“What are you doing New Year’s Eve?” asks a grinning man in one Viagra magazine ad. “What are you waiting for?” another ad teases. When the AIDS Healthcare Foundation (AHF) sued Viagra-makers Pfizer Inc. last week for inviting Americans to party down with their erectile dysfunction (ED) medicine, it wasn’t the first complaint that those flirty ads encourage “off-label” use.

But the Los Angeles-based AHF also says in its lawsuit that Pfizer is promoting unsafe sex and HIV transmission. The group specifically blames the company for encouraging the practice among some gay men of taking Viagra to counter erection problems caused by the party drug crystal methamphetamine—and then having lots of unprotected sex.

AIDS activists came out against the lawsuit right away, warning AHF to keep its hands off this beloved, if often abused, little blue pill, and to stop feeding the twitchy-barebacker stereotype. Angry emailers pointed out that most gay men don’t use meth or have unsafe sex and that, by the way, people with HIV are tired of being told not to have sex at all. One described the lawsuit as “demonizing, stigmatizing,” while another trumpeted “political and sexual coercion.”

Out of sight of the lawyers and the activists, meanwhile, Viagra (and the other ED drugs, Eli Lilly’s Cialis and Bayer’s Levitra) continued to help people with HIV enjoy sex, and even sometimes help them to keep the sex safe.

That’s the way it is for Michael Pitkin, a 42-year-old consultant in Burbank, California. A year after his 2005 HIV diagnosis, Pitkin’s testosterone levels dropped so low that he couldn’t keep a condom on, until he finally requested a prescription from his doctor. “Without [Viagra], I couldn’t perform safe sex,” he says.

Low testosterone is not the only HIV-related erection-deflator. The cholesterol and triglyceride overloads that some HIV meds cause can lead to vascular problems. Then, not surprisingly, there’s a brain-sex connection.

“If you know you can perform well, you may have the physical capacity to match your psychological capacity,” says Kwame Banks, an HIV positive New Yorker who has seen ED drugs do wonders for transmission anxiety in sero-discordant relationships. Adds River Huston, who writes and performs about the dramas and comedies of HIV positive sex, “[ED drugs] let us see that sex isn’t over when you get HIV.”

The benefits aren’t just anecdotal. Judith Rabkin, PhD, a researcher at Columbia University, has found ED drugs helpful for positive people struggling with sexual intimacy problems in long-term relationships. She says the stability tends to be good for one’s health, too. “They have safer sex—and they take better care of themselves,” says Rabkin.

You may not even have to swallow the pill. “Sometimes they just keep a few pills as a security blanket,” say HIV doctor Frank Spinelli, MD, of his patients. “Viagra gives people something to hold onto.”

These drugs are chronically overprescribed, of course. “If you can masturbate but can’t perform with a partner, it’s not ED, it’s psychological,” says Barbara Zeller, MD, of New York City’s Project Samaritan AIDS Services. “But ED is self-reported, like pain. You’re not going to check on whether a guy can get an erection.” And the dangerous three-way connection between ED drugs, crystal and unsafe sex is well established, with the risk of contracting HIV and other STDs through the roof.

The question is: Who besides the drug-takers themselves should be held responsible for the abuse? When the AHF filed its lawsuit last week, Pfizer issued a statement saying, “Pfizer does not promote Viagra for recreational use… Pfizer recognizes that the transmission of HIV and other sexually transmitted diseases is a significant health issue.”

You could try and hold doctors responsible, but many of them already balk when positive patients ask for a script. “Many assume that positive people have unsafe, excessive sexual practices,” says meth expert and psychiatrist Steven Lee, MD, while, according to Dr. Zeller, “Any [negative] man in the world gets Viagra if he asks.”

In fact, AHF critics say the lawsuit promotes that HIV-phobic attitude among medical providers. Los Angeles activist/writer Peter M. thanks the foundation, tongue in cheek, for ensuring that “once an HIV infection is diagnosed, patients must be made to see that any subsequent sexual activity is simply out of the question.”
 
As for Michael Pitkin, he is going without Viagra for now. He refused to sign a patient education form at his doctor’s office because he saw it as “a waiver stating that I would not run around using Viagra and infecting HIV negative people.” He felt the form discriminated against people with HIV.