by Zak Szymanski
http://www.ebar.com/news/article.php?sec=news&article=1311

  The Bay Area Reporter Online

  Issue:  Vol. 36 / No. 45 / 9 November 2006
  Serving the gay, lesbian, bisexual, and transgender
  communities since 1971

HIV campaigns spark debate

NEWS

  Published 11/09/2006

by Zak Szymanski

  z.szymanski@ebar.com

                               [07_HIV_Disclosure_45.jpg]

  Les Pappas, president of Better World Advertising,
  speaking Monday in front of the bus shelter posters for
  the "Disclosure" HIV prevention campaign. Photo: Rick
  Gerharter

                            Send to a Friend

  To a welcome reception on Monday, November 6, the San
  Francisco Department of Public Health released its
  long-anticipated "Disclosure" campaign. Featuring
  psychedelic photographic images by photographer Duane
  Cramer and emphasizing HIV status disclosure as a means
  of prevention, the DPH bus stop and billboard effort is
  a groundbreaking, community-led prevention method that
  marks the first time a public health agency has
  recognized the validity of "serosorting" - a longtime
  gay community practice where men have a variety of sex,
  some of it unprotected, with men of the same HIV
  status.

  "We as a health department are acknowledging what many
  men in the community have embraced as a harm reduction
  strategy," said Disclosure Initiative director Doug
  Sebesta. "Our campaign was really initiated to help
  people make better informed decisions. It's really
  empowering, and sex positive, and really about arming
  ourselves with more knowledge."

  The colorful advertisements are a piece of a much
  larger DPH project known as the Disclosure Initiative,
  which involves prevention and care professionals and
  community members and aims to help men normalize HIV
  conversations and disclose their status. More
  information is available at www.disclosehiv.org, which
  also links to www.hivdisclsoure.org.

  The San Francisco campaign comes several weeks after
  the Los Angeles Gay and Lesbian Center launched its
  controversial "HIV is a gay disease" campaign, and
  about 10 months after gay men grew vocally critical of
  the billboard in San Francisco's Castro District
  earlier this year that proclaimed, "New Years
  Resolution: I Won't Infect Anyone." All of the
  campaigns were designed by the San Francisco-based firm
  Better World Advertising, which has attracted a growing
  number of critics in recent years.

  Critics of HIV social marketing campaigns often find
  their objections described as problems with the
  messages, while sponsors of the messages often point to
  the discussion generated by the controversy as a mark
  of success.

  But there is more to the debate than a simple
  disagreement over the slogans and images in HIV
  prevention advertisements. At the core of such
  campaigns is a set of assumptions or conclusions drawn
  about gay men, namely, that they are not talking enough
  about HIV.

  It's a reasonable conclusion, said Les Pappas, founder
  and president of Better World Advertising and a former
  HIV prevention staffer at the San Francisco AIDS
  Foundation. Pappas - who conducts focus groups with men
  who have sex with men and who said he has been
  astounded by some of the misinformation that continues
  in the gay community - said there is no other way to
  explain why seroconversions continue.

  "I do believe there's a disclosure problem. I think
  some people want to believe that everybody is doing the
  right thing and behaving properly and taking care of
  each other, but that's not what's happening. I don't
  see the benefit of sugar-coating and glossing over
  problems," said Pappas, who has proudly remained
  HIV-negative through the AIDS crisis. "We know there
  are people getting infected and we know that some of
  these people getting infected because they are having
  unprotected sex with somebody who is positive."

  Pappas places the HIV infection rate at three per day
  in San Francisco, and five to six daily in Los Angeles.
  Although he said he does believe the majority of gay
  men do the right thing, he also believes "most of the
  positive men know they are positive. Some of them
  don't, but there are men out there who are out there
  and know they are positive and are allowing themselves
  to infect other people. I want people to be more
  honest, be more respectful, be more considerate.
  Getting tested, disclosure, and using condoms --this is
  basic human consideration and compassion for yourself
  and the community."

  The right conversations

  The right kinds of HIV conversations obviously aren't
  happening with frequency in the gay community, said
  Pappas, otherwise, "How do [his critics] explain the
  infections? If we were all doing that, this thing would
  end tomorrow."

