How to Have Sex in an Epidemic

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virus theory, as well as by the state of New York when they reached out for help with publication. The authors collected donations from the LGBT community in New York City to fund the printing, and received a significant donation from philanthropist and HIV/AIDS activist Randall Klose. Callen even contributed his own tax refund to the cause. In May 1983, they ordered 5,000 copies from Tower Press and distributed the copies around gay social establishments in the city, including bars, bookstores, clubs and other shops. The copyright is attributed to "News From the Front Publications," which was created by Callen, Berkowitz and Sonnabend founded in 1983 for the very purpose of printing and distributing their booklet. This independent publication method reflects the grassroots, personal nature of the pamphlet: as Sonnabend wrote, "HTHS originated entirely in the community of people with and at risk for AIDS, from individuals with no organizational affiliation."

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would put oneself in a risky position in terms of disease transmission, but also what would be dangerous for one's partner. They recognize the importance of maintaining mental control during sex, and argue that although it's easy to forget about safety in the heat of the moment, the growing threat of sickness and death should be enough to motivate people to act with foresight. Their primary piece of advice within the "control" subsection is not abstinence; instead, it centers around the importance of staying sober during sexual encounters in order to make informed decisions. This, Callen and Berkowitz write, means not drinking, smoking, or taking poppers before going clubbing. They also emphasize the importance of communication with one's partner in the broader discussion of maintaining control, including the need to talk about health concerns, disease status, and convince him to engage in whatever sexual acts safely.

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something that is "interpersonally meaningful," they argue, that should be motivation enough to use protection for the sake of both one's partner and oneself. The authors build on their feminist critique, claiming that the challenge facing the gay male community is to undo their "socialization as men" who are "trained to destroy" and to compete with one another and instead promote a community of people who take care of one another. Maybe, they argue, the goal of gay male liberation is to be able to love one's partner even when society teaches them not to. "Men loving men was the basis of gay male liberation, but we have now created 'cultural institutions' in which love or even affection can be totally avoided," they write. They also pose the question to their readers: "Have we modified the belief that we could

552:, particularly as most at the time were designed for vaginal, not anal, intercourse. David France recounts that while Callen and Berkowitz were ready to put all of anal sex into the "never again category" (i.e. high risk), Sonnabend, from his experience in clinical practice, was able to see that the people with the majority of the infections were those who were bottoms (i.e. those in the anal-receptive position), which then allowed him to discern a differential in risk depending on one's position in the sexual relationship. 1223:(although the authors make sure to clarify that promiscuity is only problematic given high preexisting rates of STDs in the sexual network). In 2008, Sonnabend defended the pamphlet's focus on promiscuity, arguing that high quantities of unprotected sex were a "very significant health hazard" whether or not one put their faith in the multifactorial model, and, indeed, a high frequency of sexual encounters was still relevant given that it increased the probability of contact with an HIV+ person. 471:

body to such high intake levels of sperm itself can present a health risk. Although the multifactorial model had been criticized for failing to account for the sudden appearance of AIDS, the authors use the fact that the rate of CMV infections in urban sexually active gay men rose significantly in last decade as evidence of the "new" component that accounts for the rapid increase in AIDS cases. They advise readers to get tested for CMV and describe which tests to get (e.g. antibody tests or

369:(i.e., condoms) during sex and 2) to limit the specific sex acts one performs to those with a lower risk of contagion. It was a model that attempted to challenge traditional anti-promiscuity and anti-gay viewpoints in previous safe sex education and AIDS prevention—as Callen and Berkowitz argued, it's what you do, not how often you do it or who you do it with. In other words, they had searched for, and come up with, what they termed the possibility of "life-affirming sex." 644:

based on the concept that a group of uninfected people can freely have unprotected sex as long as they do so only within that same group, are very much reliant on the trustworthiness of all members and are therefore more risky than monogamy. Furthermore, it was difficult to determine one's HIV status at the time of the book's publishing, given that the virus itself hadn't even been isolated, much less an antibody test designed to diagnose infection.

302:, were already at "endemic" levels. Sonnabend writes about condoms at the time: "I think most gay men said, 'Oh thank god, that's one thing we don't have to worry about,'" and many didn't know how to use one. However, as Callen, Berkowitz and Sonnabend would show them, condoms really were something to worry about and could be an easy way to prevent disease and death while continuing to have a normal and fulfilling sex life. 639:, etc. They describe dildos as a good and relatively safe way to avoid contracting STDs, with the caveat that they be 1) flexible and relatively short to avoid wounds, 2) washed and disinfected regularly, and 3) not shared from person to person. They suggest ways of getting creative with mutual masturbation and jerk-off clubs, as well as "closed circles of fuck buddies," that create the possibility for safer but non- 728:

to keep track of one's sexual encounters and communicate should someone become infected—this is part of the more community-driven mindset that the authors wanted to promote around sex. Lastly, Berkowitz and Callen recognize that visiting the baths is habitual for many gay men, and discuss the strategy that some have been using of masturbating before going to give oneself more self control and prevent risky behavior.

1609:. The politics at the time were fraught, and the AIDS epidemic revealed what Callen and Berkowitz described as the danger of having "a positive political force tied to a dangerous lifestyle ." The viewpoint presented in the booklet is one that attempted to challenge the institutions that had arisen in the urban gay male community, including bathhouses and backrooms, that had an 286:

awareness about AIDS and gay sex would be off-putting to the straight majority and damage the image of the subculture as a whole. Activists still deeply entrenched in the battle to protect the political gains of the past decade tended to overlook the AIDS crisis as a political attack, a topic too controversial to address, or an overreaction by self-hating gay men.

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starting by admitting, "It came as quite a shock to us to find that we had written almost 40 pages on sex without mentioning the word "love" once." David France explain that Callen and Berkowitz both "cared deeply for their vast sexual communities" and Sonnabend agreed, saying, "you could really love somebody even for just four hours. Genuinely."

1146:, and there was no time to wait for the debate to be cleared up before offering concrete prevention methods. It was widely accepted that AIDS was sexually transmitted, and the fraught political environment made both models unappealing for different reasons. Sonnabend argued that "to propose without supporting evidence that any 831:. Advice during the initial stage of the epidemic was to "cut down" on the frequency of sex, without giving any thought to the type of sex. The authors describe their attempt to correct this incomplete advice by educating people on what types of sexual acts are higher risk as a way to present them with an alternative to 1752:. As Alan Brandt argues, the AIDS epidemic did more than any other to blur the line between the healthcare field and the people they treated; community-based care became a central model for public and global health efforts related to this particular disease. Social scientists have recognized the importance of " 159:. Sonnabend describes the symbiotic relationship between the three as one in which he contributed medical and scientific information while Callen added the more political points and Berkowitz, who had educated himself with Sonnabend's scientific archives for the sake of his own treatment, synthesized the two. 1296:

After the pamphlet went through numerous drafts and editions, Callen and Berkowitz had difficulty finding somewhere to publish it, given its controversial subject matter and point of view. It was rejected by the Gay Men's Health Crisis, a prominent LGBT community health group that promoted the single

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of the importance of continued use of protection among people with AIDS who have sex. As is now common knowledge, once one has been infected with HIV it is almost impossible to completely rid one's body of the virus. However, the advice to continue using protection after being diagnosed was important

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Callen, Berkowitz and Sonnabend begin this section by stating that, regardless of how controversial and subjective the question may be, some people with AIDS do continue to have sex after being infected, whether knowingly or unknowingly, although many may be so incapacitated that sex is "the furthest

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facilities and also suggest some form of examination of one's partner's body before sex as another assessment of their health; they write, "you don't have to be clinical. Make it a part of foreplay." Lastly, in these situations where sex is often anonymous, exchanging numbers is a good way to be able

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In this section, the authors stress the need for the gay male community to come together to protect itself. A central component of this was that one's own sexual health and the health of others should "never became separated." They wrote that it was important to think about not only what sexual acts

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that characterized AIDS. This was based on prior scientific studies that revealed the role that CMV can play in causing cellular immune-related abnormalities. The multifactorial theory espoused in the manual has since been disproven; the majority of scientists are now in agreement that AIDS is caused

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was published, the AIDS epidemic in New York City has only recently begun and panic about the unknown causes, means of transmission and potential for treatment for AIDS was spreading rapidly. The misconception that there was something inherent in the lifestyle of all gay men that put them at risk for

