Poz4Poz saves lives

By Andrew Sullivan

Originally published on Advocate.com September 25 2005 11:00 PM ET

Eventually even
The New York Times had to report it. HIV
infection rates among gay men seem to be going down in San
Francisco. Five years ago the Times put on its front
page a prediction from San Francisco health
authorities that we were on the verge of a
“sub-Saharan” level of new infections. Oops.
San Francisco has just cut its estimate of new
infections almost by half. But what’s really
freaking out the AIDS establishment is one theory as to why
this may be happening.

Serosorting.
Never heard of it? We soon will. It’s not a new idea.
I remember a friend of mine with AIDS well over a
decade ago telling me he had the answer to the HIV
epidemic among gay men, something that would stop it
in its tracks.

“Segregation,” he said. “I refuse to
have sex with people who are HIV-negative.” If
every HIV-positive man did that, the epidemic would
soon collapse, he argued. The man is still alive, thriving
actually. And yes, he forsakes condoms with other
HIV-positive men, and he argues that it’s an
incentive to keep the firewall between positives and
negatives in place.

There is an
obvious objection. You don’t control whom you fall in
love with or whom you find attractive. Neg-poz
relationships can work, safe neg-poz sex can work, and
the virus should not be able to dictate the rules of
love. All true. But at the same time the danger of infecting
your loved one is real for serodiscordant couples, even when
consistently safe. And even in casual safer sex,
accidents happen. Other things being equal,
it’s better to find a partner with the same
serostatus. If we could push the trend more in that
direction, we’d undoubtedly reduce new
infections. And if holding out the possibility of more
intimate condom-free sex helps keep HIV within the
HIV-positive world, why not use it as a plus? Same for
neg-neg monogamous relationships. The reward for
loving one man exclusively can be intimacy and freedom from
viral fear. And both strategies could reduce infection
rates.

As for casual or
anonymous sex, disclosure is still vital. What seems to
have happened in San Francisco is that men with HIV now form
a critical mass of potential partners, disclose their
status up front, and keep the virus within the
boundaries of their own viral world. Internet hookups
may even help—because it’s less intimidating
to announce your status online than to another
man’s face. “Poz 4 Poz” and
“Neg-UB2” are slogans we need to see
more of. Ditto “Poz 4 Poz” and neg-only Web
sites.

Equally,
knowledge is power, and getting tested is a prerequisite for
serosorting. That’s why we’re seeing progress
among the more enlightened parts of gay
America—like San Francisco—but still see
worrying trends among closeted men with less
information and income. Yes, there’s a small
chance of reinfection with another viral strain for poz
couples. But the risk is low and still debated,
especially for people on meds, and certainly lower
than when having sex with men whose status you don’t
know.

Serosorting is
not a miracle cure, and it merits more debate. I’m
just trying to be constructive here and put the idea
on the table. What’s undeniable is that the old
universal condom code—based on terror of
death—is broken, as HIV has become a manageable
illness, if still one any sane person would avoid.
Since the disincentive of fear won’t work as
well anymore, the incentive of intimacy might help stem the
virus’s spread. HIV segregation may be part of
the answer. Perhaps it already is.