The documentary "Sex Positive" has been receiving some attention of late in both the queer and the mainstream media as it continued a summer of screenings around the country.  Many in the Rochester area may recall that the film screened during the line-up of ImageOut: The Rochester Lesbian and Gay FIlm & Video Festival in 2008.

For those who are not familiar with the film, it is a documentary that basically highlights the life and work of Richard Berkowitz---an HIV+ author and activist from the early days of the AIDS epidemic in the United States who is, by many, touted as one of the original authors and architects of what we today call "safe(r) sex" because of a 1983 pamphlet he co-authored.  This pamphlet, entitled "How To Have Sex in an Epidemic:  One Approach" is widely regarded as one of the first sex-positive educational pamphlets encouraging safer sexual practices among gay & bisexual men. 

The film, which has been very well received at film festivals around the country,  touched some important themes from queer history:  HIV, AIDS, advocacy, activism and the creation of safe sex.   The film definitely drives home the point that it is impossible to deny that HIV is an important part our community’s shared history...and it highlighted the ways in which queer people were an early part of the fight against HIV & AIDS through efforts to advocate for appropriate & honest education and to create an environment in which all people could express themselves sexually in a way that was (and is) both satisfying AND healthy. 

It’s important, however, for us to look at the film’s subject through not only the lens of our community’s history…but also that of our present and our future.  The CDC, in the past couple years, released revised figures indicating that 56,000 Americans get infected with HIV annually.  A significant percentage of these new infections are among men who have sex with men. In light of this data it’s clear that our community must not only honor our history with this virus and celebrate our victories---but remain vigilant in educating ourselves and others about our continued efforts in the fight. 

So let’s review some important HIV facts:  HIV is a virus passed in three primary ways: through unprotected vaginal and anal sex (& to a much lesser degree through high risk oral sex), through shared injection equipment, or from mother to child.  Once infected with HIV, there is no cure.  The virus begins debilitating the immune system leading to an eventual diagnosis of AIDS and complications that can lead to death.  There are treatments available for those infected with HIV.  These treatments have enabled many individuals to live a longer life but are, however, often a trade-off.  Medication regimens can be both complex and costly.  They can have uncomfortable side effects and do not work for everyone…and can lose their effectiveness over time (especially in patients who are less than fully compliant with their medicines and medical care).  Living with HIV is certainly possible, but it is a lifelong process that presents some very significant challenges and choices.

So that's the facts of HIV....the "how" and "what" if you will.  Those are facts that are pretty easy to recite and are not that hotly debated.  A more difficult question, though, is the "why" of HIV...in specific, many people are befuddled by the question of why gay men continue to get infected with HIV at such high rates.

For this question there is probably no simple answer.  We would be remiss not to mention the intangible effects that systems of stigma like homophobia and racism can play in people's lives and risk profiles.  The question of risk can be a very complex sociological dialogue.   That said, however, many or most experts and community members would probably agree on a few common factors that contribute to the continued risk of:

Men are still having risky and/or unprotected sex. Traditional wisdom has taught us that condoms help prevent the transmission of HIV…during all types of intercourse.  Condoms should be latex, properly stored, unexpired, and used with water-based lubricants.  Additionally, we know that some types of sexual activity are lower risk for HIV transmission…for example, it is somewhat lower risk to be the “top” than the “bottom”…oral sex is significantly less risky than anal sex…and engaging in sex that doesn’t result in exposure/exchange of bodily fluids reduces risk.

Some men still don’t know their status.  While we’ve made great strides in getting information out about testing, there are still some guys who have never been tested OR who don’t get tested regularly.  Depending on your level of sexual activity, a testing schedule of once very 6 months to a year is usually good.

Men are not talking about HIV with their partners.  This is quite possibly the most important of the three.  The fact of the matter is that you cannot get HIV from someone who is HIV negative…and the only way to know that information is to talk about HIV status with sexual partners.  Understandably, it is not always possible or convenient to talk about HIV with partners, but in instances where it is it can play an important role in protecting yourself.  If you are concerned about HIV, especially if you are having or are interested in having unprotected sex, engaging your partner(s) in discussing their status, their history of safer sex practices, and their testing history becomes VERY important.

These three things are all areas in which we, as queer men, can figure out where we are and what we can do.  Maybe you make a commitment to making your sex life safer somehow. Maybe you make a commitment to get tested more regularly.  Maybe you make a commitment to talk to partners about your status and theirs.  Maybe you make a commitment to be with just one partner.  Whatever it is you do, controlling HIV in our community is going to require exactly that....a commitment on all our parts.