Abstract
What could be more logical than a gay–feminist alliance to respond to the AIDS epidemic in Latin America? However, drawing on published articles and the author's experience in HIV/AIDS work in Chile, this paper argues that such an alliance is more rhetorical than real. Instead, both groups tend to stick to their respective niches and view the epidemic through the prism of the particular needs and concerns of their target constituencies, rather than learn from and support each other. Feminist rhetoric sometimes suggests that AIDS is a problem only because it affects women. The African paradigm of vulnerable women is inexactly applied, given the predominantly male and homosexual nature of the epidemic in most Latin American countries. Both women and homosexually active men are highly vulnerable to HIV infection, and little is gained by competing for the top slot on the “tragedy honour roll”. Latin American gay men's groups, torn between AIDS and gay rights activism, often resist both protagonism by women and women's issues. Although the fight for access to antiretroviral treatment has obscured this conflict, it resurfaces in associations of HIV-positive people and may increase along with heterosexual transmission in the region. Discussion and exchanges should be encouraged to overcome these largely hidden divisions.
Résumé
Quoi de plus logique qu'une alliance gays-féministes pour répondre à l'épidémie de SIDA en Amérique latine ? Pourtant, se fondant sur des articles publiés et son expérience du travail sur le VIH/SIDA au Chili, l'auteur avance que cette alliance est plus rhétorique que réelle. Au contraire, les deux groupes tendent à camper dans leurs domaines respectifs et à considérer l'épidémie par le prisme des besoins et des préoccupations de leurs militants, au lieu d'apprendre des autres et de se soutenir mutuellement. La rhétorique féministe suggère parfois que le SIDA est un problème parce qu'il touche les femmes. Le paradigme africain des femmes vulnérables ne s'applique pas exactement, étant donné la nature principalement masculine et homosexuelle de l'épidémie dans la plupart des pays latino-américains. Les femmes et les homosexuels actifs sont très vulnérables au VIH et il n'y a rien à gagner à se disputer la place d'honneur au palmarès de la tragédie. Les groupes d'homosexuels latino-américains, tiraillés entre le SIDA et l'action pour les droits des gays, s'opposent souvent au protagonisme des femmes et des problèmes féminins. Bien que la lutte pour l'accès au traitement antirétroviral ait masqué ce conflit, il resurgit dans les associations de séropositifs et peut s'accentuer parallèlement à la transmission hétérosexuelle. Les débats et les échanges devraient être encouragés pour surmonter ces divisions peu apparentes.
Resumen
¿Qué puede ser más lógica que una alianza gay-femenista para responder a la epidemia del SIDA en América Latina? Sin embargo, este paper plantea que tal alianza es más retórica que real. Citando artı́culos publicados y la experiencia del autor en el trabajo sobre el tema en Chile, argumenta que en vez de unirse, ambas partes tienden a mantenerse en sus propios nichos. Cada cual percibe la epidemia desde el prisma de las necesidades y preocupaciones particulares de sus grupos-objetivos, en vez de aprender y apoyarse mutuamente. La retórica feminista a veces parece sugerir que el SIDA sea un problema sólo porque afecta a las mujeres. El paradigma africano se aplica con poca precisión, dado el predominio masculino y homosexual en la epidemia en la mayorı́a de los paı́ses latinoamericanos. Tanto mujeres como hombres con prácticas homosexuales, son muy vulnerables al VIH y es contraproducente discutir quién esté en el primer lugar del sufrimiento. Los grupos gay en América Latina, tensionados por las demandas del SIDA y de la emancipación homosexual, suelen resistir tanto el protagonismo de las mujeres como sus preocupaciones. Aunque la lucha para el acceso a los tratamientos antiretrovirales ha opacado este conflicto, resurge en las asociaciones de personas viviendo con VIH y puede aumentar con el crecimiento de la transmisión heterosexual en la región. Se debe incentivar la discusión y el intercambio sobre estas divisiones generalmente ocultas, en pro de superarlas a tiempo
Trapeze artists, Chile, 2002
What could be more logical than a gay–feminist alliance to respond to the AIDS epidemic in Latin America? Who else cares deeply enough about the issue to organise their peers to provide prevention education and improve services? What better way to counteract the limited resources and influence of those of us concerned with sexual health in our region than a common front of these two natural allies?
As is well known, gay men responded early to the epidemic in many countries—including Latin America—due to the direct impact it began to have on their lives. Women coming from the reproductive health field soon saw the epidemic as part of their mandate and deeply related to reproductive health services, policy and public opinion.
