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Death Anus Ad from NYC Dept of Health

| 31 Comments

This is a long blog post about an important issue.  I know I'm supposed to keep blog posts short, but not all issues lend themselves to 300 words.  HIV is complex and understanding the challenges we face--especially in prevention--requires reading more than headlines.  So I apologize for the length, but I hope readers with the interest and patience will find this useful.  Thanks,  Sean


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The New York City Department of Health's "It's Never Just HIV" advertising campaign, targeted to encourage HIV negative gay and bisexual men to use condoms, has prompted a conversation that is profoundly important and speaks directly to the heart of the problems with HIV prevention.


The ad features doleful, frightened or ashamed young men who are so attractive they look like characters from the television program Lost , set against a sound track appropriate for a horror film.  The ad's message is that HIV doesn't exist in isolation; it also brings other serious health problems.

 

X-rays of badly broken bones, an MRI of an atrophied brain and, most shocking, a close-up photograph of a man's cancer-encrusted anus graphically make the point.  The voiceover sounds like a poor man's Don Lafontaine  (he's the legendary "voice of God" who often starts movie trailers with "In a world..."), evoking an apocalyptic end-of-the-world feeling.

 

GMHC and GLAAD share the concern of many people with HIV, prevention experts and activists and rightly issued a press release calling for the ad to be pulled, asserting it is sensationalistic and stigmatizing. 


UK-based journalist Gus Cairns, who has HIV, commented on Michael Petrelis' blog, "I hate this ad because it's sadistic and bullying... It's horrified by gay men and gay sex in general, using images of bodily corruption and disease to ram home things that -despite 50 years of gay lib--we still feel about ourselves: look at the suicide, depression and drug use statistics.  The message it gives--not factually, but with all the visceral power of that 5-frame shot of a ruined ass--is that if you're out on the scene, death and decay are stalking you and serves you right if they get you."

 

Others have questioned its presentation of facts. The horrible conditions noted are typically found only in some older people with HIV, or those who are not diagnosed until later stages of the disease; anal cancer is caused by an entirely different virus, osteoporosis is likely as much a function of anti-retroviral treatment as it is HIV itself, etc.

 

The lion of AIDS activism, Larry Kramer, loves the ad, has congratulated the NYC Department of Health and called for even more frightening ads to be produced.  Larry has written: "...these nyc department of health public service announcements are in fact not strong enough!  How about trying this one on for size (pun intended):  LETHAL WEAPON men, what you carry between your legs is a potential lethal weapon!  it can murder people.  Before you stick it anywhere PUT A CONDOM ON IT!  i bet you'll get better results with this one."

 

Larry believes in fear as a strategy to change people's behavior; he cites it as key to the success of ACT UP and other community-mobilizing efforts.  There are many who share this view, as is clear by reading comments posted online in response to coverage of the controversy.

 

Many of those comments express concern that gay men are complacent, unaware of how awful HIV can be and, at least in Larry's case, too concerned with their own pleasure to worry about protecting their partners.

 

The debate over these ads has largely been amongst people who have devoted much of their lives to combating the epidemic, which makes me hesitant to write in terms of the different "sides" of the issue.  Everyone is on the side of finding the best ways to reduce HIV transmission, but we have differing thoughts on whether this particular campaign will help reach that goal. 

 

I think this advertising campaign is terrible, mostly because it may contribute to further spread of the virus.  The only good it has accomplished is that it has provided a brief moment when a few more people are thinking about and paying attention to HIV prevention issues.  That is an opportunity that I hope we will not waste.

 

Supporters of these ads claim HIV prevention has been a failure and they are angry that the epidemic has disappeared from the media and fallen off the list of priorities for LGBT organizations and others who once were leaders in the fight against AIDS. 

 

I share that anger.  It is profoundly frustrating, disempowering and, quite frankly, depressing to see so many one-time activists, caring friends and neighbors, concerned journalists, political and public policy leaders disappear like a puff of smoke once combination therapy brought a relative cure to those with the privilege of healthcare access. 

 

As the epidemic settled into communities of poverty, communities of color and amongst the young, the milieu that once made combating AIDS their priority has acquired a collective amnesia.

