I was thrilled to be asked to be a guest on the Dr DILF podcast, hosted by the talented Simon Fox. We talked about memory, about what we can learn from the AIDS crisis, and about sex, which public discussion of that history tends to leave out.
The AIDS crisis emerged in the early 1980s, bringing widespread illness, fear and bereavement before effective HIV treatment. By November 1995, around 10,000 people had died from AIDS in the UK. Combination treatment transformed survival in 1996, but communities still live with loss. The epidemic continues. Although the sense of immediate crisis has receded, its effects shape the lives of people with and without HIV. People are still getting infected, getting ill, and on rare occasion, dying from HIV-related illnesses. Similarly, they still experience the effects of trauma, depression, and low mood.
What the campaigns left out
State-funded public health campaigns in the 1980s and 1990s spoke of risk, body fluids, and transmission. They said little about the role of sex in queer culture. For many gay and bisexual men, sex was how we met each other, made friends, and found a community in towns and cities where we faced hostility. Sexual liberation was a form of resistance. It asserted our right to our own bodies, after decades in which the law, the church and medicine had called us sinful and diseased.
When the virus arrived, the official message asked men to stop having sex or to hide it. Many refused and organised their own response. In the 1990s, groups such as Healthy Gay Manchester, Gay Men Fighting AIDS in London, and the Eddystone Trust in the south west ran campaigns that spoke to gay men about the sex they were having. They worked on the scene, in bars and clubs, and they treated pleasure as part of health. This was collective care, run by the community for itself.
Queer sex in old age
The 25 men I interviewed for Where Have All the Good Men Gone?, my study into the long-term effects of the UK AIDS crisis in the 1980s and 90s, are in their fifties, sixties, seventies, and eighties. They talk about sex with honesty and humour. They describe desire that has continued long after the deaths of friends and lovers, or becoming infected themselves. Yet health policy says little about older gay men, and even less about their sex lives.
Our sexualities are central to who we are. The World Health Organisation defines sexual health as a state of physical, emotional, mental, and social wellbeing in relation to sexuality. Research on minority stress shows that hiding our sexuality harms our mental health. Services that ignore the sex lives of older gay men ignore part of their wellbeing.
Some men describe learning to associate pleasure with danger. This is a long-term impact of institutional responses to a public health crisis.
How one crisis led to others
Effective treatment arrived in 1996, but the effects of the epidemic continued. Many older gay men live with loneliness after losing their friends. Some men use drugs during sex, known as chemsex, to feel close to partners, and this can cause harm. Charities, helplines, and social groups supported people during the crisis, and many of them struggle for funding today.
And gay men are still becoming infected. The epidemic is not over.
Younger gay men learn about sex and risk in a culture that the epidemic shaped. A young man on PrEP – a medication taken by people who do not have HIV to reduce their risk of acquiring the virus – may feel fear or shame about sex without knowing where those feelings came from.
Friendship, solidarity, and gay venues
The men I interviewed also described friendship and solidarity: nursing and cooking for each other, sitting by hospital beds when families stayed away. Terrence Higgins Trust buddy schemes matched volunteers with ill people. London Lighthouse provided residential and day care so people could live and die with dignity.
Sociologists have written about the value of weak ties. Strong ties are close friends, who for many gay men became, and still often become, their family. Weak ties are looser contacts, such as the barman who knew your drink, a regular at the sauna, a familiar stranger at the cruising ground, or the staff at Gay’s the Word bookshop. These ties often depended on gay venues. And they gave men a sense of belonging in times of deep fear.
Many venues have closed, including more than half of London’s LGBTQ+ venues between 2006 and 2017. Today’s scene caters to younger men, often promoting a narrow ideal of queer bodies. Some interviewees say nobody notices them in gay bars anymore. This ageism excludes them from the places that supported them during the crisis; closures compound the loss for men who lost many friends.
Why lived experience research matters to population science
Good public mental health research combines evidence: epidemiology shows how many people are ill and where they live; spatial analysis identifies neighbourhoods with the highest illness rates and available or missing services.
Lived experience research adds men’s accounts of how they understand what happened and its effects over forty years. Infection data cannot explain why a 70 year old fears a hospital letter; he can, if asked and given time. Medical science mostly measures symptoms and clinical outcomes. These accounts provide evidence it cannot collect alone.
What I am asking for
If you commission services, fund the community groups that keep older gay and bisexual men in contact with each other. If you work in health or social care, be ready to talk about sex and ageing with older patients. If you shape policy, treat grief after the AIDS crisis as an issue that continues to affect a whole generation of queer men.
You can hear the full conversation on the Dr DILF podcast, where Simon gave me more time to explore these issues.