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that sex was causing." It has been lauded as the "first sex-positive guide to practicing safe sex" and is widely regarded as revolutionizing the tone of safe sex education, particularly in the LGBT community. The only real sacrifices in behavior that it required were abstaining from substance use in

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was based on incomplete knowledge of the causes of AIDS, the advice given in the 40 pages was relevant to HIV/AIDS prevention, at least when it comes to sex-related modes of transmission. Its central argument was to avoid getting semen and CMV in one's rectum, although, as the authors pointed out in

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The authors categorize sucking as having a "moderate" risk: although the exposure to semen is not as direct as when it is taken in anally, they state that oral sex, for the person coming into contact with semen, is not risk free (for CMV infection) except with condom use. The compromise they suggest

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Before the AIDS epidemic, condoms were mostly advertised and used for preventing pregnancies and therefore were not considered a viable safe sex or STD prevention tool among the LGBT community: David France estimates that less than 1% of men who have sex with men in New York City used them regularly

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The booklet was co-written by Michael Callen and Richard Berkowitz, with scientific advisement from Dr. Sonnabend. Callen's partner Richard Dworkin was the editor. Both Callen and Berkowitz had been diagnosed with AIDS when they wrote the booklet and had a thorough knowledge of the sexual culture of

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of promiscuous gay men has been 'so many men, so little time.' In the `70s we worried about so many men; in the `80s we will have to worry about so little time. For us, the party that was the `70s is over. For some, perhaps, homosexuality may always mean promiscuity. They may very well die for that

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found that there were between 250,000–300,000 people living with HIV in the United States in 1983, and the number of people newly infected between `83-`84 was around 150,000). However, the model set forth by Callen and Berkowitz at least provided the possibility of a "return to intimacy" for people

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In the pamphlet's short section of "closing thoughts," the authors reiterate that "the party of the `70s is over" and that ignorance in the baths and backrooms has now turned into a form of oppression. They add that, because many members of the LGBT community are not well educated or able to afford

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This is another position where the authors identified little to no risk for CMV transmission. Again, their main argument is that it is still necessary to wear a condom to protect one's partner, and, by extension, the sexually active community of men who have sex with men as a whole. Because condoms

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categorizations were rewritten every few months: "anal sex with a condom became an endless back and forth dance, from high risk to medium risk to low risk to possibly safe." It was this confusion that prompted the authors to create a safe sex manual that clearly outlined for men having sex with men

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The example they provide in the pamphlet is a man who decides to limit the number of times he has sex to 12 per year, but does not change what he does with his partners or how he does it (e.g. with protection or not). The authors conclude that this will not prevent him from putting himself at high

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OBLIGATION TO ADVISE POTENTIAL PARTNERS OF THEIR HEALTH STATUS." It should be up to the uninfected person to make the informed decision to have sex, evaluating all the risk factors. However, sex between a PWA and an uninfected person, according to the pamphlet, would be fine if they are monogamous

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refute this idea, citing scientific proof vindicating the drug, although they also mention that there is a small transmission risk increase associated with taking poppers because it dilates the blood vessels, thus facilitating the entry of microorganisms. They also draw attention to the dangers of

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are "talking, washing, light and rubbers." They recommend talking to one's potential partner, even something as simple as "been here long?" to scope out how potentially infectious the person is, as well as to communicate about one's safe sex preferences (be it using condoms, not performing certain

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Callen and Berkowitz stress the importance sexual health in sex work, as well. To those in the position of paying for the sex, they say to make sure their partner respects their health concerns, or else look for someone else. They also warn their readers that, while escort services may claim that

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sex. They describe jerk-off clubs as typically having a friendly and welcoming atmosphere and clearly posted rules, and encourage their readers to ask around for these in their area or develop their own versions. However, Callen, Berkowitz and Sonnabend also acknowledge that the "closed circles,"

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This part of the manual stresses the fact that it's not a single infection putting people at risk, but instead repeated exposure to the virus in semen, particularly through anal-receptive intercourse. In addition to the specific cytomegalovirus in sperm, the authors argue that simply exposing the

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gay men in 1982–83, which, when factoring in the average frequency and diversity of partners in the population of sexually active gay men in New York City, would still amount to a high number of exposures per year. The reasoning behind their support of the multifactorial theory was the concurrent

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In this section, the authors describe the years post-Sexual Revolution as a time when sex and love were accepted as being distinct and that STD epidemics were a product of this newfound freedom, not just within the LGBT community but everywhere. If one cares about one's partner or accepts sex as

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Based on the multifactorial model of AIDS transmission, the uninfected person would simply be at risk for being exposed to high levels of CMV-infected semen. However, the reality is that the risk of having sex with someone with AIDS is higher than they described because it is caused by a single

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and casual, public sex, were a highly risky environment for disease spread of all kinds. Backrooms and similar spaces tend to be dark and have limited washing facilities. The authors recognize that it is still possible to have medically safe sex in these situations, only much more difficult. The

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might face from targeted quarantines and a denial of basic healthcare services. As such, the issue of safe sex was a contentious one, and any arguments criticizing frequent sex were poorly received by the majority of the community. A large sector of LGBT community leadership worried that raising

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and an "anti-sexual sense of guilt." A response written by Michael Lynch and Bill Lewis in the Toronto Politic, a Canadian gay newspaper, criticized Callen and Berkowitz for blowing the epidemic out of proportion and allowing the medical community to "pathologize" gay men, and the authors faced

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was only possible given their belief in the multifactorial model. Safe sex advocates would have been much less likely to propose condom use had they known that a single exposure was enough to contract HIV. For proponents of the single agent theory, "to suggest condom use would be tantamount to

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The authors take a positive stance on S&M, but emphasize the importance of setting limits and using protection within this environment and limiting the acts one performs to avoid direct bodily fluid contact between people. Most important in this setting, they explain, is prior communication

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were aware of the political risks they took in creating the booklet: Berkowitz noted in his autobiography the possibility that their writing could be used as ammunition by homophobic institutions and leaders. However, their advocacy was motivated by the increasingly critical state of the health

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film between oneself and certain death," as Sonnabend put it. Following the discovery of the HIV and the almost unanimous acceptance of the single agent theory in the scientific community, the authors have acknowledged the inaccuracies in their safe sex manual, while pointing out its continued

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in its approach to frequent and impersonal sex. Because the virus seemed almost entirely isolated to MSM in the early 1980s, it was difficult to see how and why a single virus would target a single demographic group. The new agent theory was adopted by the Gay Men's Health Crisis but was also,

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True to their sex-positive and nonjudgemental tone, the authors first acknowledge hustling as an important source of income for some men who have sex with men. Instead of condemning prostitution, they suggest that sex workers advertise protected sex specifically. They also recognize the unique

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was added after both Sonnabend and Richard Dworkin read it over and were struck by the complete absence of the word "love" in a manual about safe sex. Afterwards, the authors realized the potential it had as a moral and emotional justification for the use of protection and added this section,

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Much of the rest of the pamphlet is dedicated to discussing the many possible forms of sexual expression available to gay and bisexual men and providing a thorough analysis of the risk associated with each particular act. This analysis is warranted by the fact that, as the authors recognized,

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protocols such as washing, not coming in the person's mouth, etc. that someone in this position should follow to protect the health of his partner. Additionally, it is only risk free from the perspective of CMV/AIDS, as there are plenty of other pathogens that can be transmitted through oral

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stresses the importance of separating valid medical advice from moral-based arguments disguised as medicine. In this section, the authors discuss the difficulties posed by the obvious connection between gay sex and the disease, especially given that men who have sex with men, as well as

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The increasing practice of safe sex is reflected in HIV transmission statistics, which show a peak of new infection rates from between 1983–85, followed by a significant decrease in the following years. It must be noted these trends were primarily seen in white MSM: infection rates in

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on other STDs. This section presents evidence against the "new agent theory" but acknowledges that in either case, AIDS is likely sexually transmitted and therefore the best method of prevention will be the use of protection and more critical choice in which sexual acts to perform.

