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  THE NEW YORK TIMES

A Culture of Risk

By DANIEL J. KEVLES

SEXUAL ECOLOGY Aids and the Destiny of Gay Men. By Gabriel Rotello. 320 pp. New York: Dutton. $24.95. LIFE OUTSIDE The Signorile Report on Gay Men: Sex, Drugs, Muscles, and the Passages of Life. By Michelangelo Signorile. 315 pp. New York: HarperCollins Publishers. $25.

Soon after the human immunodeficiency virus was identified as the cause of AIDS in the mid-1980's, many gay activists and public health experts called for safer sex, urging in particular the use of condoms in anal intercourse. In the late 80's and early 90's, the incidence of new H.I.V. infections among gay males dropped significantly, but in recent years it turned upward again, threatening a reinvigoration of the AIDS epidemic.

The failure of what Gabriel Rotello calls ''the condom code'' prompted the writing of ''Sexual Ecology.'' Mr. Rotello imaginatively borrows ideas from the environmental movement to argue for dealing not only with the biology of infectiousness but with the interaction between H.I.V. and the gay male ecosystem -- that is, ''the entire spectrum of behaviors and thoughts and feelings and values that made gay culture so susceptible to AIDS.'' The founder and editor of the now-defunct Outweek magazine, Mr. Rotello develops a trenchant case that understanding the ecology of AIDS will point the way to establishing a gay male culture that is ''sustainable'' rather than self-destructive.

Mr. Rotello rightly emphasizes that AIDS is not a peculiarly homosexual disease, pointing out that ''90 percent of all cases worldwide are spread via heterosexual sex.'' What perhaps most encourages its spread is a high frequency of unprotected sexual activity between a core group of people who are infected and other members of the core or people outside it. From the 1970's on, core groups of gay males arose in cities like New York and San Franciso, transmitting the virus to one another by practicing unprotected anal and oral sex with dozens to hundreds of partners, mainly in bathhouses, discos and sex clubs. Gay men outside the core patronized the bathhouses too, establishing a bridge between the infected group and the rest of the gay population.

Mr. Rotello attends to why such wild sexual promiscuity became a dominant mode of behavior for many gay males -- it was apparently not so before the late 60's -- and so does Michelangelo Signorile in ''Life Outside.'' A columnist for Out magazine, Mr. Signorile was an aggressive advocate for an unashamed gay male culture -- in 1990 he pioneered the outing of closeted homosexuals -- but he had a kind of epiphany concerning its features of sexual abandon after an H.I.V.-hazardous sexual encounter. After testing negative for the virus, Mr. Signorile says he felt he gained a new lease on life and began to explore the values and lives of other gay men.

His book reports on what he learned from interviewing and surveying hundreds of them, including many centered in ''the scene'' of the big-city core and many, he discovered, ''outside'' its behavioral norms and outside the cities themselves, openly homosexual in small towns and suburbs. Mr. Signorile is a close friend of Mr. Rotello, and ''Life on the Outside'' complements ''Sexual Ecology,'' airing in the voices of individual gay men the issues Mr. Rotello's book raises. Both books primarily address the gay community, bravely advancing a critique of the attitudes and ideologies that have shaped the culture of the scene into a self-destructive force. Yet they merit the attention of a broad audience for their courage and informativeness.

Mr. Rotello and Mr. Signorile point out that at least through the 50's, gay men were stereotyped as effeminate and often obtained sex by fellating the so-called trade, nominally straight men looking for satisfaction. With the advent of gay liberation, they turned to having sex with one another and many made of multipartnered anal sex a militant outlaw culture, defiant of the heterosexual, homophobic majority. Mr. Rotello observes that the bathhouses, while offering a communitarian haven from homophobia, also institutionalized part of the liberation movement, providing sexual opportunities in private cubicles, showers, saunas, hallways and dimly lit ''orgy rooms'' devoted to anonymous encounters.

