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"It's about shifting directions in queer men's health, taking some focus off of HIV and AIDS and putting it on some of the other health concerns. ... We're tying to motivate queer men to start a grassroots movement around our own health." Libey said issues that need more attention include drug and alcohol use, eating disorders, body-image problems, the new drug-resistant staph bacteria, and all of the older sexually transmitted diseases, including hepatitis, gonorrhea, chlamydia and syphilis. "We've seen a number of pretty dramatic syphilis outbreaks among queer communities all around the country," Libey noted. The summit offered more than 130 workshops, institutes, caucuses and meetings dealing with youth, aging, transgender men, bears, Daddies, two-spirited men, non-gay men who have sex with men, long-term HIV survivors, 9/11 survivors, "differently dicked" individuals, public sex, S&M, bisexuality, prostitution, queeniness, drag, barebacking, porn, gaydar, cum, erotic yoga, tantra, massage, microbicides for anal sex, ethical slutiness, party drugs, tobacco use, leadership, racism, self-esteem, domestic violence, intimacy, trust, recovery, burnout, religion, anti-gay churches, prostate and testicular cancer, hepatitis C, HIV vaccines, new HIV drugs, failed HIV prevention programs, holistic medicine, health-marketing campaigns, the Internet, the war on terrorism, marriage, and third-wave feminism, among other topics.
"Gift-givers and bug-chasers definitely exist," said Libey. "But in my experience as an HIV-prevention worker and as someone who does pre- and post-test HIV counseling, it's not the most common thing that I see." Libey dismissed as suspect the controversial Rolling Stone magazine article that suggested 25 percent of new HIV infections result from bug-chasing -- the deliberate seeking out of HIV infection by having unprotected receptive anal sex with an HIV-positive "gift-giver." Rofes said there's no simple answer to the problem of people who get off on infecting someone or becoming infected. "Punitive approaches to gay men often get us what we don't want," he said. "So I wouldn't advocate closing down those [gift-giver/bug-chaser] Web sites, and I wouldn't advocate discouraging people from advocating those practices. I would, if I believed discouraging the most-at-risk gay men would make them not do it, but I don't believe it works that way." The Web sites actually are a good thing, Rofes said. "Web sites are really great places for people to get off without creating much risk to themselves," he said. "I think that's true in extreme sex in general." The work of bringing down the HIV transmission rate does not need to be concerned with "individual people's fetishes," Rofes said, but rather with barriers that prevent people from taking control of their sex lives. "As we approach 25 years into the epidemic, the powerful and almost unitary AIDS approach to gay men's health has produced problems for us," he said. "Starting to look at cultural interventions around health in the community in a big-picture way, without even talking AIDS, might end up having people take better care of themselves and be more conscious of various health challenges, including HIV. "We're struggling to find a way to make it exciting and meaningful to get involved with building life-affirming, sustaining queer-men's health communities," he said. "We're at the start of determining what that looks like, how that avoids being sanitizing and middle-class and 'goodie,' and how it can appeal to mass numbers of people. We face a huge challenge and we've just started the work. We're looking at getting at the underlying causes that create cycles of health challenges to gay men: Continued generations of people who feel a huge amount of shame and guilt around not only their gay identities but around their sexual desires and practices. People who feel disempowered. People who feel like their sexual, their spiritual, their physical and mental health are separated and fragmented." If the summit's vision becomes reality someday, said Donald Hitchcock of the National Coalition for LGBT Health, "We will be able to address a lot of the issues that maybe lead to higher rates of HIV infection such as mental health and substance abuse. "The ideal clinic that we would all like to see in our communities," Hitchcock said, "would be one where you would go in and it wouldn't be just focused on getting your AIDS test. You would have a doctor that could address all your health needs, asking you about your allergies, when the last time was you had a testicular exam. Wouldn't it be nice that those HIV clinics could become those centers that we could go to? This sort of broader approach is what we're working on in the [LGBT health] coalition as well."
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Members of the "collective" that organized the third NationalGay Men's Health Summit May 7-11 in Raleigh, N.C. 
National Gay Men's Health Summit convener Eric Rofes
addresses the opening session. 
Equality North Carolina Assistant Director Ian Palmquist at the National
Gay Men's Health Summit