Wednesday, November 9, 2011

2011-11-09 "Pros and Condoms: S.F. Emphasizes HIV Treatment, but a New Generation Advocates Bareback Sex" by Taylor Friedman
Gehno Sanchez doesn’t think monitoring for condom use will fly at his Cockpit parties.

Illustration by Edel Rodriguez.

Everything had to come off when Claude Wynne arrived at the Frisky SF party in the loft above the Mr. S Leather sex shop. This was a naked dance party — sex was a given.
Sex parties appeal to Wynne. Here, it doesn't matter that he's 55, on the pudgy side, or in an open relationship with his husband. The men here aren't really looking for a love connection.
Wynne paid $25 at the door and checked in his clothes. Signs and a presentation by the San Francisco Stop AIDS Project reminded participants to have safe sex. Founded in 1984, the Stop AIDS Project was a response to the toll that the human immunodeficiency virus and its often fatal counterpart, acquired immunodeficiency syndrome, had taken on San Francisco.
Wynne recalls his shock at seeing how many partygoers were forgoing the free condoms from Stop AIDS. He spotted the DJ barebacking — a term coined by the gay community as a sexy alternative to "unprotected sex." Now they see it as a word outsiders use to stigmatize them.
But barebacking and unprotected sex are not the same, according to experts who see barebacking as a separate "phenomenon" of the late 1990s. More men began consciously rejecting condoms, while simultaneously, medical breakthroughs were allowing people with HIV to live longer without getting AIDS. But left unchecked, AIDS weakens the immune system, inviting other deadly diseases that may not develop for years later. Moreover, treatments may have side effects, and they don't work for everyone. "It may not be a death sentence, but it's still a life sentence," Wynne says.
Hence, one definition of barebacking: intentional, unprotected anal sex, while accepting or seeking the risks.
In recent years, the risky business of barebacking has found a home in sex clubs that rent out their spaces to private parties for the night. Often, these third-party organizers, including bareback porn companies, screen attendees through RSVPs and membership fees.
The club-goers like this selectivity. They have a good idea of whom they will be able to hook up with, especially if the party was organized by a dating site they belong to.
The parties share some features: consistently bad techno music; furniture such as beds, couches, and slings; low lighting; so-called glory holes; and wall-to-wall sex. Whereas the San Francisco Department of Public Health asks that sex club operators monitor for safe sex at their events, anything goes at the private parties.
Until that night in May 2010, Wynne had not seen so much unprotected sex in a venue since the 1980s, when the city's bathhouses were considered a breeding zone for HIV. Wynne had campaigned for the bathhouses to require patrons to wear condoms, so when he caught wind of an upcoming party specifically for bareback enthusiasts, he began writing impassioned e-mails to the Health Department. He wanted to know: Were officials aware that bareback porn companies were inviting people at the Folsom Street Fair — San Francisco's annual leather and BDSM extravaganza — to attend their parties afterward? If so, why wasn't anything being done about events that condone, even sanction, unprotected sex? To Wynne, public sex was a privilege, not a right, and its safety should be regulated by the city as such. He wasn't asking to end the parties. Just for safe sex.
Wynne wondered how Folsom's beneficiaries, HIV/AIDS organizations, could feel comfortable sharing the event with bareback porn companies selling products and promoting barebacking parties?
Finally, this September, he received a promising if vague reply from Dr. Grant Colfax, the director of SFDPH's HIV Prevention Section. "The balance between the duty to inform and protect and the rights of informed individuals to take risks is particularly dynamic. You raise a number of specific issues we are in the process of clarifying and will share with you soon," Colfax wrote.
Historically, SFDPH has hesitated to take a firm stance against unprotected sex as it relates to the spread of HIV/AIDS, despite its being a main driver of the disease. At the same time, the department is overhauling its approach to HIV/AIDS, hoping to cut new HIV infection rates by half within five years.
If the city government were to get tough on public barebacking — abetted as it is by bareback porn, the Internet, and passive HIV/AIDS organizations — it would not be the first time the city played Father Knows Best. Here in San Francisco, toys with McDonald's Happy Meals, sweetened beverages on city property, and cigarettes at pharmacies have all been banned in the name of health. But sex is sticky, and regulating how people have it, even more so.
At the Folsom Street Fair during the last Sunday of September, debauchery is celebrated and on full display. Despite the gloomy weather, thousands have turned up wearing nothing but leather harnesses across their chests or lower extremities.
