Tim Teeter

In response to the possibility of increasing incidence of HIV among MSM in San Francisco and the consequent reexamination of prevention programs in that city, the SFDPH formulated an 11-Point Action Plan in mid-2000. Point 10 reads: "Reality Check. It remains a fundamental truth that it is better to remain HIV uninfected. If you are HIV negative, stay that way!" The clarity of this statement has not always been mirrored in prevention messages to MSM, mainly for reasons dating to the outset of the epidemic. Gay men in the early 1980s were beginning to make great political and social gains against societal homophobia and overt discrimination. AIDS had the potential to devastate gay communities if they could not stay united in their responses to the epidemic. Part of this unity-a response to a crisis-involved minimizing the differences between HIV positive men, who were both taking care of the ill and becoming ill themselves, and HIV negative men, who were also caregivers. This laudable response further united the community but inadvertently obscured, although it certainly did not eliminate, the message that it is better not to get HIV.

In an address given at the Early Intervention Program Conference of the California Office of AIDS in 1996, Walt Odets, PhD, told attendees: "Many gay men, as well as those of us working in early intervention-secondary prevention [in this context, to maintain the health of HIV positive men]-have spent the last decade assisting positive men in dealing with their…lives by essentially 'normalizing' HIV infection: we have gone to great lengths to support feelings that positive men can live and thrive with HIV. This has been a humanly important effort…[but] psychological politics within gay communities have prevented us from saying out loud that there are some real differences between positive and negative men…. Since April of 1985 when the ELISA [antibody test for HIV] first became available and we discovered that there were 'positive' and 'negative' gay men-and who they were, which is to say ourselves, our lovers, our best friends, or neighbors-we have been almost completely unable to do AIDS primary prevention: prevention to help keep uninfected men uninfected…. We must acknowledge that, if 'being healthy' in gay communities has come to mean 'HIV positive but asymptomatic,' being 'healthiest' must be recognized as being completely free of HIV…. We must acknowledge that we are already deeply divided in many ways because we misrepresent and deny our differences rather than confront, clarify, and negotiate them."

In his 1995 book, In the Shadow of the Epidemic: Being HIV-Negative in the Age of AIDS, Odets discusses at length the issues faced by HIV negative MSM. He begins his discussion of the interrelationships between positive and negative men in the introduction to the book, where he writes: "Being 'HIV-negative'-which is to say ordinary and uninfected-has meaning only because others are positive…. Any human sense and meaning I am able to make of the HIV-negative experience must also make sense of the lives of those who are positive." Thus, HIV prevention programs aimed at primary prevention, secondary prevention, or both must inevitably acknowledge the richness and complexity of the relationships among MSM, regardless of serostatus. The needs of HIV negative and HIV positive MSM are different, but their desires are very much the same: connection and intimacy.