A couple of weeks back I'd posted Dan's column discussing the new AIDS outbreak in the gay community and the possibility that it is being spread by positive guys who have unsafe sex without telling their partners, either knowingly or under the influence of crystal meth, which is similar to knowingly since they know they shouldn't be taking it or having sex when they do. Dan's idea (the original column is given at the end of this) was to impose a penalty of such sorts on such behaviour which stopped short of putting positive people in jail, but didn't just dismiss such behaviour on the grounds that 'people who get infected have only themselves to blame' which is essentially what the hardline AIDS activists stick to. His idea was to put a financial penalty where such knowing infectors would have to contribute to the treatment cost of the people they infect, on the lines of how men who casually get women pregnant have to contribute to child support payment. A lot of mail has ensued and here are some of the responses some of which lead Dan to fine tune his proposal. In particular, one of the letters from Biologist In Kansas City, answers a point raised on the GB list too, that its not as easy to track an infector as it is to track an impregnator. Do other people with relevant medical knowledge on this list (Ajit?) want to comment on this? I don't think even Dan thinks that his proposal is likely to go through anywhere, but it leads to an interesting and important debate on responsibilities and acceptable behaviour in the context of HIV/AIDS, Vikram Q. What a mean response! I totally disagree that there is a direct parallel between mugging old ladies and having unsafe sex after an HIV diagnosis. The old ladies have no way to protect themselves, whereas every single partner who sleeps with an HIV-er has the choice to use a condom. I work at an HIV service agency and we deal with the issue of disclosure all the time—it's one of the hardest things for sexually active gay men, especially those who feel validated by sex, to handle. Placing all the blame for the spread of HIV on the people who are already infected is stupid—for many of them, it's incredibly psychologically damaging to live with both the social pressure of being gay and being seen as a walking infection. Should they expose other people to the virus? Of course not. But it takes two to tango. There's a better way to reach positive people than forcing them to pay "drug support payments." We should educate them so they understand the risks, rather than scolding and punishing them for living with a tragic disease. —DOCTOR NICE Dan) A. For the love of God, Doctor Nitwit, go into some other line of work! HIV service agencies are overrun with idiots who agree with you, all making the AIDS epidemic incalculably worse. Confronted with a man who's running around indiscriminately infecting other men with HIV, your first impulse is to start spitting out excuses. We should have compassion! Disclosure is difficult! Let's educate the poor little darling—not about his responsibility to his sex partners, heavens no! Let's educate him about the risks he's putting himself at! What about compassion for the men he's infecting, and his responsibility not to spread HIV? As for education, if this asshole is smart enough to use the Internet to line up sex dates, he's smart enough to know it's wrong to give someone else HIV. And you know what, Doctor Dipshit? I didn't suggest that we scold and punish people for living with a tragic disease. I suggested that we scold and punish people who maliciously and/or negligently infect other people with a tragic disease. I have scores of friends with HIV who go to great lengths to avoid infecting others, and I certainly wasn't scolding them. They're the good guys, and I'm sick to fucking death of "HIV educators" lumping my ethical HIV-positive friends in with selfish, unethical, immoral HIV-positive shitbags who could care less about infecting other people. Yes, it takes two to tango. That's why in my drug support payment plan the malicious and/or negligent infector would only be on the hook for half the expense of the drugs that the person he infected would need to stay alive. As for being "mean," my drug support payment plan is less mean than the alternative suggested by numerous Savage Love readers: prison. In most U.S. states and all of Canada, knowingly exposing someone to HIV is a felony—just like mugging little old ladies. ---------------------------------------------------------------------- ---------- Q. As someone who has worked in HIV/AIDS in NYC for almost 17 years, I applaud your "drug support payments" idea. I have always been amazed that the onus of prevention was on the uninfected and not the person with HIV. For most communicable diseases, the infected person is educated on how to not spread disease. Someone with active tuberculosis is expected to stay home, not go to work, and to wear a mask to prevent others from being infected. So why is it so hard to counsel someone with HIV to not spread a deadly virus? Why is it such a taboo among so many gay activist groups for the HIV-positive person to be a responsible human being? —WAKE UP, PEOPLE! PS: If you print this, please do not use my name. I work for a public health agency that would not be too happy with my opinions. Dan) I was heartened by your letter, WUP, until I got to your PS. What does it tell us about HIV and public health agencies that your opinions are so controversial that you can't use your name? Nothing