Both groups realised early on that AIDS threatened their hard-won gains in sexual emancipation as opponents leaped at the chance to terrorise youth seeking sexual autonomy and even associated the disease with divine retribution against sexual dissidents. Both understood the need to combine solidarity and reduction of stigma with prevention efforts.
Both feminists and gay men grasped that the runaway epidemic could only be explained by factors that transcend the purely biological or individual/behavioural; both came to identify as an important underlying cause of the expansion of HIV infection the crushing effects of hostile social environments—termed homophobia by the one and sexism or gender inequity by the other. In both cases the adversaries were and are the same—oppressive sexual cultures, recalcitrant or timid governments and obscurantist religious forces.
Unfortunately, this promising confluence of interests has not borne the expected fruit. In my observations of AIDS work around Latin America, both as a journalist and as a direct participant for some 15 years, I see an alliance that is more formal than real, more rhetorical than practical. Notwithstanding admirable exceptions here and there, organised gays and organised women tend to stick to their respective niches and view the epidemic through the prism of their target population's particular needs and concerns. We waste opportunities to learn from one other in territories often previously explored. Shared theoretical goals and broad general sympathies have obscured the thinness of this bilateral relationship. As AIDS is a fast-moving epidemic, the weakness of this formal alliance may eventually be quite costly. We should be alert not only to the lost opportunities but the inherent dangers of not having built a real bridge between our communities and our efforts.
I believe these missed opportunities are the result of both cultural factors and conceptual and rhetorical errors which reflect short-sighted and counterproductive, but reversible tendencies. A frank discussion of them may help us to remove obstacles to what ought to be an important source of strength for gay men and feminist women in our region.
Alarm bell 1: the African paradigm
The first sign that something is amiss in our discussions about women and HIV in Latin America is the unusual frequency of references to the ongoing catastrophe of AIDS in Africa. Attention is often drawn to the now vanished gap between male and female infection rates on that continent, where, as a rash of recent articles have noted, some 19.2 million of the estimated 38.6 million adults living with HIV/AIDS are women. That is, more or less half.Citation1Citation2Citation3
Africa is rarely, however, a point of comparative reference for Latin America; it is considered culturally, politically and economically remote, despite the tendency to lump Latin America, Asia and Africa together as developing countries. The extent of the African AIDS epidemic is clearly appalling and can guide our understanding of how an epidemic can develop and how to avoid its repetition, but a more permanent gaze fixed on our own region is missing when women and HIV/AIDS is addressed. While it may be true that adolescent girls in Botswana are five times more likely to acquire HIV infection than adolescent boys, this says little about the epidemics we are actually facing in Latin America today.
In Latin America, the statistics are very clear and too often ignored. According to the statistics on the UNAIDS website,Footnote* AIDS remains predominantly a disease of men, as shown in the breakdown by sex for estimated cases of HIV infection in six Latin America countries (Table 1)
Table 1 HIV prevalence rates for selected countries in Latin America, end of 2001Citation4
Even in Brazil, however, with a notoriously early “cross-over” epidemic affecting many heterosexual men and women, there is still close to a 2:1 male–female ratio of infection. Similarities to the African pattern of heterosexual expansion of infection remain exceptional, such as the Honduran situation. But a reader of Latin American feminist writings on the subject would come away with exactly the opposite idea, especially as a result of the frequent use of phrases such as “Women are more vulnerable” in headlines and opening paragraphs. These claims beg the question of whether this means more women than men, or more women than before. As a key feminist AIDS activist wrote in 2001:
“Currently, women and girls are more vulnerable to sexual transmission of HIV/AIDS, particularly in developing countries.… How many lives of women and girls could have been saved if social consciousness about it had developed in 1985 and prevention policies adopted?” Citation5
In fact, in their respective discourses, gay men and feminist women in Latin America are rarely talking about the same phenomenon. Gays talk about AIDS; women talk about women and AIDS. Africa is therefore the preferred guidepost for the latter because that is where women are being most notoriously devastated by the epidemic.
