In the post-DOMA world, it's all about getting hitched. From Ruth Bader Ginsburg to the boys in the bar, everyone is gunning for gays to put a ring on it, or at least get off Grindr and into an established couple. But it just so happens that beneath all the his-and-his registries and gushing Facebook relationship status announcements lies a rather insidious secret: Gay relationships are HIV's BFF.
"We've gotten the message across that you should use condoms with people you don't know as well," says Michael Newcomb, Ph.D, an assistant professor in medical social sciences at Northwestern University who studies sexual risk behaviors among gays. "But the epidemic has moved into couples more than in casual encounters."
According to the latest estimates, a staggering 68% of new HIV transmissions in gay and bi men occur in relationships or in the context of two guys sleeping together regularly. For guys aged 16 to 24, we're talking about 79%.
Dante Genarro, 26, became one of these statistics two years ago, when the North Haven, Conn., resident met a guy on everyone's favorite smartphone app and they quickly got serious. The couple's only discussion about HIV was a cursory affirmation that both were uninfected before they figured condoms weren't necessary. After a few months, he found out that his boyfriend was sleeping around and they split. Genarro then came down with what he thought was strep throat, but turned out to be what's called seroconversion illness. He tested HIV-positive.
Genarro, a licensed massage therapist who has begun working at the AIDS Project New Haven, says he can't be sure whether his ex ever knew he was HIV-positive during the relationship, but figures the guy might have had an inkling. As to what factors caused Genarro to let his guard down about condom use, he recalls being in a vulnerable, insecure place at the time. He was seeking affirmation and affection and was overly eager to make what he calls "a good first impression" -- which translated into acquiescing to unprotected sex.
Todd Murray, 32, who works in marketing in Portland, Ore., and who was infected with the virus by a boyfriend when he was 19, recalls his own self-induced blindness: "I kind of had this fake, made-up safety net: that because I was monogamous and because I was the white-picket-fence type of guy, those conditions and that type of mentality would in turn not put me at risk."
While some might be quick to point the finger at poz guys, engaging in the age-old, unhelpful, and ultimately destructive practice of stigmatizing them, ignorance is likely enemy No. 1. The fact is that a third of HIV-positive gay and bi guys don't even know they're infected.
Another major problem lies in a paradox: Trust in a guy can backfire by creating a false sense of security when gays over-rely on that warm, fuzzy emotion as a proxy for more proactive measures of protection. Research has shown that gay and bi guys who have greater trust in their partners are less likely to use condoms or to have been tested for HIV while in a relationship.
According to Perry N. Halkitis, Ph.D, MPH, a professor of applied psychology and public health at New York University, the emotions of trust and love are likely much more powerful than any rational decision making. And, unfortunately, many HIV prevention efforts optimistically expect a rational mind to withstand the heat of passion or the throes of love and still pragmatically insist on condoms.
Interestingly, research suggests that gays are actually quite cautious with tricks, generally taking care to use condoms. But as pairings progress in familiarity on a continuum from casual sex to low-key dating to boyfriend status, use of condoms drops off steadily. Sex in a serious relationship is estimated to be as much as five to eight times less likely to involve condoms than intercourse with an anonymous fling.
Another problem is that young guys tend to practice what's known as "serial monogamy," hopping from one exclusive boyfriend to the next. Since a lot of these relationships only last about a month, and because the HIV test's critical "window period" doesn't cover the past month or so of exposure, the door is open for HIV to creep in unnoticed even if someone is testing regularly.
So why do guys leap into all this unprotected sex after the boyfriend shingle gets hung on the door? The obvious answer is that it feels good. While the research into more nuanced reasons is spotty, researchers suggest that unprotected sex is a way to communicate the very sense of trust, intimacy, closeness, and love that Genarro says he sought from his then-boyfriend.
Ultimately, what needs to happen to help curb the spread of HIV between couples is communication: about HIV status, about testing, and about any recent potential exposure to the virus, as well as about sex outside the relationship. These are challenging tasks, Halkitis says, that gays haven't necessarily been taught how to do.
"It takes a very, very confident person to be able to sit down with his boyfriend/partner/spouse and have an open and honest conversation about what the rules of the relationship are," he says. "And adhering to the rules. And having the smarts to know that relationships change and the rules may have to change with them."
Murray later found out that the boyfriend who infected him knew he was HIV-positive at the time. Still, he refuses to see himself as a victim. He takes ownership of the responsibility he had in protecting himself against the virus. After a long and painful road, he says he's come to a place where he can empathize with what he imagines was his ex's frame of mind, likely so fearful of rejection he couldn't bring himself to disclose his HIV status.
"There's no human, much less a gay man," he says, "who hasn't done something stupid in order to be loved."