  But there is another possibility, say some longtime
  AIDS activists and educators: that gay men are in fact
  talking about HIV and taking care of each other, but
  that a post-crisis climate has meant more people -
  positive and negative - are using harm
  [07_HIV_Disclose_45_med.jpg]
  Writer and activist Tony Valenzuela
  reduction approaches and taking calculated risks they
  can live with. Critics of marketing said the evolution
  of the disease from a death sentence to a more
  manageable condition - combined with the declining HIV
  rates among gay men - mean that sex without condoms is
  often practiced with thought, discussion, and safety
  rather than recklessness.

  "The tone of many of these campaigns presume the lowest
  common denominator of gay men. But the gay men I know
  are smart, savvy, sophisticated, and caring of one
  another. They are talking about HIV and interested in
  serosorting and knowing more of the science behind it,"
  said Los Angeles-based HIV activist and writer Tony
  Valenzuela. "With or without the blessing of health
  departments and AIDS service organizations, men are
  figuring out how to have the sex they want to have more
  safely. Some are choosing only oral sex. Some
  [negatives] are choosing unprotected sex only if they
  top. Just because things have improved doesn't mean
  people think it's no big deal. I have spoken with
  people who understand HIV to be a manageable disease
  but who still do not want to get it. But it's
  reasonable to assume that if the meds continue to get
  better, and there is a reduced threat of HIV, people
  will be taking calculated risks as a means of harm
  reduction and HIV prevention."

  Such a prevention trend is something that has already
  been acknowledged by AIDS health advocates: earlier
  this year, San Francisco's DPH predicted a 10 percent
  drop in new HIV infections in San Francisco in 2006
  compared to 2001, with another 20 percent decline in
  the rate of HIV transmission among gay and bisexual
  men. Chief reasons cited by AIDS groups for such
  progress was the decline in meth use and the increase
  in serosorting.

  Pappas, too, has at least by proxy acknowledged the
  effectiveness of this practice: his most recent DPH
  disclosure campaign does rubber-stamp serosorting -
  called "status sorting" in the ads - while noting that
  people must be honest and actually know their status
  for the practice to work. But the ads themselves stop
  short of celebrating gay men for already practicing
  this prevention method on their own for years. As
  Pappas emphasized, they also promote the idea that gay
  men are not discussing HIV or disclosing their status,
  though activists note that the well-documented trend of
  serosorting clearly requires disclosure.

  Messages that imply an irresponsible community can
  further stigmatize gay men and thus encourage new
  infections, said Walter Armstrong, former
  editor-in-chief of the internationally distributed Poz
  magazine. Recently troubled by the Los Angeles "HIV is
  a gay disease" campaign, Armstrong is among a growing
  chorus calling for an end to all HIV social marketing.

  Such measures "may seem controversial or even
  counterproductive on the surface. . .but I think this
  would, at best, force us and the prevention
  'establishment' to find more scientific, more
  innovative, more responsive forms of HIV prevention
  and, at worst, just silence all the slogans that have
  never been anything but truisms, half-truths, or
  outright lies, starting with 'Safe Sex Is Hot' back in
  1986."

  Armstrong said such campaigns are always steps behind
  what gay men are already doing; "it wasn't until the
  mid-1990s that the big gay groups officially ranked
  oral sex as low risk, despite the fact that gay men had
  never used condoms for bl.wj.bs."

  Armstrong takes issue with the LA Center's implied "HIV
  is a gay disease" message, which "may reinforce for
  young gay men that HIV is inevitable if you are gay and
  that you are not fully gay until you become
  HIV-positive."

  San Francisco HIV activist Michael Petrelis said there
  also is a problem with prevention campaigns that do not
  include measurable outcomes and markers of success -
  the goal of the LA campaign, said LA Center spokesman
  Jim Key, was simply "to get gay/bi men talking about
  HIV again."

  LA Center officials said they were responding to a
  degaying strategy of HIV that went too far: the recent
  International AIDS Conference in Toronto barely
  addressed same-sex transmission, they said, and recent
  Better World focus groups included many gay men who
  said they wanted to see more images of heterosexuals
  with HIV and who wondered, "What about the babies born
  with HIV?"

