The story of the new drug resistent AIDS strain from a gay guy who was into unprotected multi-partner sex and crystal meth usage is developing in interesting ways. There are indications that the scare has been a bit overblown and the reaction excessive, particularly some of the more draconian measures suggested to tackle it. But except for the most extreme gay and AIDS rights activists, commentators, not least from the gay community, acknowledge that it does raise questions of the extent to which the behaviour of some gay men is contributing to the persistence, even resurgence, of the virus and what can be done to tackle it. Dan Savage has just come up with a characteristically vigorous and thought provoking suggestion, which I'm giving below. The practical problems with are obvious, particularly in a country like India where so much infection happens through anonymous and even unacknowledged sex (meaning guys deny they are having it), and anyway most of them wouldn't be able to pay for their own treatment let alone that of the people they infect. Still, its interesting in that it attempts to fix responsibility which is something AIDS activists have tended to shy away from because of fear of stigmatising people. I can understand the practical reasons for this, since stigmatising makes it harder to reach out to people. But it does seem to me that the reluctance to assign responsibility also stems from the sort of moral position that says "every is guilty, no one is to blame" and that I think is rubbish. In many cases people may truly not be guilty, but in some cases - as in the one that Dan is responding to - the people who infect are guilty and should be subject to some penalty. And when, as Dan suggets, its a financial penalty with the benefits going to the victim it just seems neater than the rather gruesome option of putting them in jail. What would be interesting is to hear how people on these lists feel about the dilemma the person asking the question is in? Because its a question more and more people on these lists will be facing. More and more gay guys are testing positive, but will continue to lead normal lives in the community. So what happens if they see that 'normality' as continuing to have unsafe sex? Vikram Dan Savage Q. One of my best friends was recently diagnosed with HIV. Since college, he's been on an unending sex conquest, hooking up with countless guys he meets online to engage in risky activities. My concern is that he doesn't seem fazed by his HIV diagnosis, and he says he has no intention of giving up his online sex crusades. I worry about his mental and physical health, but also about his seeming willingness to infect others just to satisfy his sexual appetite. I'm pretty sure he doesn't disclose his HIV status to potential partners, and barebacking is what got him into this mess in the first place. I don't know what to do. He's a pretty clean-cut, attractive, A&F- wearing young guy, which doesn't match the stereotype that many in the homosexual community have about HIV-positive guys. So what am I obligated as a friend to do? Should I tell the group of friends we share, even though they are straight and are not connected to the pool of people he is sleeping with? Should we arrange a time to get together for some sort of intervention? I want to be a good friend, but I don't want to just stand by and watch him continue to hurt himself and possibly others. Any advice is appreciated. —HELP ME DO THE RIGHT THING Dan: Would you be friends with a guy who went out at night and mugged little old ladies? Or a guy who beat his girlfriend? Or a guy who ran around raping people? Of course not, HMDTRT, because you're an ethical guy and ethical guys don't hang out with violent, abusive assholes. So why on earth are you wasting your time with this guy? Knowingly exposing other people to a potentially fatal disease is an act of violence, HMDTRT, and there's just no excuse for it. Your college buddy obviously doesn't care about his own health any more than he cares about the health of his sex partners. And you know what? If you were an attractive, naive stranger he met on a website, he'd be more than willing to imperil your health to satisfy his own selfish sexual appetite. So here's what to do, HMDTRT: You're going to drop this guy. You're going to refuse to have anything to do with him anymore and you're going to tell him why. And if anyone in your circle of friends asks why you aren't friends with this asshole anymore, you're going to tell him or her the truth. Will you be violating your college buddy's privacy? I suppose so, kiddo, but someone who violates other people so casually isn't in a good position to complain about having his precious privacy violated. Speaking of new HIV infections, an apparently deadly strain of the virus that causes AIDS surfaced in New York City last week just in time for Valentine's Day. This new strain doesn't respond to the antiretroviral meds that hold most infected people's HIV in check and, even more worrisome, it appears to induce a rapid progression to full-blown AIDS. The new HIV strain was discovered in a New York City man who told health officials he had had sex with hundreds of men in recent weeks while using crystal methamphetamine. Nice. The news about what could be a deadly new stage in the AIDS epidemic broke less than a week after public-health officials began warning gay men about a rare form of chlamydia known as lymphogranuloma venereum, or LGV, that's spreading among gay men. Symptoms of LGV include a painful, bloody rectal infection, genital ulcers, and exploding lymph nodes in the groin. Six cases of LGV have been confirmed in the United States, all among gay men, and most of the men infected with LGV reported having multiple sex partners and engaging in unprotected anal sex. For some, the HIV/LGV one-two punch was the last straw: "Gays Debate Radical Steps to Curb Unsafe Sex," read the headline on the front page of The New York Times on February 15. And the radical step that's being contemplated? Partner notification, or tracking down, testing, and treating the sexual partners of people who have been newly diagnosed with HIV. As radical notions go, partner notification is about as radical as suggesting that surgeons wash their hands before they operate. Public-health officials have used partner notification to combat other sexually transmitted infections for decades and it's past time that they started using it to combat HIV too. If people are looking for a truly radical step—something that might actually curb unsafe sex—I've got a suggestion. But first some context: When extremely promiscuous gay men assess the risks and benefits of unprotected sex, most assume that if they get infected, or if they infect someone, an AIDS organization or state health agency will pay for the AIDS meds they or their sex partners are going to need to keep themselves alive. It seems to me that one surefire way to curb unsafe sex would be to put the cost of AIDS meds into the equation. I'm not suggesting that people who can't afford AIDS meds be denied them—God forbid. No, my radical plan to curb unsafe sex among gay men is modeled on a successful program that encourages sexual responsibility among straight men: child support payments. A straight man knows that if he knocks a woman up, he's on the hook for child support payments for 18 years. He's free to have as much sex as he likes and as many children as he cares to, but he knows in the back of his mind that his quality of life will suffer if he's irresponsible. If the state can go after deadbeat dads and make them pay child support, why can't it go after deadbeat infectors and make them pay drug support? Infect someone with HIV out of malice or negligence and the state will come after you for half the cost of the meds the person you infected is going to need. (The man you infected is 50 percent responsible for his own infection.) "I don't think there's anything inherently illegal about it," said Jon Givner, director of the HIV Project at Lambda Legal Defense and Education Fund, when I called to bounce the idea off of him. "It's just a matter of whether you think it's good public-health policy." Jon doesn't. "I don't want to play the role of the apologist for irresponsible behavior [but] whatever public-health policies we develop should not be based on blaming the person with HIV first." Ana Oliveira, the executive director of Gay Men's Health Crisis, was more receptive to the idea. "We find ourselves at a time where the idea of holding people accountable, of building consequences into behavior choices, may be needed to help change the paradigm," Oliveira said. "We certainly appreciate the element of justice in your idea. It could act as a deterrent, and that would be helpful. The difficulty is that it would be impractical to implement . . . and the pitfall would be a lot of he said/he said situations." Still, Oliveira thinks everything should be on the table right now, as do many other frustrated HIV prevention educators. So I'm tossing my idea out there. Anyone else care to comment? ------------------------ Yahoo! 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