Review: The HIV Epidemic and Lesbians and Gay Men

Abby Reed

Biology/General Programs 248

Professor Kaye Edwards

January 28, 1999

Greene, B., and Herek, G.M. (Eds.). (1994) Psychological Perspectives on lesbian and gay issues: Vol. 2. AIDS, Identity and Community: The HIV Epidemic and Lesbians and Gay Men. Thousand Oaks, California: SAGE Publications, 1995.

AIDS, Identity and Community is the second volume in a series, edited by Herek and Greene, entitled "Psychological Perspectives on Lesbian and Gay Issues." The series is sponsored by the Society for the Psychological Study of Gay and Lesbian Issues, a division of the American Psychological Association (APA). Each volume in the series is an anthology of essays by psychology professionals, both clinicians and theorists, as well as other AIDS service providers. The series groups lesbian and gay psychological experience together, and it is particularly interesting to produce a book devoted to the "HIV Epidemic and Lesbians and Gay Men," since the AIDS epidemic has decimated parts of the gay male community, while research has only recently acknowledged that lesbians are even at risk for HIV infection (as Cynthia Gómez describes in her essay in this volume). By grouping gay men's experience of the HIV epidemic with that of lesbians, the editors of this collection assume a shared "queer" identity for the two communities, whose experience with HIV has been markedly different. The diversity of the twelve essays in the volume allows for an appreciation of the difference within the community. The paragraphs to follow provide detail about some of the articles I found most interesting, and the conclusion describes what audiences would benefit most from the book and how it contributes to our understanding of disease and discrimination.

In my estimation, the most striking essay in the collection was "Lesbians at Risk for HIV: The Unresolved Debate." Cynthia Gómez addresses lesbians' risk for contracting HIV in her important essay, in which she reveals the way in which categorization methods have effectively effaced the way that HIV can be contracted through female to female sexual contact. Gómez describes the inadequacy of the CDC's method of constructing sexual identity in terms of a subjects' sexual behavior, which fails to acknowledge that many "lesbians" have sex with men and many "heterosexual" women have sex with women. As Gómez declares at the end of her essay, "All women who share needles or engage in unprotected sex are at risk for HIV infection. Lesbians are no exception. The debate [over whether lesbians are at risk] should end" (Gómez 30).

In general the book is effective in establishing how the complex relations within the gay and lesbian community are important in describing how this community deals with the AIDS epidemic. The collection begins with a more personal essay, "HIV and the Gay Male Community: One Clinicians Reflections Over the Years," written by gay clinical psychologist Neal King, in which he reflects on his years of treating people with AIDS and HIV. King's essay is not so much a clinically detached scholarly essay, but more a poignant and observant personal testimony about his many years of treating and being part of a community in the midst of an epidemic. King focuses on his interactions with the gay male community, but also makes an interesting comment about the presence of lesbians working in AIDS service organizations, as he states, "This inspired me to wonder about whether we gay men would have responded as generously to our lesbian sisters as they did to us had the need been theirs, had the virus infected primarily them and not us" (King 4). King describes lesbians not as AIDS patients but rather as dedicated workers in the fight against AIDS. Another article in the collection, by Allen M. Omoto and A. Lauren Crain, deals expressly with how the gay and lesbian community has responded to HIV by volunteering in AIDS service organizations, a trend which they analyze as "collective action derived from individual motivations" (Omoto and Crain 207). Another essay in the collection describes how these service organizations contribute to the long-term survival of PWA's. Robert Remien and Judith Rabkin, in which they publish the results of their study with male and female PWA's who are long terms survivors (defined as one who has experienced an AIDS-defining opportunistic infection and subsequently remained alive for 3 years or longer). Since they conducted their research in the late 1980s and early 1990s, their findings are dated somewhat by the recent development of protease inhibitors and drug "cocktails," which have dramatically extended the lives of some PWAs.

Several essays in the book address issues of identity and AIDS-related risks in communities of men of color. John L. Peterson reviews several studies of HIV infection in African American men who engage in homosexual behavior, focusing on intervention to modify high-risk behavior. He emphasizes that without an increase in AIDS prevention research for this population, "the unrelenting spread of HIV will not be abated in this population even at the end of the second decade of the AIDS epidemic" (Peterson 101). Alex Carballo-Diéguez's article, "The Sexual Identity and Behavior of Puerto Rican Men Who Have Sex With Men," addresses how different sexual identities among men who have sex with men (MSM) need to be taken into consideration when developing prevention programs. Carballo-Diéguez emphasized that many MSM consider themselves straight, and a prevention campaign addressed to them should never challenge their sexual identity but should rather take into consideration why they have sex with men. In their article "AIDS Risk, Dual Identity, and Community Response Among Gay Asian and Pacific Islander (API) Men in San Francisco," Kyung-Hee Choi, Nilo Salazar, Steve Lew, and Thomas J. Coates conduct a survey of literature and interviews with AIDS service providers who work in the Asian and Pacific Islander community. HIV infection is rising among API men, but as the authors emphasize, "to be successful, future HIV prevention for gay APIs must address the important sociocultural issues of stigmatization, family and community, identity development, community empowerment, confidentiality and ethnic diversity" (132).

I think that the essays in this book could be very useful to students interested in the issues that arise when the gay and lesbian community deals with HIV and AIDS. The essays are not overly clinical, making them accessible to students with a variety of backgrounds. Herek and Greene have included a wide range of essays in their thoughtfully constructed collection. The essays in this book considers a diverse gay community, one that is multicultural and multigenerational, but its treatment of the lesbian community is much less specific. In the book's defense, there is a paucity of scholarship relating to female to female sexual contact, a paucity which this book cannot assume all the responsibility for remedying. The book's focus on gay men is understandable in light of the far greater numbers of gay men who have contracted HIV in comparison to the numbers of lesbians. Herek and Greene provide an excellent collection of essays which emphasizes the diversity of psychological research about the HIV epidemic in relation to lesbians and gay men.