Coming Unwrapped

Novice Sister Donna Vanewday sways to the pounding dubstep in Old Town's CC Slaughters nightclub, cooling himself with a black fan. It's hot as hell inside a nun's habit.

He's a towering penguin in black patent leather stripper boots, bright pink lipstick, white foundation and two bright blue butterflies painted like a mask over his eyes. Novice Sister Donna is by day John Clark, a thickly built, 31-year-old who works in IT and whose full, brown goatee makes his makeup even more ironic.

He's an aspiring member of the Sisters of Perpetual Indulgence, a troupe of habit-wearing men whose holy mission is to cast out the stigma of being gay. 

"Sleep with everybody you want—here's a condom, here's some lube, be safe," Clark says.

Tonight, Novice Sister Donna is following others from the group in an effort to get clubgoers into the restroom.

That's where two Multnomah County health workers have transformed the stalls into a makeshift lab, ready to stick needles in patrons' arms to test for HIV—and, recently, syphilis.

The sexually transmitted disease known for ravaging figures from Al Capone to Charles VIII of France is staging what public health officials call an astronomical comeback: Cases of syphilis in Multnomah County have increased tenfold in the past five years.

Public health officials thought they were once on the brink of eradicating the venereal disease that—until the 1970s—was the dominant infectious danger of having sex without a condom.

Reports of syphilis in the county have jumped from 22 in 2008 to 208 last year. While the numbers seem relatively low—the county has a population of 748,000—the increase in the Portland area is far steeper than in most U.S. cities.

And here's what is even more worrisome for public health officials: Virtually all cases involve men who have sex with other men.

"I've seen more syphilis in the past two years than I have in the last 20 years," says Mary O'Hearn, clinical director of the HIV clinic at Oregon Health & Science University. "This is really something quite out of the ordinary."

O'Hearn and county health officials say unless the rate of infection is reversed, the number of cases could continue to double every year and move into the broader population.

The county's syphilis epidemic is symptomatic of a bigger problem: the false sense of security among many in the gay community that modern drugs mean HIV is no longer the death sentence it once was, and there shouldn't be societal pressures to always wear a condom during sex.

"There is a fight in the gay community of 'We don't want to have to use condoms, we don't want to give up our sexuality,'" says Michael Kaplan, former director of Portland's Cascade AIDS Project who now heads AIDS United in Washington, D.C.

The debate about condom use—antithetical to the public health message promoted during earlier AIDS battles—has been going on for years.

But this is the first time Portland has seen a major outbreak as a consequence, and public health officials say they haven't solved the mystery of why syphilis rates are exploding here. They also worry a corresponding increase in HIV diagnoses—something they have not yet seen—may soon follow.

As this public health fight is raging, the argument of defiance about condoms is getting louder.

And in Portland, the extreme view is personified in a gay porn star named Dice.

John Small has been a porn actor during the past eight years. One of his most recent scenes was made in Portland, and you can see it for $9.99 a month on a website called Damon Dogg's Cum Factory [NSFW, duh].

In the video, Dice—muscular, well-hung and with his stage name tattooed on his chest—has oral sex with another man. And then the other actor—wearing nothing but a straw cowboy hat and cock ring—flips Dice onto his stomach. The camera then makes the viewer more acquainted with Dice's anus than most of us will ever be with our own, and the other actor has sex with Dice, without a condom.

Dice, 26, is HIV positive. He says he's never had syphilis and gets tested for other STDs regularly. All the porn the Portland resident shoots—including this one, filmed on the east side—is done bareback.

When he shoots porn, here and in San Francisco, no one talks about HIV status or other sexually transmitted diseases. "You don't yuck other people's yums, if that makes sense," he explains. "You kind of know what you're getting into. It's up to you whether you're going to risk anything or not."

There's no evidence gay men are getting syphilis more often because porn actors are having unprotected sex. But the scene shot in Portland is becoming more and more common, appealing to a growing market of viewers who see sex without condoms as more sensual, and even as a statement of sexual freedom.

One of the most outspoken and divisive voices of the movement is Paul Morris, owner of Treasure Island Media, a San Francisco studio that shoots only bareback porn. (Dice has shot for Treasure Island Media, and has even had the company's logo tattooed on his perineum.)

