May 22nd, 2012 // 6:01 pm @ Michael Lorin Friedman
Behavioral prevention fails men who have sex with men (MSM), and it fails to protect against HIV. “Preposterous,” you may say? What about the millions of dollars spent on Prevention, Inc. and the reduction in infections we have seen? What if all that money, and all that public health behavioral prevention expertise, could never prevent the subjective HIV risks faced by MSM? What if you found out it was all government policy on testing and treating that was reducing infections?
What do you mean behavioral prevention fails MSM? First, many MSM question norms. When your mother dreams of the day you marry a nice Jewish girl, even buys you an emerald and diamond antique engagement ring, you are obviously bucking norms when you discover you like boys more than girls. They tell you not to drink, not to smoke pot, but when we do those things, we don’t die. And so when we are told to always use a condom, we wonder, “Are these boundaries to be broken in that same way?”
HIV is a subjective risk. You probably didn’t even know that, because Prevention, Inc. won’t tell you. How subjective? If a man is on HIV treatment, transmission risks in unprotected anal sex are near 1/2500. If that same man was HIV+ and not on treatment (because of choice, because he doesn’t know he is HIV+, or because he may lack access to treatment), the risk would be near 1/50. And remember, 2% is a high risk.
Confused? What is it with all these numbers? Is this too much information? These numbers and this information are the beginning of successful HIV prevention strategy. Those at risk for HIV deserve Queer Harm Reduction. QHR is not queer because it is for Queer People. It’s queer in the 1950s sense because it is non-normative and subjective in nature. It stands as a polar opposite to behavioral prevention, an objective normative school of prevention conceived of in the constricted confines of the allopathic doctor-patient relationship, and not honoring personal choice. Believing that too much information is bad is itself poisonous and risky, and near criminal.
Queers deserve HIV prevention that doesn’t withhold facts, and gives us the understanding we need to interpret risk and harm reduction. Corralling us by not telling us all the information we need to navigate the subjective risk HIV presents is not helping us at all. I challenge Prevention Inc. to give us the information that will save our lives, and shut their doors.
(from Waking The Witch, May 2012)