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describes kissing as an activity with moderate risk of CMV transmission, although this risk, they say, can be mitigated partially by kissing with closed lips. They discuss the social and emotional importance of kissing and the negative impact that avoiding it could have on the gay

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The advent of safe sex in urban gay male populations came too late for many people: by 1983, more than 1,476 people had died from AIDS and David France estimated that as much as half of all MSM in New York City and San Francisco had been infected. Retrospective analysis by the

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The authors introduce the two presiding theories of AIDS transmission and present their arguments for the multifactorial model. They describe the role of CMV in causing abnormalities in immune cells, as well as the potential for gradual immune overload by semen and harmful

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later recounted, the authors actively tried to avoid condescension or arrogance in their writing (despite the fact that Callen himself had acknowledged that telling people how to have sex is inherently an arrogant thing to do), instead attempting to establish a dialogue,

1764:/scientific context, because it was this intimate knowledge of sexual behavior among MSM that gave Callen and Berkowitz the authority to address the subject and the ability to do so in a way that appealed to their audience and avoided condescension. Queer theorist 325:

manual for safe sex—in other words, it did not present sex in a negative, shameful or moralistic light. Sonnabend writes in the introduction to the booklet that one of their goals was to "explore the many different forms of sexual expression open to gay men." As

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was written, there was no consensus on the cause of AIDS, but two main theories existed: the "new agent theory," which was increasingly the scientific consensus, and the "multifactorial theory," which Callen, Berkowitz and Sonnabend adopted as their basis for

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if automatic ostracism is the result. In all likelihood, the authors contend, the risk of unprotected sex to the person with AIDS is higher than to the uninfected person, as any number of STDs can have a dangerous health impact on someone with a compromised

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that gay men should avoid getting sperm in their own or their partner's rectum without knowing the other's status. He says, "at least we figured out very early that it was the recipient of anal sex that we needed to warn — and that we needed to celebrate."

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our way to liberation into the belief that we could somehow fuck our way there?" They end with this statement: "If you Love the person you are fucking with – even for one night – you will not want to make them sick. Maybe affection is our best protection."

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beforehand, they might have been dissuaded from attempting it. That said, Berkowitz has lamented that the grassroots origins of safe sex were rapidly forgotten as it became increasingly touted as an invention from experts in the scientific community.

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is a result of that phenomenon. Thus, it is part of the shift in behavior and mentality from the 70s to the 80s resulting directly from the AIDS epidemic. The following quote from "We Know Who We Are" demonstrates the authors' call to action:

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acts, using dildos, etc.). The authors say that, if the person gets defensive (which is understandable, given that the implication is that he will give you a disease), you should politely move on. They strongly recommend going to a place with

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was among the first safe sex educational materials produced and widely disseminated that addressed the subject in a positive and affirming light. David France described the authors' method and aims to modify the behaviors of an entire

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gay men, as well as increased frequency in condom use (from 1% in 1981 to 70% in 1987), and the impetus for this change, particularly the increase in condom use, has been partially attributed to sex-positive educational materials like

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was still gay men in New York City, but knowledge of the work spread to people of all sexualities around the country, and even, in some cases, internationally. Soon after its initial publication, the booklet was given a review in the

1391:, which had harshly condemned the "excessiveness" and "pigging out" that was occurring in the gay nightclub scene. They incorporate consistent affirmation of gay sex throughout the forty pages, including sentences like the following: 954:

safer sex fairly quickly replaced 'easy sex' as the primary framework within which gay men conducted their sex lives. By and large, changes in gay sexual behavior originated in the dissemination of the safer sex framework within the

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difficulties posed for hustlers in prioritizing their sexual health because they are "in the business of satisfying others' needs" and emphasize the need to establish guidelines for safe sex before getting together. According to

192:. Doctor Sonnabend wrote that "it may be impossible for those who did not directly experience the uncertainty and terror of the early years of AIDS to appreciate the circumstances under which these guidelines were constructed." 1386:

for its critical take on promiscuity. Callen and Berkowitz had attempted to tone down their critical tone from their first major publication, "We Know Who We Are: Two Gay Men Declare War on Promiscuity" in a 1982 issue of the

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and swallowing during oral sex all appear more risky than they actually are; on the other hand, having sex with a person with AIDS was more risky than the multifactorial theory suggested because a single contact can result in

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all the more important. The fact that the authors did not advocate for abstinence, were open to people's differing personal preferences, and emphasized that gay sex, anal-receptive sex in particular, was not dangerous or

343:, to get an idea of the best way to productively use writing to influence people through rhetoric and written arguments. The independent and community-driven nature of this approach to LGBT-related safe sex, according to 1072:

was also credited with laying a foundation for safe sex education outside of the LGBT community. Duke Global Health Institute founder Michael Merson describes lessons from this grassroots movement—e.g. the importance of

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Being penetrated in unprotected anal sex was identified as the act with the greatest risk for contracting CMV, and, under the multifactorial model, AIDS. This follows naturally from the fact that anal sex results in the

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as the first literature to recommend safe sex as a strategy for reducing the risk of contracting the transmitting agent which causes AIDS. A similar AIDS education manual, entitled "Can We Talk?" was published by the

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A common theory circulating in the early `80s was that the use of poppers (amyl and butyl nitrates), a common party drug in the LGBT nightclub scene, was a cofactor for AIDS transmission. However, the authors of

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were not commonly used at the time, the authors conceded that if someone finds it difficult to get used to the sensation to the point where they are dissuaded from using a condom altogether, they should at least

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In 1983, it was generally accepted knowledge that AIDS was at least indirectly sexually transmitted. However, it was the stigma and lack of education around this fact that made the frankness and sex-positivity

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of AIDS and CMV in the same sexual networks and locations; they called it the "one common link found in all gay men with AIDS." They summarize the characteristics of CMV and its links to AIDS as the following:

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successive healthcare visits, it's doubly important to disseminate correct, reliable information was widely as possible. Their final call is not for an end to sex, but an end to "sex without responsibility."

1685:. Sonnabend called the method presented in the manual a "do it yourself" approach that "did not wait for others to take care of pressing needs." As Berkowitz explained, having the power to control one's 1412:

and siding with the religious right. It was not an easy message for some gay men to receive: in an interview for Berkowitz' biographical film, Sex Positive, Larry Kramer described it as a blast of "cold

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sex-related situations, rather than abstinence from any form of sex itself. Most readers reacted well to the positive and casual tone of the writing, as well as the frank descriptions of sexual acts.

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also faced significant barriers in disseminating their message, most of which was due to their message's lack of popularity within the majority of the LGBT community. All of their applications for

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and semen), but also acknowledge that the price of such tests ($ 200) and the fact that it was not routinely offered at traditional clinics and labs might make it inaccessible to most patients.

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offered to buy all 5,000 pamphlets and promote them, with the condition that any mentions of the multifactorial model be removed from the writing. The authors refused. Berkowitz recounts in an

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and mainstream institutions more in depth knowledge of gay culture in general, and sexual culture of MSM specifically, including a variety of niche sex acts. This information was critical for

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audiences, its popularity and importance as a foundational safe sex manifesto ensured that it got at least some level of attention beyond the LGBT community of New York City. According to the

995:"—i.e., used condoms floating in the river—in popular cruising spots for MSM. Condom sales spikes in the mid 80s (20% between 1986–1987) and companies began producing them in varying sizes, 2455: 3720: 1796:

or did so in a substandard manner. Both the booklet itself and the partnership of the contributors (i.e., between Callen, Berkowitz and Sonnabend) helped lay the foundation for greater

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for the plague years." Many gay men were simply glad for any concrete advice in the midst of such confusion, particularly advice that did not present celibacy as the only safe option.

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As a result of the lack of agreement on AIDS cause and transmission, it was difficult to determine the risk of various forms of sexual contact. Berkowitz, in the introduction to his

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of the pathogen. However, they recognize anonymity during sex might make the issue of protecting one's partner from disease transmission less pressing and/or personally important.

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Note that some of these categorizations are incorrect given current knowledge about HIV transmission, and the descriptions below should not be presumed to be the medical consensus.

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Although this is not a sexual act, per se, Callen and Berkowitz stress the importance of washing with soap and water both before and after sex. They recommend Betadine soap with

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On a practical level, this sort of grassroots prevention advocacy was necessary because, in the early years of the epidemic when little was known about transmission and AIDS

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different diseases spread through different types of contact, and specifically AIDS/CMV (as they saw it back then) is much more easily transmitted through certain sex acts.

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against a sex negative society," but as the cost of life from these diseases rose, members of that same community saw the need to change practices to make sex safer, and

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became common in New York City (in the 1990s), the LGBT community began promoting condom use among its members to protect from AIDS. France recounts watching "a team of

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Martin, John L; Dean, Laura; Garcia, Marc; Hall, William (1989). "The impact of AIDS on a gay community: Changes in sexual behavior, substance use, and mental health".

