AIDS brought up a renewed fear about negative media coverage and the civil rights violations that LGBT people might face from targeted quarantines and a denial of basic healthcare services.

[6] A large sector of LGBT community leadership worried that raising awareness about AIDS and gay sex would be off-putting to the straight majority and damage the image of the subculture as a whole.

[14][15] The authors of How to Have Sex in an Epidemic were aware of the political risks they took in creating the booklet: Berkowitz noted in his autobiography the possibility that their writing could be used as ammunition by homophobic institutions and leaders.

[7] However, their advocacy was motivated by the increasingly critical state of the health crisis and their shared belief in what Callen described as the danger of "put[ting] political considerations over the tragedy of even a single gay man's death.

[5] The independent and community-driven nature of this approach to LGBT-related safe sex, according to Cindy Patton, can be traced back to the "self-help model" promoted in the women's health movement.

They summarize the characteristics of CMV and its links to AIDS as the following:[9] This part of the manual stresses the fact that it's not a single infection putting people at risk, but instead repeated exposure to the virus in semen, particularly through anal-receptive intercourse.

They recognize the importance of maintaining mental control during sex, and argue that although it's easy to forget about safety in the heat of the moment, the growing threat of sickness and death should be enough to motivate people to act with foresight.

They also emphasize the importance of communication with one's partner in the broader discussion of maintaining control, including the need to talk about health concerns, disease status, and convince him to engage in whatever sexual acts safely.

The authors describe their attempt to correct this incomplete advice by educating people on what types of sexual acts are higher risk as a way to present them with an alternative to abstinence/self-denial and encourage a sex-positive mentality.

[4] Callen and Berkowitz also bring up the fact that anonymous sex was highly criticized by the straight majority, but telling one's partner one's name will not make a difference to the infectivity of the pathogen.

[5][6] Afterwards, the authors realized the potential it had as a moral and emotional justification for the use of protection and added this section, starting by admitting, "It came as quite a shock to us to find that we had written almost 40 pages on sex without mentioning the word "love" once."

"[5][6] In this section, the authors describe the years post-Sexual Revolution as a time when sex and love were accepted as being distinct and that STD epidemics were a product of this newfound freedom, not just within the LGBT community but everywhere.

They add that, because many members of the LGBT community are not well educated or able to afford successive healthcare visits, it's doubly important to disseminate correct, reliable information was widely as possible.

France recounts watching "a team of lesbians on a flatbed truck lovingly hurl the things [condoms] into the air like rose petals over the heads of their gay brothers" on Christopher Street.

[5] Condom sales spikes in the mid 80s (20% between 1986–1987)[28] and companies began producing them in varying sizes, colors, and flavors and expanding their advertisements to appeal to gay men, among other demographics.

[22] Despite the lack of concrete statistics about the sexual practices of queer men in the 1980s, David France estimates that tens of thousands of lives were saved by the safe sex movement.

[6] All of their applications for grants were rejected, and attempts to create a broader educational campaign built around the booklet's teachings were blocked by both the New York City government and organizations within the LGBT community.

[26] However, the model set forth by Callen and Berkowitz at least provided the possibility of a "return to intimacy" for people with AIDS, which, despite being based on a now-defunct notion of how the syndrome arose, was important in combating the social death that many PWA faced after diagnosis.

[13] Sonnabend argued that "to propose without supporting evidence that any minority group might be carrying a potentially fatal new, mutant virus is unconscionable";[7] however, the multifactorial model also came under attack for being homophobic and moralistic in its approach to frequent and impersonal sex.

The new agent theory was adopted by the Gay Men's Health Crisis but was also, according to Callen and Berkowitz, a tool used by the religious right to justify homophobia and dialogues condemning sex outside of marriage, as well as a reflection of the "Western tradition of blaming calamity on the Third World.

[6] Following the discovery of the HIV and the almost unanimous acceptance of the single agent theory in the scientific community, the authors have acknowledged the inaccuracies in their safe sex manual, while pointing out its continued importance.

[6][7] Berkowitz describes How to Have Sex in an Epidemic as being more conservative than it needed to be, given that it operated on the sole principle that gay men should avoid getting sperm in their own or their partner's rectum without knowing the other's status.

[6] This independent publication method reflects the grassroots, personal nature of the pamphlet: as Sonnabend wrote, "HTHS originated entirely in the community of people with and at risk for AIDS, from individuals with no organizational affiliation.

[5] David France describes himself and his friends being "absorbed" by the material: "the pool table sat idle as a dozen of us passed around copies, hungry for guidance through the terror that sex was causing.

[15][7] It was not an easy message for some gay men to receive: in an interview for Berkowitz' biographical film, Sex Positive, Larry Kramer described it as a blast of "cold water in the face.

"[38] Sonnabend argued that political correctness and the "desire to be nonjudgemental" were beginning to interfere with medical practitioners' primary commitment to take care of their patients and was becoming a public health issue.

[5] Callen and Berkowitz do address the personal and political implications of their safe sex advice, specifically the loss of autonomy and joy the community might experience from having to police sexual behavior.

[13][43] Despite the negative press that How to Have Sex received for what many perceived as a criticism of promiscuity, many queer theorists have acknowledged the importance of the pamphlet and others like it to the evolution of the broader LGBT rights movement.

"[33][45] The viewpoint presented in the booklet is one that attempted to challenge the institutions that had arisen in the urban gay male community, including bathhouses and backrooms, that had an economic "stake in keeping us promiscuous," according to the authors.

[13][24] As Alan Brandt argues, the AIDS epidemic did more than any other to blur the line between the healthcare field and the people they treated; community-based care became a central model for public and global health efforts related to this particular disease.