Wednesday, February 16, 2005

Liberty, Responsibility and the New AIDS Scare

I came out almost 10 years ago, when the major advertisers in gay magazines like Out and The Advocate were becoming Pfizer and other drug companies marketing miracle drugs and combination therapies and the ads of viatical settlement companies--those companies that bought dying men's life insurance policies to give them some financial stability in their last years--were slowly shrinking and almost disappearing. I knew--and know--a lot of people who were positive, but it was a time of hope. The fear that a positive HIV test meant certain and impending doom was shrinking and the possibility that those who were infected might have many fruitful and happy years ahead of them was real.
But it has seemed clear for a long time that that combination of lack of fear and that hopeful possibility was leading us to the place we thought we had left behind, the first days of the AIDS scare. Recent reports from New York point to the arrival of a new, strengthened and exceptionately virulent strand of the virus, itself immune to 39 out of 40 approved anti-retroviral drugs. Of course, it remains to be seen whether there really is such a super-virus already at our doorstep. It may just be that the one case so far found is an exception; the patient may have a peculiarly weakened immune system, allowing him to progress from infection to AIDS in a few months. But whether or not we have the super-virus already, it's on its way.
And, this time, the gay community has no one to blame but itself. In the early 80s, chronicled so well in And the Band Played On, there was a real lack of interest in the health establishment and the government--Reagan never was able to bring himself to talk about HIV or AIDS, even as Hollywood friends of his dropped from the virus. And, even though Bush with his interest in abstinence-only education and his demonization of gays and lesbians, is no ally in the fight against the virus, all of us know how it's passed and what it does to those infected. But, now far too many of us seem not to care.
Although we know the risks, we tell ourselves that they aren't real or that, since people live longer and happier lives, it doesn't much matter whether we become infected or not. Without such obvious markers as KS or the severe wasting we saw in the early days of the pandemic, we don't worry as much as we once did about getting sick. After all, getting sick isn't really being all that sick, we tell ourselves.
As a libertarian, I'm quite happy with people assessing risks and deciding to take them, as long as they are willing to accept responsibility for the outcomes of their decisions and as long as those decisions affect only themselves. If you understand the risks and bareback anyway, it might seem, then that's something extremely stupid that you have done; but something that is affecting primarily yourself. That might seem all right and good, if it weren't for the ways in which the science of infection and viruses belie this argument.
Unfortunately, when people who are being treated for infections of any type treat those infections but allow themselves to become infected by more and different kinds of the same infection, they 'teach' those infections how to beat the treatments. This is part of the reason why flu vaccines need to be changed from year to year. Viruses mutate rather quickly, and mutations that can resist the treatments being used are the ones that survive. This means new flu vaccines are always needed, since the flu virus mutates and is so easily communicable.
HIV mutates as well--its skill at mutation is one of the major hurdles to a vaccine--and new versions arise that are resistant to the treatments we currently have. Luckily, though it is much more difficult to transmit HIV than it is to transmit the flu. So, if we essentially isolate the virus by protecting ourselves and those we have sex with, we prevent the strengthened viruses from getting out and infecting others. When we don't do this, we become complicit in the creation of new versions of the virus, versions for which we don't yet have any treatments, versions that can defeat all the treatments we now have.
This is where the libertarian argument falls apart. Barebacking--whether you are infected or not--isn't just a decision that affects you or the person with who you are then having sex. By participating in an activity that can and will create new and more deadly, you are actively leading to the deaths of many more people in the future. And then, this is no longer a matter of what one does with his own body, it's a matter of what he is doing to the world, not to mention that it opens our community to all the criticisms that the moralizers from the right heap upon us.
It's far past time that members of our community took some responsibility for the predicaments we get ourselves into. I don't mean that we need to all be coupled in monogamous 1950s marriages; that's not a solution for the gay community, either. Nor do I mean that we must stigmatize casual sex. But what we do need to stigmatize or at least talk seriously about, is irresponsible sex, because it affects us all.

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