Safer sex – lessons from the AIDS crisis

The COVID-19 pandemic, with its epicentre now in Western Europe and the United States, is rapidly claiming an increasing number of lives amid slow, or sometimes outright negligent government response. Colin Wilson looks back at the lessons learnt from the AIDS crisis in the 1980s, many of which should inform our response today.

The AIDS Quilt memorial laid out in an open square.
The AIDS Quilt, a famous memorial celebrating the lives lost to AIDS-related causes.

The last few days and weeks have seen conflicting and changing responses to the pandemic. After media reports that lots of people went to the seaside on Saturday, on Monday the government tightened restrictions and called on people to stay at home. As when they closed schools – in fact, as they have done at every stage of the crisis – they made a reactive move in response to public concern when they needed to go much further. No support was available, for example, for self-employed people, who therefore continued to work. Most building workers have been forced to become self-employed so their actual employers don’t have to pay sick or holiday pay – and so building sites stayed in operation. Millions of workers, who cannot work from home as the government suggests, continue to risk their health each day on public transport.

Why is the government acting like this? Why are people not changing their behaviour? After all, it’s not just a matter of trips to the seaside – one friend’s neighbours held an all-night party. And what’s the most effective way to reduce the impact of the virus? The experience of AIDS since the 1980s suggests some answers. 

Though it’s no longer in the headlines, AIDS remains a global health emergency. By the end of 2018, some 32 million people had died of AIDS, with around a million deaths in that year alone. Of the 38 million people worldwide infected with HIV, some 25 million are receiving treatment – treatment which can give them the same life expectancy as a person without HIV. However, some 13 million people are not. One reason is money. The cheapest drugs cost an estimated $75 per year in low-income countries, though some people will need more expensive ones. But even that small sum is above the average healthcare spend per person each year in countries including Bangladesh ($32), Kenya ($70) or Mozambique ($28). 

The cost of healthcare is also an issue for many people in the United States. In London, 98% of people diagnosed with HIV are on treatment – in the US, it’s 49%, just less than half. People without healthcare – poor people – are more likely to die. And to economic factors, we have to add the experience of oppression. Non-white and Hispanic people are 37% of the US population – but accounted for 74% of the new HIV diagnoses in 2017, twice their population share. The highest estimates have suggested that 1 in 10 men may be gay – but three-quarters of those diagnosed were men infected through sex with another man. The impact of AIDS on American gay men is staggering – some estimates suggest that 1 in 10 American gay men have died, a proportion which increases even further in cities like New York and San Francisco with big gay populations. Gay New Yorkers in their forties and fifties, as activist Sarah Schulman comments, have been through a level of trauma typical of wartime. This is not remembered or part of the popular consciousness – though the total number of deaths from AIDS in the US, at 675,000, is almost twelve times greater than the number of Americans who died in the war in Vietnam.

Diseases then, be it AIDS or Covid-19, are about biology – but they, and the responses of populations and governments, are also about the structure of society, about people’s fears, about the ways they think about themselves, and about politics. One example of how all these factors combine was the adoption of safer sex by gay men during the AIDS epidemic. When AIDS was identified in the early 80s, it wasn’t clear how people became ill, so no one knew how to protect themselves or those close to them. Gay men in cities like New York saw their friends becoming ill and were terrified. The issue of what caused AIDS wasn’t completely resolved by 1983 – but in that year, safer sex was invented. Richard Berkowitz and Michael Callen, with medical advice from Joseph Sonnabend, wrote a manual called How to Have Sex in an Epidemic: One Approach. (They saved countless lives, yet no one has heard of them: check out the Wikipedia page.) It advocated condom use and grouped sexual practices into high risk (such as passive anal sex), medium risk (oral sex) and low risk (mutual masturbation, sex toys and so on).

Scientifically, the manual contains some inaccuracies, given what we now know. But the key point was that it took a positive attitude to sex, while also taking the epidemic seriously. This was crucial. Sex – quite often, lots of sex with lots of people – had become important to gay men’s identities since Stonewall. It was seen as a marker of freedom and self-worth. People criticised gay men’s sexual practices as part of an attack on gay people as a whole. How to Have Sex stressed that you could have lots of hot sex without getting ill or infecting others. And, while most previous materials about sexual health had been produced by governments and doctors, the safer sex materials which followed How to Have Sex came from the community and spoke its language. Polite references to ‘the penis’ and ‘semen’ were replaced by materials which referred to cocks and cum.

Condoms now appeared everywhere. Jars of them appeared in New York gay bars. The author David France recalls seeing a flatbed truck driving down Christopher Street, in New York’s gay district, from which lesbians were throwing condoms like rose petals. A friend of mine who worked as a nurse had a bowl of them in her bathroom so her friends could discreetly help themselves. And this worked – a rapid decline in gonorrhoea and syphilis among gay men showed that sexual practices had changed so as to reduce infections of all kinds.

