The collective psychological response to the HIV pandemic by gay men in South Africa is a powerful sense of denial.
The argument would go something like this: "I am negative until tested positive".
So says Glenn de Swardt, Health24's Gay and Lesbian Expert, of the Triangle Project.
It must be stressed that many of the issues below are also applicable to straight couples. However, de Swardt concentrates on the gay community in the article below.
Consequences of denial
Our irrational denial initiates a pattern of bizarre consequences:
Paradoxically, our very fear of HIV and Aids is often acted out in the ritual of unsafe sex, unquestionably the most manifest and blatant expression of our collective denial. This behavioural expression of denial, which is essentially deceit of both ourselves and our partners, demonstrates that many of us would rather risk our lives than deal with reality.
Drugs play a big role
Add to this the use of recreational substances, including alcohol and poppers but most alarmingly methamphetamine (also called crystal or tik, depending on which side of the railway track you live) and, quite literally, you're screwed.
There is unquestionable proof – demonstrated by recent research conducted by the MRC – that methamphetamine is playing a major role in gay men in Cape Town being infected with HIV. Other drugs feature more prominently in other provinces.
Some of us use drugs to make it easier to collude with the collective denial. In effect the queer community is in denial of two major problems: in addition to HIV, we're experiencing a crisis of endemic drug use.
The situation is compounded by the fact that HIV infection and especially methamphetamine use are so closely interfaced that our denial of each reinforces our denial of the other.
What percentage of anonymous sexual interactions taking place right now between men in countless homes, in dark rooms, shebeens and at sex clubs, do you think are unsafe? I venture that the majority of these acts can be classed as high risk. Let's get real – unsafe sex is rife.
We've developed bizarre myths that help us to feed our denial and to still our conflicts:
We think that young twinky guys must be negative and that HIV only happens to older men. Or poor men, or very promiscuous men or thin men or black men. Always other men.
The biggest danger lies in the fact that when we, or a potential sex partner, claim to be HIV-negative we could very possibly be wrong. Although we and our partners may think we're being very sincere when we claim to be negative the truth is that the overwhelming majority of us don't really know our HIV status.
When last did you test?
If your last test was negative that doesn't mean that you're still HIV negative today. Have you or your potential sex partner had unsafe sex since your last test? Or could it be that your last test didn't detect your infection due to the window period that accompanies all tests? Has a condom perhaps broken since then? Was there one instance when either you or your potential partner may have been wired on crystal or another drug and had unsafe sex? Was there a time when you may have been too drunk to remember exactly what happened?
Consider this: if you have anonymous sex it is statistically likely that your sexual partners don't really know their own HIV status and it is very possible that you could be having sex with a partner who is HIV-positive. So how safe was your last sexual encounter?
How we break out of our collective denial of HIV? Firstly, by assuming that everyone is HIV-positive. Everyone. Regard all your sexual partners as positive, unless they can prove to you that they're negative. Of course this is very difficult to prove, but think about what's at stake here.
Secondly, because you're assuming that everyone is HIV-positive, always insist on using a condom and plenty of water-based lube. Always protect yourself. Always. If you don't know how to do this, make a point of finding out.
Thirdly, get tested for HIV. If you test negative you'll be able to value yourself more and you'll be less likely to risk your health. If you're positive, the sooner this is detected, the better for you.
Finally, remember that even if you are HIV-positive or you're concerned that you may be positive, you still need to practice safer sex. Besides the risks of infecting others, being reinfected strains your immune system and you should be doing all you can to avoid STIs such as syphilis, hepatitis and gonorrhoea.
Glenn de Swardt This article was first published in The Pink Tongue, October 2007
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