Monday, July 14, 2008

Ask gay men what they want and need

My Vision for a 2009 Gay Men's Health Agenda

by Michael Scarce
[Writer, researcher, technology consultant, and health activist - San Francisco]

Perhaps most exciting is how the progression of a gay men’s health movement is no longer a question of possibility, but rather exactly how it will take the shape of things to come.

1. Improve the care, housing and genuine health promotion for HIV-positive people.

As more of us become infected and now survive far longer than hospice waiting lists, HIV-positive people deserve a base quality of life that includes housing, adequate health care, and opportunities to fully participate in their communities. To this end, my ideal agenda for 2009 would include an overhaul and re-funding of “Prevention With Positives,” a movement that strives to improve the health of HIV-positive people as a means of reducing their likelihood of engaging in high-risk behaviors. HIV-positive people deserve health and wellness promotion even if it has no effect whatsoever on the incidence of HIV transmission. The message that public health’s primary concern for my wellbeing stems from my potential and capacity to infect others feels insincere and denigrating. Forgive me if I’m less than grateful.

2. Leverage technology to our advantage.

Organizing around gay men’s health can be immeasurably bolstered by better utilization of the Internet and other digital technologies. As a starting point, I propose the construction a global gay health wiki. A wiki is a collection of web pages that can be edited by a large number of people for the purpose of mass collaboration, including the sharing of data, media archiving, project planning, and building a repository of knowledge. My second recommendation in this area is the planning of a Virtual Gay Men’s Health Summit for 2011. Not only would this facilitate a greater breadth and depth of Summit involvement, it could also improve the representation of poor and economically deprived men. With the average cost of attending a Summit hovering around $1,000 including airfare and hotel stay, the $100 cost of a few months’ high speed internet connection could whittle away many of the disparities in participation that stem from class and geography.

3. Begin preparing for the depopulation of dense, urban gay neighborhoods and its inevitable impact on gay men’s health.

Factors such as the increasing popularity of Internet social spaces, gentrification of gay ghettos resulting in unaffordable housing, and the greater social acceptance of LGBT people in smaller and even rural communities are beginning to have noticeable effects on the density and demographics of traditional gay neighborhoods. Men are no longer migrating to coastal cities such as San Francisco, New York and San Diego to seek asylum as queer refugees in the same numbers as previous decades. This phenomenon has radical implications for everything from epidemiology to systems of social support.

4. Draw the line with self-interested and counterproductive HIV prevention.

I propose the establishment of a national watchdog coalition to monitor and respond to overly aggressive, inherently deceitful, and increasingly desperate HIV prevention efforts. This is not an attempt to bash all HIV prevention, but the widespread tactics of racism, misogyny, blame, shame, fear, and stigmatization must stop. Attempts to end the epidemic “by any means necessary,” including invasive surveillance and divisive community interventions, will only serve to further alienate gay, bi and trans men from public health. This runs the risk of accelerating infection rates rather than reigning them in. Local efforts to challenge the overstepping of these bounds have been met with varying degrees of success, and could greatly benefit from the advocacy and capacity building of a larger network of support.

5. Ask gay men what they want and need.

Too many organizations billing themselves as “community-based” are sorely out of touch with their constituents. Gay men’s health issues are different than gay men’s health concerns. The quality of men’s lives can only be improved if we seek a greater understanding of the qualitative ways in which men are affected by their health and the health of those around them within a larger context of how they live and love. The very definitions of health and wellness are subjective concepts, and we have much to learn from the perspective and vantage point of members of our communities.

In summary, my vision for a 2009 Gay Men’s Health Agenda involves a combination of accountability from existing institutions in conjunction with the strengthening and development of our own movement’s infrastructure. Perhaps most exciting is how the progression of a gay men’s health movement is no longer a question of possibility, but rather exactly how it will take the shape of things to come.

[LifeLube has been asking folks around the country to weigh in on what a 2009 Gay Men's Health Agenda might look like. Click here to read some of the ideas that have been circulated. Please feel free to comment here - share your own ideas, or spout off on whether you agree or disagree with Michael - or, you could send in a full post of your own here. We will be happy to publish it!]


  1. This comment has been removed by the author.

  2. Hey Michael - et el...

    We can create a gay mens health wiki super easy and for under 100 bucks.

    As a side project I created one we are looking at for the National Guidelines for Internet-Based STD and HIV Prevention.

    Lets just do it! I have the domain name (net and org) we can use that.

  3. I absolutely agree with Michael's insistance on technology's involvement in advocacy, health, and community for gay men.
    Combining technology into point number 3 will be even more essential in the future, as it will be one of the only ways to reach gay men in rural areas that have no culturally competent care/information available to them in clinics, schools, communities, etc.

  4. I have always enjoyed Michael Scarce's views on gay health and how the community can move forward in creating an agenda for the right kinds of research, education and prevention. However, I think it is very naive to think that the larger society, even if we do have a major regime change in the US over the next several years, will be very sympathetic to our demanding totally non-judgmental and free healthcare for persons who want to practice unsafe anal sex and consider it a right to ignore what we now clearly know about the health consequences of unprotected anal sex and methamphetamine use.
    You castigate many in the HIV prevention and public health field for trying to impose what we truly believe to be Rules of Survival in the Post-HAART era, as if every gay/bisexual man on this planet has an inalienable right to bareback and get infected or infect others despite their clearly knowing the consequences and then be given a free pass for whatever support and medical care they feel entitled to. This attitude is a throw-back to the early 80s when people like myself were crucified in the gay media for suggesting that gay men refrain from unprotected anal sex once we clearly knew that was the route of transmission of AIDS even though we had not yet found the specific virus that was being transmitted. Many lives would have been saved if the credible and correct public health warnings were heeded between 1982 and 1985 instead of denying that our sexual and drug use lifestyles had anything to do with this new epidemic.
    Furthermore, you make no mention of the role that the well established and politically connected gay bathhouse and sex club owners play in either diminishing or enhancing the risks of HIV infection in their pursuit of our dollars.
    There will always be young and newly out boys and men who may not realize the impact of HIV infection on both themselves and the community at large who need to be protected from others who will gladly introduce them to drugs, such as methamphetamine and poppers, and unsafe sex as part of their "introduction to life in the fast lane." This is not talking down or patronizing our community's members but doing what responsible community leaders must do, namely educating and protecting the most vulnerable and inexperienced young members of our community from the predatory and greedy who don't give a damn about the health of our community but just care about fulfilling their own sexual needs or greed.

  5. bigdavido!

    i am not sure where michael ever advocated for "totally non-judgmental and free healthcare for persons who want to practice unsafe anal sex"

    where do you see this?

    as a positive man myself, what i heard was that our needs as hiv pos men should not simply be about stopping onward transmission.

    i think you added a lot in here that was not at all what michael was suggesting... but maybe michael can respond himself....


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