The following quotes come from:
Jay P. Paul, Robert B. Hays, and Thomas J.
Coates, “The Impact of HIV Epidemic on U.S. Gay Male Communities,” in Anthony R.
D’Augelli and Charlotte J. Patterson, eds., Lesbian, Gay, and Bisexual
Identities Over The Lifespan: Psychological Perspectives (Oxford: Oxford
University Press, 1995), 347-97
The Impact of HIV Status
HIV Antibody Testing
The development of
the HIV antibody test in the mid-1980s immediately presented a series of
dilemmas to gay and bisexual men. Initially, there were more potential costs to
testing than apparent benefits. Suspicions about the validity and reliability of
the test were understandable, given high proportions of false positives for
other screening tests for sexually transmitted diseases (Brandt, 1988). Some
were uneasy about how governmental agencies would use test results, with fear
that a positive test result would become the new “pink triangle” to identify
members of the gay community (Siegel et al., 1989). In addition, there were
many potential costs to testing as HIV+, including psychological distress in
dealing with the test result’s implications (McCusker et al.,1988; Ostrow, et
al., 1989), and concern over whom might gain access to one’s HIV test findings
(Siegel et al., 1989). Being identified as HIV+ could potentially result in job
loss, loss of insurance coverage, social isolation or rejection by partners,
peers, and family, or loss of civil liberties. Western medicine could offer
little, initially, to those identified as HIV+ to present the progression of
HIV illness. Not until the development of antiviral therapies and prophylaxes
for such opportunistic infections as pneumocystis carinii pneumonia (PCP) did a
stronger rationale exist for gay and bisexual men to be serotested.
Siegel et al. (1989)
explored the reasons for antibody testing given by a sample of 120 New York
City gay men. They found that men were typically motivated by several factors:
(1) to relieve the stress of not knowing their HIV antibody status, (2) to
motivate the initiation and maintenance of health and life-style changes, and (3)
to make more informed and responsible decisions about sexual practices, 94) to
clarify a potentially HIV-related medical condition, and (5) to take advantage
of existing medical treatments for HIV infection. Data suggest that test
results have sometimes been helpful in motivating individuals to take action
and make life-style changes; however, the evidence is equivocal in terms of the
impact of knowledge of serostatus on sexual risk practices among gay and
bisexual men (Coats, Morin, & McKusick, 1987; Doll, O’Malley, et al., 1990;
Higgins, et al., 1990; McCusker et al., 1988; Ostrow et al., 1989). As the
epidemic continues, people will go through the testing process many times. The
meaning of getting retested, and the needs of those who return for HIV “status
reports” have not been researched to our knowledge, and it is possible that
existing pre- and posttest counselling programs may be better oriented toward
those who are tested for the first time than to those who are retested
periodically.
Concern over loss of
confidentiality of test results continues to be highly salient. One study of
those seeking HIV antibody tests at an anonymous testing site (Kegeles, et al.,
1990) found that two-fifths of the respondents stated they would not go for
antibody testing without the protection of anonymity. Those without
adequate social supports, lacking an empathic and informed health care provider,
or living in geographic regions that mandate case reporting (or simply lack
anonymous antibody-testing sites) may find the costs of identifying their HIV
serostatus continue to outweigh the potential benefits of testing and early intervention
if they are seropositive. (pp. 359-60)
HIV Status and Dating
For gay men, HIV
status has added a new complexity to the process of forming and developing
relationships. HIV status does appear to influence partner selection,
according to an analysis from San Francisco’s AIDS Behavioral Research Project
(Hoff et al., 1992a). Both HIV—gay men and men who had not been tested for the
HIV antibody showed a strong tendency to prefer HIV—men for romantic partners, whereas
HIV+ men demonstrated no pronounced preference. A content analysis of gay
personas ads in the Village Voice placed within successive 3-month
periods in 1978, 1982, 1985, and 1988 (Davidson, 1991) showed a similar rise in
health-related partner preferences. Davidson found much more concern about
health in the language of the ads (found in only about 2% of ads in 1978, but in
over 36% of ads in 1988). He also found over time that men showed an increased
likelihood to present sexual exclusivity as a condition of establishing a
relationship, rather than as an issue to be negotiated once a relationship
began (from little more than 2% in 1978 to over 13% of ads in 1988).
HIV status is an
issue that gay men who are dating must confront at some point. How do gay men
handle this? Using ABRP data, Hays and colleagues (in preparation) found that
22 percent of the men said they asked men they were dating about their HIV
status “right away.” In fact, 22 percent said they only dated men with the same
status as themselves. Eighty-six percent said they discussed HIV status if they
felt the relationship was getting serious; 79 percent said they would discuss
it if the relationship became sexual. There are inconsistencies, however,
between stated intent and practice with regard to sharing an HIV+ test result.