 

Nowhere do we feel that frustration more than when we see young gay and bisexual men put themselves at risk, either unknowing or uncaring about the consequences. 

 

At times I want to shake and scream, Larry Kramer-style, to young gay and bisexual men: "You don't want to get this virus!  It screws up your life, creates a never-ending series of health battles, makes it vastly more difficult to have intimate relationships, decimates your self-esteem and stigmatizes you beyond what anyone who is HIV negative can ever understand!"

 

At the same time, I proselytize to those who do have HIV: "You may have HIV, but you can still lead a happy, productive, and vital life, you can fall in love, pursue a career and find purpose, and with careful attention, stay mostly healthy, even while managing the tremendous burden of a life-long viral infection."

We can and should tell young people that HIV is very bad and they don't want to get it, but we can do that without condemning or stigmatizing people who already have HIV.  And we can and should tell people with HIV that a diagnosis is not the end of their lives, that they still pursue their dreams and seek everything anyone else can extract from life without sending a message to young people that HIV is no big deal.

 

We need to convey both of these messages, at the same time, and not let one negate or diminish the other.  That requires a more nuanced messaging, one that doesn't assume the intended audience can be manipulated by over-the-top fright messages, doesn't speak down to them and doesn't assume they are presently not caring whether or not they get HIV. 

 

The messaging must also be fact-based. That means including the difficult truths about what untreated HIV can do to one as well as about what is and is not known about the side effects of long-term anti-retroviral therapy.  And it means talking honestly and practically about risk-reduction techniques rather than rely on the overly simplistic "use a condom every time" message to which few gay and bisexual men adhere.

 

Much of the support for the NYC DOH campaign is an expression of frustration, a desire to see the epidemic discussed, to get the attention of young gay and bisexual men and others at risk.  Many of my generation recall how terrified we once were and how that fear affected our behaviors.  There is a sense today that "nothing else works, so let's try terrifying them" as the epidemic did to our generation.

 

Gus Cairns also noted on Petrelis Files that  "The problem is not that young gay men are 'complacent' and don't fear HIV: the problem is that they do fear HIV, but don't fear it enough.  And the reality is that, no matter how horrifying the ads, they are never going to fear it enough again."

 

I agree with Gus, young gay men who have the comfort of knowing they can access treatment if they get ill will never fear HIV the way my generation feared it.  Manufacturing fear through media manipulation is tricky and the research indicates it can just as easily compound as help the problem. 

 

Another poster on Mike Petrelis' site noted "Here's the problem fear-based tactics face.  They are countered each and every time you meet someone with HIV who's leading a normal, happy and productive life and not wallowing in a pit of despair and disease and clothed in sackcloth bemoaning his former, evil ways.  In the modern gay community, that happens all the freaking time.  Which means that people you are trying to scare will write you off as a lying hysteric.  And your safe sex message gets tarred with the same brush.  As a bonus, all of the people who don't know people living with HIV (basically, most of the population) actually will get your message loud and clear: that people with HIV are scary, disease-ridden lepers who must be shoved out of society."

 

This is what the DOH ads accomplish.  They certainly will instill fear, but they do so at the expense of further stigmatization of people with HIV, and at the expense of turning off the young gay and bisexual men whose sexual behavior they seek to change.

 

As AIDS advocates, we have demanded evidence-based approaches; this is what I ask for in considering HIV prevention efforts. There are a number of credible and serious studies of the use of fear-based messaging in the context of HIV; it is not an unexamined topic.   I hope those who have instinctively felt favorably towards the DOH ads will take a look at several of them.  If they do, I suspect their opinion on the matter may evolve.  


Fear in the Context of HIV


Two studies summarize research on the use of fear in the context of HIV.  One is by London-based Sygma Research, a part of the faculty of Humanities and Social Scientists at the University of Portsmouth.  Sygma have earned an international reputation as one of the most important and innovative sources of new social scientific information in the area of sexual health and HIV.  Their six-page brief, The Role of Fear in HIV Prevention, is clear, concise and spot-on relevant to the "It's Never Just HIV" campaign in question.

