Oasis Science Editor
AIDS Prevention: Our Reality
"One in 250 people in the United States is infected with HIV, and AIDS is the leading cause of death among men and women between the ages of 25 to 44. In the U.S. gay men, or men who have sex with men, still account for the largest number of cases... " --Peggie S. Tillman, Ph.D., from the introduction to: "Interventions to Prevent HIV Risk Behaviors: January 1991 through November 1996"
The statistics that Dr. Tillman reported in her introduction to a National Library of Medicine document regarding the impact of AIDS in the United States are not surprising news to health care providers or researchers and should not be surprising to anyone else, either, especially to young gay men, who would make up the prime demographic of those affected by AIDS. The first cases of diseases resembling AIDS in the United States were predominantly seen in young gay men in New York and San Francisco in the early 1980s. At that time, no one had a clue towards what AIDS was and why these otherwise healthy young men were suddenly becoming very ill. No one knew if a virus or some other microbe caused this disease nor how the disease was transmitted from one person to another; it was a very scary and frustrating time for both the medical profession and gay community alike. Now, nearly twenty years after these first cases, AIDS remains a serious health threat to many, yet we know a great deal about the disease. We have really come a long way since those early days, but the statistics tell us that we have not come any where close to where we want to be -- we have not reached a point where the gay community is no longer living under the constant specter of AIDS.
This is a new year and the final year in the current decade, the current century. I don't know how many health care professionals who were involved in researching those early cases of AIDS or treating those initial patients thought that we would have this then-mysterious disease conquered before the year two thousand, but if anyone had indeed thought that AIDS would by then be eradicated from the planet, then they need to reconsider the truth of the matter. The truth is, we are unlikely to see either a vaccine for HIV or a cure for AIDS in the next few years. I don't say this to be pessimistic, but to redirect where we --as this so-called "gay community"-- are placing our hopes and dreams for the end of AIDS. We should keep striving for a cure, sure, but the most plausible, doable, means of curtailing the disease is prevention and education, which means we need to concentrate more research, more funding, more people, more public education efforts, and so forth towards these goals. The most immediate differences we can bring about in the war against AIDS are not likely to occur in a laboratory deep inside some government agency but in our schools, in our streets, and most of all in our behavior. Each person reading this article can help make such a difference by conducting their own sexual relations in a responsible manner, by looking out for themselves and their partner(s). AIDS education is not simply a "in-the-meantime" measure until we can conquer this horrific disease but instead perhaps the very means that will conquer the disease. Many dreaded diseases of the past were brought under control to the point that they were no longer serious threats to the public health not through great innovations in technology or new vaccines and treatments, but by educating the public towards what measures must be taken to ensure that the pathogens that caused these disease were not transmitted. Education is one of the most powerful and meaningful techniques we have at our disposal to challenge the spread of AIDS and it is time that we start recognizing this fact.
I know that most of you have heard or read lectures and articles on the dangers of AIDS and on the most effective methods of preventing the spread of the disease before, so forgive me if I seem to be repeating what you already know, but there is a great difference between just knowing something and changing your behavior due to that knowledge. I have to encourage a change in behavior and I have to encourage an increase in awareness about exactly how serious AIDS is as a threat to health. My job is to make AIDS-related education and prevention efforts more creative, more exciting, more interesting, more understandable; whatever it takes to make them more effective. There have been rumors circulating in the gay community --especially in major metropolitan centers-- claiming that AIDS is not as deadly as we once believed it was, with some of these rumors claiming that the government had deliberately mislead the public to think that AIDS was an extremely serious health threat while other variations of the rumors claimed that new research would prove AIDS to be something we could cure sooner or later. These rumors are nothing more than rumors, I am afraid, and while I believe that one day we will indeed be able to produce a cure for AIDS, I don't think that day is anywhere close to upon us yet: the current research into AIDS-related pharmaceuticals and therapies simply indicates that we have a lot left to learn before we can possibly produce a cure. And is a very serious health threat, so make no mistake there. The government has not in any way mislead us to think that AIDS is more sinister than it really is because it is a deadly disease -- plain and simple. Speaking of therapies, there are plenty of rumors that the newest antiretroviral (ARV) drugs are so effective that having AIDS and living with the disease is not the arduous ordeal it once was; these rumors are also, I must report, quite false. Whatever progress we have made with these new drugs in no way diminishes the fact AIDS is one of the worst diseases for a person to suffer through, and I would hate for young people to believe otherwise. AIDS can still kill, and sadly, every person currently infected with HIV is very likely to die of complications relating to the disease. That is a harsh fact, and something I don't enjoy having to say, but it is also the honest truth.
