08 December 2008

Community effort no substitute for government inaction on MSM HIV

As the incidence of HIV climbs among men who have sex with men (MSM), it would be a misplaced question to ask "What is the gay community doing about it?" while accepting fatalistically the conservatism and inaction of the government. Some clear thinking is badly needed, or there'll be no progress. Full essay.

23 comments:

Lee said...

I do not think gay sex is immoral per se, and disagree with the government's continued criminalization of it. However, I question your premise that unsafe, promiscuous sex is just another "culture" or lifestyle choice, and that people are wrong to pass judgement on it.

When one's behaviour starts spreading diseases and causing harm to others, then there is a strong case to be made that such behaviour is unacceptable. Discouraging these people from partaking in such risky and unhealthy behaviour is a perfectly valid thing to do.

For example, we penalize people for spitting in public or letting mosquitoes breed in their houses, because we fear the spread of diseases. I don't see you arguing that these campaigns "impose values" on those who like to spit in public or let stagnant water accumulate on their premises. Why then the double standard when it comes to unsafe sex?

In conclusion, it is absurd to argue that unsafe, promiscuous sex is just another valid lifestyle choice, and that one is being "disrespectful" if one passes judgement on it. Society can and should draw a line between safe sex between consenting adults that harms no one, and unsafe, promiscuous sex that has the potential to cause an epidemic of STDs.

This applies to both homosexuals and heterosexuals alike, and if the gay subculture celebrates unsafe, promiscuous sex, then that culture needs to be changed, not defended (as you seem to be implicitly doing).

Yawning Bread Sampler said...

I don't know why you are putting "unsafe sex" in my mouth. Where did I say we should respect that choice?

yuen said...

unfortunately, yawningbread's point is rather contorted and easily missed: criminalizing male homosexuality makes it harder to build the same kind of social support structure that help to stabilize heterosexual relationships, so that gays see themselves as marginalized and "give up"; I am not sure how valid the thesis is, since the legal status of homosexuality is only part of the general social attitude towards it.

In any case, I rather think your call on the government to "do something" would most likely have the opposite effect - the decision makers are more likely to introduce more penalties for "bad behaviour" than to find ways to channel the behaviour towards more socially desirable directions.

Jude said...

As a sexually active gay teen, I'm going to have to largely disagree with what you are getting at Alex. The fight we need to fight is one for equal recognition, not one that grants special rights, which I feel is what you are driving at.

If its morally(by social standards) wrong or at least frowned upon for a heterosexual man to have promiscuous unsafe sex, whats to stop anyone else from doing the same for a homosexual? What, just because our we choose to have multiple partners, because our lifestyle allows it, doesn't mean that the non-gays have to give a concession of understanding, just cause we are "like that", regardless of the psychology behind it.

Again, fight for equality, not special rights.

Lee said...

Alex, I inferred that you were defending unsafe sex as a lifestyle choice from this part in your article:

"This being the case, gratification is of paramount importance. The orgasm, the high, is what matters. Some guys think that the rubber condom gets in the way of the "feeling" (some straight guys do too) and so they choose to bareback. Moreover, the focus on gratification means it's a short hop to chemically-enhanced sex -- yes, recreational drugs -- because that's what makes a higher high. The problem is that drug use induces more impulsive behaviour and condom use becomes erratic as a result."

Right beside that paragraph, you wrote this in a box:

"Some straight readers, reading this, will think: "Why must gay men be like this?"

This is exactly the problem. By even thinking this, you're already making a judgement the same way the Singapore government does. You are showing disrespect for a different people and a different culture. You are demonstrating an inability to engage with gay people without imposing your values on them. Just like the government."


If you did not mean to defend the gay community's risky sexual practices and chastise those who pass judgement, then that part of your article was very misleading.

Yawning Bread Sampler said...

Frankly, I am quite bemused at these comments. I am seeing an attempt to discern from my words what my judgement is regarding the behaviours I describe - whether I condone or don't condone. This is exactly what I am warning against - the tendency to deal with the entire issue of HIV with a heavy dose of judgementalism.

I was describing behaviour the same way that a scientist would describe a phenomenon. Describing something doesn't mean defending or opposing it.

What I was getting at is that in epidemiology, one has to deal with realities, and if the reality is that, it is that. There is no wishing it away, nor is there any purpose served by overlaying it with judgement.

