Anatomy of sexual risk

An HIV-negative gay man shares why he sleeps with seropositive men and how he deals with the danger.

By David Tuller
September 11, 2000 11:00PM (UTC)
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So let's say you surprise yourself by falling in love with your closest friend. And let's say his name is Steve, and you're HIV-negative but he's HIV-positive. You're not sure why you've fallen in love with him after all this time. But this tale takes place just before the era of miraculous drug cocktails, and his T-cells are not so great, so you know it's partly because you need to cram the long lovely future of the sweetest friendship you've ever had into the two or three years he probably has left. Plus, he's a wonderful guy, and he loves you, too.

He's terrified that he'll infect you, much more afraid than you are. You want to do as much as possible within the bounds of what you consider safe. But he doesn't want you to suck him even a little; he doesn't want to penetrate you even with a condom. In the last year he won't even let you kiss him, really kiss him, although his doctor has told him that the KS lesion on the roof of his mouth poses absolutely no risk to you.


When his health finally collapses, you clean his diarrhea off the sheets and floor and swaddle him in diapers against his will. When he falls into a coma, you lie next to him every night and jerk off amid the scent of looming death. Your orgasms are great. You hold his hand as his last breath slips away and then his mouth drops open and foam bubbles out. They take him away but you can't let him go yet, so you don't change the sheets for two days, and you masturbate some more.

Let's say all this happens when you're just turning 40, and those last two years have been the happiest and the most miserable of your life. You don't really date or have sex for the next 12 months, but finally you start going out again. You don't know much, but you know two things: You're determined to stay negative. And you won't swear off sex or love with HIV-positive men.

This astounds straight friends. They don't understand it. Your mother doesn't understand it. Aren't you afraid? they ask.


You roll your eyes. Of course you're afraid. But here's what you've learned about being a negative gay man in San Francisco in the year 2000: In your body and your mind, fear and desire will forever be joined. Your challenge is to figure out how they can coexist in relative peace. Straight friends haven't had to learn these things. So they ask you again, wide-eyed as children: How can you have sex with positive men? How can you risk your life like that?

You don't know how exactly to answer. You don't know if they want epidemiological data about infection rates and medical details about modes of transmission, or some grand statement draped in the wisdom of the ages, since maintaining an active romantic life amid an epidemic are far beyond anything they could imagine.

You try to make it clear that you don't think of it as risking your life. You explain that of course you take precautions. They just sigh or shake their heads. Sure, you say, it would be great to meet another negative guy, fall in love, enjoy an unencumbered sex life and live happily ever after -- or at least until you break up. But that's an ideal that isn't happening at the moment.


Your gay friends all face the same dilemma, although some make different choices. You know negative guys who won't go out with positive ones, no matter how appealing. And more than one positive guy has told you that he's uncomfortable going out with you because you're negative. But that solution disturbs you.

It feels like what the gay press dubbed it a few years ago: "viral apartheid." To screen out almost half of your available dating pool -- among them lots of great, sexy guys who may stave off illness for decades with ever-more-powerful generations of drugs -- seems too cold and calculating to you. And it feels like a betrayal of the man you loved, whose presence in your life, despite his early death, was a wondrous gift.


So here you are, almost 20 years into this. You've wrestled all along with the cumbersome precepts of "safe sex" and have somehow established your wobbly place on the continuum of sexual risk -- what you will do sometimes, what you can't live without doing, what you can't believe you did and have vowed never to do again.

Your straight friends are still looking at you. They're still perplexed. They want a tight little formula for avoiding risk completely. But you know you have no wisdom to share, just your fears and how you navigate them. And those fears shift with each new study of transmission, each rumor about forthcoming wonder drugs, each emotional connection you make.

It's a complex tango. This is not the 1980s, when the disease plucked its victims at random. Back then you never knew who would be next, and all the news was bad; if you didn't run into someone for a while, you figured he was dead. You set your limits and lived within them.


But now you don't know what to think. The arrival of powerful pharmaceutical treatments makes being infected seem much less of a death sentence. Then reports of harrowing side effects and drug-resistant viral strains make it seem as bad as ever. The exhaustion from 20 years of maintaining safe-sex standards undermines your resolve. Attending another memorial service strengthens it.

You know you're not the only one who's confused. And when you talk to friends and read reports in the gay press, you realize something deeply troubling is happening out there. You hear about men who have tossed away their Trojans, and about the frightening new statistics from the San Francisco Health Department. New HIV infections in the city have risen from about 500 a year in 1997 to between 750 and 900 this year, with most of that increase among men who sleep with men. Some dispute the figures, but you know the general trend is up. And you know it must be going on in other cities, too.