Mario Mastrosimone and Scott Morris have set up shop at adjoining tables in a prime spot near the entrance. Mastrosimone founded (RT for Real Time Sex), a website for men to facilitate hookups with each other. He is lanky and reserved compared to Morris, the president of San Francisco porn studio Factory Video Productions, whose imposing build and crew cut are offset by a gregarious personality. Young men with barely a hint of peach fuzz, called "twinks" in the porn industry, run up and embrace Morris. "I just did a video," one gushes. Later in the evening, BarebackRT and Factory Video subsidiary will host CumUnion, the party that riled Wynne up enough to contact the Health Department.
Mastrosimone rattles off the appeals of bareback: It feels better. Some feel more of an emotional connection. And it's a little bit taboo.
Experts say it is hard to pinpoint why individuals choose to bareback. A combination of the availability of treatment since the 1990s, safe-sex fatigue, increased substance abuse, and more complex decision-making are considered primary factors in its popularity. Also, Internet technology has allowed people prone to riskier behavior to meet their matches in a matter of minutes.
In fact, according to a study co-authored by SFDPH's Colfax in 2002, 14 percent of surveyed men said they barebacked with someone other than a primary partner — and that's before sites like BarebackRT took off.
Morris readily acknowledges that working in the bareback industry puts him in the line of fire between privacy advocates and HIV/AIDS prevention activists, including the government. "The government also says we can't get married," he says.
Mastrosimone, who is known to the bareback community mostly by his nickname, "PigMaster," met Morris in 2008 at Chicago's International Mr. Leather event. They immediately forged a friendship. Though Mastrosimone is based in Tuscon, he and Morris have teamed up to make videos and throw monthly CumUnion parties in cities such as Palm Springs, Fort Lauderdale, and Tampa.
Despite barebacking's promiscuous, irreverent reputation, Mastrosimone and Morris suggest that what they do does not aid or promote the spread of HIV, but helps make the bareback lifestyle safer.
Mastrosimone says he is "totally anti-drugs," and will kick people out of his parties who appear to be under the influence. Moreover, members of his site can disclose their HIV status on their profiles. Mastrosimone says this feature sets his site apart in two ways: People with HIV don't feel they need to hide it, and it helps those who wish to serosort — choosing sex partners who have the same HIV status as they do. It is widely believed among the barebacking community that HIV-positive men who have sex only with each other are not doing further damage. But researchers say there is a possibility — albeit a small one — of incurring different, untreatable strains of the disease.
Morris reveals an interesting paradox: "I wear condoms because I'm negative. I also make barebacking movies." Factory Video originally shot porn with condoms, but then branched out to include bareback.
Morris says he sees more used condoms at his CumUnion event than at parties where condom use is enforced, citing a reverse-psychology effect: By making condoms available without requiring them, people become more open to using them because it's entirely their choice.
Whether or not that is true, the year after their meeting, Mastrosimone and Morris would not be welcomed back to Chicago's Mr. Leather. The event's organizers released a statement explaining that HIV/AIDS had not been cured, and even at a celebration of sexual diversity, it would be irresponsible not to ban bareback porn.
Demetri Moshoyannis, the executive director of Folsom Street Events, the nonprofit that hosts Folsom Street Fair, says that is not how San Francisco operates. "We feel that the fair is a reflection of the community. For better or for worse, we are not here to judge," he says. "The way we address these things is through a community dialogue. We don't address it by saying this group of people is no longer allowed to be part of the community."
One group, however, was noticeably absent from the Folsom festivities: Treasure Island Media, San Francisco's self-proclaimed first bareback porn company, founded in 1998. Gay porn without condoms existed before HIV, but TIM maintains it was first in the world to go sans condom post-HIV. It was banned from the fair because it allowed sex at its booth. Conveniently headquartered close by, TIM posted signs this year daring fairgoers to visit: "Banned. Come See Why." Those who did were treated to live sex shows.
TIM seems to revel in its risqué reputation; the company is upfront about not testing its actors for HIV, and how sex has broken out at its meet-and-greets in bars. One press release boasts of the company's hiring an HIV-positive and HIV-negative couple.
David Downs, who distributes videos for TIM, says its videos are mainstream, and more popular than any other genre of porn on sites such as the Adult Entertainment Broadcasting Network. "Our goal is to produce authentic images of men having sex. Ultimately we're not going to sacrifice the merit of our art to satisfy a minority's viewpoint on bareback."
Despite its devil-may-care attitude, TIM is forthcoming about its support for HIV/AIDS organizations that promote protected sex.
"We don't want to paint a picture that we don't support HIV/AIDS organizations. We're a part of this community," Downs says.
