AIDS and Sexual Ecology
Editor and columnist Gabriel Rotello has authored a controversial book, Sexual Ecology: AIDS and the Destiny of Gay Men (New York: Dutton, 1997). Rotello echoes, but in much more detail, many of ethical concerns in the section on AIDS in Chapter 3 of my book.
Rotello argues that sexual behaviors, when their practice changes radically within a population, has environmental consequences for society as a whole that transcend those seen by the individual, much as do industrial and consumer behaviors that pollute or otherwise mediate the environment.
Some of his arguments seem to pick up on the "chain letter" theory of male homosexual practice. Before World War II, he notes, big city life tended to shelter "effeminate" homosexuals with whom straight men would sometimes have penetrative sex; but men did not typically reverse roles.
Gay men won enough sympathy from mainstream society to avoid the worst political catastrophe, he says. (He seems unaware of the significance of Baker). These arguments (that most gay men were infected before they knew about the epidemic, that gay men were victims of a genocidal neglect, that the targeting by the epidemic of gay men was a historical fluke) were far from intellectually honest but played on public sympathies effectively because gay men really did change their individual behaviors significantly.
The ecology paradigm becomes important as we evaluate the apparent success in making HIV disease manageable for years in many patients and in keeping many men uninfected. The use of combination drugs (like protease inhibitors) may actually exacerbate the mutation of the virus into resistant and more transmissible forms since many people (for reasons of economics or side effects or just neglect) do not take their medications faithfully. The acceptance of some forms of sex as "safer" such as oral instead of anal sex may actually encourage viral mutations (hence, again, his "ecology") to forms more readily spread through mucosal surfaces. On this point, Rotello may be less convincing: he claims that HIV cannot cause a self-sustaining epidemic among heterosexuals with a Western standard of living, yet the mutations he fears would show up first in increased heterosexual transmission (outside of the sex partners of drug abusers). And this indeed may be happening.
On page 118, para. 5, I mention a "vacation" trip to Belle Glade, Fla., largely a migrant farming community in south central Florida on a lake. In the mid 1980's, Belle Glade had become the focus of rumors about heterosexual spread within this country, and also about the possibility of spread by insects.
In fact, Robert Gallo of NIH had, in a 1985 Scientific American article, suggested that cousin virus HTLV-1 (leukemia virus) might be spread by a particular mosquito in northern Japan. However, to date, there is no evidence that HIV is spread by insects. An arbovirus (indeed, Ortleb's African Swine Fever Virus) usually can be spread by only one very specific species of arthropod, after genetic adaption to life within that host. For HIV to become insect-borne in the U.S. (indeed, this would be a political and human catastrophe) probably would require that HIV adapt itself to a specific host in Africa and then that such a host accidentally be introduced here, an unlikely combination.
The "religious right" may have had some justification in claiming that the development of a large cohort of immunocompromised people is itself dangerous in amplifying previously common infections, such as "ordinary" tuberculosis.
One theory that was convenient and popular early in the epidemic concerned the use of poppers, nitrite inhalants that stimulate sexual pleasure, at the risk of cardiac arhythmias. Some thought these substances could stimulate Kaposi's Sacrcoma, but this theory did not pan out. K.S. is likely caused by the combination of HIV and a cofactor virus such as Herpes Virus Type 6. Poppers are not commonly used in gay owned establishments today.
Another personal note: In early 1998, I required two units of blood after an accident. Since I am not allowed to give blood because of my past conduct, I guess that gives me bad karma. Is blood a "community" resource deserving moral protection? Of course, people can be paid for donating blood products, and may obtain credits in case they need blood themselves; gay men are denied such potential opportunities.
On May 31, 1998, CNN "Impact" aired a story about senior citizens becoming infected with HIV. The major demographic point was that since there are many more senior women than senior men, many women could be infected by one man.
The following materials give a further idea of the "political panic" during the early days of the AIDS epidemic.
First, I present a letter I had published in D-Magazine (Dallas, Texas) in December, 1985, during the AIDS panic. The court decision mentioned in this letter is the Fifth Circuit overturning Judge Buckmeyer in (Baker v. Wade 1982); that is, the Fifth Circuit is upholding the Texas homosexual-only sodomy law (eighteen months before Hardwick v. Bowers, which dealt with the Georgia law).