1436:' primary commitment to take care of their patients and was becoming a public health issue. Callen even applauded the negative responses to their advocacy published in 4198: 851:. The advice to cut down on only the frequency of sex and sexual partners was even less productive under the "new virus model" as opposed to the multifactorial model. 3671: 2691:

Martin, John L (2016). "AIDS Risk Reduction Recommendations and Sexual Behavior Patterns among Gay Men: A Multifactorial Categorical Approach to Assessing Change".

1234:(which it seemed to be at the time): they believed that stopping exposure to semen and CMV after infection could improve the health of the infected individual. The 802:

virus (HIV) that PWA (and people with HIV pre-AIDS) have and uninfected people do not. Either way, they conclude in all capital letters that AIDS PATIENTS HAVE AN

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said, "at last: a response to the effect of aids on our lives that goes beyond fears and myths to suggest positive actions." David France called it "a survival

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attempted to address every element of its education in a sex-positive and affirming way. "Remember that the issue is disease—not sex," they tell their readers.

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in not only preventing future transmission to uninfected people but also to protecting the person with AIDS from being exposed to more pathogens through sex.

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As you read on, we hope we make at least one point clear: Sex doesn't make you sick — diseases do. Gay sex doesn't make you sick — gay men who are sick do.

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In this section, Callen and Berkowitz elaborate on the multifactorial model to provide a basis for later applications of safe sex practices. They cite the

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crisis and their shared belief in what Callen described as the danger of "put political considerations over the tragedy of even a single gay man's death."

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Gottlieb, Michael S; Schroff, Robert; Schanker, Howard M; Weisman, Joel D; Fan, Peng Thim; Wolf, Robert A; Saxon, Andrew (1981). "Pneumocystis carinii

1613:"stake in keeping us promiscuous," according to the authors. There was a common notion in the community at the time that STDs were supposed to be what 1210:

responsible for causing AIDS—and failed to recognize that a single exposure could result in infection. Under the multifactorial model, kissing a PWA,

924:, others became monogamous, and many made no changes whatsoever --, behavioral studies showed "dramatic declines" in risk-related sexual behavior in 3871: 583:

when it comes to accepting that this is inherently a more dangerous position to be in, in terms of contracting AIDS. This is a prime example of how

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Wilton, James (Fall 2012). "Putting a number on it: The risk from an exposure to HIV." CATIE: Canada's source for HIV and Hepatitis C information.

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about the sexual practices of queer men in the 1980s, David France estimates that tens of thousands of lives were saved by the safe sex movement.

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http://www.slate.com/articles/health_and_science/science/2015/04/latex_condoms_are_the_worst_why_after_all_these_years_don_t_we_have_a_better.html

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However, all three authors firmly believed in the importance of disseminating their message despite negative reactions. Callen wrote in his book

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lovers and use protection. Given scientific evidence against casual transmission of AIDS, the authors saw no reason to discourage other forms of

2144: 3783: 3613: 273:

in the 1960s and '70s, sex in urban gay epicenters was not only newly acceptable, but also often seen as key to gay identity and resistance to

3221:

Oliver, Chris. "Who was reading 'How to Have Sex in an Epidemic'?" London school of Hygiene and Tropical Medicine Archives, 12 December 2014.

619:

The authors include various pieces of advice about how to change or moderate one's sexual behavior to avoid getting infected. Among these are

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between the people involved about the need to have safe sex, which can naturally be incorporated into the customary setting of boundaries,

575:/men who are penetrated in gay sex. The authors incorporate a feminist critique into the pamphlet, arguing that the ingrained concept that 2544: 1238:

latency period had not yet been defined, and accounts of people with AIDS, including Berkowitz himself, maintaining a relatively healthy

4719: 4151: 2282:

Sonnabend, Joseph A; Witkin, Steven S; Purtilo, David T (1984). "A Multifactorial Model for the Development of Aids in Homosexual Men".

4588: 3828: 1428:

that "to be attacked for trying to save the lives of others was deeply wounding. But we felt we had no choice." Sonnabend argued that

1191:

the first section of the booklet, CMV could be substituted for the new, unidentified retrovirus that was hypothesized to cause AIDS.

4011: 3901: 2863: 2798: 2640: 2586: 1897: 1037:

were rejected, and attempts to create a broader educational campaign built around the booklet's teachings were blocked by both the

1780:. Our promiscuity taught us many things, not only about the pleasures of sex, but about the great multiplicity of those pleasures. 4714: 3758: 3135:

Adnum, Mark. "Saving Safe Sex: An Interview With Richard Berkowitz." HuffingtonPost, 6 February 2013. Retrieved 14 December 2017.

2087: 1913:

Merson, Michael H; O'Malley, Jeffrey; Serwadda, David; Apisuk, Chantawipa (2008). "The history and challenge of HIV prevention".

1586: 254: 2598:

Baumann, Jason. "A Prophecy Before Our Time: The Gay Men's Health Project Clinic Opens in 1972, Part Two: A Wasted Opportunity"

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The authors identified this as a high risk activity, stating that there is no way to rim in a risk-free way without being in a

408: 314: 4749: 4491: 3753: 3549: 3461: 3356: 3300: 3272: 3256: 3193: 3156: 2212: 2095: 881:, we must stay healthy. To stay healthy, we must realize that the issue isn't gayness or sex; the issue is simply disease." 335:

to queen," between themselves and the people for whom they created the manual. Callen even educated himself about different

2606: 858:

sex was highly criticized by the straight majority, but telling one's partner one's name will not make a difference to the

4553: 4067: 4047: 3778: 3666: 1560:

to interview the authors about their work. Callen, Berkowitz and Sonnabend also received response letters from around the

939: 168: 3562: 2954: 4729: 4666: 3939: 3927: 3808: 3768: 1058:

with AIDS, which, despite being based on a now-defunct notion of how the syndrome arose, was important in combating the

204:

around AIDS transmission prevention. The new agent theory proposed that AIDS was caused by a single, previously unknown

4134: 2341:

https://books.google.com/books?id=nf-xokXdGegC&q=cmv+causing+cellular+abnormalities+1980s+causing+aids.&pg=PA21

571:. Callen and Berkowitz made sure to acknowledge, however, that this statement about high risk is not a condemnation of 4438: 4062: 3991: 3949: 3693: 3651: 3080: 2632: 2025: 1007:

to appeal to gay men, among other demographics. Due to the awakening to safe sex in the LGBT community, condom use in

789:

as the rest of the population, desire the same human contact and will simply end up being unwilling to disclose their

666:

This activity, although it is described as "extremely dangerous" in other capacities, had no known connection to AIDS.

260: 3525: 2938: 4128: 4052: 4042: 3773: 3606: 2517: 2516:

Escoffier, Jeffrey (1998–99). "The Invention of Safer Sex: Vernacular Knowledge, Gay Politics and HIV Prevention."

2336: 1042: 213: 1589:

in San Francisco at the beginning of 1983, although it is less often credited as being foundational for safe sex.

657:

describes water sports as something to be avoided, particularly anything that resulted in urine inside the rectum.

4602: 4570: 4558: 4511: 4087: 3292: 413: 111: 3065: 4443: 4293: 4166: 3854: 3813: 3541: 2140:

Sonnabend, Joseph. "The First Safe Sex Guidelines Proposing The Use Of Condoms For AIDS Prevention," POZ Blog.

1811: 1549: 1038: 2658: 2334:

Scientific Errors and Controversies in the U.S. HIV/AIDS Epidemic. How They Slowed Advances and Were Resolved

1540:, although it is unclear whether they were aware of the explicit content of the manual before purchasing it. 1321:

men/MSM) in New York City. Sales exceeded what the authors had expected, and within two weeks of the initial

1118:

and power in gay sex was vital; Sonnabend himself recognizes that "perhaps the most valuable contribution of

4661: 4533: 4408: 4326: 4228: 3793: 3788: 2600: 1889: 1456: 1168: 597: 298:

in the 1970s, despite the fact that many other sexually transmitted diseases, including cytomegalovirus and

4744: 4373: 4346: 4336: 4258: 4243: 4141: 3961: 3891: 3698: 3688: 3173: 1130:

In 1981, when Sonnabend was formulating the multifactorial theory of HIV/AIDS transmission, the available

628: 3581: 3313:

Weinberg, Martin S; Williams, Colin J (1975). "Gay Baths and the Social Organization of Impersonal Sex".