good. ---------------------------------------------------------------------- ---------- Q. Longtime reader, first-time writer. In regard to your "drug support payments" idea, why stop with just HIV? Why shouldn't we do the same for smokers? Their health problems are numerous. And what about fat people? They regularly make themselves more obese. Shouldn't they have to pay for their diabetes meds, heart disease meds, heart operations, etc.? —J. Dan) Someone has to stuff his own face to get fat and light his own smokes to get lung cancer, which means every fat person and smoker out there is solely responsible for his own health problems. To get infected with HIV, however, someone has to infect you. But I'll take your bait: Yeah, I believe that people who smoke or stuff themselves should pay higher health insurance premiums than people who don't take those risks—and I said "higher," not crushing. The idea is to create a financial incentive for people to make better choices. Likewise, I think people who maliciously and/or negligently infect others with HIV should be held responsible for their actions, and drug support payments would create a financial incentive to make better choices. ---------------------------------------------------------------------- ---------- Q. I'm a 52-year-old gay man—native San Franciscan—who lost count of the friends I buried from AIDS. I worked at San Francisco General Hospital and saw the horrors of ward 5A. I volunteered at Project Open Hand to feed those infected. I've walked in countless AIDS walks. How I escaped is beyond me, because I was there in the thick of it. But not a day goes by that I don't remember one of those who died. We didn't know what caused AIDS then. We do now. That this asshole is purposely infecting others for his own physical pleasure is nothing short of criminal. It is premeditated murder. Yeah, I'd drop his ass quick—and I'd tell everyone I knew why. Hell, I'd probably tell total strangers. He would not be a friend. Sorry, but my friends care for other people. And ya know what else? I don't want to pay for his fucking medication. Nor do I want to pay for the medications of his barebacking asshole partners. Once upon a time we opened our hearts and our wallets to those infected. We demanded that the government step in and help. I really hate to say that I don't care, but I don't. Go ahead and die. —TIM D. Q. It's difficult for me to read about people like Help Me Do the Right Thing's friend. At 32, I contracted HIV from a guy I'd been seeing who lied to me about his status. I've accepted my part of the blame. But I also know that in the state of California knowingly transmitting the virus is a felony. I'm not sure if prosecuting this guy is what I want, or if it will make any difference, but I do agree with the idea that he should pay for the obscenely expensive meds I now have to take for the remainder of my life. —TODD Dan) Thanks for sharing, Tim D. and Todd. We'll have more on this subject next week—including whether or not it would be possible to establish an HIV "paternity"—but in an online special only, not in the print version of Savage Love. ---------------------------------------------------------------------- ---------- Dan) Finally, mail from people who want to praise, bury, or perfect my "drug support payments" proposal continues to pour in. Should guys who infect others with HIV have to help pay the costs of the drugs the people they infect will need to stay alive? Reader) If something like "drug-support payments" were ever implemented, when people discover they are HIV-positive they will be afraid to let their past and present sexual partners know for fear of being sued for support. The uninformed, then, would not be receiving treatment and would be passing the virus, unknowingly, on to others. Your idea, I believe, would lead to even more HIV infections. —Brian C. Dan) I picture the drug-support payments going to the state health agencies that foot the bill for AIDS meds, Brian, not to infected individuals, so there would be no incentive for a newly infected person to go after his infector. A drug-support program could also be designed to reward responsible behavior, so any pro-active steps an HIV-positive person made to help curb the spread of HIV-such as cooperating with partner tracing programs-should weighed when determining if he should have to make drug-support payments at all. And in cases where an infected person took all reasonable precautions (i.e., he disclosed his HIV status and used condoms), drug-support payments should be waived entirely. Reader) Drug-support payments from deadbeat infectors? A bloody fucking brilliant idea. A financial penalty might just encourage personal accountability. But please broaden this to include straight men and women who knowingly infect their partners. —Christine M. Dan) Consider it broadened, Christine. Reader) The idea that the person with HIV is going to have to pay even part of the drug costs for someone they are deemed to have infected is ridiculous. To suggest that if I willingly have unprotected sex with a stranger and am infected as a result the other person is responsible for infecting me is a recipe for disaster. You seem to like metaphors, Dan. Try this one. The little old lady has a tumor that is growing and decides to jump in front of train. Is it the conductor's responsibility when he hits her? Okay, she doesn't have a tumor. She is a little kid who is playing "chicken." Even if you did charge the conductor, it doesn't solve the problem. HIV and AIDS are not going away as long as people continue to