The focus on Africa has led to other bizarre manifestations. Early articles about AIDS in Latin America described horrific situations occurring halfway around the globe while saying little or nothing about rapidly expanding male epidemics closer to home. It was not at all unusual to hear activists on women and HIV/AIDS state with alarm that rates in country X had dropped from an early 30:1 or 35:1 male–female ratio to 8:1, 4:1 or lower. Although these familiar statistics were and are worrisome, they did not mean that AIDS was “increasing more rapidly” among women, as was claimed or assumed, but rather that the sex ratios were falling while actual numbers of new infections often continued to be higher among men. The Pan American Health Organization continues to promote this epidemiological confusion:
“The risk of HIV infection is higher in women… All over the world, due to their unequal social conditions, women run more risk of contracting HIV infection… As a result of these inequities, the rate of HIV infection in women is growing more rapidly than the rate in men in Latin America and the Caribbean.” Citation6
As with Honduras, parts of Central America and the Caribbean which do approach the African pattern are exceptions, but rarely identified as such. Of course, one could well argue that focusing on the relative numbers of men and women does not really matter when facing a crisis involving human misery. However, feminist discourse consistently does so.
It is entirely reasonable for groups dealing with women's health to become concerned with the growing numbers of women affected by HIV/AIDS and to concentrate their attention on them. However, the way in which this concern is phrased is extremely relevant to the solutions being proposed. While no one should be excluded, those of us promoting sexual health have a responsibility to avoid suggestions that HIV/AIDS is now a problem because it affects women or, for that matter, any specific group of people. If comparisons are odious, then surely comparing the extent of one or another group's suffering is, at best, a disagreeable epidemiological necessity. What is to be gained by placing women at the head of the tragedy honour roll?
Although the tendency described here dates from the early years of the epidemic, current discourse has not evolved very far, as this February 2003 article from Mexico illustrates:
AIDS increases among worlds female population AIDS is affecting women more and more, according to the UN agency dealing with the epidemic, UNAIDS. Of the 7500 daily cases registered in the world, nearly half are women although circumstances vary in each region or country… in Mexico for every six men infected there is one woman with HIV. “The greater physical and social vulnerability of women and paradoxically the risk represented by sexual relations with the husband, are said to be the principal causes of the increase.” Citation7
Alarm bell 2: women are “more vulnerable” to HIV/AIDS
Activists and researchers have done important corrective work about the different ways in which HIV/AIDS affects women. As Revista Mujer Salud (Women's Health Journal) pointed out in its recent issue dedicated to the subject, heterosexual women are in the “front lines” of the AIDS pandemic not only because of their greater biological vulnerability (through the vaginal and anal mucosa, high concentration of HIV in sperm, etc) but also as a result of social, economic, political and cultural conditions.Citation8 This common assertion describes the spread of HIV/AIDS as following a sort of gender fault-line in which the disadvantages women face aggravate their risk of infection. Women are less able to refuse sexual relations, are frequently victims of sexual violence and coercion, depend economically or emotionally on partners who often maintain additional sexual contacts, are culturally indoctrinated to serve or accept abuse, are kept ignorant of matters involving sexuality, and tend to place priority on the health of family members above their own. As one UNAIDS document sums it up: “Heterosexual transmission of HIV can be viewed as a direct reflection of gender inequality.”Citation9
However, we need to pause here and examine more closely just what is being said or meant with these battlefield metaphors. The UNAIDS quote refers to heterosexual HIV transmission, not all HIV transmission. In the light of the statistics above, the bulk of the Latin American epidemic is elsewhere. By casually lumping heterosexual and homosexual men into a single category as “less vulnerable” (or perhaps the rearguard), these arguments dispatch the homosexual HIV/AIDS epidemic into invisibility. Is this conscious?
In fact, men are only less vulnerable to HIV infection if they are exclusively heterosexual. Indeed, men who have penetrative anal sex are at least as vulnerable as women. The failure to make this distinction is extremely significant for the potential to build a gay–feminist alliance. The exclusive concern and worry expressed about rising rates of HIV infection among women skate dangerously close to the postures of governments which ignored the epidemic as long as it remained concentrated among gays, injecting drug users and other stigmatised sectors. Mass cultural homophobia sustained this attitude. In Chile, for example, a 1996 study of public opinion found that homosexuality ranked first on a list of negatives, and a repeat survey in 2000 still found over 70% agreeing that “doctors should study its causes to avoid the birth of more homosexuals”.Citation10 Official views only began to shift when health authorities and politicians realised that the ghettoisation of AIDS was unlikely to last. Then the rhetoric changed, often quite explicitly, to sudden panic. HIV was presented as dangerous and urgent because it was “not just affecting prostitutes and homosexuals, but our own children!” as a Chilean legislator pronounced in a 1991 congressional debate.Citation11
The effects of making gay men invisible in relation to AIDS were nefarious. During the 1990s regular epidemiological announcements by the Chilean Health Ministry noted with concern that rates among women and drug users were on the increase, while remaining mum on homosexual transmission, which at the time accounted for easily 85% of known cases. Similar patterns occurred around the region. The message was certainly not lost on gay men, who understood quite clearly that their lives were of little importance to policymakers. When challenged on his skewed perspective, Chile's Undersecretary of Health replied that mentioning homosexuals would have encouraged stigma and discrimination (Corporación Chilena de Prevención del SIDA, personal correspondence, 1997).
Even in the late 1980s when Chile's male:female infection ratio was in the range of 30:1, health authorities (not to mention the popular press) emphasised the threat to married couples and, of particular concern, the newborn. Virtually everyone—myself included—felt uncomfortable placing emphasis on the fact that the overwhelming majority of early infections were the result of homosexual relations. Although this may have been tactically wise at a very early stage, this extreme prudence quickly backfired as gay men were downplayed as victims of HIV in need of prevention, care and solidarity. What began as an attempt at inclusion with slogans along the lines of “AIDS: everyone's problem,” rapidly turned into a permanent erasure of the reality of homosexual transmission and male vulnerability. The tendency resurfaced when organisations of people living with HIV became important protagonists and often slipped into the “Titanic”—women and children first—approach in their early media strategies.
One can hardly overemphasise the impact of this steady insistence on “women as more vulnerable” on gay men whose friends were falling ill and dying with depressing regularity in the early years. When we attempted to estimate HIV seroprevalence in Santiago among homosexually active men in the mid-1990s, our data indicated rates of 15–20%,Citation12 an estimate repeated fairly consistently throughout Latin America. While individual women flocked to volunteer in care and prevention activities, organised women's health groups tended to remain on the sidelines, focused on when and to what degree AIDS was spreading into the female population. An important exception were initiatives among sex workers, in the Chilean case quickly and amply funded by the government, albeit with outside funds.
In one of the few writings on this issue from the Latin American gay perspective, Cáceres and Pecheny argue that the “strategic de-homosexualisation” of AIDS was based on two unsupported assumptions: that male-to-male transmission was under control and that these communities' vulnerabilities had been addressed sufficiently already.Citation13 This is polite understatement, given the massive refusal to face the reality of homosexual transmission during the early years when HIV infection was skyrocketing among the region's homosexually active men. These authors add with characteristic restraint that “the difficulty of conceiving of populations of men who have sex with men … as persons with rights, including the right to health,” was a factor.
Meanwhile, officialdom continues to focus its worries on women—as vectors of HIV infection to newborns—right up to the present. A 2001 publication put out by the UNAIDS regional office in Lima, Peru,Citation14 acknowledges that the country's male:female infection ratio started out at 14.5:1 and had remained at nearly 3:1 at the beginning of the new millennium. But the men who make up 75% of the cases are nowhere to be seen. As the introduction states:
“This change in tendency could reach a 1:1 level in a few years, with the resulting risk for vertical [mother-to-child] transmission.” Citation14
The urgent need to anticipate statistical equality between female and male victims reiterates the historical dismissal of a devastating homosexual epidemic. The document proceeds to discuss women's greater vulnerability to HIV infection, reflecting a view of sexual health that reduces women to reproductive vehicles and erases men altogether.
Alarm bell 3: gay rights vs. AIDS
What were the recently formed groups of gay men engaged with HIV/AIDS doing in the meantime to seek allies and sympathisers beyond their narrow circles? In many countries of Latin America, tremendous debates and internecine struggles were taking place inside these groups to decide whether the priority issue was AIDS prevention or gay rights, given the obvious links between the two and the fact that in many countries gay organising began with the onslaught of AIDS. Some argued that the extent of societal homophobia required that priority attention be paid to agitation for homosexual rights and non-discrimination. Others favoured work on AIDS to draw in broader sectors with appeals to the universality of the HIV threat to sexually active individuals and indirectly affirming people's choices and autonomy in this area.
In retrospect, both approaches were necessary and performed symbiotically, despite the frequent outbreaks of hostility among their proponents. Individual projects consistently fomented dialogue between gays and women, especially among youth, and many informal links were established. Together, we managed to promote considerable solidarity with people living with HIV and AIDS, especially since sympathy with the sick was culturally easier to achieve than broadmindedness about homosexuality, which nonetheless came along for the ride. The tactical overlap was entirely legitimate and useful. However, those early joint projects rarely evolved further; 10 or 15 years later the two sides still come together in defence of treatment access for people living with HIV. But that does not constitute an active alliance on issues of sexual, much less, reproductive rights.