The new gay male culture came to put a premium on tanned golden youth, the he-man of pectoral-thick chest and big-bicep arms. Some observers spoke of ''body fascism,'' Mr. Signorile reports. To keep themselves attractive, younger men took steroids while older ones had face lifts. Tens of thousands of them were habitues of the ''circuit'' -- a series of large gay dance parties held in different places, where they used one kind of drug to heighten their sexual energies and another to relax their sphincter muscles. Both Mr. Rotello and Mr. Signorile note that early on the trend was encouraged by bathhouse owners, who made millions from it; by the commercial gay media where they advertised, telling their readers to ''go ahead and cross the line''; and later by sponsorship from large corporations. Mr. Signorile also castigates groups like the Gay Men's Health Crisis for sponsoring circuit parties that gain them hundreds of thousands of dollars to combat AIDS.

When the AIDS epidemic first struck, many gay activists tended to attribute its rapid spread to the inadequate attention of scientists, government and the press. They blamed everyone and everything but themselves and their behavior. Mr. Rotello says that he feared playing ''dangerously'' into the hands of homophobes, particularly social conservatives who saw the epidemic as retribution for perversion. Even those who called attention to the behavioral element in the epidemiology of AIDS were often shouted down, decried as homophobic sellouts to straight values.

Mr. Rotello argues convincingly that the condom code was so readily adopted because it promised to reduce the diffusion of H.I.V. while permitting gay males to keep their sexual life style largely unchanged. The dominant reaction, he says, was: ''Do not interrupt the cultural and behavioral context of AIDS transmission. . . . Just interrupt the virus.'' But condoms can leak, and are not always used. They amounted to an imperfect technological fix to the behavioral problem that experience has now thrown into glaringly harsh relief.

Many gay males never embraced the bathhouse culture, and Mr. Signorile reports that the increasing number of men on the ''outside'' reject both its behaviors and the values that undergird them. They are finding institutions of belonging not in the bathhouses but in community and hobby groups, professional organizations and churches. They are committing themselves to long-term relationships and, where law allows it, some are adopting children. The trend to coming out of what one of Mr. Signorile's respondents calls ''the closet in this community'' has been encouraged by gay rights statutes and greater tolerance, and by the simple human desire to find definition and meaning in something more than sexual orientation.

Mr. Rotello reports, however, that resistance to such change remains powerful among many gay males. It has been reinforced by the advent of therapeutic drugs -- notably the protease inhibitors -- that appear to have made AIDS a disease you live with rather than die from; by glorifications of being H.I.V. positive as putting those with the virus beyond the anxieties of risk; and by celebrations of the circuit as an escape from the reality of so many friends dying young. The bathhouses are thriving, and most men even in committed gay relationships continue to engage in casual third-party sexual encounters. ''For various reasons,'' Mr. Rotello comments tartly, ''we are, in effect, defending the behaviors that are killing us.''

Along with Mr. Signorile, Mr. Rotello hails ''moderation'' and ''balance'' in gay sexual practices and calls for ''the integration of sex into a wider fabric of private intimacy and public community.'' No doubt the more that homophobia is beaten back, the greater the chances that integration will occur. Yet in halting the spread of AIDS, gay men have to face up to ''our own individual responsibilities,'' Mr. Rotello insists, adding, in an echo of Pogo's immortal phrase, ''Ultimately sustainable AIDS prevention is not 'us versus them,' but simply us.''

 

 

 

THE BOSTON GLOBE

                    Grim warning on AIDS in the '90s

                    By Frederic M. Biddle, Boston Globe Staff, 07/23/97

                    Anyone who was there remembers what happened on V-E Day on the

                    home front. There is, as yet, no cause for similar celebration

                    in the AIDS epidemic. Ominously, the early promise of protease

                    inhibitors worries prominent gay activists, when they consider

                    some of the ways gay male culture has coped with AIDS over the

                    years.

                    Nowhere is this clearer than in Gabriel Rotello's ``Sexual

                    Ecology: AIDS and the Destiny of Gay Men''..

                    Rotello's ambitious book is the ``Silent Spring'' of the AIDS

                    epidemic. Lacking an MD or epidemiologist's credentials, he

                    nonetheless cogently rethinks the epidemic as the ecologically

                    enabled result of HIV's biology and the post-Stonewall gay

                    sex. He suggests that the sexual

                    revolution did not create, but expanded, the possibilities for

                    AIDS, which may have for generations occurred in isolated

                    cases in the West. It was not gay sex per se, but unprotected,

                    multipartner anal sex, abetted by bathhouses, jet travel, and

                    inhibition-suppressing recreational drugs, that ``produced one

                    of the greatest shifts in sexual ecology ever recorded,''

                    Rotello writes.