But, of course, things were more complicated than that. People who were horny or drunk might not use a condom. Sometimes people couldn’t find a condom or used one that tore. Some people complained about a lack of sensation. It was unclear if it was advisable to use them for oral sex, let alone enjoyable. Some men saw it as a sign of their love for their partner that they were willing to share everything he had, including AIDS. So, while safe sex spread fairly rapidly among gay men, human psychology means it did not happen overnight or with absolute consistency. Condom use increased from 1% to 70%, but that meant some unprotected sex was still happening. Many people were already infected before safer sex became the norm. Altogether, deaths from AIDS continued to rise until the mid-1990s, when effective treatments became available.

How does this compare with the situation today? One reason why safer sex had an effect was that gay men began to respond to a call raised in How to Have Sex – to act as part of a community where people took responsibility for protecting themselves and each other. As Callen and Berkowitz wrote, ‘If you love the person you are fucking with – even for one night – you will not want to make them sick. Maybe affection is our best protection.’ This approach, they argued, was different from the one prevailing among gay men, which saw liberation in terms of individual freedom and even competition.

The task we face, now, is to create communities, where people take responsibility for themselves and each other, based not just on sex but throughout society. We should act not just to protect ourselves – we should act as if we are infected and need to protect others, who may be more vulnerable than we are. To do this effectively, to reduce the level of infection, involves rejecting what has become the common sense of our society since Margaret Thatcher expressed the idea in 1987 that ‘there’s no such thing as society. There are individual men and women and there are families.’ We need to organise in whatever way makes sense for us – in our streets, in unions, online, in faith communities, in language communities – to keep each other cheerful, to fetch food and medications for people who can’t go out, to respond to cries for help. Just as gay men in the 1980s felt that sex was central to their sense of themselves, and so changes in behaviour were complex and partial, building communities now involves people revising deeply-held ideas about privacy, interdependence and family. 

Of course, there are differences between the current pandemic and the AIDS epidemic. Some are caused by the different nature of the viruses involved. Many people recover from coronavirus, while no one recovers from HIV. On the other hand, HIV was spread through specific acts like sex and sharing needles – so it was possible for people to form organisations to care for the sick, and for those infected and their supporters to campaign politically without infecting others, in a way that’s not possible now. But there are also similarities – in both cases, a key lesson is that we cannot rely on national governments. The Reagan government in the US, supported as it was by the religious right, responded with murderous inactivity to a disease associated with gay men – Reagan only made a speech about AIDS in 1987, by which time over 20,000 Americans were dead.

But the problem with governments is not even, necessarily, their particular political colouration or attitude to certain communities. The problem is that, by their nature, they are bureaucratic machines, headed by people of a different class from most of the population. That class divide between rulers and ruled means that people don’t trust politicians, and that lack of trust has been growing for decades along with the divide between a rich minority and the rest of us. The political class were unanimous that there were weapons of mass destruction in Iraq. Boris Johnson claimed that Brexit would mean millions for the NHS. So, if a figure as remote from most people as Johnson says they shouldn’t go to the seaside on a warm spring day, why should they believe him? It’s easy for Johnson to say, they might think when he had a free Caribbean holiday at Christmas.

A second problem with governments, or more precisely with the state, is that it claims to represent all of society impartially, but of course, it doesn’t – it’s controlled by business and the powerful and acts in their interests. That’s why we’ve consistently seen attempts on the part of governments worldwide to balance economic interests with the need to preserve human life. Elderly people, who are less likely to work, can be sacrificed – even in Italy, where overwhelmed doctors saved treatment for the young and allowed the old to die, workplaces from the chemical industry to all call centres remain in operation.

We need more effective action from the local and national government – the rs21 article Acting on Covid 19 includes many concrete demands. National and local governments claim that they represent the whole population – so let’s see them doing that. But a key lesson of AIDS in the 1980s is that we need to build communities of people who trust each other, can care for each other now and which can play their part in rebuilding society in the future. It’s a huge task – but then, Berkowitz and Callen suspected that How to Have Sex in an Epidemic would disappear without a trace. Instead, it changed the lives of millions and prevented the deaths of millions more. The rapid spread of Mutual Aid groups in the last week, including now almost 150 in London alone, shows how many people are ready to get involved in organising. For example, a group exists in our street, where about 1 in 4 households so far are members of our WhatsApp group. We’ve taken the first small steps. A few people have been involved in Zoom chats. My housemate left paracetamol outside the door of someone who was running short. A neighbour distributed some glitter they had spare – kids made rainbow paintings and put them in the windows. From these little actions there can develop a feeling of trust and community – and the collective action we’ll need so badly when this immediate crisis is over.


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