Bangkok, Thailand, May 2004: Earlier this year I had a disturbing
encounter with a young Thai - I'll call him Nok - who told me some of
his lifestory. He was twenty-four, a moneyboy like so many others, with
little education and few opportunities, living off a cute face and body.
He had just returned from Amsterdam where he had gone to live with the
love of his life, whom he had never met in person, only on the
internet. (There is a clich there, as anyone who has cruised Gaydar or
its cousins could tell you.)
Predictably, the love affair turned sour and Nok
was on the streets. For two months he sold himself,
finding foreigners more willing to pay than the Dutch. And with money in
his pocket and an itch in his pants he went to sex clubs and ingested
various drugs. A week before he came home, high on ecstasy, he allowed
himself to be gang-banged in a darkroom. It was painful and there was
blood but he did not regret it. When we met, the pain had gone but the
blood was intermittent.
He had said he always used condoms. How do you know if the guys who
fucked you used condoms? I asked. I don't, he said. Besides the Dutch don't like to
use them. (Nor do many Brits, USAmericans and many others.)
So his condom use was erratic.
I asked if he wasn't worried about
catching HIV or giving it to someone else. Although I gently repeated the
question in different ways, he either didn't or didn't want
to understand. The disease was vague and of little concern to him. I
tried to tell him how serious it can be but my words were water off a
duck's back. What about the future? I asked. No problem, he said. As
long as my parents have money, I can die. Not the first time I had come across this mentality
in Thailand, where the rural poor often see their gay sons as a source of income.
He left and I wrote an article that I submitted to
a British magazine lamenting the failure of HIV education programmes
to persuade Nok and others to use condoms as matter of routine. I
was sympathetic to Nok because he was
young and information campaigns for gay men in Thailand have
been rare to non-existent, but I was less charitable to the older, Dutch
or other, men in Amsterdam who were presumably more aware of the risk
and were happy to take advantage of a darkroom to bareback him.
The article was turned down. The editor was unwilling to accept a piece that
appeared to blame men living
with the virus and to ignore the many psychological
issues that prevent men from protecting themselves and their partners. I
was, in his eyes, reinforcing the fence between those who are HIV-positive and those
who are HIV-negative. A lively correspondence ensued. I argued that I
was not concerned with HIV-positive men, but of all men,
whatever their serostatus, who refuse to use condoms.
Writing forces me to think and our exchange of views was no exception. I realised that
the fence was not between HIV-positive and HIV-negative but between, on
one side compassionate and thoughtful and on the other stupid and
selfish.* The personal part of me - the bit that doesn't get paid to
work in HIV care and prevention - cannot understand why anyone at any
time would not want to protect, if not themselves, then at least their
partner, particularly if that partner is a stranger.
At gut level, the situation is simple; when you have sex you should
always assume that at least one of
you has HIV, even if your last test was negative and he tells you the
same. After all, he could be lying and / or either of you
could have contracted the disease since your last test. He may want to
be fucked without a condom but you don't do it, because you tell
yourself that you don't know if he's only saying that because he's off
his head on drugs or alcohol. And even if he's stone cold sober, you refuse
because you don't want to ask yourself the next day or the next year,
hey, what did I give him or what did he give me?
So each time you fuck you put on a condom as
automatically you put on clothes in the morning. Anyone who doesn't is
stupid and / or selfish and deserves a job in the US government. Only
when you've been dating three months or so and begin to know each other
can you start to discuss the pros and cons of barebacking.
From a wider perspective, HIV is irrelevant. The
question is not who has or may have the virus, but
whether you consider the needs of the person you are with. Refusing
to wear a condom may have more serious consequences, but it is no
different from dropping litter or pushing your way onto the bus or underground
train before others have got off or from changing the television channel
without asking others in the room. Each of these acts betrays your
selfishness and assumption that other people are less important than you
are. Or if you want a stronger analogy, on a moral level refusing to wear a
equivalent to the Israeli settlements in Palestinian territory, to the
hijackers that killed thousands in September 2001, to the mugger beating
someone to the ground to steal their mobile phone, to whatever act of
selfish aggression that you wish to use. It satisfies your ego, but it
may extreme psychological or
physical pain or actual death to others.
In other words, refusing to wear a
condom - even at your partner's request - is an act of selfishness, of
considering one's own needs at that particular moment as being more
important than the needs of others or their or one's own long-term
needs. There is no justification for not wearing a condom. You put one
on, or insist he puts one on, because it would be rude not to so, because you respect
you do not want to endanger his life - and hopefully you are not stupid
enough to want to endanger your own.
We are all sometimes capable of acting in our own best long-term
interests and in the interests of others around us. Unfortunately,
however, our priorities are
more often short-term; because we want the pleasure now and damn the
consequences, for ourselves and others. So the condom gets ignored.
Luckily for my work, the part of me which holds
these rigid opinions is kept in a kennel and only allowed out at night
when respectable people are asleep in their beds. The professional part
of me recognises that most people are less than perfect; they are
vulnerable, do not process information easily and most face many
internal and external constraints that prevent them from acting in the
way that others might wish them to act. Appealing to people's better
nature just doesn't work.
So the challenge of helping people adopt consistent
safer sex is still out there. There is a wealth of literature to confirm
what techniques and approaches at least partially succeed in persuading
people to protect themselves and others, which will be updated at the
international AIDS conference in Bangkok in July. Let us hope that
someone has the key to helping Nok and his dark-room partners see
condoms not as a killjoy but as an essential part of pleasure.
* Another perspective is not a fence that
divides the world into two (HIV-positive and HIV-negative) but one that
divides it into three - those who know they are positive, those who know
they are negative and those who do not know (including those who choose
not to know) on the third side. Some issues are applicable to one side
of the fence, some to two, some to a different two and some to all
three. But then the metaphor and its applications start to get strained,
so may be it's time to go and have a cup of tea.