Sexual Roulette

Despite the risk, HIV-positive gay men are engaging in unsafe sex in the wake of improved AIDS medications. Don't believe us? Check out South Florida's "backroom bars."

To counter the misconceptions that have given rise to the new recklessness -- fisting, barebacking, and oral sex -- Dr. Fallon started a new outreach program at Center One last October. Using a subtle approach to AIDS education that contrasts starkly with the hard line of the "condom code," Center One's Infinite Edge Productions stresses personal responsibility and doesn't mention the words "safe sex" in its printed materials or at the recreational outings it organizes. "We're targeting those guys who may need a little nudge to go back on the side of safety," says Fallon. "That might mean putting up a poster over a urinal, handing out a condom outside a bar, or having a good-looking guy tell them, 'Be careful tonight.'" Among the most effective of the program's new posters is a black-and-white glossy featuring a bare-chested young man standing in a graveyard. The text reads, "This year, 21,000 Floridians will die from a 'chronic manageable disease.' Don't get someone else's blood or sexual fluids into your body. You can manage that right?"

In light of plummeting infection rates among gay men in the last few years, most AIDS service organizations substantially scaled back their gay outreach programs and focused their efforts on groups in which the spread of HIV is clearly surging: heterosexual women, Haitians, and African-Americans. But Fallon thinks a "we've won the war in the gay community" mentality is premature, that it's dangerous to ignore one group to focus on others. "In October we went from the gay outreach portion of this department being less than 12 percent of our budget to being a full third again," says Fallon. "That's right around where it should be."

Greg and his lover, Steve, both active in the Broward County chapter of the People With AIDS Coalition (PWAC), are trying to spread their own versions of the safe-sex message, one stressing not condom use but full disclosure of HIV status before every sexual encounter. "If you are HIV-positive and don't disclose to your partner, you are reckless," says Greg. "The best protection is honesty." In the old days, when condom use was pretty much a given, there was an unnatural silence about HIV, according to Greg. "To disclose said it mattered," he says. "I felt really uncomfortable with not telling people I was positive, but every time I tried to disclose, I was met with such a negative reaction. It was a lot of, 'I don't want to know that, that doesn't matter, we're going to wear condoms.' It was a kind of denial about what we were dealing with." Last year PWAC issued a formal decree in support of making disclosure "a fundamental principle of HIV prevention." Although that group does not formally endorse barebacking among HIV-positive men, more and more of its members, feeling healthy and hopeful, are exploring unprotected sex.

What many of these men are ignoring, according to Fallon and others in the AIDS service community, is that in the end most of them will still die of AIDS. Although no one knows to what extent the drugs will prolong the lives of the HIV-infected, research indicates that the prognosis is not nearly as good as scientists first thought. In fact, according to researchers at Stanford University, patients on protease inhibitors might live an average of only six months longer than their non-cocktail-taking counterparts. "We're seeing that the drugs are slowing up the parade in front but not in back," says Fallon, meaning that those on the drugs will live healthier but still greatly curtailed lives.

In the end, researchers believe, death will come quickly. Also, increasing numbers of patients -- as many as a third of those who've taken the cocktails in the last three years -- have developed resistance to the drugs. "Unless we come up with something that can't be resisted and conferred, the death toll will start to come back up," says Fallon. That means the great big sex party that many men have started to embrace in the bars and bathhouses may soon be over, and men like Greg, Bill, and Steve may start to waste away once again.

"I don't know how severely my life has been curtailed by this disease," says Bill. "It's a bad situation. I don't know whether to buy disability insurance or retirement." Having glimpsed death and survived, Greg believes that optimism kept him alive long enough to see the protease inhibitors hit the market. "Everything is icing on the cake at this point," he says. "I am so proud to be surviving at 37. I have so many friends who are now ashes who would love to experience 34, 35, 36, 37, so many who didn't even make it to 30. How lucky am I that I am going to see the year 2000."

Contact Jay Cheshes at his e-mail address:

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