                    Instead of railing against the bygone excesses of the 1970s,

                    Rotello attacks the medically sanctioned culture of ``safer

                    sex'' that persists today. The condom culture may be another

                    ecological disaster in the making, he argues. Just as

                    drug-resistant ``superbugs'' have created a scary world in

                    which reports of meningitis, salmonella poisoning, and

                    ``flesh-eating bacteria'' have become common, protease

                    inhibitors that do not completely eliminate HIV may give rise

                    - Rotello warns - to HIV superstrains that will destroy a gay

                    male community that has laminated, but not changed, its

                    sexuality.

                    Far from being homophobic, Rotello is administering an

                    intellectual tough love. He seeks ``a sustainable gay culture

                    ... one that does not destroy the very souls it liberates''

                    with a sexual ecology that must constantly add unnatural

                    appliances, ranging from condoms to pills to who knows what

                    else, to keep its members alive.

 

 

SALON

Rotello's book is a bombshell. It's as controversial (and mass marketable) as the late Randy Shilts' "And the Band Played On," because, like Shilts, Rotello unflinchingly links gay male promiscuity with AIDS. But "Sexual Ecology," while well written, largely avoids Shilts' sensational narrative pandering. He also largely avoids the righteous indignation of, say, Elinor Burkett's "The Gravest Show on Earth."

With "Sexual Ecology," Rotello joins a very short list -- one that includes most notably San Francisco Bay Area psychologist Walt Odets, author of "In the Shadow of the Epidemic" -- of those who have articulated a transformative plan for sustaining gay culture and dealing with AIDS. While Odets and Rotello vehemently disagree on many points, gay men are better off reading both their books than neither.

Rotello sets out to destroy what he believes are myths, namely that HIV is new, that it's accidental that HIV struck gay men, that gay men have always behaved in the same way, that HIV will soon strike American heterosexuals, that safe sex makes multiple partners acceptable. Well aware that any critical discussion of gay male promiscuity invites accusations of homophobia, he notes that different conditions in different countries cause transmission, but he pulls no punches in explaining how the epidemic has thrived thus far. In his view, highly promiscuous core groups both form a feedback loop and build bridges of transmission out to the overall gay community. Commercial sex establishments -- in particular, bathhouses -- were a major part of the problem in the '70s, with men having up to a dozen pickups a night. While Rotello never directly says today's sex clubs should be closed, the belief is evident in his arguments.

That's just one belief in "Sexual Ecology" bound to raise ire in the urban gay community, where many men, in Rotello's opinion, define liberation as "the freedom to be as furtive as possible." While Rotello's arguments regarding core groups are strong, his scientific authority does seem questionable at times. In his discussion of early-20th century gay sex he speculates that oral, not anal sex, was central, but provides no evidence. More provocatively, his views on the current risk of unprotected oral sex run counter to those of other leaders. Rotello places oral sex's risk factor much higher than most -- one-fifth to one-10th the risk of unprotected anal sex. Who's to say he's right? Many people. Who's to say he's wrong? Many people. Just last week, a letter to the weekly Bay Area Reporter by a doctor claimed only six to 10 people have ever gotten AIDS from oral sex.

The riskiness of oral sex is just one hot spot of dissent between Rotello and West Coast thinkers like Odets, who tend to take a more libertarian view than their East Coast counterparts. Their major point of contention is over how best to deal with the second wave of AIDS transmission. Like Rotello, Odets aims to stop HIV transmission. But he has more sympathy for and understanding of risky gay sexual behavior than Rotello. In Odets' view, homophobia has a strong effect on AIDS transmission. He argues that feelings of alienation from growing up in a homophobic culture cause low self-esteem that leads in turn to risky behavior. He believes open discussion of unsafe sex is a necessary part of the prevention process. And unlike Rotello, he acknowledges transmission within long-term relationships.

For all their differences, the two men reach largely similar conclusions as they confront AIDS's catastrophic effect on the gay community -- basically, suspended extinction. They agree that the "condom code" -- simply preaching that condom use is safe -- isn't effective, or truthful, on its own. Both think gay men could learn from feminists; both think gay men benefit from integrating with the greater culture.

