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By the late 1980s, it looked as though the sexual party was over. Most gay men abandoned the sexual bacchanals that had been such a central aspect of gay culture. In the later 1980s and early 1990s, that recreational sexual culture began to be examined by some social commentators and therapists, and the picture they were painting was often not flattering (Quadland & Shattls, 1987). For example, psychologist Patrick Carnes (1983) began to popularize the concept of “sexual compulsivity” or “sexual addiction,” which remains a controversial concept because its central premise is based on a heteronormative concept of sexual behavior and frequency. While certainly sex had been a joyful expression of play, selfdiscovery, and interpersonal connection for many, there had always been those who had used sex as a way to cope with a variety of emotionally distressing realities such as boredom, depression, anxiety, and loneliness. Those men sought sex at least in part to anesthetize themselves against experiencing their uncomfortable feelings. In therapy, these clients struggled with the loss of their self-soothing behavior — sex — and with the abrupt change it had undergone from a source of relief and comfort to a profound source of uncertainty, anxiety, and fear. They wrestled with how to face and cope with feelings that had been intolerable and predated the emergence of AIDS. It didn’t help their already existing anxieties that they were now living in a fearful time, with AIDS wiping out large swaths of the urban gay communities across the nation. Some gay men found that their profound anxiety and fears sometimes interfered with their ability to adopt low-risk sexual practices. Some even discussed in therapy sessions how nerve-wracking it was for them not to be able to reduce their number of sexual partners or adopt safer sex precautions, even while knowing that it was precisely the sexual nature of HIV transmission that made them afraid and anxious. When talk therapy alone did not help, a referral to a psychopharmacologist for a prescription of antianxiety or antidepression medication sometimes was appropriate.

Gay men who had used sex as a central way to meet other men often found it difficult to change their patterns of seeking anonymous sex because they did not feel able to learn or comfortable with alternative ways to meet men, to socialize, and have their needs for intimacy and sex met. I reminded those clients that it was not sex with an anonymous partner or even many partners that placed them at risk for spreading HIV, but engaging in high-risk sex acts.