You are reading my "Don't judge" as a statement: "Do condone". Is it because you expect me TO judge? And when I didn't, it is read as defence for the behaviour?

Yawning Bread Sampler said...

Jude - we may be phrasing the same thing in different ways. What is equality? In this issue of HIV, it is equal access to health care and to public health interventions.

A superficial reading of "equality" leads to the idea that what is good enough for heterosexuals should be good enough for MSM, but I would contest that.

Substantive equality must necessitate a recognition of the unique features of a minority, and cater to them to a reasonable extent. Thus, we have a Malay-language TV channel even though it doesn't make money. We make special provision for the physically disabled on our buses, we affix special strips on the pavements to guide the blind.... even when these measures cost a lot of money, but it's part of providing equal access to public transport for the disabled minority.

Some people will call all these special provisions "special rights", but that is an error. An error that stems from blindly treating the blind in exactly the same way as they would treat the sighted. In wanting to treat Malays in exactly the same way they treat the Chinese majority ("Why can't you all watch Channel 8 just like the Chinese?")

With MSM HIV, my criticism is that the state is failing to provide similarly substantive equality in access to healthcare and public health intervention. Its failure is due to its moralism and judgementalism.

Programs must be tailored in away that suits the reality of MSM behaviour. Is that "special rights" or "equal rights"?

Frankly, it's not even an important question when lives are at stake. Effectiveness, saving lives, is paramount.

Robert L said...

Dear YB

Your article sets me thinking. Why is the HIV rate higher in the gay community than the straight community? Why is multiple partners more prevalent in the gay community than the straight community?

I found the answer immediately and it's staring us in the face. The straight community has all the social and legislative conditions that, without any exception, ALL point to promoting monogamy. You have legal marriage that binds straight couples together. They gain access to all sorts of social benefits like income tax, housing, medical etc. And they are penalised if any of the partners are unfaithful - divorce laws work against the adulterer.

For the gay community, all the opposites apply. All our laws and social fabric work against gays forming permanent and monogamous relationship with one another. In the extreme case, a gay person who is forced into a sham marriage will have no other outlet except to trawl the public toilets looking for brief and surreptitious sex with strangers.

From this clinical analysis, it is a clear conclusion that the Singapore Government has CREATED the conditions that make gay men more likely to have multiple sex partners. Startling, yet inescapable logic. As soon as the laws for gay men are equalised with those treating the straight population, the artificial conditions forcing gays to have multiple partners would be removed.

Anonymous said...

What actions are you expecting from the government? Other than stating that they should be free of moralism, that they should stop preaching , being judgemental etc? I suppose repeal of s377a? Or should they come up with safe sex education messages for the gay community? And why just them ? Shouldn't that be a personal responsibility whether one is heterosexual or homosexual. Are homosexuals with HIV not getting equal access to healthcare as heterosexuals with HIV? Also your comments that 95% of homosexuals are in it "for the gratification stupid" and "if the reality is that, it is that" are not really helpful. Pedophiles are a reality too and surely they find sexual gratification in what they do. Are we also to show respect for a different group of people with a different sexual inclination there? I have to agree with Lee's comments. You fail to make your usual persuasive arguments in this particular instance. I believe homosexuals should not be discriminated against. But practising unsafe sex and blaming it on the government's "moralism" and "judgementalism" is stretching it too far. Take some personal responsibility for crying out loud!

Anonymous said...

To anonymous @10 December, 2008 21:00:

If responsibility for HIV issues in the MSM polpulation lies completely with ourselves - with NO information available from the government that is publically funded (by gays included) for the task of dispensing authoritative information about its epidimiliogy, modes of transmission, prevention and treatment - then would you agree that there should also be ABSOLUTELY NO RESPONSIBILITY for the government to inform the general (read: hetero) population on HIV issues?

After all, HIV prevention should also be the personal responsibility, with absolutely no help from the government, of heterosexuals themselves?

Yawning Bread Sampler said...

To anonymous, 10 Dec, 21:00

1. Pedophiles go for in non-consensual sex. They are not comparable, except perhaps to rapists.

2. "Or should they come up with safe sex edduction meesages for the gay community? And why just them?" - That's exactly it, they should. They have to be more focussed on safer sex education for all communities at risk, namely such communities that most frequently engage in sex, whether hetero- or homosexual.

