RALEIGH, N.C.—Gay-oriented health workers and activists are overly focused on HIV to the exclusion of other serious gay health problems.
That was one of the main premises driving the third National Gay Men's Health Summit, which drew more than 320 people to this humid, historic southern capital May 7-11.
'What we're trying to do is create a multi-issue, multi-racial, queer men's health movement,' said the summit's media man, Erik Libey, who works with AIDS Rochester in New York state.
'It's about shifting directions in queer men's health, taking some focus off of HIV and AIDS and putting it on some of the other health concerns. ... We're tying to motivate queer men to start a grassroots movement around our own health.'
Libey said issues that need more attention include drug and alcohol use, eating disorders, body-image problems, the new drug-resistant staph bacteria, and all of the older sexually transmitted diseases, including hepatitis, gonorrhea, chlamydia and syphilis.
'We've seen a number of pretty dramatic syphilis outbreaks among queer communities all around the country,' Libey noted.
The summit offered more than 130 workshops, institutes, caucuses and meetings dealing with youth, aging, transgender men, bears, Daddies, two-spirited men, non-gay men who have sex with men, long-term HIV survivors, 9/11 survivors, 'differently dicked' individuals, public sex, S&M, bisexuality, prostitution, queeniness, drag, barebacking, porn, gaydar, cum, erotic yoga, tantra, massage, microbicides for anal sex, ethical slutiness, party drugs, tobacco use, leadership, racism, self-esteem, domestic violence, intimacy, trust, recovery, burnout, religion, anti-gay churches, prostate and testicular cancer, hepatitis C, HIV vaccines, new HIV drugs, failed HIV prevention programs, holistic medicine, health-marketing campaigns, the Internet, the war on terrorism, marriage, and third-wave feminism, among other topics.
'We face a lot of challenges as we meet this week,' said veteran activist Eric Rofes, convener of the summit. 'Some of us are coming together because we're aiming to build community, to have more holistic approaches to health. Some of us are here because of serious reports we've read about syphilis, staph infections, all kinds of HIV challenges, substance abuse and crystal epidemics. ... Some of us are here knowing that as political winds move to the right, we really need to unite and support ourselves more so we can continue to do the kind of work we know is meaningful to the communities and subcultures we come from.'
Some of the workshops were closed to the media, including the one entitled 'Eroticizing HIV: Beyond Bareback, Beyond Edge, Beyond Taboo,' although a reporter was allowed to sit in the workshop if he didn't take notes.
'Gift-givers and bug-chasers definitely exist,' said Libey. 'But in my experience as an HIV-prevention worker and as someone who does pre- and post-test HIV counseling, it's not the most common thing that I see.'
Libey dismissed as suspect the controversial Rolling Stone magazine article that suggested 25 percent of new HIV infections result from bug-chasing—the deliberate seeking out of HIV infection by having unprotected receptive anal sex with an HIV-positive 'gift-giver.'
Rofes said there's no simple answer to the problem of people who get off on infecting someone or becoming infected.
'Punitive approaches to gay men often get us what we don't want,' he said. 'So I wouldn't advocate closing down those [gift-giver/bug-chaser] Web sites, and I wouldn't advocate discouraging people from advocating those practices. I would, if I believed discouraging the most-at-risk gay men would make them not do it, but I don't believe it works that way.'
The Web sites actually are a good thing, Rofes said.
'Web sites are really great places for people to get off without creating much risk to themselves,' he said. 'I think that's true in extreme sex in general.'
The work of bringing down the HIV transmission rate does not need to be concerned with 'individual people's fetishes,' Rofes said, but rather with barriers that prevent people from taking control of their sex lives.
'As we approach 25 years into the epidemic, the powerful and almost unitary AIDS approach to gay men's health has produced problems for us,' he said. 'Starting to look at cultural interventions around health in the community in a big-picture way, without even talking AIDS, might end up having people take better care of themselves and be more conscious of various health challenges, including HIV.
