Play now, pay later? 

Q: One of my best friends was recently diagnosed with HIV. Since college, he’s been on an unending sex conquest, hooking up with countless guys he meets online to engage in risky activities. My concern is that he doesn’t seem fazed by his HIV diagnosis and he says he has no intention of giving up his online sex crusades. I worry about his mental and physical health, but also about his seeming willingness to infect others just to satisfy his sexual appetite. I’m pretty sure he doesn’t disclose his HIV status to potential partners, and barebacking is what got him into this mess in the first place.

I don’t know what to do. He’s a pretty clean-cut, attractive, A&F-wearing young guy, which doesn’t match the stereotype that many in the homosexual community have about HIV-positive guys. So what am I obligated as a friend to do? Should I tell the group of friends we share, even though they are straight and are not connected to the pool of people he is sleeping with? Should we arrange a time to get together for some sort of intervention? I want to be a good friend, but I don’t want to just stand by and watch him continue to hurt himself and possibly others. Any advice is appreciated. —Help Me Do the Right Thing

A: Would you be friends with a guy who went out at night and mugged little old ladies? Or a guy who beat his girlfriend? Or a guy who ran around raping people? Of course not, HMDTRT, because you’re an ethical guy and ethical guys don’t hang out with violent, abusive assholes. So why on earth are you wasting your time with this guy? Knowingly exposing other people to a potentially fatal disease is an act of violence, HMDTRT, and there’s just no excuse for it. Your college buddy obviously doesn’t care about his own health any more than he cares about the health of his sex partners. And you know what? If you were an attractive, naive stranger he met on a Web site, he’d be more than willing to imperil your health to satisfy his own selfish sexual appetite.

So here’s what to do, HMDTRT: You’re going to drop this guy. You’re going to refuse to have anything to do with him anymore and you’re going to tell him why. And if anyone in your circle of friends asks why you aren’t friends with this asshole anymore, you’re going to tell him or her the truth. Will you be violating your college buddy’s privacy? I suppose so, kiddo, but someone who violates other people so casually isn’t in a good position to complain about having his precious privacy violated.

Speaking of new HIV infections, an apparently deadly strain of the virus that causes AIDS surfaced in New York City last week just in time for Valentine’s Day. This new strain doesn’t respond to the anti-retroviral meds that hold most infected people’s HIV infections in check and, even more worrisome, it appears to induce a rapid progression to full-blown AIDS. The new HIV strain was discovered in a New York City man who told health officials he has had sex with hundreds of men in recent weeks while using crystal methamphetamine. Nice. The news about what could be a deadly new stage in the AIDS epidemic broke less than a week after public health officials began warning gay men about a rare form of chlamydia known as lymphogranuloma venereum, or LGV, that’s spreading among gay men. Symptoms of LGV include a painful, bloody rectal infection, genital ulcers, and exploding lymph nodes in the groin. Six cases of LGV have been confirmed in the United States, all among gay men, and most of the men infected with LGV reported having multiple sex partners and engaging in unprotected anal sex.

For some, the HIV/LGV one-two punch was the last straw: “Gays Debate Radical Steps to Curb Unsafe Sex” read the headline on the front page of The New York Times on Feb. 15. And the radical step that’s being contemplated? Partner notification, or tracking down, testing and treating the sexual partners of people who have been newly diagnosed with HIV. As radical notions go, partner notification is about as radical as suggesting that surgeons wash their hands before they operate. Public health officials have used partner notification to combat other sexually transmitted infections for decades, and it’s past time that they started using it to combat HIV too.

If people are looking for a truly radical step — something that might actually curb unsafe sex — I’ve got a suggestion. But first some context: When extremely promiscuous gay men assess the risks and benefits of unprotected sex, most assume that if they get infected, or if they infect someone, that an AIDS organization or state health agency will pay for the AIDS meds they or their sex partners are going to need to keep themselves alive. It seems to me that one surefire way to curb unsafe sex would be to put the cost of AIDS meds into the equation. I’m not suggesting that people who can’t afford AIDS meds be denied them — God forbid. No, my radical plan to curb unsafe sex among gay men is modeled on a successful program that encourages sexual responsibility among straight men: child-support payments. A straight man knows that if he knocks a woman up, he’s on the hook for child-support payments for 18 years. He’s free to have as much sex as he likes and as many children as he cares to, but he knows in the back of his mind that his quality of life will suffer if he’s irresponsible.

So why not drug-support payments? If the state can go after deadbeat dads and make them pay child support, why can’t it go after deadbeat infectors and make them pay drug support? Now that would be radical. Infect someone with HIV out of malice or negligence and the state will come after you for half the cost of the meds the person you infected is going to need. (The man you infected is 50 percent responsible for his own infection.) Once a few dozen men in New York City, San Francisco, Toronto, Los Angeles, Chicago, Miami and Vancouver are having their wages docked for drug-support payments, other gay men will be a lot more careful about not spreading HIV. Trojan won’t be able to make condoms fast enough.

“I don’t think there’s anything inherently illegal about it,” said Jon Givner, director of the HIV Project at Lambda Legal Defense and Education Fund when I called to bounce the idea off him. “It’s just a matter of whether you think it’s good public health policy.” Jon doesn’t. “I don’t want to play the role of the apologist for irresponsible behavior, [but] whatever public health policies we develop should not be based on blaming the person with HIV first.”

Ana Oliveira, the executive director of Gay Men’s Health Crisis, was more receptive to the idea. “We find ourselves at a time where the idea of holding people accountable, of building consequences into behavior choices, may be needed to help change the paradigm,” Oliveira said. “We certainly appreciate the element of justice in your idea. It could act as a deterrent, and that would be helpful. The difficulty is that it would be impractical to implement. It would require some kind of a determination process and the pitfall would be a lot of he said/he said situations.”

Still, Oliveira thinks everything should be on the table right now, as do many other frustrated public health officials and HIV-prevention educators. So I’m tossing my idea out there.

Anyone else care to comment?

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