Mastrosimone says he also has contributed more than $100,000 to HIV/AIDS nonprofits through a private foundation he created, because he believes they will not accept the money if they know it is connected to barebacking. (For that reason, he asked that the name of his foundation remain confidential.)
Morris too declined to say whom Factory Video gives to, although he says the organizations ask him for donations. Often he donates bareback DVDs for HIV/AIDS charities to raffle off at their fundraisers, which prove to be a big hit. "More people want to watch barebacking," he says. "It's all about the money [for the organizations]."
According to Downs, HIV/AIDS organizations are not trying to hide the fact that they request and receive donations. The majority of organizations Downs mentioned and SF Weekly contacted, however, did not respond to interview requests.
Most of the HIV/AIDS organizations given an opportunity to confront barebacking head-on have not done so, even when Folsom's Moshoyannis says he has intentionally placed bareback companies next to HIV/AIDS organizations to spark a dialogue. The money the event raises is awarded to several HIV/AIDS nonprofits of Folsom Street Events' choosing. Last year, the funds totaled $320,000. This year's recipients overwhelming said it's not their place to protest the presence of exhibitors whose messages conflict with their own, and stress that money from barebacking has not influenced their position. Regulating barebacking encroaches on privacy too much, they say; prevention education and incentives are the best tools.
HIV/AIDS activists in the city also say it is unclear how much bareback porn affects its viewers. Some argue that people are smart enough to keep fantasy and reality separate. But others contend that it has played a direct role in how people choose to have sex.
On a recent sunny day in the Castro, Billy Twee strolls into Superstar Satellite Video, past the new Hollywood releases and into a back room, where the bareback porn selection is vast: videos like Oliver Twink, G.I. JIZZ, and the occasional sequel, Double Fuck My Ass 2.
Twee is an avid porn reviewer and barebacker. Sparing no detail, he writes about it on his blog Bareback Pozboi: A Documentary ("Poz" is slang for HIV-positive). His first post says his name is William Harry. From there, as far as the blogosphere is concerned, he is Billy Twee. He is also vague about his age, only offering that he is "not 21, not 22, and older than 45" — a thinning head of hair covered by a faded baseball cap tips the scale toward 50 or so.
Even before sites like Mastrosimone's BarebackRT made it easier for him to find people nearby to hook up with, Twee always had a lot of sex partners. But he insists he practiced safe sex until after he tested positive in 1995. What followed was years of abstinence, attending bareback parties in Palm Springs hotels to watch but never participate. One day in 2000, it dawned on him that the men he was living vicariously through weren't getting any sicker. He went bareback and never looked back.
"I'm older than most of these guys now, so I'm trying to make every day count. When I resumed my sex life, it was fabulous. I haven't stopped," Twee says.
Nor has he stopped writing about it. His raunchy tales are not for the faint of heart, but in person, he speaks much more seriously about the realities he faces. "No one really knows how long the medication is going to be good for. I know most of us have our livers checked on a regular basis, because that's the greatest danger."
That is why he is taken aback by the amount of young people he sees entering the porn business and joining bareback sites.
"The amount of bareback porn has quadrupled in the last couple of years, and most of it is focused on really young guys, twinks, between 18 and 22," he says. "It blows my mind. These kids aren't even scared. They didn't live through the era of AIDS. You want to be on medication for 40, 50 years? Is that what you want?"
Twee surmises that the young men are looking to be part of a subculture within the gay community where they too can get invited to people's homes for barepacking parties, where methamphetamine use is "de rigueur."
Yet despite the surge of younger men, Twee says that when the action is moved offline, there isn't so much talk about one's status; it's assumed men at parties are HIV-positive, because common sense says no one is trying to get HIV, or is oblivious to the risks of unprotected sex. Studies show that a majority of barebackers identify as HIV-positive. At the same time, Twee says he has seen more young people at barebacking parties in the last year than ever before. But he says he can't worry during every encounter whether he is exposing someone to HIV. And sexually transmitted diseases "go with the territory."
Jim Illig, the previous director of the SF Health Commission and currently director of government relations for the nonprofit Project Open Hand, says he too worries that teenagers and twentysomethings aren't paying HIV enough heed. "It's shocking that people aren't taking this seriously. They grew up after the introduction of the antiretroviral [drugs]," he says. "But this is a serious disease. It's not something you want to catch. In the younger population, there are higher infection rates." Experts cite increasing HIV rates particularly among young black men who have sex with men.