The other study is Applying Persuasion Strategies to Alter HIV-Relevant Thoughts and Behavior, by Loraine Devos-Comby and Peter Salovey at Yale University.  This one is especially important because Larry Kramer claims its author supports Kramer's enthusiastic endorsement of the DOH campaign while I cite it in support of my position, which is quite different from Larry's.   

 

Salovey's research and response is important.  He endorses "loss-framed" messaging (in effect, fear-based) for "early detection behaviors" (ie: HIV testing).  However, despite repeated requests for clarification, he has declined to endorse "loss-framed" messaging in pursuit of long-term changes in sexual behaviors. 

 

His published research notes that "...fear arousal does not necessarily lead to the adoption of health recommendations.  In some cases, it can produce the reverse effect, as illustrated by a study in which a cohort of Australian gay men exposed to the "grim reaper" advertisement subsequently reduced safer sex behaviors." 

 

Salovey's Yale study specifically addresses the defensive avoidance or resistance triggered by messages that cause a high level of fear, noting that the stronger the emotional reaction following threat appeals, the greater the resistance to persuasion that results in behavioral change. 

 

Fear-based messaging is more supported by those who are older and who already practice the desired behaviors (in this case, safer sex).  Fear-based message can be effective at increasing HIV testing (although it may not increase testing amongst those at greatest risk).

 

The Sygma study notes that "...fear appeals are more favored by individuals who are already engaging in the desired, health-protective behavior than they are for individuals not already doing so...there may be a role for fear to help reinforce existing safer sex behavior, but that arousing fear is not necessarily an effective means of facilitating change among those who engage in risky behaviors." 

 

The bottom line is that fear-based messaging is more effective in raising awareness, changing attitudes and behavioral intent and possibly reinforcing existing safer sex behaviors than it is in actually changing sexual behaviors amongst those who engage in the riskiest behaviors. 

 

More from the Yale study: "campaigns that focus solely on the negative consequences of HIV infection may serve to disempower men with HIV by making them appear weak, helpless or diseased; depictions of visible symptoms reinforce commonly held beliefs..."  The NYC DOH campaign certainly focused solely on the negative consequences.

 

Sygma also notes "it is important not to always present target populations with the 'worst case scenarios' that are in fact unlikely to arise for the majority of individuals"; yet presenting the worst case scenario is exactly what the NYC DOH campaign does.


The studies also indicate that the targeted audience--those whose behavior the campaign is seeking to affect--can feel threatened by fear-based messaging, which triggers avoidance (ignoring the fear-arousing message), denial (believing the harmful consequences are unlikely), counter-arguing (rejecting the risk presented, believing it to be exaggerated by authorities) or deflecting (believing the message is intended for someone else).  

 

When experiencing fear-based HIV prevention messaging, older gay men believe it is intended for younger gay men.  Younger gay men believe it is intended for "scene-oriented, promiscuous gay men".  These reactions lead to rationalizing or defending one's present behaviors, rather than a change in behavior.  

 

Loss Framed vs. Gain Framed Messaging

 

The Yale study makes an enormously important distinction between "loss framed", focused on what one has to lose (getting sick and being miserable) vs. what they call "gain framed", focused on what one has to gain (being healthy, and happy).  

 

"...participants expressed greater intentions to engage in the preventive behaviors when the information was gained framed than when it was loss framed; loss framed messages were more effective at encouraging the detection behaviors."


The DOH ad is clearly "loss framed", which is not the strategy proven most effective for actually changing sexual behaviors amongst the targeted audience.


Further more, "threat appeals" that lack ways to avoid the negative consequences depicted in the message produce a "boomerang effect, in that participants were less likely to adopt the recommended behavior." 

 

Use a Condom Every Time?

The only part of the DOH ad that suggests a way to avoid the negative consequences is the generic and, at this point, largely useless "Use a condom every time" message tacked onto the end of the ad.  The ad does not provide the information young gay men need and want to help them avoid contracting HIV.

 

I call "use a condom every time" message largely useless because at this point in the epidemic repeating this to young gay men is as helpful as hectoring teenage girls to "don't get pregnant".  Young gay men know they don't want to get HIV and they know condoms are effective at preventing its transmission. Like virtually every young woman who suffers an unwanted pregnancy; they know exactly how not to become pregnant.


