Risk

As someone who struggles with meeting or attracting human beings in person, I often rely on online dating and hookups to meet and/or play with new folks.  I was thinking about a recent online correspondence with an older woman who, after I revealed the bombshell that I identify as bisexual (while I identify as queer specifically, for the sake of convenience and depending on my expectations of what someone may know about “queer” as a sexual identity that I identify with, I’ll often refer to myself as bi and decide to elaborate later), she very respectfully told me that she was not really interested.  To quote: “And the bisexual thing is also an issue for me. I understand you might play safe, but there are too many risks involved for me to be comfortable, and condoms break.”  (The other kiss of death having been my status as an occasional smoker.)

Fast forward to yesterday, I had a great date with this really cool girl I just met via a post I put up on CL.  I ended up spending the night at her place, and we had sex.  I realized after the fact that I had not disclosed my sexual identity and preferences on my ad, and I got really worried.  I have had a number of experiences where women will lose any interest in me that they may have had because of my status as a guy who is attracted to and has sex with all genders.  As someone whose presentation of self does not typically drop cues or lead to assumptions based on cultural signifiers and stereotypes in regards to my queerness, I’m often (as far as I can tell and based on my experiences) considered to be a straight man.  While we used a condom, I got nervous and felt a sense of shame about my failure to do what I as of more recently always try to do before engaging in sexual activity with anyone, especially women: disclose my sexual identity as a queer man.  Thankfully, my new friend didn’t have any qualms about it, unlike the subject of my earlier email correspondence.

I was thinking later today about how annoyed I am with this dynamic.  I shouldn’t feel like disclosing my queerness is obligatory, I shouldn’t feel shame and like I need to walk on egg shells, or that I have something to “confess” in regards to my sexual preferences, attractions, and behaviors.  Why don’t I just problematize people’s thinking about so-called “risk groups” such as MSM and misconceptions regarding what I assume to be the (sometimes but not always) unnamed but implicitly understood subject of risk, HIV transmission?  Sure, there are other reasons why being a self-identified queer who fucks other boys could be considered problematic to some folks, but perceived HIV risk grounded in my identity seems to be the most prominent issue at hand.

Then I started thinking about my own problems with letting go of the “risk group” category when it comes to HIV prevention in particular.  I totally agree that a focus on risk groups can be incredibly stigmatizing to populations under scrutiny (African American women and men, black and Latino men on the “downlow,” gay men and MSM, and intravenous drug users) and result in homophobic, racist, and even misogynistic stigmas with these populations being framed as disease vectors, while totally ignoring the most prominent ways and behaviors in which HIV is actually transmitted (e.g. unsterilized needle use or sharing needles with a syringe with HIV-infected blood, condomless and unlubricated anal intercourse, etc.), which of course are not exclusive or essential to any of these aforementioned populations.  Not all gay men or MSM have anal sex.  Not all intravenous drug users share or use dirty needles.  As my colleague, Gabriel Solorio, has pointed out in a previous blog of his, straight-identified men of color who have sex with men and then women are portrayed as fascinating carriers of disease by media and public health figures.  Meanwhile, white MSM like myself, while not nearly as problematized by the CDC and popular culture, were and are still perceived as a risk to unsuspecting women who sleep with us.  Some people’s assumptions about HIV risk rely on totally epidemiologically unsound fallacies on transmission (such as the often-cited “Russian Roulette” statistic or “it only takes one encounter” theory) which further stigmatizes those who engage in casual sex and fails to recognize that HIV serodiscordant primary partners who regularly engage in unprotected sex are often most at risk, but even my last blanket statement does not really outline all of the risk contexts and factors involved.  Clearly, this is a complex issue that can’t be answered with “risk group” classifications.  In fact, that may just make it worse.

However, I believe that adhering to risk behaviors (and environmental factors) while disregarding the risk group classification is a mistake.  Are these classified “risk groups,” such as men and women of color (especially Latinos and African Americans) and gay men and MSM, especially in impoverished areas or epicenter cities, inherently at risk based on their group affiliation?  Of course not.  Are they potentially at an increased risk?  Yes.  Otherwise, we wouldn’t be pointing out how these structural and systemic inequalities exacerbate but do NOT directly cause HIV risk for certain demographics.  Otherwise, we wouldn’t talk about HIV and racism or homophobia in the same sentence.

We’ve long ago determined that AIDS is not an equal opportunity disease.  That has been constantly demonstrated by (when sound) U.S. epidemiological data since the onset of research on HIV and AIDS, and more recent data disturbingly points to underprivileged people of color (especially African American and Latino women and men) being at incredibly disproportionate levels of risk for a complexity of reasons.  (Of course, the statistical data does not account for all of these complexities and universalizes demographics as risk groups.)  But it’s interesting that we can talk about poverty, racism, and homophobia being related (or, when talked about uncritically, directly casual) factors to HIV transmission and how these factors disproportionately affect particular groups of people, and yet many of us are completely appalled by the idea of using the concept of risk groups in prevention efforts.  As Michael Fumento discussed in his book The Myth of Heterosexual AIDS, the media-fueled myth of “equal risk” did terrible things during the late 1980s in terms of creating a fervor where straight men and women at miniscule to no risk of HIV infection flooded testing grounds and clinics where these resources should have been provided for the underprivileged who do not have the former’s social and cultural capital.  And it’s interesting on how a group like Gay Men’s Health Crisis can publish a sex education text targeting gay men that centers around HIV prevention, and yet I feel I’m risking accusations of homophobia in acknowledging how in epicenter cities such as SF, HIV-negative gay men who have anal sex with other men are statistically at a higher risk of seroconversion than HIV-negative men who only have anal sex with women based on documented SF HIV rates among gay men and MSM versus MSW.

We know that everyone is not at “equal risk” of HIV, just like we know that all people are not given an “equal opportunity” in this country.  I believe that to simply address risk behaviors, even with an adherence to environmental and localized factors and contexts, is problematic.  Particular groups and communities are more in need of HIV prevention resources.  That would make them risk groups, albeit with qualifications.  I argue that a singular reliance on either “risk group” and “risk behavior” classifications is not the answer, particularly when even “risk behaviors” such as unprotected anal sex does not lead to equal risk of transmission, depending on an assortment of factors.  In fact, my own research on “barebacking” has convinced me that categorizing UAI as a “risk behavior” by itself without qualification is problematic, reductionistic, and stigmatizing.

So what’s the answer?  I really don’t know, and again, this blog is largely just myself musing on things that were on my mind today after a wonderful night where the last thing on my mind should’ve been shame.  I don’t think any one proposed solution will address every dimension of inequality and stigma related to “risk group” and “risk behavior” classifications.  A brief conversation I had with Dr. Cynthia Gómez after her somewhat recent lecture at the downtown SFSU campus about my conundrum over “risk groups” helped offer some perspective.  She recommended that the CDC focus on behaviors rather than risk groups and then let localized HIV prevention and research efforts, based on communal needs and dynamics, decide from there on how to address the realities of certain demographics being at greater risk based on a group’s greater affiliation with certain behaviors or because of particular environmental conditions.  As she put it, the CDC is not in the business to address cultural and social dynamics; they should be concentrating on behaviors.

That makes a lot of sense to me.  I’d be curious to hear any feedback, including if I am overlooking any significant points.  I'm open to criticism and to have my assumptions challenged, as HIV prevention is not only relevant to my thesis but also what I would like to look into via non-profit work.  The more I think about it, though, the more I wonder if Dr. James Chin had a valid point in his book, The AIDS Pandemic, when he talks about HIV prevention efforts and epidemiological data being distorted by good intentions and political correctness.