I would argue that for ideological reasons, the education messages now are targetted at those who are much less at risk, than those most at risk. Talking about abstinence and faithfulness (their preferred themes) doesn't address those who do not believe in abstinence or do not have a long-term partner/spouse. All this kind of preachiness does is to alienate those who most need to be targetted.

This is not to absolve people of personal responsibility... but this is an INFECTIOUS disease. It's not quite like eating fatty food, and saying if you get a heart attack, it's your fault. Going on about personal responsibility over HIV has obviously not worked. Going on about abstinence and faithfulness has not worked too. Unlike some other countries, Singapore has seen HIV numbers increase every year; it has never once dipped.

If we carry on like what we've been doing, we'll soon see 1,000 new cases a year, then 2,000, then 3,000.

How can we insist on continuing as we are, however comfortable it may be to our pet ideas about morality and personal responsibility?

What I'm arguing is for the increasingly desperate need to think out of the box. To drop what are ultimately ideological and moralistic objections to doing things differently.

I took the trouble to describe behaviour as it exists - high frequency sex, major focus on self-gratification, even though many gay and straight men will hate me for shining a spotlight on their behaviour. The point is: we need to have effective education messages BASED ON the fact that people will continue to have high frequency sex and focus on gratification. Not based on the assumption that we can expect them to become saints LIKE US.

Anonymous said...

reply to anon 11 Dec 11:08 and YB

Personal responsibility applies to both homosexuals and heterosexuals. If the government helps heterosexuals, they should also help homosexuals. What I don't get is what specific action is needed from the govt. If messages like abstinence and faithfulness alienate irresponsible homosexuals and heterosexuals due to their "preachiness" as indicated by YB; is the govt then expected to put a message along the lines of "yes, have all the sex you want with as many people as you want, but please use a condom". I doubt very much if that message will change the minds of promiscuous and risk taking heterosexuals or homosexuals. It amazes me how we blame the government for inaction in some situations and for being too controlling/paternalistic in other situations. ps I am neither a saint nor a PAP supporter - just an advocate for personal responsibility and facing the consequences of one's choices/actions.

yuen said...

I dont think either yawningbread's call on the government to do something, nor others calling on the gays to be less promiscuous, would produce the wanted result; may I suggest a different tack: make homosexuality and aids major research themes to be pursued in singapore

the government has been spending large sums of money on various research issues; homosexuality and aids are no less worthy themes than some of those already being funded; this would show that the government takes the issues seriously, and the gays can find comfort that they are not being neglected

if the gays are willing to redirect their lobbying efforts on something more acceptable to the government and the public, things might be more productive for everyone

Anonymous said...

To Anonymous@11 December, 2008 20:10:

I am the poster that you are responding to.

First, acknowledge that you wouldn't have come to the thinking that you are now expressing without mine, and especially, YB's posts.

I am as 'for' personal responsibility as the next guy. But I, like YB is clearly, am also a realist; that's a far cry from the moralistic idealism many of you displaying, and likely not practising the same standards you are preaching.

The truth of the matter is that the cumulative effects of millenia old homophobia has taken its toll on gays today; we have never had the opportunities you would prefer to fantasize we do to build social institutions that could help shape our sexual attitudes and behaviour.

One manifestation of that non-support is the seemingly disproportionate number of gay men who have multiple sex partners. If there is no such thing as a marriage for us, then who do you have to be faithful to?

That is about culture. But there is also biology to take into consideration.

As the risk of sounding like I espouse sex based double standards, I also happen to see this phenomenon as also having to do with gay men being MEN and having all the sexual proclivities that ALL men; watch enough of those nature shows of our fellow male animals in the wild to be convinced of this.

The government is being paid to be knowledgeable of these FACTS and respond to them as FACTS for the sake of the public interest.

There are many things that we as individuals are powerless over, and preaching responsibility as a purview that exclusively belongs to the individual ignores that.

Anonymous said...

"First, acknowledge that you wouldn't have come to the thinking that you are now expressing without mine, and especially, YB's posts."

lol ! You give yourself too much credit ! Why should I acknowledge that? I am saying nothing different from my first post. Why should blame be placed on the government's "moralism" and "judgementalism" if gays are in it for gratification as YB states? Unless the government has done more for heterosexual HIV sufferers than homosexual HIV sufferers, the gay community has to stop the blame game and spend more effort educating its members on safe sex rather than slamming the govt for this situation. Jude of 9 Dec makes a valid point "If its morally... wrong or at least frowned upon for a heterosexual man to have promiscuous unsafe sex, whats to stop anyone else from doing the same for a homosexual? What, just because..we choose to have multiple partners, because our lifestyle allows it, doesn't mean that the non-gays have to give a concession of understanding...Again, fight for equality, not special rights."

