The discussion about how to stop the spread of HIV in the gay community has been heating up. Now that the focus on gay marriage is abating, the spotlight is coming back to the health crisis among gay men. The stubbornly high number of new infections in this country and around the world is frustrating. After three decades and all the efforts that have been made, why are we not more successful in promoting safer sex and reducing new infections?

The whole subject of safer sex is incredibly complex. There are no easy answers. Understanding human sexuality has stumped the most brilliant people for centuries. The question I pose here is whether having a norm of safer sex in the gay community is asking too much. Are we setting ourselves up for failure thinking that we can get the majority of gay men to wrap it up most of the time? My answer is no.

One million two hundred thousand people are estimated to be HIV-infected in this country. Half are men who have sex with men (MSM). There are 50,000 new infections in the U.S. each year—a number that has been stable for years. More than half of these new infections—about 30,000—are among MSM. Half of these infections come from men who don't know they are positive—15,000. That means that less than three percent of the 600,000 HIV-positive MSM in the U.S. pass the virus to another individual each year. If most men were not using protection, those numbers would be much higher.

Various anonymous surveys show that about two-thirds of gay men ‘always’ or ‘sometimes’ use condoms. If we were able to raise the ‘always’ number to half and have the ‘sometimes’ number at 30 percent—or 80 percent of gay men using condoms sometimes or always—infection rates would tumble. Is raising these numbers by those margins impossible? I don't think so, because we really haven't made a very good effort.

The success of the effort to promote safer sex in the gay community doesn't compare to other behavior modification campaigns like getting people to quit smoking or to buckle their seat belts.

Any serious effort to improve rates of safer sex must be fully embraced by the organized gay community and promoted down to the individual level—getting as close as possible to the heat of the moment. A game plan using the best evidence needs to be plotted, implemented, evaluated and sustained over a long period of time.

If we can win a herculean battle like defeating the Defense of Marriage Act, why can't we convince the community to adopt safer sex as a community norm?

We did it before, in the 1980s. We can do it again.