Joseph Butler, 23, of Oakland, validates those concerns. He began barebacking at age 16 after he was inspired by a porn movie. He says he has considered intentionally getting HIV, a case of what researchers call the rare "bug-chaser." It would make him feel unique and "different." Something to set him apart, he says. When a friend and "secret lover" in his early 20s died from AIDS, Butler expressed regret that he couldn't share the experience. Currently, he is HIV-negative. He uses BarebackRT and hosts his own website to meet partners.
"If I got HIV, I would accept it, and just move on with my life," he says. "I would look for people who have it as well, and get in that community."
Though Butler is not representative of his generation, his lifestyle shows that barebacking is not exclusive to men who are avoiding transmitting or receiving the disease by practicing risk-reduction strategies.
Whether it's the city's responsibility to step in is a different question — something it has grappled with at length during the last 30 years.
Back when little was known about HIV/AIDS, gay men congregated at bathhouses for anonymous sex. As awareness of the disease increased in the early 1980s, and the public learned that it was mostly concentrated among the gay population and spread through sex, the bathhouses became an obvious target for debate.
Ultimately it was San Francisco Public Health Director Dr. Mervyn Silverman's decision to keep the bathhouses open or shut them down. He waffled for more than a year. "By the thousands, gay men continued to go to the baths, and by the thousands, they would later die," wrote Randy Shilts in his 1987 novel And the Band Played On.
Dr. Silverman's main concern was not putting the Health Department and gay community at odds. He wanted consensus.
Those who wanted the bathhouses closed said it was a no-brainer: If gay men were having high-risk sex in bathhouses, then bathhouses presented a public health hazard that Dr. Silverman should use his authority to close.
Bathhouse advocates took offense to the department sticking its nose in their business. The bathhouses symbolized the sexual freedom and civil liberties that men gained in San Francisco.
Finally, toward the end of 1984, after attempts to post safe sex education messages in the bathhouses failed, Silverman ordered their immediate closure. A court countered that they could stay open, but would have to follow regulations that included monitoring for and expelling people having unprotected sex, and eliminating private rooms with locked doors. Between HIV/AIDS and the new rules, the bathhouses swiftly lost their appeal and went out of business. Silverman resigned. Attempting to regulate gay sex was shaping up to be the stuff of political suicide: damned if you do, damned if you don't.
More sex clubs followed the bathhouses in the mid-1980s. They met considerably less resistance. In 1990, a group of concerned individuals formed the Coalition for Healthy Sex to draft a set of minimum standards for sex clubs and parties. The hope was that the guidelines would be made law, when and if the sex clubs were required to have special business licenses. The rules ranged from general to specific: condoms at all times; frequent monitoring; no locked rooms; and no shared use of sex toys, to name a few.
In 1996, a proposal to license sex clubs flopped — there simply wasn't enough political support. Several members of the Coalition withdrew their endorsement. SFDPH adopted the standards anyway, but only as voluntary guidelines. While the department still attempts to check that they are followed, there is no penalty for a breach.
Today, Wynne says he feels alone in his efforts to call the department on its lack of firm policy. Gone are the days when a man punched him in the face for suggesting the bathhouses remain open as long as condoms were required. His attacker had just lost a friend to AIDS. Wynne could have done without the assault, but says he wishes more people were passionate about the issue — or at least talking.
With San Francisco upending its approach to eliminating HIV/AIDS, that might happen sooner than he thinks.
A week after the Folsom Street Fair, the national Road to AIDS 2012 town hall meeting made its first stop in San Francisco on its way across the country. The issues discussed here at City Hall would inform what the global HIV/AIDS community will talk about in July 2012, when the U.S. hosts the International AIDS Conference for the first time since 1990.
The Bay Area panelists, including Dr. Colfax, began with one of the big talking points: 2011 marks the 30th anniversary of the first reported HIV cases in the U.S., and while more people are surviving with the illness, there are still thousands of newly infected people every year.
This reminder, coupled with the country's first-ever National HIV/AIDS Strategy from the Obama administration, signals a renewed determination to stamp out the epidemic. Released in 2010, Obama's strategy first acknowledges that U.S. citizens don't regard HIV/AIDS with the same urgency as before, and examines how traditional prevention approaches have grown stale. "We must also move away from thinking that one approach to HIV prevention will work, whether it is condoms, pills or information," it says.
San Francisco released its own ambitious plan along the same lines: reduce all new HIV infection rates, and new infections among men who have sex with men, by 50 percent by 2015. With funding cuts on the way, the city is forced to zero in on which methods yield the best results and are most cost-effective.
