AIDS Fighters Face a Resistant Form of Apathy
Published: April 3, 2005
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But others, describing such talk as naïve, say it makes more sense to stress personal responsibility. Demonize crystal meth, stigmatize unprotected sex and remind people that living with H.I.V. can be grueling, or worse. An important first step, they say, would be to stop running pharmaceutical ads that portray people with AIDS as carefree and virile.
Other ideas include following the lead of the San Francisco health department, which is seeking strict limitations on the availability of erectile dysfunction drugs that counteract the impotence induced by crystal meth and encourage the spread of sexually transmitted diseases.
Many AIDS activists in New York, describing current public service campaigns as toothless and ineffective, say bus ads and billboards should remind people that AIDS is a devastating and entirely avoidable illness.
Many prevention advocates agree that only a creative, ever-changing arsenal of tactics can reduce the number of new H.I.V. infections. They point out that it has taken years and millions of dollars to change public attitudes about tobacco and seat belts, and even now reasonable people lapse into old ways.
"Everyone knows smoking is bad for you, but we still print those health warnings on cigarette packs," said Kwame M. Banks, a consultant specializing in prevention work. "People need to hear these messages 100 times a day. That's the way these things work."
Still, when it comes to H.I.V. and AIDS, some wonder whether it is time for a new strategy. Perry Halkitis, a psychologist at New York University who studies the relationship between drug use and sex, believes that many gay men who engage in risky behavior are grappling with profound mental health issues.
"People are not taking risks because they're stupid, or because they wake up one day and say, 'I'm going to take a risk today,' " Dr. Halkitis said. "They do it because the sexual risk fulfills a need, or somehow makes them feel better about themselves."
He and others say any successful fight against H.I.V. must deal with depression, substance abuse and low self-esteem, problems that studies have shown affect gay men at disproportionately higher rates.
"Many people might argue that as a community, we suffer from post-traumatic stress disorder because we're so ostracized by society," Dr. Halkitis said. "Being rejected by family, by our churches, and these days by our government most certainly has an impact."
That emotional fragility has been compounded by the trauma of the 1980's and early 90's, when sickness and death permeated the lives of so many. Peter Staley, a veteran AIDS activist, said it was no coincidence that some of the first people in New York to pick up crystal meth habits have been men 35 to 45 years old.
"We are the long-term survivors who watched friends die, who never thought we'd live to have a midlife crisis," said Mr. Staley, who is H.I.V.-positive and himself a recovering meth addict. "Then the new medications came along, and suddenly everyone returned to their old lives and people moved on to other issues, like gays in the military and gay marriage. Where was the communal processing of the emotional hell we had just gone through? I think as a result we're a deeply scarred group."
While such scars can lead to substance abuse, psychologists say the internalized homophobia and deep-seated feelings of low self-worth are just as powerful. That is where the allure of crystal meth kicks in. Those who have used the drug say it tends to blot out feelings of vulnerability, boosts self-confidence and imbues them with a false sense of connection to strangers.
Then there are the "bug chasers," H.I.V.-negative men who actively seek infection. Although such men are thought to be few in number, mental health experts say the phenomenon reflects the intense alienation that many gay men feel. Louis Pansulla, a psychoanalyst who runs gay therapy groups in New York, said younger men, in the generation that missed the darkest days of the AIDS crisis, believe that infection will win them membership into a clique, albeit one coping with a dreaded disease.
"It's almost a longing to belong, even though it's a completely unconscious thing," he said.
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