests we might in fact be able to relax some of our safe sex paranoia. For example, the following quotes from a New York Times article are intriguing and would seem to argue against Whitman Walker’s extreme view:
“Dr. Poiesz reports that he can only find [HIV] in about 20 percent of the semen samples from infected men, whereas several years ago he could find it in 70 percent of semen samples from infected men. He continues to detect the AIDS virus in virtually 100 percent of the blood samples from these men. The researchers say they are baffled because, theoretically, if the AIDS virus is present in the blood, it should also be present in the seminal fluid, since that fluid contains white blood cells that the virus attacks.”
“Another group of researchers…also reports that it can no longer detect the AIDS virus [sic] in most semen samples from infected men although it almost always finds it in the men’s’ blood. A third group…reports that it too finds the virus in only a minority of semen samples…even [using] a new technique…that can detect the genetic material of the virus with unusual accuracy, even if the virus is lying dormant in cells and not actively reproducing itself.”
“ `We know from individual studies of infected people and their sexual partners that in the majority of cases, the partners have not become infected,’ said Dr. Harold Jaffee of [the CDC].”
Let me now boldly go where Whitman Walker fears to tread. No more equivocation. Those who believe HIV is “the cause” of AIDS and who further believe a single, unlucky exposure to HIV stands a good likelihood of leading to AIDS and death should consider giving up all forms of sexual contact which potentially involve the exchange of bodily fluids until a vaccine or cure for AIDS is found. (It’s like those who oppose nuclear energy. Even if you admit that the safety record of the nuclear industry is pretty good, the risks of a single failure are so great–the devastation from a single mistake so tremendous–that the benefits aren’t worth the risks.)
If you think a single contact with HIV can lead to AIDS but you simply cannot give up sex entirely, admit to yourself that some forms of sex are worth dying for and make peace with that fact. (It’s like riding in an automobile. We apparently have a 1 in 50 chance of dying in a car crash within our lifetimes; but most of us have decided that life without locomotion would be so onerous that we fasten our seat belts and make peace with the risk.)
And finally, while I’m out on this limb, those who believe the central task of safer sex is to avoid the transmission of HIV should bite the bullet and say that people who are HIV+ should never have sex with people who are HIV negative or whose antibody status is unknown. I realize that what I’m proposing might undermine the single standard of safer sex, i.e., that everyone should have sex with everyone else as if one or both parties were HIV positive. But in fact I think the time has come to admit that many people who are already HIV positive obviously don’t have to worry about becomingHIV antibody positive. (Of course, the question of whether one can be multiply and repeatedly infected by HIV, and whether such reinfection is significant, needs to be answered. And those of us who believe that co-factors such as intercurrent infections other than HIV play a role in the development of AIDS will have to factor in these concerns in our risk assessment.)
As much as we might like to make other people’s decisions for them–to enforce our personal standards of safer sex–the fact is that each of us must make his/her own determination about what risks he/she is willing to take. Our task as a community is to make sure that each person has all the information needed to adequately and accurately assess risk to the extent possible in a situation where there are no absolutes. Further, we must insure that people have the information they need to reduce any risk which they may choose to take.
I understand Whitman Walker’s frustration–their desire to be more conservative. By force of will, or by legislation, or through peer pressure, we’d love to prevent another individual from becoming infected with whatever is causing AIDS. But we must resist the temptation to judge each other harshly for the sexual choices we make. We must instead be satisfied with a commitment to providing every individual with the information she/he needs to have sex as safely and responsibly as possible.
I worry about the new generation of gay men. Many–maybe most–have not experienced the joys of anal sex. They have no experience to measure the dire warnings against. They hear their own leaders giving the same advice as the Falwells: anal sex kills, even if you use a condom. No wonder they judge harshly those of us from the ’70s who want to defend anal sex as a central and important form of sexual expression.
Some may feel that only an asshole would defend the asshole in the age of AIDS, but I take the radical view that butt fucking must be defended vigorously–especially in the sexophobic, homophobic period we’re living through! What’s needed is a clear statement of the importance of sexual freedom and the right to sexual fulfillment combined with a commitment to provide each and every person with the information they need to celebrate sex safely!