Morris says movies that show men using condoms only serve to keep them in what's labeled the "appalling phenomenon of the HIV closet." Advances in medications, he says, have made HIV virtually a nonissue.

Moreover, Morris argues, movies that depict condom use are hypocritical.

"The only men who seemed to consistently use condoms were porn actors who wore them in front of the camera," he tells WW in an email. "And the sex that was captured by the camera in no way resembled the sex that I was seeing—and engaging in—everywhere.

"A basic lie was being told to the cameras and to the men who were watching the videos. I decided to film sex the way the men actually had sex, without moralistic judgment, and privileging honesty and actual documentation."

But others in the gay community say Morris' message is dangerous.

Andrew Klaus-Vineyard is a Portland filmmaker whose erotic movies are filled with gay sex. He says he goes out of his way to show the actors are using condoms.

"Sometimes, I think I'm overfocusing on the condom use," Klaus-Vineyard says. "Like, maybe I only need a three-second shot of the condom wrapper, not five."

Klaus-Vineyard, 34, says that's the problem. If there aren't erotic images of condom use in films, then it's not an erotic fantasy to mirror in the bedroom. "For better or worse," he says, "whether we want to admit it or not, people learn sex through porn."

But many people understand that Morris' views—while fringe—arises from the complicated history of HIV and AIDS. Before the disease took hold, gay men experienced the "most libertine period since Rome," according to the 2005 documentary Gay Sex in the 70s.

That decade saw the rise of a gay revolution that lasted until AIDS devastated the community and touched off a stigma that for many still survives, says Kim Toevs, director of the Multnomah County Health Department's sexually transmitted diseases, HIV and hepatitis C virus program.

"For some people, the trauma and grief they've not fully processed and healed from is tied up in sex and condoms," she says.

But others say it's partly reflective of a larger trend: As HIV becomes manageable with daily meds, men are shedding condoms in favor of unprotected sex.

"The marketing for HIV medication companies—'Look, I have HIV and I'm carrying a kayak!'—inadvertently has created this second effect of getting people thinking HIV isn't as dangerous," explains Michael Anderson-Nathe, director of Prevention and Education Services at CAP.

Dice has been on the anti-viral drug Complera since he was first diagnosed with HIV in 2012. His viral load is undetectable—reducing the risk of transmission by 96 percent, according to one often-cited study. His HIV-positive status is disclosed on his online dating profiles and websites. (He's known as johnakadice on the amateur porn site Xtube).

In his private life, if someone wants to use a condom, he's game. But he's not about to change the way he does porn. "I like the feeling of it physically and mentally," Dice says. "It's more raw and real, literally and metaphorically speaking."

And he says the kind of porn he appears in has nothing to do with the choices that people make for themselves.

"No matter what, people are going to do what they do," he says. "I did what I did. Everybody makes their own decisions."

For much of history, syphilis has been the scourge of the sexually active. Nicknamed in the Middle Ages "the French Disease"—it was often introduced to populations by invading armies—syphilis's corkscrew-shaped bacterium, Treponema pallidum, drills into the skin and spreads throughout the body. Unchecked, syphilis can spread to the blood, causing heart problems, mental disorders, blindness, nerve system problems and even death. But it can still be cured with what Multnomah County's Toevs calls "a whopping dose of penicillin."

One in three men don't exhibit symptoms, which can include sores, rashes and hair loss. It's not commonly included in STD screenings, and Toevs says it's so rare now that many doctors don't recognize it. And she says studies have shown syphilis sores increase the risk of HIV transmission by up to five times.

"Syphilis hugely increases risk of transmission and acquisition of HIV," OHSU's O'Hearn says. "We have definitely seen cases where people were infected at the same time with both."

About half the new cases of syphilis found in Multnomah County are among men who already have HIV. The Centers for Disease Control and Prevention has a name for the practice of two HIV-positive men seeking each other out so they don't have to use a condom: "serosorting."

This practice can explain why syphilis rates are increasing among gay men nationwide even as the disease declines overall.