Although the vast majority of gay and bisexual men surveyed at alternative testing
sites in California said they intended to tell both their primary partners
(88%) and nonprimary sexual partners (73%) if they tested positive (Kegeles,
Catania, & Coates, 1988), 52 percent of the HIV+ gay and bisexual male
sample recruited at a Los Angeles HIV clinic said they had not told at least
one of their sexual partners that they were HIV+ prior to having sex with them
(Marks, Richardson, & Maldonado, 1991). It appears that HIV status is acknowledged
as having important ramifications for the growth of intimate relationships, but
the potentially disruptive consequence relationships, but the potentially
disruptive consequences of disclosing an HIV+ status inhibit total candor. The
impact of HIV issues on dating and relationship formation is an extremely
important topic that unfortunately has received scant research attention. (pp.
366-67)
On the topic of “The New Gay Activism” and
the Impact of the HIV Epidemic on a Community Level:
It was in a climate
of outrage and radicalized gay politics that the debate about “outing”
(publicly announcing the sexual orientation of covert gays who are in influential
positions, through either their public stature or their pollical power)
developed (Cain, 1991; DeRanleau, 1990; Huston, 1990; Outweek, 1990). The gay
community debated the sanctity of an individuals’ right to privacy
counterbalanced by the individual’s responsibility to the lesbian, gay, and
bisexual collectivity To activists forcibly outed by AIDS, the right to privacy
appeared to be largely a matter of social privilege rather than a legal
guarantee, and activists were furious that those with the most social power
apparently were ignoring their putative responsibility. This argument is still
strong, as outing was a tactic approved of by a vast majority of those polled
in the OUT/LOOK survey mentioned previously in all cases where elected
or appointed officials obstruct the fight against AIDS where elected or
appointed officials obstruct the fight against AIDS (68%) or support policies
that perpetuate homophobia and obstruct gay/lesbian rights (73%). In any event,
the debate about outing has led to an unparalleled public discussion of “the
closest,” and that process may be linked to the increasing numbers of “out”
public figures. An article in the June 1993 San Francisco Sentinel listed
120 openly gay and lesbian publicly elected officials in the United States.
(pp. 372-73)
Studies Referenced Above
Brandt, A. (1988). AIDS in historical
perspective: Four lessons from the history of sexually transmitted diseases. American
Journal of Public Health, 78(4), 367-371.
Cain, R. (1991). Disclosure and secrecy
among gay men in the United States and Canada: A shift in views. Journal of
the History of Sexuality, 2(1), 25-45.
Coates, T., Morin, S., & McKusick, L.
(1987). Behavioral consequences of AIDS antibody testing among gay men. Journal
of the American Medical Association, 258, 1889.
Davidson, A. (1991). Looking for love in
the age of AIDS: the language of gay personals, 1978-1988. Journal of Sex Research,
28(1), 125-137.
DeRanleau, M. (1990, May 10). Truth and
Soul: Why I outed a “prominent local official” (Editorial). San Francisco
Sentinel, pp. 7-9.
Doll, L., O’Malley, P., Pershing, A.,
Darrow, W., Hessol, N., & Lifson, A. (1990). High-risk sexual behavior and
knowledge of HIV antibody status in the San Francisco City Clinic cohort. Health
Psychology, 9(3), 253-265.
Higgins, D., Galavotti, C., O’Reilly, K.,
Schnell, D., Rugg, D., & Johnson, R. (1990). The effect of HIV antibody counselling
and testing on risk behaviors: Are the studies consistent? Poster presentation
at the VI International Conference on AIDS, San Francisco, CA, June 20-24.
Hoff, C., McKusick, L., Hilliard, B.,
& Coates, T. (1992a). The impact of HIV antibody status on gay men’s
partner preferences: A community perspective. AIDS Education and Prevention,
4(3), 197-204.
Huston, B. (1990, May). Crosstalk: “The
secret gay life of . . .”. San Francisco Bay Times, p. 14.
Kegeles, S., Catania, J., & Coates, T.
(1988). Intentions to communicative positive HIV antibody status to sex
partners. Journal of the American Medical Association, 259, 216-217.
Kegeles, S., Catania, J., Coates, T.,
Pollack, L., and Lo, B. (1990). Many people who seek anonymous HIV-antibody
testing would avoid it under other circumstances. AIDS, 4,
595-588.
Marks, G., Richardson, J., & Maldonado,
N. (1991). Self-disclosure of HIV infection to sexual partners. American
Journal of Public Health, 81(10), 1321-1322.
McCusker, J., Stoddard, A., Mayer, K.,
Zapka, J., Morrison, C., & Saltzman, S. (1988). Effects of HIV antibody
test knowledge on subsequent sexual behaviors in a cohort of homosexually
active men. American Journal of Public Health, 78, 462-467.
Ostrow, D., Joseph, J., Kessler, R.,
Soucy, J., Tal, M., Eller, M., Chmiel, J., & Phair, J. (1989). Disclosure
of HIV antibody status: Behavioral and mental health correlates. AIDS Education
and Prevention, 1, 1-11.
Outweek. (1990, May 16). Smashing the closet: The
pros and cons of outing. Essays by S. Berry, V. Brownworth, A. Folayan, H.
Madsen, A. Miller, S. Pettit, G. Rotello. Pp. 40-53.
Siegel, K., Levine, M., Brooks, C., &
Kern, R. (1989): The motives of gay men for taking or not taking the HIV
antibody test. Social Problems, 36(4), 368-383.