What enables gay men to protect themselves and young women to avoid unwanted pregnancies is not hectoring them with a catch-phrase, but providing empowering information, practical strategies and solutions that they can integrate into the reality of their sex lives and cultural milieu. 

 

For the NYC DOH to base a campaign on the slogan "Use a Condom Every Time" is likely to be as effective as Nancy Reagan's "Just Say No to Drugs" campaign.   

 

All sexual behaviors are not of comparable risk of HIV transmission.  We know that receptive anal intercourse accounts for the vast majority of new infections amongst gay men and is exponentially riskier than other sexual activities. 

 

Sharing the truth about the relative risks of different kinds of behavior will do more to help young gay men avoid acquisition of HIV than will hitting them over the head with "Use a Condom Every Time". 

 

Focusing our prevention efforts on these riskiest activities, rather than generic messages that have become part of the background noise to our lives, will result in greater success.

 

We also need to stop saying that using a condom every time is the only way to avoid acquiring HIV.  Most gay men have already permanently rejected the "use a condom every time" message.  At the peak of the crisis, many were willing to forego skin-to-skin contact for a period of time.  But over the long haul, many gay men (and perhaps most younger gay men), have identified situations where the risk of transmission is so low or non-existent that sex without condoms becomes, for them, an acceptable risk.

 

If they feel certain someone is of the same sero-status, if they are engaging in oral sex, or as the active partner in anal sex, or if they are certain an HIV positive partner is on treatment and has an undetectable viral load, or in other circumstances, they may skip the use of condoms.   We need to recognize that different individuals will tolerate different levels of risk. 

 

Some of those people will make decisions most of us might find foolish, but our task is to give gay men is the education and tools to make their risk assessment processes as informed as possible.  Those who will accept no risk can choose abstinence.  Everything else involves some level of risk and where the line is drawn is ultimately a personal decision.

 

The Role of Treatment in HIV Prevention


We also have failed in recognizing the role treatment plays in reducing risk.  A person with HIV on treatment who has been undetectable for six months or more is unlikely to transmit the virus.  It is not impossible, but the chance of transmission is dramatically reduced, for many that chance is reduced to the extent they are comfortable having unprotected sex with a person who is undetectable. 

 

Our community's failure to have an honest discussion about this has resulted in people making judgments that are often poorly informed.  We need to recognize the reality of how treatment does reduce transmission risk, even while also communicating that it does not eliminate such risk.

 

Condoms sometimes fail--the most responsible studies generally put the failure rate between 2% and 8%--but we as advocates have been slow to acknowledge this fact, in part because we have had to fight the Catholic Church's propaganda that claims condoms "don't work".  

 

But it may be that the risk of transmission due to condom failure is comparable to, or even greater than, the risk of transmission from a person with HIV on treatment with an undetectable viral load.  That discussion is happening in my quarters of the community, in bars and at dinner tables, but it has not been undertaken by our public health establishment or AIDS service providers and that silence is damning.

 

Post-Exposure Prophylaxis

 

Another damning silence concerns post-exposure prophylaxis.  The culture of the epidemic, amongst gay men, was based in a time when most people who got ill did not know when or by whom they were originally infected.  Many of us assume we were infected more than once.

 

Today that is much different.  Young gay men who are diagnosed often know exactly when and by whom (the individual, if not their name) they were infected.   I have been struck by how often I have been told by recently infected gay men that they knew at the time they had just been potentially exposed, either because a condom broke or they did something in a weak moment that they quickly came to regret.

 

But what is appalling--and the blame for this must rest with the public health and AIDS service establishment--is how few of them knew that there was something they could do shortly after the potential exposure to avoid sero-conversion.

 

Post-exposure prophylaxis (PEP) has been a standard procedure for persons in a healthcare setting who accidentally get stuck with a needle.  They are put on a 28-day course of anti-retrovirals immediately (it must be within a couple of days to be effective) and in almost all circumstances that prevents them from becoming HIV positive.

 

For several years, the Centers for Disease Control has recommended post-exposure prophylaxis in a non-occupational setting (read: sexual context) as well.  So why don't gay men know about PEP and why can't they access it easily?

