In the early days of HIV/AIDS, the U.S. public and public health at large witnessed the disease as only affecting, and spread by, gay men which lead to the still existing idea that AIDS is a “gay disease.”
On Dec. 3, public health officials, clergy and activists came together for a panel that bore the most provocative title of any Utah event in honor of World AIDS Day: “Who’s to Blame for AIDS?” Far from pointing fingers, however, panelists Lynn Beltran, Lee Beckstead, Annabel Sheinberg, Samuel Rangel and Fr. Sam Dinsdale discussed how religious and cultural stigmas and changing attitudes about sexuality and HIV/AIDS have contributed to rising infection rates across the country (and in Utah), and what can be done to slow them.
“There’s a sense of complacency where HIV is concerned and frankly people don’t want to hear about condoms anymore,” said Beltran, the Salt Lake Valley Health Department’s HIV/STD program director and QSaltLake’s health columnist.
In the past, said Beltran, public health workers could help prevent HIV infections by passing out condoms at local gay bars. But the advent of social networking and the “hookup” culture it created has made this tried and true method obsolete.
“Everyone’s attitude about sexual behavior and activity, and what it means to them has changed and what I’m seeing is, ‘I don’t want people to tell me what to do about my sex life,’” said Beltran, who counsels HIV-positive Utahns.
When moderator Doug Fabrizio, KUER 90.1’s RadioWest producer, asked Beltran if prevention was still “stuck in the ’80s in some way,” she agreed.
“There’s still very much a lack of knowledge of how [HIV] is transmitted,” she said, noting that today’s young people do not remember the AIDS panic of the 1980s. “I find the young community isn’t aware that HIV is around.’”
Another thing that has changed little since the ’80s is the stigma surrounding the disease, Beltran added, noting that her patients who are men who have sex with men fear that their peers will shun them if they find out they are HIV positive. Public health uses the term MSM because not all men who have sexual intercourse with men identify as gay or bisexual.
“[People think] it’s your fault and you did something to deserve this,” said Beckstead, a therapist who works primarily with gay clients. “This takes away the idea that it’s holistic.”
Beckstead postulated that anti-gay cultural attitudes are one reason why HIV infection rates are so high among MSM. If gay men are told that their sexuality is evil and are kicked out of their communities and pushed into “the gay culture whatever that means, [they] don’t have a sense of who [they] are.” Unless gay men can be taught how to explore their sexuality in healthy ways, including learning how to date, “then you will have these immediate hookups and you won’t have the ability to negotiate sexual health.” Beckstead also noted that gay men, in his experience, will often not use condoms because they are ashamed of their sexuality, or because they don’t want to be rejected by a partner who doesn’t want to use protection.
Beltran agreed. “I can’t tell you how many patients, when I have to tell them their test was positive, will say to me, ‘You know, when I came out my mom told me I’d get AIDS and die.’”
“I see so many of them acting through the lies,” she said. “They’re now living down to these expectations and they’ve stopped valuing who they are as a person,” which makes them gravitate toward sexually destructive behaviors.
Fabrizio asked Dinsdale, the pastor at St. Marguerite Catholic Church in Tooele, how religious attitudes played into HIV infection rates.
“The stigma has to do with our resistance to honestly talk about sexuality and be able to explore sexuality,” said Dinsdale, who attended seminary in San Francisco, which has a large population of gay men. “What makes a man attracted to a man or to a woman we really do not know. It’s a big mystery, a big question mark, and anything that challenges the assumptions made by society is scary.”
Sheinberg, education director at Planned Parenthood Association of Utah, said that various religions’ encouragement for abstinence-only sex education and advocacy against homosexuality and contraceptives also plays a part in HIV infection rates.
“There is a lot of overlay in how we deal with students and our religious views, and it’s kind of hard to split it apart sometimes,” she said.
Beltran encouraged religious communities not to cast sexuality as “black and white.”
“Please don’t say, ‘If you are doing this than you’re not worthy,’” she said. “Let’s all start to recognize there are shades of gray in everything in our lives, including our sexual behaviors.”
Barriers for treatment and prevention also exist because of racism and anti-immigrant sentiment, said Rangel, outreach coordinator for the group United for Social Justice. (According to Stan Penfold, executive director of the Utah AIDS Foundation, Latinos make up 12 percent of Utah’s population, yet account for 17 percent of the state’s HIV infections.)
“The Latino community, and especially the undocumented community, are more likely to live a second-class existence and are afraid of going to the doctor even,” said Rangel. “Most don’t have the resources, like health insurance, to go to a doctor and get tested.” Fear of being deported and language barriers can also interfere, he added.
“And in the Latino community it’s less likely that you might talk to your parents about any type of sexual relationships or relationships, period.”
Beltran agreed, noting that she had diagnosed one Latina woman with HIV who would only meet with Beltran in locations other than the health department, out of fear that her roommates would discover her status and evict her.
She added that public health had “even taken a few steps backward” in serving the Latino community in 2010 thanks to harsh anti-immigration laws passed in states such as Arizona.
“In the clinic, people are saying, ‘Tell me what you need to tell me, but I’m not going to tell you who I am, and I’m not getting tested and I’m not going to stay,’” she said.
As the panel wound down, participants attempted to identify how the gay community has shifted from instigating what Beltran called “one of the best community-based public health interventions in history” in response to AIDS in the 1980s to not wanting to discuss the disease today.
Beckstead said that the gay community has fragmented between men who don’t want to be associated with HIV-positive men and “bug chasers, bug gifters and barebackers” — that is, men who have unprotected sex who often deliberately try to get (“chase”) HIV or give (“gift”) the virus.
“It’s really them versus us again,” he said.
Noting that Utah is the only state that doesn’t accept money for sex education from the Centers for Disease Control & Prevention, Sheinberg said the Utah Legislature needs to get serious about approving a comprehensive sex education program, which includes discussions about rape and sexual violence.
“That impacts women a lot, and people can’t talk about sex to say they’ve been assaulted because it’s so shameful,” she said. “The prevailing social norms are big issues in our state and probably everywhere, and we need to help people break out of those stereotypes and empower women to really speak up.”
All panelists agreed with Beltran’s first contention: the way the community at large — and particularly the gay community — talks about HIV/AIDS has to change.
“I think each generation has its own level of homophobia or burdens or pressures and consequences and obstacles, so there can’t be a one-size-fits-all model,” said Beckstead, adding that programs for youth and men in their 30s, 40s, 50s, and 60s could be helpful. Above all, he stressed that gay men need safe spaces to talk about sex and places to meet that encourage socializing and friendship rather than hooking up.