As a result, the new local strategy calls for more emphasis on testing and treating people, just as the national strategy recommends. The city is attempting to test thousands more people each year; knowing their HIV status decreases the likelihood that they will inadvertently transmit the disease. According to a U.S. Centers for Disease Control and Prevention survey, in 2008, 23 percent of men who have sex with men in San Francisco had HIV, and 19 percent of those infected did not know they had the disease.
This approach, "Prevention with Positives," involves identifying who is HIV-positive faster, and then treating and linking them to continued care quicker. Treating people sooner and lowering their viral load — the amount of disease in the blood — makes it less likely HIV will spread, even during unprotected sex.
The department is also in talks to begin piloting a pill called PrEP (pre-exposure prophylaxis) that HIV-negative men would take daily as another form of protection against the disease. Because condoms serve the same purpose, this indicates that men could respond better to some prevention strategies than others. As part of this rollout, the city would first give pills to the men most susceptible to HIV, which include men who have multiple male sex partners or a primary partner who is HIV-positive.
The strategy came to a head on Sept. 1, just weeks prior to the town hall meeting, when SFDPH's new funding contracts for community-based HIV/AIDS organizations went into effect. It was evident from the allocation of the available $7 million that SFDPH was prioritizing testing and treating over risk-reduction programs.
Several organizations were left with little choice but to scale back their prevention programs. The Stop AIDS Project, for example, announced at the end of October it was merging with the San Francisco AIDS Foundation. Up until that point, Kyriell Noon, the Stop AIDS Project's executive director, said that the organization had halted in 2011 its visits to sex clubs to give presentations and provide condoms.
Experts around the country largely herald SFDPH for leading the pack in HIV/AIDS research and treatment, though they caution the city not to lose sight of traditional behavioral models of prevention that help the uninfected change and avoid risky behaviors, and keep the infected from abandoning their treatments and jeopardizing the health of others.
It is curious then that the department says it is revisiting the issue of sex clubs at a time when it is shifting its focus toward more tests, treatment, and care, and when funding has prevented organizations from doing their usual outreach in sex clubs.
The Department of Public Health began formal, internal discussions about the sex clubs and private parties during the second week of November. The STD Prevention and Control unit oversees most of the department's outreach in sex clubs, from checking to see if its guidelines are voluntarily followed, to offering on-site HIV and STD screenings (as of September). Director Dr. Susan Philip says the city has a good relationship with the clubs, but that it is difficult to reach out to the private parties, since they are not permanent fixtures, and because the clubs are not required to regulate or report their activity.
If the city were to try to extend its voluntary sex club standards to the private parties, it would likely be futile, especially at parties people attend to bareback.
Gehno Sanchez, the man behind some of TIM's press releases, and organizer of the sex party SF Cockpit, says as much. He has worked with the department to arrange HIV and STD tests for Cockpit members, and says he too is concerned about the ambivalence he sees in the younger generation to finding out their HIV status. Sanchez says he is all for providing resources to encourage safe sex. He is even changing his party from a one-size-fits-all format to separate parties for people of different statuses. But he says he draws the line at telling people to wear condoms, if that ends up being what SFDPH wants.
"If I started monitoring people, they would hide," Sanchez says. "I want people to monitor themselves."
Philip declined to offer any fact-based or anecdotal information to suggest the department believes barebacking at sex clubs or private parties is increasing or that it is a setback to its new HIV strategy. Rather, she says the department's discussions were prompted by community complaints.
"Any decision we make ... we would want to make sure it actually promotes public health, instead of decreasing privacy and people's ability to determine their own levels of risk," she says, singing a familiar tune.
Interestingly, the biggest setback to the bareback movement has come not from SFDPH or HIV/AIDS organizations, but from the state's Division of Occupational Health and Safety. Cal/OSHA's rule prohibiting the spread of blood-borne pathogens in the workplace, including through semen, has caused TIM and BarebackRT to take their filming out of state rather than put on condoms.
"From what I understood, they had already fined Treasure Island, and we were just like, 'Yeah, that's not going to work,'"Mastrosimone says.
Meanwhile, SFDPH continues to deliberate doing anything more than the status quo. Philip says a decision will only come after heavy community input.
The department can count on at least one person to participate.
After Wynne checked in his clothes at the CumUnion party, a man approached him. He wanted to have intercourse. But Wynne hesitated, and bargained for other sexual activities. He wants to stay HIV-negative.
Wynne acknowledges that continuing to go to bareback parties doesn't send the strongest message of opposition; in fact, it borders on hypocrisy. Temptation has gotten the best of him before; he has had unprotected anal intercourse, but has never been on the receiving end, which reduces his odds of infection. Still, it is a constant battle.
"In a way, I'm asking the government to protect me from myself," he says.

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