AIDS and responsibility

Here we go again. From the Washington Post:

Twenty-five years after AIDS was branded the "gay plague," the virus is again exacting a disproportionate toll on men who have sex with men, not only in the United States but also in countries where the epidemic is just emerging.

Globally, men who engage in homosexual relations are 19 times as likely to contract HIV as the rest of the population, according to data released at the International AIDS Conference. Here in Mexico, men who have sex with men are 109 times as likely as others to develop HIV, while in the United States, 53 percent of new infections in 2006 were in gay and bisexual men.

Homophobia, biology and misplaced confidence that AIDS has become a treatable chronic illness are contributing to a disturbing flashback among scientists and activists, who say much of the world appears to have forgotten the early lessons of the AIDS epidemic.

"We have come full circle," Michel Sidibe, assistant secretary general of the United Nations, said in an interview. "In the beginning, gay men in places like San Francisco and New York proved we could do prevention. When we moved from that and started talking about the broad scope of the epidemic, suddenly men who have sex with men became marginalized."

So let me understand: gay men are disproportionately coming down with AIDS in part because society and the medical community have "marginalized" them, and because of "homophobia"? I get the point that in societies in which it is difficult to be openly gay, and gay men are stigmatized, it's harder to get treatment to the HIV-positive, and to educate them about AIDS.

But there's something deeply irritating about the idea, which one often hears from the "AIDS community," that AIDS continues to spread here among gay men because of a lack of prevention efforts. Really? Is there a gay man alive in the US who doesn't know how to avoid AIDS? What about taking responsibility for one's choices? That's not to say anybody "deserves" to get AIDS, or any other disease, but come on, in the year 2008, if you live in the United States, how to acquire AIDS isn't a mystery. There is an act of volition involved.

I feel the same way about the teen pregnancy discussion. There's this assumption that no one in her right mind would choose to become pregnant as an unmarried teenager, so the problem must be lack of sufficient education. Is it really the case, though, that young people today don't know that if you put that thing there, without benefit of contraception, you run a good chance of getting pregnant? Really?

At what point does one have to bear responsibility for one's choices? That depends on the extent to which the act by which one acquired HIV was a choice. The monogamous partner who is infected by his or her unfaithful or IV-drug-using partner -- no, of course not. The guy who chooses to behave promiscuously and take his chances? Hey, that's not society's fault; that's his own.

Of course we have no more moral right to refuse to treat him than we would the right to refuse to treat the glutton who came down with heart disease as a result of his conscious choice to overeat. But I do have no patience with the cant that the spread of AIDS is the fault of government, of society, of the church, and of everybody else but the people who made the behavioral choice(s) that exposed them to the disease. You cannot build a culture that celebrates sexual libertinism, then blame others when the awful consequences of the ideas undergirding that culture become manifest (and this is true for hetero culture too).

One thinks of gay AIDS sufferer and activist Larry Kramer's 2004 speech at Cooper Union. He hates the religious right and blames the US government for a lot, and is all in all fairly hysterical. But there is more to his message than that. Excerpt after the jump: