Dialogue: World Aids Day a time to talk about taboos

Today is World Aids Day. At 39, I, for one, am pleased to see another one roll around because I was told long ago to expect to be dead by now.

Yet grief and sadness also mark this day for me as I think of those I loved who have died. The epidemic continues to grow alarmingly around the world. The theme from the United Nations this year is "men make a difference." What do they mean?

Globally, the proportion of women becoming infected is rising faster than men, but men still make up the majority of those living with the virus. The spread of the virus is so fast and devastating that some predict that within 15 years South Africa could have a white majority population.

The numbers from the rest of the developing world are as ominous. South-east Asia, China, the old Soviet states and Latin America are all experiencing worrying growth in the spread of HIV.

In the rich, developed world the figures are not much better. The virus leaves entire communities crippled or wiped out at the social level, and tragedy and immense suffering at the personal one.

Men are the main transmitters of HIV and it is in an effort to get men to face up to their role in this epidemic that the UN has adopted this theme.

The vast majority of people living with HIV around the world have been infected through unprotected heterosexual contact. This is often the case in developing nations, where strongly entrenched ideas of what is appropriate masculine behaviour make it hard to get a message of safe sex across. It is just as hard in the developed world, where men are still the most likely to pass the virus on to others.

This dismal picture is not all that new, although it seldom makes the news these days. Yet what about New Zealand? How are we doing here?

The picture of HIV infection in this country is somewhat different from that outlined above. About 80 per cent of those recorded as HIV positive are male, and most of them were exposed through sex with men. Some of these men openly and comfortably identify as gay, others do not. They may simply see it as a bit of mucking around with another guy. Others are racked with guilt and confusion. Some were infected through shared needle use.

Of the women infected in New Zealand, the larger proportion were infected while living overseas in areas of high HIV incidence. Some have been infected by their partners here and some through needles. But most HIV-positive people here are men who have sex with men.

One of the main tasks facing the Aids Foundation is how to reach these men so they behave in ways that will protect them, those they love and their communities. This is a difficult and complex task and all men need to be involved. To talk of HIV/Aids in New Zealand necessitates talking of the sexual behaviour of men, especially men who have sex with men.

Like most cultures, New Zealand finds it difficult to talk about sexual matters in a calm and informed way. The typical Kiwi bloke is not renowned for easy and open discussion of sexual matters. There are taboos, religious and cultural, which make it difficult. There are accepted patterns of behaviour that discourage those at risk from speaking openly about what they will and will not accept as sexual behaviour.

As long as sex is seen as something shameful or bad and not to be talked about, we create an environment where people are placed at risk.

The only way to stem this plague is to change our attitudes to sex and sexuality. Men are going to continue to have sex with other men. They always have, in every culture and in every era in the world, and will continue to do so.

It is not a lifestyle choice as some try to make out. It is as much an inborn part of who I am as my eye colour. It is beyond the realm of choice.

The question we need to ask is: are we prepared to continue to support these taboos when the price is so high? There are those who will say that what we should be aiming at is a world where everyone waits until they are married or are in a serious relationship before they have sex, and then stay strictly monogamous. This is an option for some people. But we must work with what we have rather than what we would want in an ideal world.

The fact is that young people have sex, whether their parents or schools educate them about the risks or not. The fact is that a lot of men who have sex with men still feel so confused and guilty about it that they are not open to hearing the messages about how they should look after themselves and those they love.

Until we can talk freely and openly about these matters we in effect put ourselves at risk. More worryingly, we endanger our children .

People are still becoming infected with this virus in New Zealand. In spite of the advances in treatment, people are still dying from it as well. Aids is not over, as some seem to think.

Today, remember those of us who are living with the virus, those who have died, and think about how we can protect both ourselves and our children from being touched by this plague.

Put a coin in the collector's bucket, put on a red ribbon and talk about why you are wearing it.

* Michael Stevens is the interim chairman of the Aids Foundation.