As a parent of teenagers, I would rather YB and others of influence in the gay community educate gay teenagers like Jude about safe sex than to bash the government in this instance. I can accept the rants against discrimination. I know a lovely lesbian couple who are parents to 3 young children. But if promiscuous homosexuals and heterosexuals don't exercise safe sex because it is less gratifying, they have no one to blame but themselves.

I enjoy reading YB's blogs because I tend to agree with his politics and sense of social justice. But I had to disagree with his stance in this particular article. I appreciate his posting my comments here even though I disagree with his views in this particular article.

Finally , as to your last point, are you saying that safe sex is not an individual's responsibility but the government's? Dude , as a parent of teenagers, safe sex is their responsibility , not mine; let alone the government's !

Jude said...

Ditto to Anon 13Dec 19:23.

I feel that again, this entry missed the point. No YB, we are not talking about the same thing. You are clearly fighting for special rights, when what I feel the community should be fighting for is equal rights.

It is, in my opinion special rights for the blind and disabled when the government sets up railings and ramps for them in public spaces; simply because they are handicapped and disabled. Are you now likening us gays to the disabled and handicapped? We don't need special rights, we are fully capable, able well-minded human beings who just happen to be attracted to the similar sex. I see no disability or handicap in that!

I really feel that in this case, the government is and has treated the gays equally; and it is really up to us as individuals and our support groups to build upon that current equality, not to demand a higher level of attention on it just because we are unable to cope with the lifestyles people in our community choose to have. If a parent is unable to cope with his or her child, do they run around blaming the government when the government treats every child equally? No. I think the same should apply here.

The government is not prohibiting places like Raw or Shogun or whatnot from giving out free condoms to its male clientele, are they? Nor are they actively persecuting or blaming the homosexuals for this increasing trend in HIV rates, so what gives? Have they not given us the fairness we so fervently fight for in this regard?

I also widely agree that sometimes we are too demanding on the government (despite how much I disagree with many of their policies). On one hand, as someone mentioned, we are too critical about their tight grasp on things that are supposed to be our business, and on the other we expect them to be controlling on fronts they are not. So where are they to stand?

Anonymous said...

I don't think you got my point:

You have made a huge leap from my point - that the responsibility for ALL the HIV/AIDS issues (its epidemiology, prevention information, treatment etc.) that can only be a government's responsibility - to saying we imagine that the already infected are discriminated against if they also happen to be gay. (Two different groups, btw.)

Only after the government takes responsibility for what it is responsible can we start talking individual responsibility because the necessary information would already have been made available.

Then comes another complication: what of the responsibility of the government to help in the eradication of the societal homophobia that is now documented in reasearch as a predisposing factor in HIV infection? Homophobia is likely to remain with us even after ALL the necessary information around HIV/AIDS is made available.

Tell me one thing: would you be able to identify with a HIV prevention poster campaign that depicts two men being sexually intimate with the tagline "Protect Him If You Love Him"?

That is exactly the kind of public messaging that alienates gay men when the only visuals are those of heterosexuals with taglines that don't speak to us.

What a waste of public funds then, if this is touted as a campaign that is 'equally' directed at the MSM population!

Your call to fight for a equality rather that an imagined 'special rights' drives home my point: it's similarly a huge leap. The equality that both YB and I are making is about equality in OUTCOMES; if differentiated routes - based on the recognition that we ARE talking about different circumstances in the MSM population - are called for to achieve parity in outcomes, then that has indeed have to be the case.

And, finally, I know how loathe Singaporeans are to give credit where it is due, and especially to uncelebrated individuals. You can deny me that if you want, but I know how much of what I wrote has impacted on not just you.

Joshua said...

Alex,

I share the views of most of the comments here... as someone who would fight for equal rights for gay people (you can check out my comments on TOC), I feel that the gay community also has to earn that respect if it is to convince the rest of society to accept them.

Your talk about not being judgemental and that promiscuity is a reality isn't going to win many people over... now that's the reality.