 

One big reason is that PEP is seen by some as a potential "disinhibitor" and will enable gay men to be sexually irresponsible and use PEP as a sort of "morning after" pill.  The research doesn't support this premise, but that doesn't stop those who are uncomfortable with gay male sexuality, especially anal intercourse, to operate from a conscious or subconscious desire to discourage sexual expression.

 

The truth is that those who go to the effort to access PEP--and it is not easy--are the guys who really do not want to get HIV.  They aren't those who don't care or are indifferent to risk; they are those who will go to a lot of effort to avoid acquiring the virus.

 

Last year, I helped launch a site to provide information about accessing post-exposure prophylaxis; now we're trying to get providers to register their information so it is available.


And for several years, I have been giving out "starter kits" to young gay men that include three days of anti-retroviral treatment and some instructions for use.   I tell them to put the kit in their medicine chest or dopp kit so it is available in the event they need it.  The kit buys them some time, to give them a chance to talk to their doctor or another expert to evaluate their risk and whether they should pursue the 28-day treatment protocol. 

 

Risk episodes most often happen at night or at a time when one can't quickly reach a medical professional to assess one's exposure risk; the starter kit gives them the chance to start treatment immediately and not lose the opportunity to avoid infection.  Emergency rooms, in theory, should provide this service but in practice they remain a nightmare. 

 

Hospitals are often are unfamiliar with PEP for use in a sexual exposure or the cost is prohibitive; typically $1500 or more, which isn't a practical consideration for most young men who have sex with men. When faced with the long wait typical at most emergency rooms in New York, and the uncertainty of whether or not they really need or will ultimately receive PEP from the ER as well as the enormous expense, it is easy to say "nuts to it" and just cross one's fingers and hope for the best.


If the Department of Health wanted to provide a real tool to young gay men to avoid infection, they would educate the community about PEP and make it convenient and available without cost.  That goes for hospitals, AIDS service organizations, physicians and others. 

The Whitman Walker Clinic, in Washington, DC, has a "red carpet" program for people who think they might have been exposed to HIV.  Upon presentation at the clinic, they are processed on an expedited basis.  They promote this service throughout the community so people know that if a condom breaks or they do something they regret that they can go to Whitman-Walker and quickly and discreetly have their risk assessed and, if necessary, put on the 28 day preventive treatment without cost.

 

Educating about the relative risks of various sexual activities, for those who are negative, and those who are positive on treatment or not on treatment, and promoting PEP are practical and useful strategies that will do much more to prevent new infections than a scare-mongering campaign that may ultimately drive new infections rather than avoid them.

 

HIV prevention is a process, not an advertisement or given campaign.  We can alert people to the dangers of HIV without resorting to fear that risks losing the very audience we most need to reach.

 

Respecting the Rectum

 

Our success in preventing HIV transmission has been hampered by an unwillingness to recognize and celebrate sex between men as something beautiful, admirable and morally equivalent to sex between men and women.

 

In 1983, very early in the epidemic, Joseph Sonnabend, MD, famously and courageously said, "the rectum is a sexual organ and it deserves the respect a penis gets and a vagina gets."  Eric Rofes, Walt Odets and other pioneering thinkers about gay male health and sexuality have subsequently explored similar themes. 

 

I couldn't help but think of this when I saw the close-up image of a man's anus, covered in cancerous lesions, in the NYC DOH ad.  Anal cancers are preceded by genital warts, which are caused by strains of HPV, the Human Papiloma Virus.  Last year, 4,000 women in the U.S. died of cervical cancer; in virtually every case the cancer was caused by HPV. 

If the NYC Department of Health pursued a campaign to combat transmission of HPV, does anyone think they would, for a moment, consider using a close-up image of a horribly diseased vagina?

 

The bodies and sexuality of gay and bisexual men are seen as dangerous and our sexuality as threatening.  We are so little respected that it is acceptable to show an exceptionally intimate part of a gay man's body, one visibly riddled with cancerous lesions, and put it on television as a tool to frighten us. 


We need to respect anal intercourse and recognize the important role it plays in the sexuality of many gay and bisexual men. 

