World - Vulnerable to HIV,Resistant to labels

The 29-year-old is not gay. He wants that known. He did have sex with a man once, but that was the result of loneliness and his hormones' being in overdrive, he said, not because of any attraction to men. He suspects that the one encounter was responsible for giving him the virus that causes AIDS. But he is not gay no matter what anybody may think.
"It was just once," said the man, who goes by the name Eduardo, recounting the sexual liaison he had when he was an illegal immigrant in New York City. He acknowledged that he went back to see the man a second time and noticed then that the man looked sickly.
"I have never felt that I am homosexual because I have never let them make love to me," said Eduardo, who lives an hour outside Mexico City, reflecting an oft-heard sentiment here. "It's the opposite. I penetrate. I have never liked it being done to me." Still, he did not want to be identified further because of the stigma attached.
Long ago, AIDS specialists the world over essentially shelved the terms "gay" and "homosexual" in connection with the epidemic and began referring instead to "men who have sex with men." No matter what label such men apply to themselves — gay, bisexual, transvestite or a heterosexual who experimented for a night or was forced into it — they remain an extremely high-risk group when it comes to HIV
Here in Mexico, where the 17th International AIDS Conference is taking place this week, some hombres que tienen sexo con hombres, or HSHs as they are called, consider themselves gay. Some swear up and down they are straight. Many fall into the gray area in between.
"Sexual identity is a very complex thing," said Hector Carrillo, a professor of human sexuality studies at San Francisco State University who has done research in Mexico. "We like to think that once someone figures out their sexual attraction, they will fit into the categories we've created. But life isn't like that."
HIV and AIDS are concentrated in Mexico among men, particularly those who have sex with other men. While the HIV prevalence in the general population is 0.3 percent, among men who have sex with men it approaches 15 percent.
But this is no homogenous population. Because machismo is pronounced in Mexico and homosexuality is far from accepted, social conditions in the country and in other parts of Latin America force much sexual behavior into the shadows. That increases the challenges that AIDS experts say they face in combating the risky sexual practices that fuel the disease.
For example, when Eduardo was first interviewed, more than a year ago, he referred to the person who gave him HIV as a woman. After months of counseling at a public clinic in connection with his antiretroviral treatments, he now acknowledges that it was a man he had sex with. But he professes no attraction to men.
Experts say that those who live lives of denial, a group that may or may not include Eduardo, frequently engage in high-risk behavior, but do not acknowledge it to anyone, often not even to themselves. Such men are particularly hard to reach in public education campaigns because they bolt or tune out if they sense the message is geared toward gay men.
"I'd say most of the men in Mexico who have sex with men will never recognize that they are gay or bisexual," said Jorge Saavedra, an HIV-positive gay man who directs Mexico's government program to fight AIDS. "Only if you go into in-depth interviews will the information slowly come out. It makes our job all the harder since there is so much shame involved."
Professor Carrillo, who has studied the issue, said that conducting comprehensive surveys on the issue is hard because it is inherently taboo. He said that even north of the border, where homosexuality is far more accepted, some people are uncomfortable with labels and men lead double lives, and he cited the case of James McGreevey, the governor of New Jersey who had a wife and resigned in 2004 after revealing he had had an affair with a man.
And the same applies in the rest of the world. A survey in China showed that half the men who had sex with men also had sex with women, with a third of them reporting that they were married, according to Unaids, the United Nations agency. In Senegal, another study cited by Unaids found that 88 percent of men who reported having sex with men said they also had sex with women.
Those women, of course, also face risks. Mexico has promoted condom use and not stressed fidelity as the cornerstone of its anti-AIDS fight, Saavedra said, because if only the woman is faithful, the man could still acquire the virus by having sex with men on the side. Experts call this the "bisexual bridge."
These relationships can be complicated.
Take the case of a 69-year-old married man, who did not want to be identified, and who is in a relationship with a younger lover, Carlos. Carlos, who has a girlfriend and a child and dresses as a woman, prefers the name Yessica.
"It's a bit unusual," the older man acknowledged. His current wife is unaware of his secret life. A previous wife found out, divorced him and has kept their two children away from him for decades.
He arranges his visits to Yessica on one of two cellphones he carries to keep his life in order: one is for his wife, who lets out occasional homophobic comments and who he says would leave him in a minute if she discovered what was going on; the other is for his occasional lover, who is physically male but feels trapped inside a body that is not his own.
The older man and Yessica say they use condoms most of the time to reduce the risk of contracting the virus that causes AIDS. Both say they were tested for HIV a year ago and were negative.
As for his sexual orientation, the older man with the secret life declared, "I'm not the least bit gay."
Acceptance of gay relationships in Mexico has increased significantly, and that change is evident in the recent adoption of a law in Mexico City allowing civil unions for gay couples. The annual gay pride parade in the capital has grown over 30 years from a small group of people marching down a side street to tens of thousands celebrating on the city's main avenue.
All the same, gay slurs are still commonly heard, attacks on gays are regularly reported to the authorities and many gay people opt to live their lives in the closet.
"We have a culture that obliges us to marry," said Luis Manuel Arellano, an openly gay man who has been active in combating the spread of AIDS and has no plans to find a wife. "We grow up learning to be macho, no matter what we think inside."
Martín Márquez Chagoya, a gay man who has had HIV for 14 years and counsels other men, visits a park in central Puebla where men go to have sex with other men, but he said his efforts to promote condom use there often fell on deaf ears. The No. 1 response he hears from men there is that they are not gay and are therefore not at risk. They say they are merely having sex with gays.
Elisabeth Malkin contributed reporting from Puebla, and Lawrence Altman from Mexico City.