Furthermore, once consolidated into organisations, gay activists faced the risks brought about by success. Although it took a good decade, many national AIDS programmes finally began paying more attention to their own epidemiological statistics and to act upon them, accepting the need for focused prevention initiatives among gay and other homosexually active men. Resources began to flow. Although in some countries gay-led AIDS groups tended to avoid working with their peers out of lingering fears of associating the two phenomena, most AIDS organisations run by gay men became successful advocates of the needs of their interest group.
But AIDS epidemics evolve and change, and the standard safe sex workshop, complete with condom-fitting practice, is now a bit old hat. Many gay men are either blasé about or bored with AIDS, and anecdotal reports consistently indicate that the new generation all too often thinks the disease is now treatable and therefore no big deal. At the same time, the fight over access to the miracle-working antiretroviral treatments has overshadowed the original issues that drove prevention work and that promised a radical new look at human sexuality.
In my view, the next generation of AIDS prevention must grapple with age-old issues of how to promote healthy, enjoyable sexual relations for all people, an area in which women's health groups and feminists have valuable experience and methodological tools. Providing sexuality education and services to younger generations requires the forging of new alliances and the elaboration of innovative approaches. However, instead of opening up to the incorporation of new issues and broader alliances, including the women's sexual and reproductive health movement, I see much gay-oriented AIDS activism headed for repetitive oblivion.
One reason for the resistance to this apparently natural alliance is that gay men tend to have just as many unresolved gender issues as their straight counterparts. Latin America remains a setting in which men may live out a gay existence without ever examining the gender injustices that form part of their daily existence. Accustomed to the ghetto and still facing a hostile, heterosexual environment in their jobs and families, many gay men are in no hurry to see their organisations converted into social service agencies, full of women as both providers and clients. They look at the older, more established women's health groups and wonder why the gay-oriented projects they have constructed should “do their work”. As a result, the gender-related factors influencing their own actions often go unexplored.
When people living with HIV/AIDS began to organise in the 1990s, usually around the issue of access to antiretroviral treatment, these tensions shifted to a different plane. But they did not disappear. Thrown together by the common need to obtain treatment, women and men living with HIV could not ignore that gender dynamics were at work in their organisations, where gay men were often first past the post and used to being in charge. Women-only HIV-positive groups were not long in coming, and in many countries the situation is far from resolved.
Meanwhile, thinking about gender and rights from the gay side of the HIV context in Latin America is surprisingly undeveloped. A Spanish-language Internet search of these keywords gleans slim pickings, implying that it has not occurred to many people that gay emancipation or sexual health work should be building on four decades of feminist precedent. (However, the situation is quite different in Portuguese-language writings because many Brazilians do think in these terms.)
Alarm bell 4: AIDS as a gender issue
It is good that much is now being said about the gender issues involved in women's vulnerability to HIV infection. These are important discoveries, challenging the typical multiple-choice sort of official campaigns, which offer abstinence, condom use or monogamy as prevention options—as if social behaviours were available in supermarkets where one can select the preferred product and put it to use.
But in the descriptive and denunciatory writings about women, gender and AIDS in Latin America, rare are the references to the undeniable fact that a man, in order to transmit HIV to a woman, has to have acquired the infection himself. Are there no gender considerations at work in the risk behaviour involved? If we are serious about addressing these phenomena, can we allow ourselves the luxury of focusing exclusively on who is on the front lines of vulnerability and leave out the rest?
Furthermore, doesn't social discrimination against homosexual orientation also have gender implications? What do gay men and lesbians face if not aggressive pressure to conform to their assigned gender roles? Is gay men's psychological battle for survival not a gender issue related to their capacity to protect themselves from HIV infection?
Here, women's health activists in Latin America have lost an opportunity to see what gay-oriented AIDS prevention projects have learned about male eroticism and men's gender conflicts. As long as men are not seen as important co-beneficiaries of sexual health services and advocacy, these lessons will remain sequestered in gay sub-cultures. The Spanish-language writings on women's health that I see may exhort men to change their attitudes and behaviours, but they rarely stop to consider what feelings or experiences drive this conduct. If greater sexual and inter-relational satisfaction for men is not part of the offer in sexual health programmes, they will remain female ghettos, and male resistance will be reinforced.