Some guys have made a conscious decision to "bareback" -- to have anal sex without condoms. Others just slip up in the dark urgency of the moment. Some are positives screwing other positives. Some are negatives screwing other negatives. Though the AIDS prevention crowd would prefer that they discuss their status before they have sex, lots of guys just make assumptions based on what their partner is willing to do. Many guys figure that if someone of unknown status is willing to penetrate them without a condom, he couldn't be positive. Others figure that if someone of unknown status allows himself to be penetrated without a condom, he couldn't be negative. Sometimes, they're right; other times, of course, they're wrong.


You're obsessive and depressive, but not impulsive. You've always had a tough measure of self-control, even when drunk or stoned. So you don't bareback and don't intend to; you haven't been fucked without a condom since the Dark Ages back in 1984 -- by Tony, the spry little elf who taught your Spanish class when you spent a month in Barcelona.

You'd fled the States to take a breather from AIDS. You slept with Tony after a night of sweat and dancing. You were too tired or too smashed or too excited to say no. You justified the risk after the fact, by telling yourself that AIDS was not yet a problem in Spain -- even though you knew Tony had lived for a while in San Francisco. He died a few years later. Was he already infected when he had his way -- when you let him have his way -- with you? You assume so, but who knows?

Since then, you've done your best to be careful. You've had more sexual partners than most heterosexuals could imagine, but on the gay scale your numbers are probably somewhere in the middle. And yet you still don't ask whether someone's positive or negative before you decide to mess around with them. Demanding to know feels intrusive to you; it's something to discuss on the second or third date, not right away.

This "don't ask, don't tell" policy shocks many straight folks. But you figure, Why bother asking? Suppose someone tells you they're negative. Does that mean they tested negative two years ago? Six months ago? Last week? Besides, you know they could be lying. So you patiently explain to straight friends that you assume everyone is positive and restrict your activities accordingly.


But here's one thing you don't tell your friends: If a guy does say he's negative -- even if you're not convinced you can believe him -- you relax a bit more. Sometimes you even search for evidence. Like when that burly guy with the killer laugh took you home from the bar, and you peeked in his medicine cabinet and unzipped his toiletries bag looking for HIV drugs.

You found no drugs and made an assumption, but the joke was on you. He told you, after it was all over, that he was positive. Did that make you anxious? A little. Had you done anything you could possibly regret? No. But knowing the worry is pointless doesn't always banish it.

Sometimes, of course, you can just tell. You go to the gym and see men with sunken cheeks and thinning butts. The HIV drugs they take have redistributed their body fat. But many are still sexy, and you go home with one of them, the tall, angular man with talented hands and the devil in his eyes. You wonder how he looked before. You imagine him with a full-fleshed face and redwood legs. And the touching is textured and lovely, and of course you do nothing risky, and you mean to call him soon. But you don't. And he doesn't call you either. Maybe he could feel how your body tensed when your desire strained against your self-imposed limits. Or maybe, as with Steve, the infinitesimal risk of infecting you worries him too much. Or maybe it has nothing to do with AIDS at all.

The fear you feel is not a constant. When the guy you're with strokes you here and you kiss him there, it disappears for an hour or two. But sometimes, when it's all over, you lie there and fret as details tumble through your mind. Did his uncondomed dick slip too close to your butt? Did you go down on him too enthusiastically? Did his sperm splash on your paper cut? For you, pleasure and fretting are a zero-sum game. If you had a great time, you fret less. If it was just OK, you fret more. It doesn't make sense, but does anything about sex or love? And you keep testing negative, so you must be doing something right.


These ruminations and calculations have droned on for so long now that you almost don't notice them. It's been that way since AIDS first hit your life about 200 years ago, and the doctors couldn't even say for sure that kissing was safe. Frank, your boyfriend at the time, had swollen glands. You both knew it was an early sign of what was then called GRID -- gay-related immune disorder. You were terrified and tried to keep his tongue at bay.

But you couldn't survive without kissing, or at any rate didn't want to. So you kissed. You thought, what the hell. And the fear drowned in the pleasure. For the most part.

You cherished the pleasure because you remembered how much you despised your body's yearnings as a kid. Other teenagers fumbled in the back seats of cars and made out at drunken graduation parties, but it took you years to ease into the rhythm and flow of desire.

You remember, when you were 22, the first time you set foot in Man's Country -- a New York bathhouse on West 15th Street. The place took your breath away -- nine floors of naked men doing all the things Jerry Falwell could never have imagined. You wanted to indulge and did, but gingerly. You were squeamish. You shed that quality in fits and starts, but by the time you were ready to shed it for good, the epidemic had blossomed. And it was too late. You ached for what you thought you might have missed, but it was too late.