781:

thing from their minds." The solution, they argue, does not involve treating people with AIDS (PWA) like

4656: 4610: 4548: 4538: 4448: 4383: 3954: 3922: 3859: 3683: 3599: 1745: 1710: 1666: 1433: 1429: 1199: 980: 743:

poppers outside the realm of disease transmission, including the drugs' extreme toxicity when swallowed.

704: 327: 1740:

in an Epidemic is evidence of a larger trend occurring in the 1980s and 1990s in which the impetus for

920:

Although MSM showed a wide range of responses to the epidemic in terms of sexual practices—some became

441:

It remains in the body for more than a year after the immune system has fought off its initial effects.

3120: 942:

MSM continued to rise or stayed static in the later half of the 1980s. Gay rights activist and writer

4739: 4625: 4543: 4458: 4433: 4418: 4356: 4308: 4288: 4213: 4208: 4193: 3934: 3866: 3235: 3103:

Callen, Michael and Richard Berkowitz. "We know who we are: two gay men declare war on promiscuity."

2291: 2141: 1815: 1606: 964: 189: 3222: 1605:

have acknowledged the importance of the pamphlet and others like it to the evolution of the broader

1532:, a surprising number of which were in traditionally conservative states that still had functioning 1049:

it being "infuriating" that in 1985, the city still hadn't adopted any standard safe sex education.

444:

It often manifests again in people with severely compromised immune systems (i.e., those with AIDS).

122:

to prevent the transmission of STDs in men having sex with men, and has even been named, along with

4640: 4615: 4583: 4501: 4473: 4423: 4341: 4331: 4283: 4273: 4263: 4238: 3849: 3823: 3105: 3044: 1438: 1106:, safe sex, particularly the use of condoms that had been traditionally seen as only necessary for 1098:

in and of itself, made it much more effective and well-received by the gay community. According to

174: 600:

where both people have been tested. Their advice is to avoid it unless the above criteria are met.

548:

before coming to prevent exposing their partner to semen. They also point out the risk of condoms

514:

is to avoid having your partner come in your mouth, and, if they do accidentally, to spit out the

26: 4630: 4620: 4528: 4523: 4496: 4483: 4468: 4453: 4403: 4366: 4351: 4303: 4298: 4278: 4248: 4223: 4183: 4175: 4107: 4102: 3971: 3896: 3798: 3519: 3386: 3330: 3078:

Armstrong, Elizabeth A. Forging Gay Identities: Organizing Sexuality in San Francisco, 1950–1994.

3061: 2840: 2716: 2521: 2472: 2464: 2315: 2255: 2247: 1938: 1239: 976: 975:

lovingly hurl the things into the air like rose petals over the heads of their gay brothers" on

624: 545: 448: 1354:, said of the pamphlet: "this is the sanest, most sensible advice I've read yet about AIDS" and 798:. For a person with AIDS to go to the baths or backrooms would therefore be "extremely unwise." 2541: 1450:

in an Epidemic. "It turns out historically to have been one of the advantages of our status as

1194:

However, there are several instances in which the advice is inaccurate and no longer a part of

753:

their employees are healthy, they cannot actually know for sure and cannot be entirely trusted.

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as moralistic and attributed the advice against some types of sex to internalized homophobia,

1383: 1099: 943: 869:

and making sure the information one gets about the disease is reliable by looking at multiple

824: 366: 274: 266: 225: 99: 37: 3234:

Lieberson, Jonathan. "Anatomy of an Epidemic." The New York Review of Books, 18 August 1983.

1154:

virus is unconscionable"; however, the multifactorial model also came under attack for being

1077:

over abstinence—as being key in "a generation of prevention approaches to follow," including

803: 4635: 4413: 4393: 4388: 4318: 4253: 3996: 3490: 3425: 3417: 3378: 3322: 3019: 2988: 2980: 2900: 2892: 2824: 2760: 2752: 2700: 2439: 2418: 2408: 2369: 2299: 2239: 1922: 1793: 1749: 1690: 1660: 1521: 1139: 714: 386: 201: 107: 4146: 3886: 3656: 3276: 2665: 2548: 2148: 1777: 1761: 1647: 1513: 1500:

In his memoir, Berkowitz wrote, "there was little chance we would water down our safe sex

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that makes it easily transmittable and impossible to discern when picking sexual partners.

456: 417: 310: 245:

the dangers of each type of contact and various methods to protect oneself from exposure.

221: 3371:

Health: An Interdisciplinary Journal for the Social Study of Health, Illness and Medicine

2607:

https://www.nypl.org/blog/2013/12/20/mens-health-project-clinic-opens-wasted-opportunity

2295: 579:

is compromised in the act of being penetrated in gay sex can create a certain degree of

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risk for contracting AIDS at some point during the year. They stress that sex is not a

828: 463: 347:, can be traced back to the "self-help model" promoted in the women's health movement. 270: 103: 41: 2955:

https://www1.nyc.gov/assets/doh/downloads/pdf/condoms/condom-availability-timeline.pdf

2881:"Epidemiology of HIV Infection in the United States: Implications for Linkage to Care" 1926: 1860: 827:, were, even before the outbreak of AIDS, often accused of having too much sex by the 771:

context because sex workers were key to the national and international spread of AIDS.

4703: 4077: 3986: 2844: 2578: 2259: 1797: 1772:

We were able to invent safe sex because we have always known that sex is not, in an

1765: 1355: 1226:

The multifactorial model also gave the authors and their writing a certain degree of

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was its ability to propose condom use in a manner that was able to celebrate sex."

1107: 1059: 1019: 988: 925: 747: 620: 572: 416:

in a New York City cohort in 1981, but later estimate that CMV was present in ¼ of

344: 336: 322: 278: 216:(HTLV). According to the multifactorial theory, however, continual overexposure to 3269: 3526:

https://www.nytimes.com/1987/08/03/opinion/when-doctors-refuse-to-treat-aids.html

2939:

https://www.cdc.gov/nchhstp/newsroom/images/2012/incidence-fact-sheet-figure7.jpg

1102:, given that many members of the LGBT community saw gay sex as transgressive and 843:, and therefore giving up sex to avoid getting AIDS is not the same as giving up 4016: 3917: 3708: 2969:"Increase in condom sales following AIDS education and publicity, United States" 2867: 2802: 2678: 2373: 2204: 2084:

How to Survive a Plague: The Inside Story of How Citizens and Science Tamed AIDS

1819: 1533: 1404: 1322: 1220: 1180: 1103: 870: 859: 848: 695:. True to their sex-positive style, they recommend making showering part of the 568: 560: 431: 299: 282: 3382: 2704: 1483:

ultimately, it may be more important to let people die in pursuit of their own

3976: 3818: 3646: 3539:

Fighting for Our Lives: New York's AIDS Community and the Politics of Disease.

2575:

Hold Tight Gently: Michael Callen, Essex Hemphill, and the Battlefield of AIDS

1801: 1753: 1721: 1553: 1505: 1334: 1330: 1254: 1203: 1155: 1115: 1023: 960: 947: 866: 865:

This section of the manual also highlights the importance of talking to one's

832: 790: 640: 447:

It was also found in some KS tumors of people with AIDS, and can activate the

390: 230: 209: 124: 3421: 3066:

https://partners.nytimes.com/library/national/science/aids/timeline80-87.html

2443: 2413: 3406:"Only Your Calamity: The Beginnings of Activism by and for People with AIDS" 3268:"AIDS Prevention Flyers: Can We Talk?", Pacific Oregon University Archives. 1698: 1536:. The frank description of gay sex did not seem to dissuade more mainstream 1501: 1484: 1464: 1379: 1279: 1243: 1207: 1063: 1046: 1015: 855: 808: 692: 648: 576: 515: 422: 3504: 3439: 2914: 2774: 2451: 2432: 1934: 1822:

in their attempts to understand the risks associated with contracting HIV.