Neither Odets' nor Rotello's books are flawless, but they must be engaged with if prevention is to become more effective. Ideally, "Sexual Ecology" will lead to more honest, rational discussion about AIDS transmission, without feeding the hellfire flames favored by anti-gay outsiders. Ideally, it will generate practical, beneficial action. Ultimately, though, when it comes to life-and-death matters in large communities, books can only do so much.
May 2, 1997

 

WASHINGTON BLADE

-- Louis Bayard

Well, who invited him, anyway?

There we were, busily celebrating our victory over AIDS, clapping each other on the shoulder, raising toasts to Dr. Ho ... and along comes Gay journalist/activist Gabriel Rotello, looking a bit like the Ancient Mariner, holding us with his glittering eye and saying: Put away your noisemakers. Fasten your windows. The worst is yet to come.

He sure knows how to kill a party.

Indeed, his deliberately controversial new book, Sexual Ecology: AIDS and the Destiny of Gay Men (Dutton, $24.95) may cause an outbreak of partying on the far right, for it propounds an argument that is, in some ways, inseparable from what "the enemy" has been saying all along.

AIDS, Rotello maintains, is not a random evil, not an impartial killer, but something the Gay community brought on itself -- unwittingly but ineluctably -- and something we will never be free of until we have undergone a profound cultural transformation.

Sexual Ecology is a fiery piece of analysis, steeped in rationalism and almost guaranteed to make readers irrational. Rotello, you see, is bent on demolishing a few deeply cherished myths, most notably the Edenic myth of our own innocence -- the bit of lore that says we were just crossing the street when the HIV Express hit us. It could have been anybody!

Nearly two decades have passed, though, and AIDS has yet to make dramatic inroads into this country's heterosexual population (with the exception of IV drug users and their sexual partners). "It was one thing," Rotello writes, "to believe we were accidental victims who would soon be joined in our sorrow by everyone else. It is quite another to discover we will not be joined, that we stand almost alone, consumed with disease."

According to Rotello, the Gay sexual culture that first flourished here in the 1970s proved the ideal vehicle for transforming a previously obscure virus into a major killer. And now, with a second wave of infection sweeping through our ranks and a possible third wave on its heels, we are less equipped than ever to stem the epidemic. Why? Because, Rotello says, we've channeled all our energy into getting  Gay men to wear condoms, a technological fix that ignores the larger environmental factors sustaining the virus -- chiefly high levels of multi-partner anal sex among high-risk "core groups."

"The basic nontransformative strategy of containing HIV exclusively through the condom code is destined to continue to fail," Rotello writes. "If gay men want to avoid continued saturation with HIV, or avoid a repeat of the AIDS disaster with new strains of HIV or new diseases altogether, a larger transformation seems required."

What does that transformation look like? "A sustainable gay culture, one in which people are free to be homosexual, but one that does not destroy the very souls it liberates ... a life that respects sex but does not make it the central point of existence." Gay culture, he says, "needs to embrace the whole human being, his spiritual and personal self, his humanity, his vocations, his dreams, and not just his muscles or his libido or his penis."

To many, Rotello's vision is a trifle unrealistic. But the author is keenly aware of the dangers of not striving for utopia. "Gay men can never go back," he insists. "If we recreate the ecosystems of disaster, disaster will likely ensue."

OK, Rotello is a little grim and a little too attached to his eco-metaphors. And maybe because he's hunkered down in New York City (what he calls "ground zero" of the epidemic) he fails to see the ways in which his new world is already beginning to materialize, through unstructured, self-sustaining networks of committed relationships. Nonetheless, this is a brave, powerful, and convincing book, one that raises our national AIDS discourse to a new level of honesty.

And if Rotello gets thrown out of a few parties for writing it, he can at least take comfort in knowing that some of the guests will be joining him.

 

 Kirkus (* starred review)

A compelling warning about gay culture and the imperative need for a change in beliefs and behavior, issued by a gay activist and journalist.

Rotello, a founding editor of Outweek magazine and former columnist for New York Newsday, once promoted the belief that it was simply an accident that in the United States AIDS first manifested itself among gay men. Here he dismisses that notion with persuasive scientific and epidemiological data.

