"One of my friends recently confided in me that he has unprotected sex with guys who want to contract HIV," writes a Health24 user on the gay, lesbian and bisexual expert forum.
So-called "bug-chasers" actively set out to become infected with HIV, while "gift-givers" are HIV-positive people who oblige bug-chasers by trying to infect them. They are part of an underground world of ritualistic conversion parties – a world where infected semen is perceived as a kind of liquid gold, and where becoming infected makes you part of a sacred brotherhood.
There is, however, only scant evidence that such parties actually occur outside of anyone’s imagination, and similarly slight evidence that bug-chasing has much of a life anywhere outside some marginal subcultures in the US and Europe.
Why people do it
Some people – particularly gay men - argue that they are going to get infected anyway, and that “chasing the bug” is a way of taking control of the situation and relieving the consistent stress of worrying about infection.
In other cases, as in a much-cited 2003 article in Rolling Stone magazine, there is a suggestion that bug-chasing or gift-giving is about making sex more dangerous or exciting.
Glenn de Swardt, Health24's gay, lesbian and bisexual expert and the psychosocial manager at Health4Men in Cape Town, says he hasn't had any direct contact with men who consciously want to become HIV infected during his ten years of counselling gay men.
De Swardt says the much greater problem is bare-backing – men having unsafe sex with other men.
He views bare-backing as a complex and paradoxical ritual of denial, where the existence of HIV, and the risk of contracting it, is denied. "The concept of HIV is completely denied in such settings. The reality of HIV simply doesn't exist in this scenario, often due to various fears and anxieties. Two people thus collude and engage in a dangerous ritual of barebacking. This is very different from someone consciously wanting to be infected, but it is equally dangerous."
One might say that this ritual of denial is the flip side of the self-conscious "seeding" of bug-chasing and gift-giving. In either case, though, the greater problem is simply men having unsafe sex with other men.
Beyond the myths
Both bug-chasing and ritual denial illustrate the extent to which prevention messages have failed to reach certain high-risk groups. As in the general population, the scientific reality of HIV has been clouded by myths and complex cultural and psychological responses.
Just as HIV is not a disease of promiscuous black men, it isn't the exclusive domain of gay men, or of poverty, or of promiscuity generally. Men and women, adults and children, New Yorkers and Sowetans all get infected. Even three of the actors in the 70s television series Dallas were HIV-positive.
Getting infected also isn't the end of your life. Whatever live-fast fantasies or social constructions may fuel bare-backing – or unprotected sex of any kind, for that matter – it is little more than an excuse to evade responsibility.
A chronic disease
Due to highly active anti-retroviral therapy (HAART) HIV is no longer a death sentence. Far from it: in one study, researchers found that HIV-positive people in rich countries who start HAART at the age of 20 could expect to live to the age of 63 (the general population could expect to live to about 80).
HIV can be considered a long-term chronic condition, researchers wrote in The Lancet medical journal. Examples of people living long and productive lives with HIV are many and various.
From the South African Supreme Court judge Edwin Cameron and the Aids activist Zackie Achmat, to someone like David Patient – who was diagnosed in 1983 – it is clearer than ever that HIV, though not a disease anyone wants to live with, is far from being a death sentence.
Our knowledge of how to deal with HIV is growing all the time. From things like circumcision as part of comprehensive prevention programmes, to the possibility of providing high-risk groups with antiretroviral drugs to prevent infection – rather that treat it – we are not without new tools to fight the pandemic.
On a basic treatment level as well, the days of complex handfulls of pills to be taken at various times of day are being replaced by single once-a-day regimens. And not only is compliance getting easier, side-effect profiles are also improving.
(Marcus Low, Health24, Updated July 2009)