In his overview of AIDS in Dallas, Tim Allis (D, Sept. 1985) mentioned the Fifth Circuit's reinstatement of the Texas homosexual conduct law (21.06) and the circuit court's claim that "implementing morality" is a "permissible state goal." The bottom line of this matter is: If two adult people of the same sex love and are committed to each other, may the state or their community rightfully interfere with their relationship?
True, promiscuity in the male homosexual community was largely responsible for the amplification of AIDS once it was accidentally introduced. But does this mean all gay people may be considered "guilty" by association? I think the court should have explained how far it thinks the state may go to "implement morality"; it seems too conventional to let "Western tradition" cover up for irrational prejudice, from which the country has a responsibility to protect "different" people.
The gay community, however, must greatly reduce the incidence of all sexually transmitted diseases if it is to overcome the now legitimate fears of the public; educational efforts in the gay community are doing just that. I am afraid that the fear of AIDS will make otherwise reasonable people become determined to hunt down gay men and isolate them from their livelihoods and society. Individuals should remember that some things they do in private do indeed affect others. Sexual activity with multiple partners is not any more a guaranteed "right" than is drug abuse.
Letter to me from Nathan Fain, Gay Men's Health Crisis, December 12, 1983
Thank you very much for writing December 3 about the controversies surrounding employing gay men.
Like you, I have been dismayed by the efforts of Dallas Doctors Against AIDS and others. Their program seems not to have won them much ground, and my sense of the situation is that the Dallas Gay Alliance has taken the problem on very well.
More serious--and more difficult to address--are comments that appear often in the medical press. I am aware how emotionally loaded a phrase such as "public health problem" is, especially when such phrases are taken out of the disciplines of science and placed in the political arena. The fact is, gay men have a public health problem on their hands, and would even if AIDS itself never appeared. My view is that gay men are doing a commendable job taking the problem on, working hard to remedy it, acting responsibly and fairly. To me, our only real defense against demagogues such as Dallas Doctors Against AIDS is our record of intelligent, well-advised caution. To keep that record as it is, we must recognize what the facts are. Then we appeal to society to be as fair with the facts as society itself would want to be treated.
Excerpts from letter to me from Dallas Doctors Against AIDS, March 30, 1984
It is encouraging to learn of recognition of the seriousness of this public health problem from thinking members of your community...
The average cost of treatment for an AIDS patent is in excess of $100,000 per case, and this must be borne by the general public....
It is clear to us that AIDS is spread among male homosexuals mainly by anal intercourse. This practice, even when carried out in private among "consenting adults," is very much everyone's business. The rectal wall is very thin, poorly lubricated, and easily torn, when compared to the much thicker wall of the female vagina...."
Subsequently, AIDS, first spread among homosexuals, may jeopardize the general public through the blood chain, the food chain, and the dental chain..."
"Lesbians are also subject to health problems, such as vaginitis and candida albicans. Lesbianism also violates community standards of morality and decency...."
More on eligibility to donate blood:
Ross D. Eckert, The AIDS Blood-Transfusion Cases: A Legal and Economic
Analysis of Liability, 29 San Diego L. Rev. 203, 217-18 (1992).
Provides a definite list of those asked not to give blood:
· Persons with evidence of HIV infection;
· Any man who have had sex with another man even one time since 1977;
· Past or present intravenous drug users;
· Persons with hemophilia or related clotting disorders who have received clotting factor concentrates.
· Persons born in or emigrating from countries where heterosexual activity is thought to play a major role in transmission of HIV 1 or HIV 2 infection.
· Persons who have had sex with any person meeting the above descriptions;
· Men and women who have engaged in sex for money or drugs since 1977 and persons who have engaged in sex with such people during the preceding six months. (slightly condensed)
· On the issue that some HIV negative gay men may feel pressure from colleagues to donate blood in company blood drives:
"The FDA recommended blood banks also use 'confidential unit exclusion,' a procedure to give donors a second opportunity to decide whether their blood should be transfused. At many blood banks donors choose in privacy between one bar coded label indicating that it should be used and another indicating it should not."
Id. at 219. (See also DADT book, p. 279, note 173 in Chapter 5).