have sex. If people don't want kids or sexually transmitted disease, they need to stop having sex. If they don't want to stop having sex, they need to decide what personal level of risk they are willing to take and take responsibility for themselves. —Sex Is Something Society Yearns Dan) If the train conductor can see the little old lady and can stop the train before it hits her and hits the gas (or whatever they use on trains) and speeds up . . . yes, he's responsible for her death. Someone with HIV and a hard dick is a not an unstoppable train, SISSY. Reader) As a side note to the column on HIV/AIDS, there is a law in Michigan called the HIV Exposure Law. Basically, it says that if you know that you are HIV-positive and you engage in sexual penetration without disclosing your status to your partner beforehand then you have committed a felony. Not sure if they have these laws in other states as well, but I would think they would. —Allene Dan) I'm aware of the existence of these laws, Allene, but they're rarely enforced-at least against gay men. Every time you hear about a person being prosecuted for exposing someone to HIV it's invariably a heterosexual male, usually African American, who exposed a group of women, usually white. I'll leave it to others to tease out what that says about our culture. Meanwhile there are gay men out there advertising their willingness to infect other men with HIV, as well as gay men advertising their willingness to be infected, and nothing is done about it. Clearly we need a penalty for exposing other people to HIV, some sort of consequence, that falls somewhere between doing nothing and throwing someone in prison. Reader) In light of your recent topic, I though you would find this news from Canada of interest. An HIV-positive man has been charged with murder after two of the people he infected died. —Shelly Dan) And the man is from Africa, and both of the people who are dead are women. I'm all for charging him with murder, Shelly, I'm just mystified that these sorts of charges are never brought against gay men. Reader) Although your idea seems like a good one in the abstract- making people who negligently or willfully infect others with HIV pay some sort of support to their victims-I am afraid it is an impractical solution to the problem. First and foremost, how do we determine exactly who did the infecting? In other words, assuming the newly infected person has had multiple partners, how do we figure out which sexual partner passed the HIV virus along? And even if we establish that the newly infected person had only one partner, how do we determine whether or not the infector purposefully or negligently infected the other person? Unlike DNA testing, which can establish paternity, there are no tests that I know of which are able to trace the path of HIV infection. I also do not support any plan that would eliminate or reduce access to drugs and medical care for people infected with HIV. —Hoping For A Solution. Dan) Nor do I, HFAS. I never said that drugs should be withheld from anyone. Indeed, I said the opposite. A drug-support payment program would merely help defray some of the costs of providing drugs to people with HIV while also encouraging HIV-positive gay men to be responsible and protect their partners-even partners who are too stupid to protect themselves. And I don't think we would need to catch all, or even a large number, of infectors for drug-support payments to have a deterrent effect. Like I said in the column, a handful of men in every major city who can no longer afford recreational drugs or trips to circuit events because their wages are being docked for drug support payments . . . shit . . . could you imagine the impact that would have? Reader) I thought your idea of making some of these assholes pay for their meds was great. If you have HIV, it might not be "your fault," but it most certainly is "your problem." Therefore you have responsibilities. The same is true for child support: A hetero man can be liable for child support even in spite of good intentions, maybe through a condom break or a botched vasectomy or whatever. Thus, even the ones who aren't deadbeats can end up paying. In many cases, the payments are based in part on how much you make. Just because it was an accident doesn't mean you're not responsible. So why not just garnish a percentage of the HIV-positive person's income to offset for the meds? Make it progressive, just like child support: If you're extremely poor maybe you get off the hook, but as you make more money, you pay more. If you have no job but you have assets, they can extract a percentage of them up to a certain percentage of your net worth. If it can be established that someone displayed rampant disregard for their own health and the health of others, make the percentage higher. As for the uninfected, I have one word: condoms. I don't give a rat's ass if you have "condom fatigue" or if unprotected ass sex feels better. So does unprotected pussy sex to me, and we hetero guys sure don't love rubbers. But we use them, because we don't want to pay child support and/or get a disease. So use the damn rubber, or you'll be paying for your meds when you catch HIV. —Reader In Helsinki Dan) Making the payments progressive, and not demanding them of people who are poor, is a wonderful idea, RIH. Thanks for sharing. Okay, I'm going to stop interrupting . . . Reader) I love the drug-support-payment idea. To answer the concern Ana Oliveira had about determining who infected whom: By sequencing the genomes of HIV viruses