3002: 2984: 2836: 2712: 2659:

http://www.catie.ca/en/pif/summer-2012/putting-number-it-risk-exposure-hiv

2461:. If this is an intentional citation to a retracted paper, please replace 2381: 2311: 1325:

they had ordered a second batch, and, soon after, a third to meet popular

4082: 3981: 3678: 3626: 3495: 3478: 2896: 1773: 1756:

knowledge" from within the gay community, such as the vocabulary used in

1686: 1670: 1610: 1468: 1451: 1443: 1195: 1176: 1159: 1135: 968: 921: 874: 757: 696: 674: 538: 508: 452: 394: 356: 205: 152: 130: 59: 2862:

Chambers, David L. (1994). "Gay Men, AIDS, and the Code of the Condom."

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https://richardberkowitz.com/category/4-how-to-have-sex-in-an-epidemic/

2828: 2251: 1741: 1625: 1561: 1488: 1432:

and the "desire to be nonjudgemental" were beginning to interfere with

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bilateral prevention of disease transfer in sex work is important in a

732: 661: 632: 604: 591: 549: 529: 277:. AIDS brought up a renewed fear about negative media coverage and the 119: 3334: 1724:

as something so radical that, had they discussed its feasibility with

114:(MSM) about how to avoid contracting the infecting agent which causes 4122: 2626: 1834:

is featured in the second episode of the fifth season of the podcast

1621: 1601:

received for what many perceived as a criticism of promiscuity, many

1476: 1326: 1151: 1143: 1078: 1012: 877:. They conclude: "If we are to celebrate our gayness and get on with 782: 724: 684: 636: 564: 2243: 1257:, as well as the authors themselves, recognize that the creation of 1018:

diagnoses dropped significantly, up to 80% between `83 and `86 in a

528:

oral sex probably has no risk for the receiver, but there are still

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https://www.plannedparenthood.org/learn/stds-hiv-safer-sex/hiv-aids

1442:, because it ended up causing debate and dramatically widening the 1022:

of New York City primarily white MSM. Despite the lack of concrete

3591: 3236:

http://www.nybooks.com/articles/1983/08/18/anatomy-of-an-epidemic/

2142:

http://aidsperspective.net/articles/Callen-Berk_collaboration4.pdf

1785: 1642: 1414: 1363: 1338: 1318: 1263: 1231: 996: 984: 935: 899: 786: 476: 472: 217: 3223:

http://blogs.lshtm.ac.uk/library/2014/12/12/reading-sex-epidemic/

2540:

Sonnabend, Joseph. "A doctor in the trenches." AIDS Perspective.

2230:

Crimp, Douglas (1987). "How to Have Promiscuity in an Epidemic".

184:

infection was common at the time and led to the development of a

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implications of their safe sex advice, specifically the loss of

1418: 1342: 1227: 1131: 992: 840: 241: 129:

as one of the foundational publications in the advent of modern

115: 3595: 3249:

After the Wrath of God: AIDS, Sexuality, and American Religion.

2360:

and Mucosal Candidiasis in Previously Healthy Homosexual Men".

1650:

have demonstrated tremendous change. So must the next 13 years.

1198:

education. The authors put more emphasis than necessary on the

3641: 3622: 3369:

Flowers, Paul (2016). "Gay Men and HIV/AIDS Risk Management".

1629: 1618: 1472: 1219:. The multifactorial model was also unnecessarily critical of 1110:

sex, was therefore a "normalization" of gay sex and a loss of

148: 118:. It was among the first publications to recommend the use of 4038:

European and Developing Countries Clinical Trials Partnership

563:

of semen into the rectum, where it is easily absorbed by the

2542:

http://aidsperspective.net/articles/adoctorinthetrenches.pdf

2397:"Questioning the HIV-AIDS Hypothesis: 30â€‰Years of Dissent" 1689:

and to prevent oneself from getting sick was the essence of

1341:

of us passed around copies, hungry for guidance through the

3151:

University of Chicago Press, first edition (June 1, 1999).

3017:

We Should Have a Better Condom by Now. Here's Why We Don't.

2967:

Moran, J S; Janes, H R; Peterman, T A; Stone, K M (1990).

1504:

to make it more presentable for the general public in the

1399:

Many gay community members and leaders saw the writing in

1081:(which was criticized for its emphasis on abstinence) and 372:

The categories below contain summaries of the chapters of

3205:

Sonnabend, Joseph. "Promiscuity is bad for your health."

3168:

Berkowitz, Richard. "4. How to Have Sex in an Epidemic."

1278:

than it needed to be, given that it operated on the sole

1114:. Thus, safe sex education that did not detract from the 412:

study that found that traces of CMV were found in 94% of

3721:

WHO disease staging system for HIV infection and disease

3251:

Oxford University Press; first edition (July 1, 2015).

3149:

Victory Deferred: How AIDS Changed Gay Life in America.

2951:

A Brief History of the NYC Condom Availability Program.

1810:

was an important medical text in that it gave straight

1011:

MSM between 1983 and 1987 quadrupled, and as a result,

4689:

List of HIV/AIDS cases and deaths registered by region

2351: 2349: 1163:

according to Callen and Berkowitz, a tool used by the

707:, Bookstores, Balconies, Meatracks and Tearooms" and " 3290:

Practicing Desire: Homosexual Sex in the Era of AIDS.

1479:

sexual behavior. In "We Know Who We Are" they wrote:

835:/self-denial and encourage a sex-positive mentality. 240:, describes how, in the early years of the epidemic, 4684:

List of countries by HIV/AIDS adult prevalence rate

4649: 4601: 4569: 4510: 4482: 4317: 4174: 4165: 4073:

President's Emergency Plan for AIDS Relief (PEPFAR)

4058:

Joint United Nations Programme on HIV/AIDS (UNAIDS)