Practical effects of the distances between women's health and gay activists
The fact that feminists and gay men are still far apart on HIV/AIDS has not only political but also entirely practical negative effects, as the two camps easily slip into errors which the other could help them overcome. For example, feminist writings are justly critical of the prevention campaigns that offer women only the ABCs of Abstinence, Be faithful or Condom use. Gender considerations tend to go out the window in these appeals, and women who cannot realistically apply any one of the three are often left without an alternative that could truly protect them. Women have rightly become exasperated by constantly hearing how marital fidelity is supposed to protect them from AIDS while their male partners sleep around and show no inclination to change. However, to conclude that the sole-partner strategy is “absolutely irrelevant” because marriage is in fact “a risk factor rather than a protective one”Citation7 is an error.
Gay-focused AIDS prevention programmes have faced this conundrum for nearly two decades, and few counsellors or prevention educators would deny that monogamy is in fact an important prevention strategy for many people, gay and straight—including, I would be happy to wager, a good many readers of this journal. While vulnerability issues do not disappear when one opts for this approach, tossing the baby out with the bathwater is unrealistic and wasteful. Much can be accomplished by engaging with real human beings about their sexual and relational lives and seeking ways to improve their chances of remaining HIV-free while respecting their considered decisions about the risks they take. Work to prevent AIDS among women requires more than simply declaring monogamy to be problematic. While awaiting the arrival of true gender equity, many more women are going to be casting about for orientation on monogamy as a prevention strategy, and if we wish to accompany them in doing so, the experiences of gay couples include useful insights.
For their part, gay HIV prevention educators slide smoothly into their own rhetorical traps. HIV prevention has been shown to be strengthened by a degree of pride or at least comfort around issues of identity and sexual practices—be they gay, bisexual or “MSM”Footnote* as the new sex technocrats insist on terming them. But pumping up fragile adolescents with rallying cries about the validity of their desires does not automatically lead either to sexual health or to avoidance of HIV-related risk. As more than one disappointed youngster has confided to me, gay counsellors, convinced that pride=prevention, may be so focused on encouraging clients to be proud of their gay lives that they provide no guideposts on how these lives are to be constructed. Rather than oversimplify, gay educators in Latin America could take a leaf from the decades of feminist experience in reconstructing gender identity, including among the women who have spent half their lives trying to do it for themselves.
Conclusion
The combination of feminist rhetorical miscues and gay men's closet misogyny have blocked gay–feminist collaboration for too long in our region, especially in projects that might actually address women's risk of HIV infection. In my efforts to drum up interest in AIDS among women's health groups in Chile—in the face of the pronounced reluctance of my gay colleagues—the results have been very spotty. Some neighbourhood health and other projects in Santiago incorporated AIDS work with enthusiasm. But until very recently, the larger, collaborative projects designed to be developed through the Forum Network on Sexual and Reproductive Health and Rights or the UNAIDS Theme Group (the UN Interagency Committee for Chile) never got off the ground. Despite the statistical alarmism, HIV infection among women in Chile remains relatively low, and until that situation changes, concern will probably remain at current levels. Meanwhile, the gay-oriented groups have retreated explicitly back to their target population, reinforced by the enormous largesse soon to be available from the US$38.1 million recently awarded to Chile by the Global Fund to Fight AIDS, Tuberculosis and Malaria, from which most women's health groups have been shut out.
In the meantime, we can all prevent the situation from further deteriorating by not ranking anyone's suffering above anyone else's and by stating clearly that both women and gay men (and injecting drug users, straight men and everybody else) have needs and vulnerabilities. For now, however, AIDS has been re-medicalised to varying degrees around Latin America, with concerns about drug access for people living with HIV dominating news coverage and public opinion. The big questions of sexual culture, sexual autonomy, health services, sex education and the like have been pushed to the back burner once again.
This may change, especially if the long-awaited heterosexual epidemics do take off in more Latin American countries, as appears to be occurring in some. But a gay–feminist alliance logically could have played a leading role in getting in front of this new wave of HIV. Despite the similarities between our demands for autonomy, privacy, health, pleasure and emancipation from the reigning gender system, the dynamic combination of feminist and gay experiences that could have informed and energised AIDS efforts remains, in many countries, just a dream.
Acknowledgements
Support for visits to AIDS programmes outside Chile on an unrelated project, from which some of the awareness reflected in this article was gained, was provided by the Ford Foundation.
Notes
* The UNAIDS estimates of HIV infection give the nod to the current emphasis on AIDS among women—adults, women and children are the categories; men with HIV are invisible.
* The acronym for “men who have sex with men,” an epidemiological category describing homosexually active men which now threatens to absorb all others and wipe out three decades of reflection about sexual orientation as a conscious choice and a basis for community.
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