Medical Bias in the Health Care Smearing the Queer Medical Bias the Health Care of Gay Men This page intentionally left blank Smearing the Queer Medical Bias the Health Care of Gay Men Michael Scarce RRoutledge Taylor & Francis Group NEW YORK AND LONDON First published by Harrington Park Press, an imprint d! The HMVdrtl Press, Inc, 10 Alice Stmt Birmingham. NY 13904 *1580 Tills edition published 2011 by Routiedge 711 Third Awnue, New York. NY 10017, USA 2 Park Square, Milton Park. Abingdon, O*on OXt4 4RN Routledge Is an imprint of the Taylor & Fnarxrls Group, an informa business |t|Q9 i>y THr tta*o*fh Prate. Inc All rights ft:served. No pirt of ihr* wu»k may be Kpn. kJuccJ or unlived in any form or by any mean*, electron*: or mechanical, including ptoolocopyiM. microfilm, and recording., or h> nn> information storageand retrieval xvsiem. wiitoui permeation in writing from ihc puMi$te« Cover an by I jftda HivamkI. Cover design by Monica L. Seiferl. The Library of Comgrtss ha* cataloged the hardcover edition of this book as: Scarce, Michael Smearing ihe queer: medical bias in ifee health care of gav men Michael Scarce, p. cm Includes bibliographical references and indes. ISRN 0.7390-04HM) 1 Oty men—Medical cant. 2, HcttfOftttisnn. I. Tick- RA564.9.1I65S28 1999 3rKtr0ftf»ri4—dc2l 99-23095 HP ISBN 1-56023-926-3 <pbk) This book is dedicated to Matt Brown ABOUT THE AUTHOR Michael Scarce is a doctoral student in medical sociology and Coordinator of Lesbian, Gay, Bisexual, and Transgender Resources at the University of California, San Francisco. Serving as a national consultant and lecturer on sexual health, he is also the author of Male on Male Rape: The Hidden Toll of Stigma and Shame. His work has appeared in publications such as the Journal of Homo­ sexuality, Journal of American College Health, POZ magazine, and Diseased Pariah News. CONTENTS Foreword xi Eric Rofes Acknowledgments xv Introduction: Fucking with Technology 1 SECTION I: SMEAR AS DEFAMATION Dr. Kazal’s Ace in the Hole 9 Chapter 1. Harbinger of Plague: A Bad Case of Gay Bowel Syndrome 11 Gaying the Bowel 19 Siting the Bowel 23 Speaking in Syndromes 24 Dual Diagnoses 27 Prevention 28 In the Bowels of the Other 29 AIDS and Gay Bowel Syndrome: Causation, Correlation, and Conflation 32 The Homosexual Menace: Gay Bowel Syndrome As Grounds for Antigay Discrimination 36 Conclusions 41 SECTION II: SMEARING TO SPREAD A WET SUBSTANCE The Plumber’s Applause 49 Chapter 2. Gay Men and the Female Condom: Is Rectal Reality Getting a Bum Wrap? 51 Historical Reality 53 Sexual Governance 56 Feminizing Safer Sex Technology 59 Instructing the Anus 62 Queering Reality 68 The San Francisco Controversy 73 The Appropriateness of Appropriation 77 Threadbare Back 83 Chapter 3. Condomless Condoms: The Politics and Prospects of Rectal Microbicides 85 The Need for Rectal Harm Reduction 87 Rectal Microbicide Research and Development 95 Gendered and Anatomical Comparisons 98 Types of Microbicides 101 Prospective Politics 104 Left to Our Own Devices 108 SECTION III: THE SMEAR FOR MICROSCOPIC EXAMINATION A Recipe for Rectal Tarts (or, Just Add Feces and Stir) 113 Chapter 4. Queering the Smear: A Detective Named Pap 115 Carcinogenic Homosexuality 118 Smearing the Anus 121 Behind the Screen 122 Comparative Sex 128 Negotiating the Smear 133 Adviser 135 Chapter 5. Something Borrowed, Something Blue: Viagra Use Among Gay Men 137 Recreational Erections 141 Sex As a Class Act 144 Criminal Aids and Criminal AIDS 145 Conversion Therapy: Bottoms Become Tops 147 How Hard Is Hard Enough? 149 Real Men Don’t Need Viagra 151 SECTION IV: CLEARING THE SMEAR Immaculate Infection 157 Chapter 6. Heterocopulative Syndrome: Clinico-Pathologic Correlation in 260 Cases 159 Problem and Literature Review 160 Method 161 Results 162 Discussion 162 Conclusion 163 Chapter 7. Smear-Resistant Strategies 165 Notes 173 Index 189