HIV and the Power of Escape

For the last six months I have been working on my new book The AIDS Generation. In this work, I share the life stories and strategies for survival of 15 incredible gay men infected with the virus as young adults in first decade of AIDS, and who now, having survived the plague, find themselves in middle age.

During the course of writing last Fall, we lost our brilliant colleague Spencer Cox. This event and the flurry of speculative articles which emerged as a result of Spencer's death inspired me reflect further on this idea of survival, and specifically, how some of the men of the AIDS Generation relied on strategies, specifically frequent and anonymous sexual encounters and the use of substances -- acts rarely deemed as honorable -- to cope with HIV in a time of little hope. The tragic loss of Spencer, coupled with what I was hearing in the interviews I conducted for the book, prompted me to try to recast our understanding about these "bad behaviors" in a somewhat different light.

For the men of the AIDS Generation, substance use served several purposes bestowing behavioral, cognitive and emotional benefits, and for many there also were complex attributions assigned to sex, including but not limited to an affirmation of self. This is how I come to understand the role of sex and drugs in the lives of the men of the AIDS Generation. While not all of the men whom I interviewed partook in ongoing sexual adventurism or in the use of substances, for some, these behaviors were key to their lives as they ameliorated the ongoing reality of living with HIV. In the absence of any effective treatment, and surrounded by death, some of these men relied on these behaviors to manage their emotionally burdened lives.

For many men of the AIDS Generation, sex, including unprotected sex, provided an emotional connection, a validation of self, and an ability to perceive oneself as more than simply a vessel for transmitting HIV. Richard, one of the men whose life is explored in the book, avoided the inevitability of his diagnosis until 1993. In our discussion, he expressed the role of limitless sex post diagnosis as follows: "There was a certain acceptance I wanted through sex because I was positive."

A similar approach emerged with regard to substance use. Despite the fact the behavioral literature often portrays drug use as causal of seroconversion, the reliance on substances does not always precede the diagnosis, but rather is the result of it. In our own recent study of gay male crystal meth users, we found 65 percent of these men initiated use after they had seronverted. This temporal association between HIV and substance use also was illustrated in the story of Gianni, now 49 years-old, and diagnosed in 1998 who was not heavily reliant on substances prior to the personal trauma incurred caused by the AIDS epidemic: "There was too much death. I was scared. Partying and sex helped me deal."

For the men of the AIDS Generation when death was an inevitability, sex and substances provided an escape, not only from the realities of AIDS, but also from the stigma and discrimination experienced by so many of us growing up as gay men, and living our adult lives as HIV-positive gay men. To judge and belittle the reliance on sex and substances as deficient or harmful fails to understand the complexity of the lived experience these men, during the height of the AIDS crisis.

To say that conditions have improved since the implementation of antiviral therapies is only partially true. HIV disease is more than medical condition, and is one that transgresses emotional and social states, to which we poorly attend, neglecting the trauma of this diagnosis during the height of the epidemic and even to this day. And for many long term survivors, the years of trauma inflicted by the AIDS epidemic is just too much to bear, made somewhat more tolerable by escaping. This is not to say that I am advocating for limitless amounts of anonymous sex and use of substances as the sole means for coping with HIV. Rather we should all have a little more compassion and try to truly understand what it means to be living with HIV and what it meant particularly for men like Spencer -- men of the AIDS Generation.