We Need to Put Sex on the Table

How can we undertake effective HIV prevention programs in the U.S. if we refuse to talk openly about gay sex?

Carl Schmid, Director of Federal Affairs for

The AIDS Institute (Washington DC), shares his ideas on the 2009 Gay Men's Health Agenda

One of the first sessions I attended at the 2008 International AIDS Conference in Mexico City was “Sexuality on the Table”. It was organized, believe it or not, by the Federal Government of Mexico and moderated by Javier Cabral, Director of Prevention for Mexico’s HIV/AIDS office. He began by saying how can we have a conference on AIDS in Mexico City without having a session on sex since AIDS is primarily transmitted through sex? I listened in amazement to speaker after speaker from Mexico and Spain talk opening about sex, including gay sex, in a positive manner and how the failure to put sex on the table impedes HIV prevention efforts. In this session and others, we heard about the successful anti-homophobia and positive gay HIV prevention media campaigns conducted by the Mexican government.

While I sat in astonishment, during the same weekend the U.S. released its new estimates that revealed that 57 percent of all new HIV infections in 2006 were among men who have sex with men, I said to myself, this would never happen in the United States. Sure, private individuals and groups could put on such a program, but certainly our federal government would not nor could groups do it with federal dollars. But, there in Mexico, a conservative Catholic country, their own government was leading a session titled “Sexuality on the Table” at an international AIDS Conference.

The failure to talk about sex in our country, including gay sex, in part, is fueling the spread of HIV. How can we undertake effective HIV prevention programs in the U.S. if we refuse to talk openly about gay sex? Over the past 8 years most anything “gay” in our federal government has been erased and there is little talk about the “g” word. What has not been erased is not talked about and is allowed to continue in silence. There have been very few positive gay moments, while numerous anti-gay ones. Sad to say, this attitude reflects a large segment of our society, but we know things are changing and our government needs to change, as well, with the times.

In order to put sex on the table in the United States, one of the first goals for 2009 to advance gay men’s health should be to delete what has become known as the “no promo homo” law. A relic of the past, thanks to Sen. Jesse Helms, this provision in the Ryan White law prohibits the expenditure of federal money “to fund AIDS programs, or to develop materials, designed to promote or encourage, directly, intravenous drug use or sexual activity, whether homosexual or heterosexual” This is why our federal government could not put on that session in Mexico or why our prevention for positive programs within the Ryan White program are so bland or non-existent depending on the clinic. It is time we change that and the next time Congress takes a look at the Ryan White law should be an opportune time. It will not be an easy battle, even with a Democratic Congress, but if we are going to put sex on the table in this country this must be a debate we are willing to wage.

CDC and the NIH also need to develop more behavioral interventions for men who have sex with men, particularly for African American and Latino MSM. Earlier this year, The AIDS Institute conducted a review of CDC’s Updated Compendium of Evidence-Based Interventions. We found that of the 49 evidence-based prevention interventions only four target MSM and none target African American or Latino MSM. With 57% percent of the epidemic and growing, this is completely unacceptable and needs to be rectified immediately. We also have to make sure CDC allocates its prevention funding and programs for MSM in proportion to our share of the epidemic. There is ample evidence that they and the states, who receive the bulk of CDC’s prevention funds, do not.

Finally, the HIV/AIDS and LGBT communities have to stop “de-gaying” HIV and take ownership of the virus that is infecting our community. For far too long, HIV/AIDS and LGBT advocates have downplayed the number of gay men with HIV in our country. We really did not need the latest CDC numbers to remind us that MSM is the population most impacted by HIV in the U.S; we knew that already. It has been reassuring to see the response of many community organizations to the new CDC numbers and a desire to address gay men and other MSM in HIV prevention. It is a good beginning and it is time for all HIV/AIDS and LGBT organizations to put this near the top of their agenda and devote the necessary time and resources it takes to reverse current trends.

Results won’t happen overnight and we have a long way to go, but if we are going to prevent HIV in the U.S. we are going to have to put sex on the table.

[Click here to read previous input into the 2009 Gay Men's Health Agenda. Please feel free to comment there - or you could send in a full post of your own here. We will be happy to publish it! The feedback we receive will be featured in the closing plenary of the upcoming National Gay Men's Health Summit and will be a means of moving the community forward in the new year around issues that are important to all of us.]