Gay adolescents are one group of people --one demographic cohort, to use our epidemiological term-- that stand to have the most gain from more effective AIDS prevention programs and conversely, the most to lose from a lack of the same. As gay youngsters reach their adolescent years, they enter a developmental and social position where they are more likely to become sexually active to some degree. The constraints of the individual (locality, access to potential sex partners) play a key role in how many (if any) sexual experiences the gay adolescent may have while still in high school. When these adolescents come of age and leave their home communities for college, work opportunities, military service, or other after-high school options, the chances for them to engage in sexual relations greatly increase. Many young gay men (and also lesbians) find this period of their lives to be quite liberating in the sense that they are no longer (in many cases) under the authority of their parents and the social controls instituted their peers and community settings to not engage in homosexual activity, however, such liberation can be dangerous when it leads to promiscuous and/or unsafe sexual behavior. The opportunities for gay adolescents and young adults to become involved in "risky" sexual behavior are clearly present and many such young people will take advantage of these opportunities, so we must be pragmatic about the messages we transmit to such people, saying, in a manner of speaking, that what they do with their lives and their bodies is their business yet that their choices can easily have serious ramifications that will impact perhaps not only their own health but also that of others. We have to make this message strong enough to stick in everyone's minds when they are confronted with tempting situations that might encourage them to throw proverbial caution to the wind and when they hear rumors and falsehoods that are more appealing than the truth of the matter. We must make our message of responsibility and forethought powerful enough to outweigh all messages that will inevitably compete for its attention.
When I say "we" in the above paragraph, I am not using this pronoun as some sort of creative or coy literary convention. Nor am I including just other health educators with my own efforts and goals, instead, I am including each one of you reading this article, regardless of your age, your gender, whether you're gay or not, or any other factor. I am imploring you to take it upon yourself not only to listen to the truth about AIDS and to realize the gravity of the situation, but to also --to the best of your abilities-- do what you can as an individual to promote the spread of accurate and timely information about AIDS and sexual behavior among your peers. It may not be someone like myself or a teacher or a doctor who reaches a young person and convinces him or her not to engage in unsafe sex: it might be you who makes that crucial difference, your words and your concern may extend far beyond the layers of confusion, desire, and other mixed emotions that a young person is experiencing. I don't discount the informal impact of peer-to-peer communication about health issues among youth, particularly among gay youth; instead, I wholeheartedly encourage such communication and believe that it is one of the most efficient methods we have of reaching adolescents and young adults. I challenge each one of you in this new year to make a difference in your own lives first through the ardent protection of your health and then to go the extra step when possible to make a difference in someone else's life through your care, concern, and willingness not to shy away from issues that may be unpleasant, frightening, and difficult to discuss. I appreciate and cherish the intelligence, potential, and promise of gay youth --and for that matter all young people-- and want to see as many of you as possible have as successful and healthy lives as possible. The prevention of AIDS is as much in your hands as it is in mind: take this opportunity and run with it.
Violence and Gay Bashing
Aside from AIDS and its related illnesses, I believe violent acts against gays and lesbians based upon their sexuality to be one of the most important issues which we must grapple with over the coming year. The case of Matthew Shepard probably needs no introduction to most of you; for those who do require an introduction to this terrible instance of cruelty let me just say this: a young college student was beaten and left to die simply because he was gay. I don't think I need to say anything more than that. I am glad that Shepard's death has received considerable media attention from the mainstream press because that is indicative that our nation as a whole is as appalled by Shepard's death as I am, and as I expect all of you are. But media attention alone rarely betters a situation. Just as in AIDS prevention, we can write articles and give lectures all we want to (probably more than we really want to) and still not generate the sort of change in behavior that we desire. What we need is public action and public concern to the degree that anyone considering acts of violence against gays will realize that such acts will be swiftly dealt with through the established legal channels and will also be met with condemnation from not only those who are gay, but from the vast majority of the populace. College communities need to champion the acceptance of gay students more than many currently are because for every person who would dare consider assaulting a fellow student because of his/her sexuality, there are maybe five or six students who would see nothing wrong with such an action and maybe ten more who would see such an attack as morally wrong but who would view homosexuality as morally worse. Those are the very people we must reach because they are the same people who live next to us, who sit next to us in class, who share offices with us, and who will ultimately either side with us in our demands for justice or who will remain misguided enough to continue to stick their collective heads in the sand.
The Centers for Disease Control and Prevention (CDC) has recognized violence as a serious health problem for some time now, delegating research and prevention efforts to curtail the rates of various kinds of violence (i.e., domestic violence, rape, and assault) in the United States and around the world. Thus, violence is most certainly a health-related concern. Hate crimes are not simply criminal acts in that they violate established laws and cause physical harm but they are assaults (in every sense of the word) on the health of individuals and the health and welfare of us all. Hate crimes are terrorism, plain and simple. Their main objective is to terrorize, to inspire fear and shame, and those objectives are equally deplorable whether they are carried out against someone because of religious differences or differences in sexuality and sexual orientation. I see what happened to Shepard as the same as a group of terrorists in the Middle East or Northern Ireland bombing a building, and I see it as the responsibility of law enforcement agencies, health care researchers and providers, and all of the rest of us to combat this sort of terrorism. This is terrorism on our own home ground and we cannot allow it to continue. Violence is a threat to our health, and one threat that theoretically can be eliminated. So let us in this new year start sending the message that violence against person due to any kind of difference will not be tolerated. That's a very good start to better beginnings.
Michael Walker has served as an Oasis columnist and Science Editor since late 1996. His articles on gay youth-related medical and social issues have appeared in a number of other general interest and scientific publications. He can be reached at: MCWalker@hotmail.com