Sexual Ecology: AIDS and the Destiny of Gay Men is a 1997 book by gay activist Gabriel Rotello, who discusses why HIV continued to infect large numbers of gay men despite the widespread use of condoms and why a number of experts believed that new HIV infections will disproportionately affect gay men in the future. Rotello examines the origins and timeline of the AIDS epidemic, drawing on epidemiology, sociology, gay history, and ecology. His conclusion is that gay men need to reduce their number of partners and increase condom use to bring the infection rate down. Rotello's central argument derives from the epidemiological concept that sexually transmitted epidemics are the result of three factors, sometimes called the Triad of Risk: the "infectivity" of a sexually transmitted disease (STD), or how easily it spreads; the "prevalence" of that STD in a particular group; and the "contact rate," or the average number of sexual partners that people have within a particular group.
Rotello writes that gay men significantly lowered the first leg of the triad (infectivity) with condom use, but condoms alone were unable to quell the epidemic because the second leg of the triad (prevalence) was already so high. Gay men needed to address the third leg of the triad: the contact rate. According to Rotello, lowering the contact rate while continuing to emphasize condoms might provide enough additional "room for error" to bring new infections below the epidemic's tipping point.Sexual Ecology, p. 206.
Sexual Ecology was considered a major contribution to AIDS discourse, and became a gay bestseller. New Scientist called it "a remarkable book ... a breath of fresh air in the growing litany about the AIDS epidemic." The New York Times called the book "trenchant" and "brave", saying that it "merits the attention of a broad audience"; The Boston Globe described it as "the Silent Spring of the AIDS epidemic." It was also praised by the LGBT community. For The Nation, gay historian Martin Duberman called Sexual Ecology "the most important book about gay men and AIDS since And the Band Played On. And it is far better."
The book was criticized by others in the gay community for arguing that multiple partners played a significant role in the etiology and longevity of the gay AIDS epidemic and that, with condom use, partner reduction was key to containing the epidemic. In The Village Voice, Mark Schoofs called Sexual Ecology "toxic" and "an ugly distortion of gay life." AIDS activist Jim Eigo compared Rotello to right-wingers such as Pat Buchanan and Jesse Helms, writing that he "scapegoats and stigmatizes those of us who engage in multipartnerism." The Sex Panic! activist organization was formed in part to combat the message of Sexual Ecology, accusing Rotello and other writers the group called "gay neo-cons" (particularly Michelangelo Signorile, Larry Kramer, and Andrew Sullivan) of betraying gay sexual freedom.
Background During the 1980s, Rotello was a New York City AIDS activist and a member of ACT UP. In 1989, he founded the magazine OutWeek and became its editor-in-chief. The New York Times called it "the most progressive of the gay publications," saying that it "gave voice to a new generation of AIDS activists ... and provided a rallying point for the more militant members of the gay community." Rotello was controversial for promoting the word "queer" as a catchall phrase for sexual minorities and for the phenomenon of "outing," which began at OutWeek; he considered himself a member of the gay left. In 1992, he became the first openly-gay man to become an op-ed columnist for a major American newspaper (New York Newsday) and used that platform to argue for gay rights and AIDS activism.
During Rotello's tenure at New York Newsday, AIDS epidemiologists began reporting a "second wave" of HIV infections among gay men. Some studies indicated that 40 percent or more of young gay men would become infected with HIV by the time they reached middle age, despite the wide promotion of condoms. Many activists, including Rotello, had previously argued that the problem of new HIV infections had been largely solved by the promotion of condoms in the 1980s.
He began investigating the underlying reasons why AIDS had affected gay men originally and why it was continuing. One result was "The Birth of AIDS", a cover story for the magazine OutRotello, Gabriel. "The Birth of AIDS", Out, April 1994, pp. 88-93, 130-137. that described the emerging scientific consensus that HIV had existed in human populations for decades before the 1980s but had not previously produced an epidemic because it required a unique set of circumstances to spread. The article was eventually expanded into Sexual Ecology.
As Rotello began writing the book, gay sex clubs opened in New York City which allowed unprotected anal sex in open settings for the first time in over a decade. He wrote columns criticizing this for New York Newsday,Rotello, Gabriel, "Sex Clubs are the Killing Fields of AIDS", New York Newsday, April 28, 1994. and joined a group called Gay and Lesbian HIV Prevention Activists (GALHPA), which believed that such venues should enforce safe sex or be closed. GALHPA's stance was controversial and reignited the "bathhouse debates" of the early 1980s. It was against this backdrop that Sexual Ecology was published by Dutton in 1997.
Summary Rotello presents a number of myths about the epidemic.Sexual Ecology, pp. 8-10. HIV existed in humans for at least several decades before the AIDS epidemic first appeared in Africa, Haiti, and American gay men. According to this theory, HIV did not cause previous epidemics because it is difficult to transmit and the collective behaviors needed to create an epidemic did not exist before the sexual and IV-drug revolutions of the 1960s and 1970s.