4025: 3910: 3842: 3746: 3634: 83: 75: 65: 55: 47: 33: 3209:September 13–26, 1982. Retrieved 14 December 2017. 1655:For the People With AIDS Self-Empowerment Movement 653:Because CMV is found in high quantities in urine, 3188:HarperCollins, first edition (November 1, 1990). 2801:. National Academies Press, First Edition, 1993. 1861:"2000 Honoring with Pride: Joseph Sonnabend, M.D" 1520:archives, the pamphlet was purchased by numerous 1463:Callen and Berkowitz do address the personal and 1150:group might be carrying a potentially fatal new, 1041:and organizations within the LGBT community. The 854:Callen and Berkowitz also bring up the fact that 16:1983 book by Richard Berkowitz and Michael Callen 3110:November 8—21, 1992. Retrieved 14 December 2017. 3083:, December 15, 2002. Retrieved 14 December 2017. 2136: 2134: 2132: 2130: 2128: 2126: 2124: 3672:National Addiction and HIV Data Archive Program 3270:http://exhibits.lib.pacificu.edu/items/show/940 2792:The Social Impact Of AIDS In The United States. 2122: 2120: 2118: 2116: 2114: 2112: 2110: 2108: 2106: 2104: 1770: 1639: 1481: 1393: 1167:to justify homophobia and dialogues condemning 952: 3351:Crown Forum, Reprint edition (June 22, 2004). 1788:was highly prevalent, many mainstream medical 1693:at a time when AIDS was taking away gay men's 1518:London School of Hygiene and Tropical Medicine 1508:." Although he and Callen both stressed that 1475:the community might experience from having to 1230:that the endpoint to AIDS was not necessarily 713:These locations, generally sites designed for 3607: 2868:https://repository.law.umich.edu/articles/91/ 2803:https://www.ncbi.nlm.nih.gov/books/NBK234564/ 2679:https://www.aidsmap.com/Poppers/page/1322957/ 2512: 2510: 2508: 2506: 1673:occurring around the country, pamphlets like 677:, etc. that occurs in the context of S&M. 309:, its San Francisco counterpart written by a 224:(CMV) in semen, lead to an eventual state of 8: 2734: 2732: 2730: 2504: 2502: 2500: 2498: 2496: 2494: 2492: 2490: 2488: 2486: 95:How to Have Sex in an Epidemic: One Approach 19: 3764:Diffuse infiltrative lymphocytosis syndrome 3456:Routledge, first edition (April 27, 1994). 3143: 3141: 2786: 2784: 2536: 2534: 1681:have been described as key elements of the 4516: 4171: 3997:People With AIDS Self-Empowerment Movement 3614: 3600: 3592: 2931:Centers for Disease Control and Prevention 2475:|...|intentional=yes}} 2284:Annals of the New York Academy of Sciences 1884:Trickett, Edison J., and Willo Pequegnat. 1683:People With AIDS Self-Empowerment Movement 25: 18: 3564:Episode 2: How to Have Sex in an Epidemic 3494: 3472: 3470: 3454:Safety in Numbers: Safer Sex and Gay Men. 3429: 2992: 2904: 2764: 2741:"The Syndemic of AIDS and STDS among MSM" 2422: 2412: 2195: 2193: 2191: 2189: 2187: 2185: 2183: 2181: 2179: 2177: 2078: 2076: 2074: 2072: 2070: 2068: 2066: 2064: 2062: 2060: 2058: 2056: 2054: 1804:and the affected communities they study. 1329:. David France describes himself and his 979:. Condoms rose in popularity "as fast as 2935:HIV Prevalence and Incidence, 1980-2010. 2817:American Journal of Community Psychology 2619: 2617: 2615: 2201:Staying Alive: The Invention of Safe Sex 2175: 2173: 2171: 2169: 2167: 2165: 2163: 2161: 2159: 2157: 2052: 2050: 2048: 2046: 2044: 2042: 2040: 2038: 2036: 2034: 2020:Callen, Michael, and Richard Berkowitz. 1908: 1906: 3582:Image files giving the text of the book 3544:, annotated edition (August 21, 2006). 3217: 3215: 3131: 3129: 3099: 3097: 3095: 3093: 3091: 3089: 3049:Film, 2008. Retrieved 14 December 2017. 3038: 3036: 3034: 3032: 2277: 2275: 2273: 2271: 2269: 2016: 2014: 2012: 2010: 2008: 2006: 2004: 2002: 2000: 1998: 1996: 1994: 1992: 1990: 1988: 1986: 1984: 1982: 1980: 1978: 1976: 1974: 1972: 1865:amfAR, The Foundation for AIDS Research 1852: 1701:against heteronormativity through sex. 1669:, the San Francisco model of care, and 1333:being "absorbed" by the material: "the 1313:was met with a mixed response from its 3119:"HIV/AIDS." Planned Parenthood, 2017. 2926: 2924: 2858: 2856: 2854: 2569: 2567: 2565: 2563: 2561: 2559: 2557: 2225: 2223: 2221: 1970: 1968: 1966: 1964: 1962: 1960: 1958: 1956: 1954: 1952: 1593:For HIV/AIDS Activism and Gay Politics 4033:Discredited HIV/AIDS origins theories 3517:"When Doctors Refuse to Treat AIDS." 2653: 2651: 2649: 556:Getting fucked (i.e. anal-receptive): 376:and the arguments presented therein: 7: 3295:, first edition (November 1, 1996). 1748:for HIV/AIDS came directly from the 987:" and it soon became common to see " 522:Getting sucked (receiving oral sex): 430:Cytomegalovirus itself is a type of 4152:The Freddie Mercury Tribute Concert 2028:, 1983. Retrieved 13 December 2017. 1306:By the New York City LGBT community 518:to reduce the risk of transmission. 4735:Sex education in the United States 2304:10.1111/j.1749-6632.1984.tb37134.x 1171:, as well as a reflection of the " 815:Guilt, morality and sex negativity 651:(sexual activity involving urine): 14: 3738:Countries by AIDS prevalence rate 3479:"How AIDS Invented Global Health" 3410:American Journal of Public Health 2973:American Journal of Public Health 2864:University of Michigan Law School 1262:suggesting that one place a thin 1202:argument—that there are inherent 776:Should people with AIDS have sex? 718:solutions, then, as presented in 188:surrounding both the disease and 4199:Democratic Republic of the Congo 3759:AIDS-defining clinical condition 2339:: December 2007. First Edition. 2088:Knopf Doubleday Publishing Group 2026:News from the Front Publications 1886:Community Interventions and AIDS 1646:belief. The last 13 years since 1597:Despite the negative press that 1587:Harvey Milk LGBT Democratic Club 1572:Social scientists have credited 1564:and from international readers. 1360:The Homosexualization of America 255:LGBT rights in the United States 3483:New England Journal of Medicine 2362:New England Journal of Medicine 1582:Sisters of Perpetual Indulgence 931:How to Have Sex in an Epidemic. 459:(both common symptoms of AIDS). 409:New England Journal of Medicine 315:Sisters of Perpetual Indulgence 20:How to Have Sex in an Epidemic 2757:10.1179/2050854913Y.0000000015 2022:How to Have Sex in an Epidemic 1832:How to Have Sex in an Epidemic 1808:How to have Sex in an Epidemic 1758:How to Have Sex in an Epidemic 1574:How to Have Sex in an Epidemic 1545:How to Have Sex in an Epidemic 1510:How to Have Sex in an Epidemic 1272:How to Have Sex in an Epidemic 1259:How to Have Sex in an Epidemic 1188:How to Have Sex in an Epidemic 1120:How to Have Sex in an Epidemic 1091:How to Have Sex in an Epidemic 1070:How to Have Sex in an Epidemic 946:summarizes the impact of this 891:How to Have Sex in an Epidemic 820:How to Have Sex in an Epidemic 389:resulting from the binding of 374:How to Have Sex in an Epidemic 363:How to Have Sex in an Epidemic 319:How to Have Sex in an Epidemic 291:How to Have Sex in an Epidemic 197:How to Have Sex in an Epidemic 181:How to Have Sex in an Epidemic 1: 4068:Misconceptions about HIV/AIDS 4048:International AIDS Conference 4002:HIV/AIDS in the porn industry 3945:Discrimination against people 3552:. Retrieved 14 December 2017. 3528:. Retrieved 14 December 2017. 3464:. Retrieved 14 December 2017. 3359:. Retrieved 14 December 2017. 3349:The Death of Right and Wrong. 3303:. Retrieved 14 December 2017. 3279:. Retrieved 13 December 2017. 3259:. Retrieved 14 December 2017. 3225:. Retrieved 14 December 2017. 3196:. Retrieved 14 December 2017. 3159:. Retrieved 14 December 2017. 3123:. Retrieved 14 December 2017. 3068:. Retrieved 14 December 2017. 3059:The AIDS Epidemic: 1981–1987. 3026:. Retrieved 14 December 2017. 2957:. Retrieved 14 December 2017. 2941:. Retrieved 14 December 2017. 2805:. Retrieved 14 December 2017. 2681:. Retrieved 14 December 2017. 2668:. Retrieved 14 December 2017. 2643:. Retrieved 13 December 2017. 2625:Moving Politics: Emotion and 2609:. Retrieved 14 December 2017. 2589:. Retrieved 13 December 2017. 2551:. Retrieved 13 December 2017. 2528:. Retrieved 13 December 2017. 2518:Berkeley Journal of Sociology 2215:. Retrieved 13 December 2017. 2151:. Retrieved 13 December 2017. 