But some parts of the country are seeing higher numbers overall, largely in cities on the West Coast, including Seattle and San Francisco. King County—home of Seattle—has syphilis rates half that of Multnomah County. San Francisco's rates are above those here, but the Portland area has seen a far faster increase.

No one is certain why Portland is seeing such steep increases in syphilis rates among gay men, compared to other cities. But there are theories.

Toevs, the county health official, says the city's small size may have made it easier for syphilis to spread. "We may have had a couple of people who were really infectious at the same time and in an extensive sexual network, and it gave it a jump from there," she says.

Barbara McCullough-Jones, director of the Q Center, a nonprofit meeting space for members of the lesbian, gay, bisexual, transgender and queer communities, says she wonders if the county is missing the mark when it pitches safety only to men who have sex with men.

"There's the Portland persona of a much younger generation coming here, with a different kind of gender and sexual fluidity," she says. "Somebody who doesn't see themselves in that kind of messaging is not going to get the message."

Other cities have pushed their concerns about rising syphilis rates into the public consciousness. When syphilis cases spiked in 2010 in San Francisco, public health officials there launched a phone app to help men gauge risky sexual behavior. That same year, Seattle started a website called syphilisrising.org.

While the cities of Seattle and San Francisco issued press releases and got coverage on blogs and in some mainstream press, Toevs says Multnomah County's approach has been quieter. "I didn't want to stigmatize a population that can already be stigmatized," she says.

The county sent out a public health alert, asked HIV care providers to test for syphilis up to four times a year, and advertised on gay hookup websites and apps, such as Grindr, Growler and Sacked. The county already supplies 158,000 condoms targeted to gay men each year through organizations like CAP and the Sisters of Perpetual Indulgence.

But public officials have not called out people who say condom use is passé or inhibiting—a change from the approach of 20 years ago, when government's message about safe sex was uniformly forceful.

"We aren't the condom police," says Letty Martinez of Cascade Aids Project, which works with the county on testing, safe-sex education and condom distribution. "The mission of CAP is to end the stigma of HIV and to prevent new cases. But we have to meet people where they are."

Toevs says condemning people for not using condoms will simply alienate many. "My job in public health is to help them make healthy choices, not to shame them if they don't," she says. "Otherwise, they won't come back for services they need."

But Klaus-Vineyard says CAP and the county should send a louder direct message. "If not them, then who?" he asks, throwing his hands up. "That is West Coast hippie-dippy BS. I'm sorry, but people are dying and participating in reckless behavior."

A young man with an eyebrow ring passes Novice Sister Donna Vanewday, who reaches out and bops him on the ass with her fan. The man turns, raises an eyebrow and without a word takes the fan, returns the gesture, and walks away.

"This fan has smacked so many butts," Clark, aka Donna, says, smiling.

The sisters love a party. In the sisters' purses are "bliss kits" for clubgoers, small bags holding two condoms, lube and a breath mint. 

Clark says it's still important for the sisters to push condoms.

"People get comfortable," Clark says. "They think we have the cure for so many different things. But is it worth 30 minutes of joy to have something that's going to affect you for the rest of your life?"

Becoming a member of the Sisters of Perpetual Indulgence, Benevolent Order of Bliss, takes at least a year and a near-religious calling. Novices, like Clark, get lipstick, a white veil and scapular. Each wannabe sister must complete a community-service project before being recognized as a fully professed sister.

As a novice, Clark says, he can't speak for the sisters. But outreach nights like this at CC Slaughers are what Clark says motivate him.

Clark says he came out five years ago at age 26 after growing up Mormon in Utah. "You know Mormons, of course, are going to shove it under the rug," he explains. "I did a lot of research online before I had sex. That drew me to the sisters, because they're open about everything."

There's a lot of men who are safety conscious, Clark says, but not many know a condom must be worn to prevent transmission of diseases like syphilis during oral sex, too. 

He's not sure how many care.

"People have gotten a little more lax," he says. "You can get a shot, wait a couple of days and go back to whatever you're doing. It seems like we do have a sexual revolution coming around. We're making sure they have the tools to be safe.” 

WWeek 2015