  "There are no babies being born with HIV in San
  Francisco. Period. So that's what about babies," is
  Pappas's response.

  In Los Angeles, where 75 percent of people with HIV are
  gay and bisexual men, LA Center CEO Lorri Jean said
  there is an underlying internalized homophobia behind
  the desire to degay HIV, and she is confused by the
  campaign criticism - much of it from sex-positive
  activists - that seems overly invested in the
  right-wing reaction to the ads, or "what straight
  people think." Regaying HIV, she said, was meant to
  re-invigorate the spirit that once demanded research
  and funding for marginalized populations.

  "We've become largely invisible in the world of AIDS
  policy and funding structures. . .we're being written
  out of the epidemic even though were still the most
  impacted," said Jean. "In the old days, we would demand
  attention and recognition of these realities. Today, we
  are responding out of fear and silence."

  It should also be noted, said the LA Center's chief of
  staff Darrel Cummings, that much of the controversy
  stemmed from a Los Angeles Times article that contained
  inaccuracies; the two public billboards never contained
  the words, "gay disease;" that phrasing was reserved
  for the LGBT newspaper ads to generate discussion
  inside the community. Placing the HIV discussion back
  in the cultural context of the gay community is
  critical to HIV prevention, he said, noting that
  epidemiological terms like, "MSM" do not resonate with
  gay men who make their decisions within their own
  community. He added that one HIV-positive man who was
  present at a community forum said he felt isolated and
  unwelcome at gay events as a visibly sick person until
  the campaign was launched.

  Valenzuela, whose grassroots group "Real Prevention"
  has taken to task recent HIV marketing efforts, said
  his group was mixed on the L.A. campaign, but that most
  people agreed it's counterproductive to measure a
  campaign's success by the community in-fighting that
  occurs as a result of its controversy.

  "[LA Center officials] said their goal was to get
  people talking. In the forums and meetings I attended,
  people were talking, but not about how to have safer
  sex or do real HIV prevention," said Valenzuela, who
  also takes issue with the campaign's "Own It. End It"
  slogan, which he says promotes a "fantasy" that it is
  possible to end HIV through prevention alone.

  Valenzuela is not convinced that a moratorium is the
  solution to the inherent limitations of HIV prevention
  marketing - "maybe we are expecting too much of this
  vehicle" - but he would like to see posters that are
  arming gay men with information that is useful for what
  they are already practicing, rather than telling them
  what to do. A recent anti-smoking ad, he said, told
  people who wanted to quit that they would "need a
  plan," acknowledging the complexities of that decision
  without resorting to scare tactics.

  That's exactly the spirit of the San Francisco's
  Disclosure Initiative, said DPH officials. Even the
  outspoken Petrelis - who has made a career of
  criticizing "AIDS Inc." - saw the merits of San
  Francisco's most recent campaign, though he remains
  troubled that financial figures on the costs of the
  program were not readily available.

  San Francisco DPH officials such as Tracey Packer,
  interim director of HIV prevention at DPH, said she has
  agreed with many of the concerns about HIV social
  marketing, and believes the disclosure initiative in
  many ways responds to that.

  "I think it's good that we're hitting the mark," said
  Packer.

  Meanwhile, this week the LA Center launched another
  Better World advertising campaign, entitled, "I Am the
  Cure," an extension of the "HIV Stops With Me" campaign
  that encouraged HIV-positive individuals to take
  control of limiting the virus' spread.

  "I beg to profoundly differ with Better World; poz guys
  are not the cure," said one man in response to the ads
  on an e-mail list that discusses prevention campaigns.
  "The cure is a scientific breakthrough that we have
  been denied as a society by inadequate early response
  and funding for research that goes all the way back to
  the Reagan administration. The cure is not anything
  young poz men can do; it's the charge of scientists and
  researchers the world over from an infectious disease,
  medical, and biochemical approach. Even if there is a
  role for positive men to attempt to prevent new
  infections, they share this responsibility with
  negative men who need to also protect themselves."

  Check out the B.A.R's new blog section!
http://www.ebar.com/news/article.php?sec=news&article=1311
by Zak Szymanski