As was true during the initial, critical moments of the AIDS crisis, we again find ourselves at the crossroads of a conversation that pits civil rights and sex-positivity against a public health crisis that is killing our men.
A generation ago, a new, as yet untreated sexually-transmitted disease was killing gay men at an alarming rate. Some gay activists, in league with public health officials, worked to close bathhouses in major cities throughout the United States. Why? Because it made sense that a sexually-transmitted disease was likely spreading in places where people generally went to have sex.
In San Francisco, Director of Public Health Mervyn Silverman closed 14 San Francisco bathhouses on October 9, 1984. This was seen as a necessary life-saving step, something intended to support the gay community and not demean it. Within 24 hours of those closures, all but two of the bathhouses had reopened. Why? Because if you wanted to discriminate against a sexual minority, it made sense to close down a place where members of that sexual minority generally went to have sex.
And therein lay the problem. For every activist who advocated for bathhouse closures as a way of protecting lives, there was another one who advocated that they stay open as a way of protecting civil rights.
It’s deja-vu all over again. Once again, a plague is killing off a generation.
Now as before, we are facing the literal deaths of men who are our brothers, our sons, our friends, our lovers, our husbands, our present and future leaders. Like our last holocaust, this one is also killing off the life force of our community, making our neighborhoods landscapes of the walking dead. We need only take a stroll down the streets of New York or San Francisco or Los Angeles and gaze into the glazed eyes of (mostly) men who have been up for days, exhausted from endless parties that even they don’t think are fun anymore. Where we once saw the lesions of Kaposi’s Sarcoma, now we see open meth sores. Where we once encountered dying men with dementia, we now encounter psychosis. Now as before, our men are wasting away before our very eyes.
The plague of this generation is the deadly co-occurring addiction of meth and sex.
Before we get into the politics of it all, let’s get clear – crystal clear – about the nature of the meth/sex epidemic that is killing our men. This co-occurring addiction is not one thing or the other. It’s its own thing. It’s one, two-pronged thing.
People who have been working on the front lines of the meth/sex epidemic are clear that, once the substance of meth and the behavior of sex link up, the two become mutually supportive. The PNP culture (party and play, a slang term used to describe combining drug use with intercourse) is alive and well and destroying lives at an accelerating pace. Crystal addicts use the drug to act out sexually. Sex addicts spend days at a club or in a hotel room or in some guy’s house having lots of sex and they use meth to keep the party going. So whether the chicken-or-the-egg story begins with sex or ends with sex, sex as an addiction has to be addressed with the same care and consideration we use in dealing with the substance addiction.
Because sex/meth addiction isn’t two things. It’s one thing. It’s one two-pronged thing.
When it comes to dealing with the meth part of the equation, most of us agree that you have to start with total abstinence. And even if you support harm-reduction, it’s likely that you, too, will agree that the best way to stop using meth is to stop using meth.
It’s when we get into a discussion about sex/no sex that people — especially those men whose sex lives are directly impacted by the discussion — start to bristle about the idea of total abstinence. People on the front lines of the addiction will tell you that best practice is for people with this addiction to abstain from sex for a year. And not only sex, but the sexually compulsive behaviors that feed the substance addiction. Maybe it’s compulsive masturbation, or perhaps it’s porn or fantasy or even compulsive use of dating and sex apps. Or maybe it’s all of it.
Whatever the behaviors that fuel the addiction, total abstinence from those behaviors is essential if you want to find recovery from the meth addiction. Why? Because what fires together, wires together. If you’re hooked on meth, if you’re a member of the PNP generation, then meth will fire up the sex wire and sex will fire up the meth wire. This addictive alchemy can only fire for so long before it burns the house down.
If you want to find recovery from this addiction, or if you’re trying to help someone else recover from this addiction, you cannot take an either/or approach. You need to deal with both addictions at the same time. That means getting real about whether or not this conversation about sex is about sexual liberation or about public health.
I lean toward the side of public health. And best practice says that total abstinence from meth and a year’s abstinence from sex is essential if you or someone you care about wants to beat the tall odds stacked against people with this disease. Best practice says this, but it’s also I’ve seen over and over and over again. The men who abstain from sex and from sexually triggering behavior stay clean. The ones who don’t, don’t.
But the conversation about sexual liberation matters. So often, sexual liberation has been equated with a kind of capitalistic pursuit for more, better, newer, kinkier, boundary-testing sex.
Is “more” better? Is “more” liberating? Has “more” ever freed us from the heteronormative shaming that is imposed on gay sex? Or is it just “more?” If it’s just “more,” than what is the “more” covering?
Talk to just about anybody who’s hooked on meth-sex and they will tell you that the meth pushes the shame aside so that sex can be a fantasy of feeling and emotion and yes, more. But the shame doesn’t go away. It goes underground and lies in wait, ready to emerge when the high is over and suicidal depression follows.
It’s ironic that the process of disentangling the wiring that connects just plain sex with mind-blowing meth sex creates an opportunity for the recovering person to create a new, personal sexual ideal that is, in fact, truly, finally, liberating. Abstinence can provide an opportunity to take a look at the shame that has been there all along, to identify new ways of creating intimacy, to become truly relational and to celebrate and not merely accept the gift of gay sex. The road back to a new way of sexual being isn’t easy, but it does promise something new, something sustainable.
The generation-old conversation about the bathhouses has meaning now because again we have a public health concern pitted against this question of community dignity. We want to uphold the imperatives of sex-positivity and community solidarity, but we also have before us a plague that is killing our men. A generation ago, the community responded to these needs by taking control of the conversation. Bathhouses regulated themselves and used their role as community gathering places to educate and support the people who spent time there. They helped to define a solution in the hopes of saving lives. It’s worth it for us as members of the LGBTQ community to look for solutions to this epidemic that uphold dignity while taking practical steps to address the problem.
Nobody wants to take gay sex away. We just want to save lives.
Donna Trujillo is a licensed marriage and family therapist.