Before World War II, most American gay men did not engage in high-risk behavior; they had fewer partners and were more inclined to have oral (rather than anal) sex. Gay men had fewer STDs than the heterosexual population.Sexual Ecology, pp. 39-43, 49-50. An epidemiological "tipping point" is when an infected person infects more than one other person and a disease begins to spread. A triad of risk is prevalence (the percentage of people in a pool of sex partners who are already infected), infectivity (the likelihood that a disease will be transmitted during one sexual encounter), and contact rate (the average number of sexual partners in a given population).Sexual Ecology, pp. 44-45.Simply put, without partner change no STD can spread. Partner A may infect partner B, but things will end there. In a thoroughly monogamous population, there would be no STDs at all, no matter how infectious certain microbes might theoretically be. Conversely, the higher the level of partner change, the more likely that even microbes that are relatively hard to transmit will have an opportunity to spread.Sexual Ecology, p. 45."Core groups", smaller groups who transmit STDs at higher levels than the surrounding population, are an additional factor. Core members have large numbers of sexual partners who have large numbers of partners, creating a feedback loop which can amplify disease.Sexual Ecology, pp. 47-49.
During the 1960s and 1970s, gay liberation and casual sex with multiple partners became widespread; similar changes among young heterosexuals were overshadowed by the gay community's network of bars, cruising areas, sex clubs, and bathhouses. Attendees of gay bathhouses and sex clubs might have hundreds of sexual partners per year,Sexual Ecology, p. 62. leading to sexually transmitted epidemics of syphilis, gonorrhea, herpes, giardia and other intestinal parasites, hepatitis A and B, Epstein-Barr virus, chlamydia, and cytomegalovirus.
From rare viruses such as HTLV to more common infections such as hepatitis A, every sexually transmitted infection that entered the gay male ecosystem rose to unprecedented levels, so that by the end of the decade homosexual men had by far the highest sexually transmitted disease load of any social group in America. In many instances, it was dozens or even, as with intestinal parasites, hundreds of times higher than average.Sexual Ecology, p. 70.
HIV entered this system and began to spread. A study of Hepatitis B transmission among gay men began in 1978, and its blood samples
... were to become invaluable measures of the rise of HIV infection once a test for HIV antibodies became available in the mid-eighties. Researchers were then able to go back, retest the blood, and obtain a stop-motion picture of HIV’s deadly incursion into the gay male population.Sexual Ecology, p. 73.
When the study began, the percentage of gay men infected with HIV was in the low single digits. It rose to between 40 and 60 percent in most test cities by 1985, with peaks of 58 percent in Denver and Seattle, 60 percent in San Diego, 70 percent in Philadelphia, and 73 percent in San Francisco.Sexual Ecology, p. 73. HIV took longer to start and spread than the other epidemics because of its lower infectivity. Aspects of gay sexual ecology cited by epidemiologists included insertive-receptive versatility, partner concurrency, viral load, reduced immunity due to STD re-infection and substance abuse, and the role of travel. According to evolutionary biologist Paul W. Ewald, high levels of HIV transmission among gay men produced more virulent strains of the virus.Sexual ecology, pp. 75-85.
AIDS prevention and the "condom code" developed during the mid-1980s. Condoms became the primary response to AIDS prevention in the gay world after the publication of "How to Have Sex in an Epidemic", a pamphlet by Michael Callen and Richard Berkowitz. The code was expected to prevent new infections and allow the gay sexual revolution to continue.Sexual Ecology, p.100.
A second wave of AIDS arose during the 1990s. Gay men were using condoms up to 60 percent of the time, but epidemiological studies and mathematical models indicated that it was not enough to bring the epidemic below the tipping point.Sexual Ecology, pp. 124-127 The late-1980s drop in new infections was due to saturation; when 50 to 60 percent of gay men were infected, infections declined until a new cohort of young, uninfected men became sexually active.Sexual Ecology, pp. 127-129. Prevention activists focused on increasing condom use,Sexual Ecology, p. 135. citing a lack of safer-sex education, condom availability, the closet, and substance abuse.Sexual Ecology, pp. 136-145.
Dieters slip off their diets. Alcoholics fall off the wagon. Former smokers impulsively light up. Responsible drivers sometimes drive drunk or fail to buckle up. Couples desperate not to have a child sometimes fail to use birth control. Failure at compliance is not a specifically "gay" problem, and although failure to be perfect can be exacerbated by contributing factors like lack of education, substance abuse, self-hatred, or survivor’s guilt, such failure is not in its deepest sense caused by those factors, at least not for most people. It seems part of many of our natures to be occasionally impulsive creatures who do not always act in our own genuine long-term best interests. In fact, from the perspective of behavior change, the amazing thing about gay men’s rate of condom use is not that it is so low, but that it is so high. Compared to campaigns that attempt to encourage people to quit smoking, or to diet and exercise, or to quit using addictive drugs, campaigns that often measure success in single percentage points, the consistent adoption of condoms by approximately half of all gay men is a remarkable success by almost any behavioral scale.Sexual Ecology, p. 147.
AIDS was not epidemic among heterosexuals in the developed world but was in sub-Saharan Africa, Haiti, and Thailand, infecting heterosexuals whose behavior was similar to gay male behavior in the United States.