2098:. Retrieved 13 December 2017. 1927:10.1016/S0140-6736(08)60884-3 1900:. Retrieved 13 December 2017. 1760:being brought into a broader 169:HIV/AIDS in the United States 3928:Catholic Church and HIV/AIDS 3809:HIV Drug Resistance Database 3238:. Retrieved 14 December 2017 2885:Clinical Infectious Diseases 1524:(twelve known examples) and 4229:Côte d'Ivoire (Ivory Coast) 4063:Media portrayal of HIV/AIDS 3992:List of HIV-positive people 3081:University of Chicago Press 2790:National Research Council. 2633:University of Chicago Press 2374:10.1056/NEJM198112103052401 2343:Retrieved 13 December 2017. 1665:Along with buddy programs, 1576:and a 1982 pamphlet called 1454:," he was quoted saying in 889:The penultimate section of 623:and alternative methods of 402:CMV in connection with AIDS 261:Media portrayal of HIV/AIDS 229:by the transmission of the 4771: 4720:Books by Richard Berkowitz 4129:Reports from the Holocaust 4053:International AIDS Society 4043:Elton John AIDS Foundation 3383:10.1177/136345930100500103 2705:10.1177/109019818601300406 2693:Health Education Quarterly 2401:Frontiers in Public Health 2395:Goodson, Patricia (2014). 1708: 1658: 1543:The primary readership of 1062:that many PWA faced after 539:anal penetrative/insertive 354: 258: 252: 214:Human T-lymphotropic virus 172: 166: 4679: 4519: 4088:Treatment Action Campaign 3804:Tuberculosis co-infection 3667:disease progression rates 3587:Archived copy of the book 3293:Stanford University Press 3172:Wordpress, 29 June 2010. 2879:Moore, Richard D (2011). 1792:refused to offer care to 1528:, as well as seven known 1496:By the straight community 1287:Publication and reception 483:Ethics and responsibility 249:LGBT culture and politics 112:men who have sex with men 106:, under the direction of 24: 3814:Innate resistance to HIV 3784:Neurocognitive disorders 3542:Rutgers University Press 3477:Brandt, Allan M (2013). 3422:10.2105/AJPH.2013.301381 2937:NCHHSTP Newsroom, 2012. 2677:"Poppers." NAM AIDSMAP. 2444:10.3389/fpubh.2019.00334 2414:10.3389/fpubh.2014.00154 1812:healthcare professionals 1550:New York Review of Books 1408:frequent accusations of 1378:did receive significant 1039:New York City government 1029:However, the authors of 959:Even before mainstream, 4715:Books by Michael Callen 4135:AIDS–Holocaust metaphor 4118:Gay Men's Health Crisis 3794:Opportunistic infection 3537:Chambré, Susan Maizel. 3147:Andriote, John-Manuel. 2601:New York Public Library 1890:Oxford University Press 1715:Along with Play Fair!, 1697:and ability to enact a 1568:Historical significance 1487:than to limit personal 1457:How to Survive a Plague 1382:from other gay men and 1169:sex outside of marriage 1043:Gay Men's Health Crisis 627:, including the use of 598:monogamous relationship 361:The primary message of 4755:HIV/AIDS in literature 4725:English-language books 4710:1982 non-fiction books 3962:HIV-affected community 3902:HIV and homosexual men 2739:O'Leary, Dale (2014). 1782: 1652: 1493: 1397: 1186:Despite the fact that 957: 785:, as they are just as 617:Low risk alternatives: 475:isolation of CMV from 4750:Sexuality and society 4142:Silence=Death Project 3940:Criminal transmission 3860:Multiple sex partners 2985:10.2105/AJPH.80.5.607 2745:The Linacre Quarterly 2635:, December 15, 2009. 2629:'s Fight against AIDS 2467:|...}} 2438:(Retracted, see 1711:Sex positive movement 1667:The Denver Principles 1512:was not intended for 1434:medical practitioners 1430:political correctness 1175:tradition of blaming 873:and doing individual 670:Sadism and masochism: 507:Sucking (i.e. giving 4464:United Arab Emirates 3935:Circumcision and HIV 3892:City of Hope Patient 3652:structure and genome 3496:10.1056/NEJMp1305297 3404:Wright, Joe (2013). 3207:The New York Native, 2891:(Suppl 2): S208–13. 2199:Berkowitz, Richard. 1750:infected communities 1607:LGBT rights movement 1270:Berkowitz describes 1206:patterns in the MSM 1003:and expanding their 462:Like HIV, CMV has a 98:is a 1983 manual by 4730:History of HIV/AIDS 4012:AIDS Memorial Quilt 3824:HIV-positive people 3106:The New York Native 2605:December 20, 2013. 2332:Holmberg, Scott D.. 2296:1984NYASA.437..177S 1776:or not, limited to 1491:by regulating risk. 1439:the New York Native 1352:The Joys of Gay Sex 950:safe sex advocacy: 434:that is present in 175:History of HIV/AIDS 21: 4589:Dominican Republic 3972:HIV/AIDS denialism 3897:Women and HIV/AIDS 3887:The London Patient 3754:Signs and symptoms 3662:CDC classification 3520:The New York Times 3275:2017-12-17 at the 3170:Safe Sex Positive. 3062:The New York Times 2953:NYC Condom, 2015. 2897:10.1093/cid/ciq044 2866:: 29(2), 353–385. 2829:10.1007/BF00931037 2664:2017-12-16 at the 2623:Gould, Deborah B. 2573:Duberman, Martin. 2547:2017-12-16 at the 2147:2016-06-29 at the 1446:and popularity of 1240:standard of living 977:Christopher Street 963:-regulated condom 691:soap scrub called 449:Epstein Barr virus 179:In May 1983, when 4697: 4696: 4675: 4674: 4597: 4596: 4078:The SING Campaign 3967:HIV/AIDS activism 3955:Cost of treatment 3877:Timothy Ray Brown 3872:World AIDS Museum 3288:Dowsett, Gary W. 3247:Petro, Anthony M. 3184:Callen, Michael. 1921:(9637): 475–488. 1733:For Public Health 1726:social scientists 1384:gay organizations 1142:or the new agent 1100:Jeffrey Escoffier 944:Jeffrey Escoffier 825:transgender women 380:What causes AIDS? 313:group called the 275:heteronormativity 267:Sexual Revolution 226:immunosuppression 195:At the time when 163:HIV/AIDS epidemic 100:Richard Berkowitz 91: 90: 76:Publication place 38:Richard Berkowitz 4762: 4667:Papua New Guinea 4517: 4172: 3616: 3609: 3602: 3593: 3569: 3568: 3559: 3553: 3535: 3529: 3524:August 3, 1987. 3515: 3509: 3508: 3498: 3474: 3465: 3450: 3444: 3443: 3433: 3401: 3395: 3394: 3366: 3360: 3345: 3339: 3338: 3310: 3304: 3286: 3280: 3266: 3260: 3245: 3239: 3232: 3226: 3219: 3210: 3203: 3197: 3182: 3176: 3166: 3160: 3145: 3136: 3133: 3124: 3117: 3111: 3101: 3084: 3075: 3069: 3056: 3050: 3040: 3027: 3022:, 2 April 2015. 3015:Anderson, L. V. 3013: 3007: 3006: 2996: 2964: 2958: 2948: 2942: 2928: 2919: 2918: 2908: 2876: 2870: 2860: 2849: 2848: 2812: 2806: 2788: 2779: 2778: 2768: 2736: 2725: 2724: 2688: 2682: 2675: 2669: 2655: 2644: 2621: 2610: 2596: 2590: 2571: 2552: 2538: 2529: 2514: 2481: 2480: 2478: 2476: 2468: 2457:Retraction Watch 2436: 2426: 2416: 2392: 2386: 2385: 2353: 2344: 2330: 2324: 2323: 2279: 2264: 2263: 2227: 2216: 2197: 2152: 2138: 2099: 2080: 2029: 2018: 1947: 1946: 1910: 1901: 1882: 1876: 1875: 1873: 1871: 1857: 1794:people with AIDS 1691:self-empowerment 1661:People with AIDS 1522:public libraries 1134:did not clearly 765:How to Have Sex, 720:How to Have Sex, 526:How to Have Sex, 387:immune complexes 281:violations that 202:sexual education 108:Joseph Sonnabend 67:Publication date 29: 22: 4770: 4769: 4765: 4764: 4763: 4761: 4760: 4759: 4700: 4699: 4698: 4693: 4671: 4645: 4593: 4565: 4506: 4478: 4424:Myanmar (Burma) 4313: 4161: 4147:Day Without Art 4093:The Global Fund 4021: 3950:Economic impact 3906: 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1912: 1911: 1904: 1892:, 2005, p. 60. 1883: 1879: 1869: 1867: 1859: 1858: 1854: 1849: 1828: 1778:penetrative sex 1762:epidemiological 1738:How to Have Sex 1735: 1717:How to have Sex 1713: 1707: 1675:How to have Sex 1663: 1657: 1634:How to Have Sex 1603:queer theorists 1599:How to Have Sex 1595: 1570: 1498: 1448:How to Have Sex 1401:How to Have Sex 1389:New York Native 1376:How to Have Sex 1372: 1315:target audience 1311:How to Have Sex 1308: 1303: 1294: 1289: 1165:religious right 1128: 1083:The Global Fund 1031:How to Have Sex 918: 909: 887: 817: 778: 740:How to Have Sex 655:How to Have Sex 610:How to Have Sex 585:How to Have Sex 494: 492:Risk categories 485: 457:lymphadenopathy 418:sexually active 404: 382: 359: 353: 289:The authors of 263: 257: 251: 222:cytomegalovirus 220:, specifically 212:similar to the 177: 171: 165: 144: 139: 84:Media type 68: 40: 17: 12: 11: 5: 4768: 4766: 4758: 4757: 4752: 4747: 4742: 4737: 4732: 4727: 4722: 4717: 4712: 4702: 4701: 4695: 4694: 4692: 4691: 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