'We're struggling to find a way to make it exciting and meaningful to get involved with building life-affirming, sustaining queer-men's health communities,' he said. 'We're at the start of determining what that looks like, how that avoids being sanitizing and middle-class and 'goodie,' and how it can appeal to mass numbers of people. We face a huge challenge and we've just started the work. We're looking at getting at the underlying causes that create cycles of health challenges to gay men: Continued generations of people who feel a huge amount of shame and guilt around not only their gay identities but around their sexual desires and practices. People who feel disempowered. People who feel like their sexual, their spiritual, their physical and mental health are separated and fragmented.'
If the summit's vision becomes reality someday, said Donald Hitchcock of the National Coalition for LGBT Health, 'We will be able to address a lot of the issues that maybe lead to higher rates of HIV infection such as mental health and substance abuse.
'The ideal clinic that we would all like to see in our communities,' Hitchcock said, 'would be one where you would go in and it wouldn't be just focused on getting your AIDS test. You would have a doctor that could address all your health needs, asking you about your allergies, when the last time was you had a testicular exam.
'Wouldn't it be nice that those HIV clinics could become those centers that we could go to? This sort of broader approach is what we're working on in the [LGBT health] coalition as well.'
The summit took place in downtown Raleigh, about two miles from Jesse Helms' house.
'I really like the idea of having an event like this in the South,' said Ian Palmquist, assistant director of the statewide gay lobbying group Equality North Carolina. 'I think very often our national movements don't pay a lot of attention to the South and we have a lot of work to do here. But we are not so bad off that we need to be written off completely, and I think that's an attitude that a lot of folks in other parts of the country may have.'
North Carolina is one of 13 U.S. states that criminalize gay sex.
Blazing the Path for Gay Men's Health
By Bob Roehr
'It is time to give specific attention to [the health needs of] gay-identified men,' Eric Rofes told the more than 300 men and a handful of women attending the Gay Men's Health Summit 2003. It met May 7-11 in Raleigh, NC.
'We are not leaving it to Time magazine, we are not leaving it to the CDC or the Department of Health and Human Services to be the only ones calling the shots' on gay men's health issues, he said. 'We want to see community-based responses and actions ... . This is about our voice and about being heard.'
Rofes, one of the guiding forces behind the gay men's health movement, described it as 'decentralized, anarchistic, and neo-tribal. We do this and think there is power in it.' It seeks to expand health concerns beyond HIV and beyond a purely medical paradigm.
The Summit brought members of the community together at the national level 'in a rich dialog' about those issues, with the aim of stimulating further discussions in communities across the nation. Two earlier gatherings had taken place in Boulder, Colo., in 1999 and 2000.
Rofes advocates replacing the current 'HIV-centric paradigm' of gay men's health with a more holistic one. He criticized public health officials for framing problems of syphilis infections and methamphetamine use within a context of HIV. 'Crystal addiction is a problem in and of itself, not just because it can lead to the spread of HIV.'
He urged an 'exit from the crisis paradigm' that shaped programs in the mid-1980s, but that is no longer applicable today. And he challenged the men to move from 'deficit-based models' to 'assets-based' approaches that build upon their strengths.
'Shame and guilt are the health hazards,' not specific sex practices and cultures, said Rofes. Racism, sexism and homophobia have health consequences.
He embraces a 'big tent vision of community, respecting diverse ways of organizing sex and relationships.' He urged them to 'launch efforts that are not overtly or covertly sanitizing, sanctimonious, or moralistic.'
What are the meanings of anal sex, penetration and the exchange of semen, Rofes asked? He argued that 'sexual acts have different meanings' to different people, depending upon the values that each attaches to them.
The Summit embraced questions such as those in a variety of sessions, along with more practically oriented matters such as working with hard-to-reach populations with effective HIV-prevention messages.
Rofes said the community has to grapple with the issues of responsible sexuality, but he offered little guidance as to what that might look like.
During comments from the audience, one man said, when you talk about health, you are talking about values; there is no way to avoid it.
Christopher Smith, an AIDS educator from Tucson, Ariz., threw out the ultimate challenge on that subject. He asked, 'Do we have the courage to say to our funders, 'We taught you everything that we know, and we were wrong.''
