So I’ve been reading Reviving the Tribe by Eric Rofes. He was an HSU professor who passed away last year. He’s a long time gay activist and thinker who used to head the Shanti Project, an organization responding to the AIDS crisis centered at the time in the Castro in San Francisco. Before that he headed a leading AIDS-response organization in L.A. These were some of the most turbulent years in the gay community and he discusses the community’s response to AIDS during this time, drawing parallels to the Holocaust and the Atomic bombing in Hiroshima.
He helped me understand how AIDS felt to members of the gay community in a way I never did before. He tells the story of that culture from the early ’70s through the outbreak of the epidemic and the early fallout; the initial response and then the evolution of response as it became clear that AIDS wasn’t going away, in fact was going strong through the ’90s. He discusses what it felt like when he first heard of ‘gay cancer’ and then GRID, he discusses the impact of Stonewall and so forth.
Finally, he tries to reconceive a means of addressing the epidemic. I’m really startled by his view of AIDS prevention. He is critical of an approach to prevention that emphasizes safe as opposed to unsafe behaviors. For example characterizing unprotected sex with an HIV positive partner as an ‘unsafe behavior’ is problematic for Rofes. That’s startling. I was startled by that anyhow.
He argues that exchanging body fluid is an act with more value for some gay men than staying alive. In that light he feels we should respect these men’s values and that AIDS education should be limited to informing people of the relative risks of activities and the best scientific knowledge available on the disease, its transmission and other relevant facts without representing any particular acts as ‘unsafe.’ That, he would say is a determination to be made by individual gay men. He advocates a transition from risk prevention to risk management.
In defense of this position, it does seem that its first premise is sound. There do appear to be a large number of gay men who value unprotected sex with potentially infected partners more than they value life, or at least life without these acts of unprotected sex. Well after high risk behaviors were well identified, high risk behavior clearly continued. The idea that education equals prevention was obviously oversimplified.
In a way this isn’t an unusual problem at all. There are situations all around us where folks value various activities such that they are willing to die to continue enjoying them. Many smokers value a high risk behavior more than life, or at least more than life without the high risk activity. How about people who prefer overeating with cardiac infarction more than life without the two? For that matter, what about folks who’s personal spirituality involves Nike’s and Kool-Aid? Do we respect their values and allow them to make an informed decision? I suppose intelligent people can disagree about the answer to that one, but I think we have to.
One important difference between binging oneself to death on deep fried twinkies and pork rinds on the one hand and having unprotected sex with a man who is or may be HIV positive on the other, is the issue of harm to others. HIV is communicable, and exposes one to other communicable diseases in a way that obesity isn’t and doesn’t. A person who makes an informed decision to contract HIV doesn’t offer an informed decision to those who may in turn contract other diseases as a result of his disease.
The perfect world of informed decision makers that makes Eric Rofes’ argument work only exists if everyone who allows themselves to be infected informs everyone whom they partner with that they are infected. It only works if they exercise the utmost diligence to stay informed about whether or not they have become infected. Doesn’t it? And it only works if they don’t contract other diseases as a result that in turn are passed to others.
I’m sort of thinking aloud here. It is an interesting question that the book raises either way.