The term ``sexual ecology'' refers to all the biological and behavioral factors that influence the spread of sexually transmitted diseases. According to Rotello, ``the simultaneous introduction of new behaviors and a dramatic rise in the scale of old ones produced one of the greatest shifts in sexual ecology ever recorded,'' one that had ``a decisive impact on the transmission of virtually every sexually transmitted disease, of which HIV was merely one, albeit the most deadly.''

The new behaviors that Rotello cites are multipartner anal sex, particularly in core groups centered in commercial sex establishments, widespread abuse of recreational drugs, and high intakes of immune-system-compromising antibiotics to deal with high rates of hepatitis, herpes, syphilis, and other sexually transmitted infections.

The key to AIDS prevention, cautions Rotello, lies not in technological fixes but in changes in the way gays live. Rotello's message that absolute sexual freedom has been biologically disastrous for gay men and that behavioral changes are crucial has been carefully and convincingly laid out. In his closing, Rotello offers up for discussion his own suggestions for building a healthy and positive gay culture.

Well aware that his call for increased sexual restraint will be seen as reactionary and homophobic by those who cling to an orgiastic view of gay liberation, he anticipates their arguments and answers them persuasively in this impressive analysis of a pressing social problem.

EDWARD KING

Are condoms enough?

For years, condoms have been the cornerstone of HIV prevention campaigns targeting gay men. Since anal sex is by far the commonest route of HIV transmission during sex between men, stopping transmission means either stopping anal sex or making it safer. Since a good quality condom, properly used, can block HIV transmission, educators have concentrated on campaigns to encourage gay men to use a condom every time they have anal sex, and to help them overcome the difficulties or objections they may have with consistent use. There is no doubt that unprotected anal sex between men has declined dramatically since the early 1980s, and this behavior change is generally credited for the fall in the HIV infection rate among gay men during that decade.

But now, along comes a book that argues that over-reliance on condoms is damning HIV prevention among gay men to long-term failure. Gabriel Rotello's book Sexual Ecology: AIDS and the Destiny of Gay Men has provoked strong reactions, both positive and negative; read the reviews from the Dallas Voice, Out NOW! and the Village Voice for a sample. It's easy to get caught up in the controversy about the specific measures Rotello advocates if HIV is to be contained, such as regulating sex clubs, reducing promiscuity and building incentives to monogamy into gay culture. But the book's central importance to safer sex educators lies in its challenge that we must assess the effectiveness of prevention strategies not just in terms of the individual, but also in terms of whole communities.

Let me explain. Rotello doesn't doubt that the gay man who does use condoms consistently and correctly whenever he has anal sex is likely all but to eliminate his risk of HIV infection by that route. Thus, condoms are a highly effective tool for individual HIV prevention, which alone will enable many men to avoid becoming infected or infecting others with HIV.

However, over fifteen years into the epidemic it is equally clear that gay men do not always use condoms, for a range of reasons. These times include occasional 'mistakes' by men who usually use condoms, and which they usually regret after the event, as well as deliberate decisions to have unprotected sex with certain people such as a regular partner, sometimes knowing that they share the same HIV status (i.e. negotiated safety strategies), but often not knowing.

Rotello argues that the cumulative effect of this inconsistency in condom use is to allow HIV transmission to continue at rates that doom current prevention campaigns to failure on a community level. He points to research suggesting that a young gay man coming out in his late teens in a city such as San Francisco or New York may have over a 50 per cent risk of becoming infected with HIV by the time he reaches middle age, despite exposure to safer sex campaigns throughout his sexually active life.

In other words, condoms used consistently can protect the individual against HIV, but because many individuals will be unable or will choose not to use them consistently, condoms alone will never protect gay communities against continuing high rates of HIV infection. That's why Rotello advocates much deeper cultural changes to minimise HIV transmission -- especially those that are likely to limit multi-partner sex.

That's where the arguments will rage. But it would be a tragedy if in the heat of that debate, we lose sight of Rotello's key contribution to thinking on HIV prevention -- the challenge to measure the effectiveness of our campaigns not only by whether they equip individuals to protect themselves against HIV if they so choose, but also whether at the end of the day they are likely to advance us towards a goal of a healthier gay community in which HIV and AIDS may one day be things of the past.

     

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