The gay community has to recognize that for whatever reasons it has for a greater number of promiscuity and drug taking etc etc, it is simply giving the fundementalists and conservative groups fodder to keep things as they are. It has to see that some of stereotypes are caused by its own actions.

You speak of discrimination as a cause for all these problems... ok, so suppose you DO get equal rights. Section 377a is repealed. Gay events and parades are allowed. Hell, even same-sex marriage is legalized. You even get subsidized treatment for AIDs. Then? Gay promiscuity and drug-taking will drop to a level similiar to hetros? Or the gay community is going expect the rest of the world to accept gay promiscuity and drug-taking as 'just another lifestyle'?

Unfortunately, the world doesn't work this way. The majority of religions in the world don't take very well to polygamy and drugs. (notice the issue here is not gender-preference)

Here's the reality. I know it's tough. I know it's unfair, I know the cross you bear. But until the day you stop the blame game (justified or not), and start to respect yourself, slap those promiscuous risk-taking gays awake, those that give the gays who just want to live like normal folks a bad name, you will never get very far in your fight for equal rights. Hence your gay-activism fatigue.

Yes, I do agree with you that whatever the cause, and whatever the character of the person, there should be equal and affordable access to HIV treatment as it is for other diseases.

And that not enough is done to ensure equality for gays in Singapore. But defeatism isn't the way to go. The gay community needs to show that it understands the concerns of the majority, and not simply attribute everything to discrimination.

Perhaps you can have a Gays Against Drugs, or Gays For Monogamy campaign. Show the rest of the country that the only difference between you and us is gender-preference. Make an effort to change the negative 'decadent' stereotype. And I promise you, you will win more friends.

Anonymous said...

Jude , thanks for dittoing my point. You sound like an intelligent teen. Whatever you do, remember to take care. I was the same anon who said that we make noise at the govt for being paternalistic n controlling, yet blame them for this situation. To the other anon of 15 Dec 3:46, you are right , I don't get your point. So let's just agree to differ. A blessed Christmas to all!!

Jude said...

I'm sorry, but you, whoever you are, give yourself too much credit, especially seeing as to how it isn't due.

What necessary information are you going on about? Isn't facts of HIV/AIDS already plastered all over the place, regardless of government aid?

Are the facts about HIV/AIDS different from that of a straight couple and gay ones? No. So what provisions are you calling for?

Homophobia is an entirely different subject matter, what we are discussing here is, government action or as YB suggested, inaction on MSM HIV. That said, using homophobia as a backing factor to your whole argument just proves how weak it is -it is hardly related to the topic. Sure, it contributes, but is it a direct contributor? Honestly, coming from a sexually active gay teen, no.

Besides, as much as I do not get it, people are entitled to their phobias, its very much in line with the whole freedom of expression and thought us gays always fight for. You don't see the government stepping up campaigns against arachnophobia; some people like spiders and some people just don't. At the end of the day, its an individual's prerogative.

Lets not be hypocritical by accusing our straight counterparts of setting double standards if we ourselves are going to do the same by telling them that their phobias are unfair just because we deem it so.

Give and take!

Anonymous said...

The readiness to deal with the TRULY difficult gay-realted issues is clearly a capacity that we have not developed among the readership in this blog.

That said, it is best I make my exit on this topic until that capacity exists.

Regardz,

Anonymous who disagrees vehemently with both Jude and Anonymous parent of two teens

Anonymous said...

Oh, and btw Jude, the Social Determinants of Health (or SDOHs) which identifies racism and homophobia along with many other determinants that negatively affect health (including HIV infection disproportantely)has not even entered the vocabulary in Singapore.

This is even while there is already tons of research already published on the matter. (You might identify with the many circumstances described in that research if you can lay your hands on them.)

One of the many themes that emerges from the research is the nihilism in MSMs that YB mentioned in his interview to the press.

In short, I am directing the responsibility where it belongs: in the hands of those who perpertrate the annihilism of gays which gays internalize as the said nihilism.

I am proud to play the 'blame game' as you call it except this no game: these are life and death issues that need to be treated with the dignity it deserves.

Jolene said...

http://www.glass-castle.org/blog/2009/01/family-homophobia-affects-youth-mental.html

A study has found that gay youths who experience family rejection of their orientation are more likely to engage in unprotected sex, attempt suicide, or take drugs.

- Jolene (www.glass-castle.org)