And that’s why birds do it, bees do it
Even educated fleas do it
— Cole Porter, 1928

Recently I was asked a question that, in various forms and various contexts, comes up from time to time. It goes something like, “Do you believe that gay men are having more risky sex as treatments for HIV have improved?” My responses to the question and its variants have improved over time. A few years ago, for example, I was still answering the surface question with something like, “I don’t know that we have data to support an answer one way or the other.”

I’ve heard that lizards and frogs do it
Layin’ on a rock.
They say that roosters do it
With a doodle and cock.
— Cole Porter, 1928

Then after a while I tried out some other responses. These went more along lines of: “No, that is not my belief. However, my beliefs are not what I think you are actually asking about.” What followed in many cases was a set of subject switches in which my interrogator only asked questions, rarely if ever actually making statements. Still these questions all pointed to an underlying, but apparently unpolitic, statement: gay men are irresponsible and reprehensible. Improving AIDS treatment only encourages their outlandish behaviors.

Some Argentines, without means do it;
I hear even Boston beans do it.
— Cole Porter, 1928

However, the most recent experience I had with this question of risky sexual behaviors of gay men got a different response from me. The question came in a group of people studying to become medical professionals. My response is one that I think I will use for a while to test how it works. It goes something like this:

Click on this picture of Ella Fitzgerald for a link to her singing this song.

It might be helpful to consider how viruses work. If you shake hands with someone who has a virus and sneezed on their own hand or failed to wash their hands recently, you might contract that virus. If you kiss someone with a virus, say, something like the Zika virus, it is believe that this mosquito-borne virus can be transmitted among humans. Similarly, Ebola virus spread fairly rapidly from infected patients to those who cared for them, even through skin contact. You might also get the flu, Zika, a cold, or Ebola, if the person who served me in a fast food restaurant recently had those viruses and waited on you. She wiped her nose on the side of the vinyl glove on her hand, the glove likely meant to be a health precaution. But, hand-shaking and kissing does not cause a virus. Unless the virus is in the population you kiss or shake hands in, you cannot get it. The virus must be present.

When the US generally viewed gay men and injection drug users as expendable in the 1980s because the virus appeared to be contained in their communities, it created a situation in which the prevalence of the virus in those populations made it spread quickly, through body fluids to sex partners and care givers. I would guess that the risky sex you are talking about is not dissimilar from the sex you yourself have, but you don’t consider it risky because the virus is not prevalent in among your sex partners.

The most refined lady bugs do it
When a gentleman calls.
Moths in your rugs, they do it.
What’s the use of moth balls?

The chimpanzees in the zoos do it,
Some courageous kangaroos do it
— Cole Porter, 1928

Heterosexual teens across the U.S. are plagued with chlamydia and other sexually transmitted infections. Gynecologists and pediatricians are having conversations with teens that would have been unimaginable twenty years ago. Some are fielding questions about the number of sex partners it is possible to safely have at a sweet 16 party. Obstetric nurses are reporting second and third pregnancies among 14 year old girls. Still, the question comes down to, “Do you believe that gay men are having more risky sex as treatments for HIV have improved?” We will not be ready to address the pressing issues of sexual health, sexual misconduct, or even public health overall until we learn to chill about sex.

I’m sure sometimes on the sly you do it.
Maybe even you and I might do it.
Let’s do it; let’s fall in love!
— Cole Porter, 1928