from the two individuals, it is possible to determine to a high degree of accuracy whether or not one person infected another. It's like a paternity test; because this virus mutates so rapidly, each carrier will accumulate quite a few new mutations. If those new mutations in person A's strain are also in person B, then odds are person B's virus is a descendant of the virus in person A. The actual test is a bit more complicated (like a paternity test, there are some fairly advanced statistics to arrive at those one-in-a-billion odds), but the technology to do this sort of test is getting much cheaper and more automated all the time. I bet you're going to get letters from people complaining that your plan punishes people who infect others before they knew that they were HIV-positive. If you do, let me be the first to tell them to go fuck themselves. Giving an exemption for people who don't know if they're HIV-positive or not will just encourage people to not get tested. Besides, we don't give paternity exemptions for guys who aren't sure if they're shooting blanks or not, do we? —Biologist In Kansas City Reader) I am a 36-year-old gay man living in San Francisco. I am astounded at the people who make no excuses for having unsafe sex, proudly proclaiming "It's my body, and I can do what I want with it, and it's none of your business!" These radical individualists are the same people who, once they become HIV-positive, run to publicly funded health clinics to bail themselves out. My feeling is, if you expect the taxpayer to foot your health-care bill, then we have the right to be judgmental about your personal sex life and the choices you have made. Not until I see messages condemning risky sex and stigmatizing sexual risk-takers who contribute to the spread of a deadly disease will AIDS organizations get another dime out of me. — Stephen B. Reader) People who infect others without their consent are fucked-up assholes, but in a heteronormative society the real blame lies with the systematic devaluation of homosex, of the body, and of the planet- and for that, we queers should be blaming the straight people, not each other. Trying to punish the fucked-up assholes is like sending mean, violent people to prisons (mean, violent places last time I checked) to turn them into nice, loving people. It's just going to make the problem worse. Instead, why aren't you asking why the medications are so expensive? Why aren't you attacking corporate- pharmaceutical executives? I'm sick and tired of homos eating themselves up inside wondering how to be good according to the norms of a society that has already decided we're bad. If you start to do your research or pay any attention to the scientific consensus on global warming, it's impossible to avoid the conclusion that heterosexual violence and overpopulation are not only threatening us as queers but indeed all life on earth. —Queer Liberation Now Reader) I am gay, and frequently on the outs with local gay activists who are adamant that the poor guy who knows he is HIV positive has enough problems without being expected to inform his possible partners of his status. I agree with you that such people are irresponsible, criminally so, and should be punished for it. The payment idea sounds very good. But let's not stop with just the criminally irresponsible gay fools who spread HIV. Let's include the druggies who get HIV from sharing needles, but refuse to ever wear a condom when with a girlfriend because "I ain't no fag, so I ain't got no AIDS, and I ain't wearing no rubber!" —Old Fart Reader) Bravo to you, Dan, for saying what needs to be said about the current state of HIV prevention and the infuriating refusal of too many "HIV educators" and "activists" to unequivocally say that it is unethical to spread HIV via unprotected sex. Just this morning I attended a meeting at an AIDS service organization where a representative of another agency objected to the notion that we need to promote an anti-barebacking community norm. His organization, as he told us, is "nonjudgmental," and prefers to tell barebackers how to "do it safely." If we were to explicitly tell the barebackers that their behavior endangers their lives and those of others, why, we might hurt their feelings! It didn't seem to dawn on this well- meaning but clueless young man that there is no way to bareback "safely" unless you and your partner know for certain you are not infected. This failure to confront gay men with the consequences of their behavior (to themselves and to others), this deeply entrenched refusal to challenge people engaging in or contemplating self-destructive and antisocial behavior, is endemic to AIDS service organizations and activist groups. I'm all for sexual freedom, for pleasure, for sexual self-determination, and I believe we must fight for those good things now more than ever. But we also need to promote an ethic that values social responsibility, mutual concern, and community health, not the kind of rampant selfish individualism too many AIDS educators condone under the guise of being "nonjudgmental" or "sex-positive." I, too, like "Wake Up People," work for a public health agency and my comments here would no doubt make my job and life more difficult. So, please sign me . . . —Fed-up Faggot ---------------------------------------------------------------------- ---------- The Original Mail: 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! Groups Sponsor --------------------~--> Help save the life of a child. 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