After that you sometimes found it hard to get hard. You felt like your body was bound tight in Saran Wrap. A few of your friends didn't have sex for years. Others did whatever they wanted and managed not to worry about it. You weren't sure if they were liberated or insane. You and Andy, your next boyfriend, attended a workshop designed to "eroticize" safe sex. You read porn stories centered around condoms and tried to trick yourselves into believing that putting latex on each other could be an exciting part of the evening's events.

It didn't work. Condoms were not sexy to you. They've never been sexy. Nothing will ever make them sexy. No matter how much you experimented with different brands, you couldn't feel anything with them on. Some guys didn't seem to mind, but others had the same complaint. Still, for the better part of a decade, people generally obeyed the primary rule: No intercourse without latex.

Blow jobs were another matter. Doing it with condoms was like sucking on a garbage bag. You missed the taste of rubbery flesh, the trail of tongue on naked shaft. Everyone knew it was safer than anal sex; how much safer they couldn't tell you. So you stopped doing it for years. But eventually you found that, like kissing, you couldn't do without it. Apparently nobody else could, either; you can't remember the last time you or anyone else donned a condom for oral sex. You know the risk is real, but you're also sure it's tiny, because otherwise everyone you know would be positive by now.

You've still maintained some blow-job limits. You won't do it for a long time, and you won't swallow anything. You stop if you taste much pre-cum, but for really sexy guys you've made exceptions and gone on for a few minutes more. You interrogate your periodontist about all the dental work you've had and what state your gums are in now. You try to remember not to floss beforehand. And somehow you've learned to live with it all.

Because you figure sucking is a lot safer than other things you do. Like crossing the corner at Market and Noe Street -- the most dangerous intersection in San Francisco, where a pedestrian got killed last month. Like hang gliding off Fort Funston, which you haven't actually done but intend to someday. Like reporting from Russia and whipping around in decrepit Aeroflot planes flown by possibly vodka-laden pilots. Your family worries about that, but you don't. You figure if you can do that, you can indulge your oral desires.

It's funny, the tricks your mind plays. You parse the fine points of every encounter and constantly make little deals with yourself. If you don't know the guy's sero status, you'll push things a little further than if you know he's positive. You hope, since he looks healthy, that he's negative, though you know it's absurd to make that judgment. You tell yourself that, if he's positive, whatever meds he takes must have pushed his viral load down to undetectable levels. You hope, if his viral load is down, that it reduces the risk of transmission. The doctors and researchers think that's so, but you know no one knows for sure. You decide to believe it anyway. You hope that the condom doesn't break, and so far it never has. You hope he listens when you tell him not to come inside you, even with the condom on.

You think negatives being penetrated without condoms is nuts, but you're a little nuts yourself so you sort of understand it. You're horrified that people are still sero-converting, but it horrifies you more that the last time someone asked to fuck you without a condom you ached to say yes. It horrifies you how much the edge of danger appealed to you. How much you wanted sex to be, once more, just sex; not barriers and planning and limits and control, but skin and lust and spontaneity.

Maybe some of those who do say yes are depressed because their lover and five best friends have died. Maybe, being young and having never seen anyone waste away, they confuse being gay with having HIV -- as if infection is a mark of adulthood or community. Maybe they're so worn out from years of restraint that something inside them breaks. Maybe they thrill to flirt with the forbidden. Maybe they don't believe HIV causes AIDS. Maybe they think if they get infected, they won't get sick for 10 years, and then new drugs will save them.

Maybe they're in love and have an overwhelming urge to merge.

Can anyone but gay men understand this? Probably not. Still you want to tell your straight friends to think about performing the sexual act they love the most with the person they love the most, and then imagine never experiencing that again for the rest of their lives. You want to tell them that everyone -- straight or gay or somewhere in between -- takes risks all the time, and risks the lives of others, and finds ways to justify it. The other day you were driving to the airport on the freeway in your clunky old Toyota and kept within the speed limit. Everyone else zipped and whizzed right by you. Were they putting you more at risk for serious bodily injury than the HIV-positive man you had sex with the night or week before? Or the guy whose sero status you didn't know?

You think they were. But would they see it that way? You doubt it.

So that, in the end, is your dilemma. You need to touch men and make them feel good, and so do most of the gay men you know. You tangle with each situation and do what feels most comfortable -- or rather least uncomfortable. You know the only way to avoid risk completely is not to have sex at all. You also know that's not possible.

You've heard straight people say that gay men must have some sort of death wish. And at times, when you plumb your own dark depths, you almost agree. But then you wonder at how passion still thrives, in you and your friends and other gay men. And you feel awed at how heroic it is, and how strong you have to be, to sustain heat and desire after so many years of illness and decay. You believe you're brave to want to touch anyone at all. But you're not really sure.

David Tuller

David Tuller is a contributing writer at Salon. He is the author of "Cracks in the Iron Closet: Travels in Gay and Lesbian Russia."

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