Welcome to the history of the 1983 invention of the first, sexually explicit, safe sex guidelines that went way beyond condoms. This is how it happened…

In August 1982, my doctor, Joseph Sonnabend, diagnosed me with early symptoms of AIDS. Everything I’d read said no one survives. I was 26 and doomed. When I told Sonnabend that, it became the day he saved my life.

He said AIDS was new, so there were no experts, so why would I assume I was doomed? Was I stupid enough to believe whatever I read or saw on the news? Suddenly, I had hope.

Sonnabend said doctors treating gay men with AIDS forgot the old credo, “first do no harm.” Some were using treatments that hastened early AIDS deaths. Sonnabend was using prophylaxis medications to prevent infections that were needlessly killing young gay men with AIDS.

I went to work in Joe’s office to learn all I could. While organizing his massive library, I found his published research in the “Journal of Virology.” I discovered Joe was more than a doctor — he was a world class virologist with a distinguished history in lab research.

Joe introduced me to another patient, Michael Callen, to write and alert gay men. Our November 1982 articles, “A Warning to Gay Men with AIDS”, and “We Know Who We Are,” called for the end of urban gay male promiscuity, but I had nagging doubts.

Three months earlier, I was doing sex work to pay for grad school at NYU, until I woke up to AIDS, stopped having sex and disconnected my phones. One night, a pushy client named Tom rang my doorbell for sex.

The word AIDS was only 4 months old, so I had to explain what it meant. I assumed Tom would fly out my door in fear, but instead, he asked, “Can’t you just put on your leather and boots, let me worship you, and jerk off?

As soon as Tom came and left, I ran to my typewriter and typed, How to Have Sex in an Epidemic. That was my eureka moment in December 1982.

Every day at Dr. Sonnabend’s frantic office, while he was treating sick, dying and AIDS-panicked gay men, I began pestering him about ways to make sex safe.

“Is sex all you care about?” Joe yelled at me. No, but I had nurtured a close circle of friends and ex-lovers who were my gay family, who I wanted to protect and grow old with.

So, I kept pestering JOE until one day, he exploded:

“All my patients with a history of oral and penile sexually transmitted infections (STIs) are not showing signs of AIDS – it’s only my patients with a history of rectal STIs who are.”

After that bombshell sunk in – receptive intercourse was the risk — I was able to finish writing How to Have Sex in an Epidemic.

In February 1983, when Mandate magazine decided to publish my article, Joe recognized its importance. But it took 9 months for my article to come out, and I refused to wait. That’s when Joe had the idea to publish it ourselves.

He got Michael Callen to join us and turn my article into a booklet we self-published in May 1983. At that time, America had 1,400 cases of AIDS, 558 deaths and 70% were gay men. Our guidelines worked, so what happened?

Gay leaders who encouraged the gay sexual revolution of the 1970s hated us for writing that promiscuity was causing AIDS in gay men, so they cancelled us for our mistake instead of confronting their own: they unwittingly contributed to the deaths of their own people.

It took two agonizing years after our booklet came out for gay leaders to agree on what to say in the first safe sex campaign in the NYC area – which had half of all the AIDS cases in America for the first 20 years. By the time Act Up began in April 1987, AIDS cases had climbed to 50,000 from 1,400 when our booklet came out.

For 40 years, the most consistent attack on How to Have Sex…is that we were wrong about the cause of AIDS — but that ignores what we got right.

As Joe explained, when a new epidemic appears, scientists examine the evidence and propose theories to minimize risk. Theories are just frameworks. They’re often wrong in detail, but that’s all scientists have when people start dying and we need ways to limit sickness, death and contagion.

Sonnabend used cytomegalovirus (CMV) as a hypothesis. When HIV was discovered 3 years later, it spread the same way as CMV, entering the bloodstream from getting fucked by infected partners.

So, Dr. Joe was right about the risk of receptive intercourse. And that’s what scientific theories can accomplish — if ideologues without expertise don’t get in the way, as they did with our invention of safe sex guidelines.

Sonnabend taught me and Callen that in science, as in life, there’s always more to learn, that the nature of being human is we all make mistakes. That’s often how progress gets made.

I was 26 when I told Joe I was doomed. This October (2025), I turn 70. I want to thank everyone who continues to honor those we loved and lost – including people like me — who could have still been here with us today.

You won’t find that in AIDS or queer history books, because the first casualty in any war is truth.

Richard Berkowitz

July 2025

(Below are older introductions to this website. History never stands still so my introductions keep reflecting that.)

Welcome:

I remember gay sex in the 1970s.  I came out in 1972 at age 17.

When I moved to NYC in 1979, I became immersed in gay men’s political and sexual subculture.  It radicalized me and propelled my efforts at writing and activism. 

This website contains some of my key writings and collaborations from that era, including the invention of safe sex guidelines and the Denver Principles, which launched a global movement for medical patient empowerment. The original text of How To Have Sex in an epidemic is here.  

In May 1983, How to Have Sex... gave gay men the tools to remain sexually active AND stop the sexual transmission of AIDS, but while safe sex guidelines made sense to ordinary gay men, and later, women and people in general, some community leaders failed us. In their quest for mainstream respectability, they were more concerned with how promoting gay safe sex would appear, than with confronting what was: our best and only chance to stop sexually active gay men from being infected with HIV — and reduce or eliminate exposure to many sexually transmitted viruses and infections.

When safe sex was invented in 1983, gay men could talk about being victims of a virus but not behavioral changes that could have ended the sexual transmission of AIDS when it began. 

Luckily, common sense prevailed.  Safe sex went on to define the era.

 I created this website (see post below) to focus on safe sex issues and keep a radical history of safe sex alive. New technologies keep changing what safe sex issues are.  They will probably continue to do so.  Still, as a resource and archive into the past, this website remains useful to writers, researchers and filmmakers. I thank them for their support and encouragement.

My New Writing Is Here: