Rotello and HIV


Readers have asked me to address a central point in Gabriel Rotello's argument: that if we had sustained the levels of fear after the retroviral drug breakthrough in 1996, we might have reduced HIV to a sliver and even ended it altogether. This is epidemiologically highly dubious, but let's pretend it's valid. I guess there are two points to make. If sustaining fear meant hiding or concealing the astonishing turn-around in HIV treatment, then no ethical journalist should have done so (though many did). Getting the news out about hope in HIV care was and is essential to saving lives. Repressing such news - for fear of breeding complacency - essentially tries to sacrifice an existing sick population for a future HIV-free world. In 1996, I felt the need to tell the truth about the miraculous turn-around, but also an ethical obligation to reach as many sick gay men as possible with the good news. Many had given up; many didn't know new treatments could save them. I'm proud I helped spread the news. I know the essay saved lives. To accuse me of fomenting HIV when my goal was to help many men survive is deeply unfair. I watched a friend who refused to believe in the good news die in front of me. It scarred me and made me determined to reach others.

The second point is that there is an obvious paradox in any successful treatment for a virus like HIV. If it makes the diagnosis less grave, it will also make it seem less terrifying. More important: It will make it seem less terrifying because it is objectively less terrifying.

And if it is objectively less terrifying, people will be less likely to wear a rubber every time. This is human nature. We can try to prevent sex without condoms or sex that risks infection, but all intimacy risks infection at some point. There is no completely risk-free sex. And relaxing the extreme strictures of the plague years is a perfectly rational assessment of costs and benefits. That equation changed in 1996 for good. You either deal with that or you stay in the same stopped-clock position Rotello has occupied for over a decade.

Under those circumstances, I think it's more realistic to accept the change and work to develop new strategies for health maintenance. Sero-sorting - restricting sex to people within the same HIV-status - has been by far the most effective barrier against HIV transmission among gay men in this new world. San Francisco has led the way in reducing HIV transmission through sero-sorting. Marriage helps too, in channeling sex into love and commitment. Fear as a weapon cannot last for ever. And fear-mongering is not a substitute for serious efforts to maximize gay men's health and freedom. And, yes, both matter.

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