 

In this context, "gain-framed" could communicate how protecting one's self and one's partner from HIV transmission can provide peace of mind, is socially responsible and enable the person to live a long, healthy and happier life, free of the tremendous burdens that come with an HIV diagnosis.  In this context, risk reduction strategies have more meaning and will resonate more strongly with gay and bisexual men, resulting in the behavioral changes that will reduce HIV transmission.

 

That's HIV prevention messaging that may not please Larry Kramer and those who are hell-bent to use fear to bludgeon the psyches of young gay and bisexual men--and in the process, further stigmatize those of us with HIV--but it will change sexual behaviors and result in less HIV transmission.

 

 

 

 

 

 

 

 

 

 

 



Sean on:

31 Comments

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Comments on Sean Strub's blog entry "Death Anus Ad from NYC Dept of Health"

Great blog, Sean. In the focus groups we've conducted here in Iowa with young gay men, fear tactics most certainly do not work. I favor much more positive, holistic messaging (i.e. Chicago's "Life Lube" is awesome) that does not further stigmatize.

Perfect commentary on these ads.

I'm shocked that the NYC DoH is still going to absolutist prevention messages. The problem with abstinence-only prevention education is that you are building a house of cards. I remember sitting in Health class in high school hearing that smoking pot would quickly and inevitably lead to personal catastrophe and looking to the pot-smoking ivy-bound A student sitting next to me and thinking, "Well that can't be right." The same goes for fear-based messages, because we are hard-wired by evolution to adapt to fear so we can start using our problem-solving skills again.

But what I really find jarring about this ad is the (permit me to lapse into Larry Kramer-esque block caps here) THE TOTAL AND ABSOLUTE DISREGARD FOR THE HEALTH AND LIVES OF GAY MEN. What other possible explanation can there be?

I and every other sexually active gay man I know has questions... Can you seroconvert from having sex with someone on meds with a very low viral load? How risky is it when you're the active partner? What if he doesn't cum in you? ...and it's not easy at all to find answers. So most gay men, myself included, go forward on best guesses. But the public health establishment has shown and continues to show no interest in providing information like this, falling back on "Use a condom every time."

The years I spent working at a sterile syringe access program taught me that the best approach to preventing the spread of HIV is to give people the tools and the information that they need to make good choices.

I work at the Triangle AIDS Network, an ASO in Southeast Texas. I have worked in HIV as a casemanager and currently as an outreach worker for over 14 years. Most casemanagers, prevention workers and medical providers who are worth a grain of salt know that the "use a condom everytime" message does not work. This is one of the most clear and well thought out response to that message that I've ever seen. Tolerance, acceptance and knowledge are the only things that will lead to a reduction in the spread of HIV. Well said Sean! Keep up the fight!

Incredibly informative and compelling post. I will be referring to this a lot in the future.

I concede that this is a complex issue, but for years, I have wondered where all the outcry is over the sex clubs, bareback crystal meth parties, prostitution and other taboos that no one will confront. I also don;t buy this 'sensibility' argument for a minute. Where I live HIV rates are back to 1984 levels. If all this 'tolerance and acceptance' is working, it ain't here. I've lost too many friends and loved ones over this, and I cannot be politically correct on the issue. The reason the drug companies are laughing all the way to the bank is because 'we' have offered ourselves up like sheep for the slaughter.

If you have unprotected sex, you are very much at risk for HIV, which causes all the things shown in this ad. And AIDS. ANd people are still dying. We used to get angry, and ActUp. Silence (still) = death.

Great post Sean. You make so many good points. I'm really shocked that the city's DOH would use an ad like this.

This is awful. You are giving gay men chemotherapy without a prescription and calling it a "starter kit?" Set up to fail now has a new low! Stigma any one? How is this not a bullying and a disrespectful approach? Although the advertisement is distasteful and medically inaccurate what is your excuse for being disrespectful and medically inaccurate while indoctrinating young gay men into your life style of inevitable HIV infection rhetoric and pills, pills, pills for the HIV- to boot?

The take a pill every day or before sex or ever set and the pharmacy enthusiasts ignore the fact that for every 56,000 infected in the US every year 23,000 die of AIDS complications; this is an upward curving epidemic with exponential growth rates. There is no meaningful treatment for HIV if in New York City alone the diagnosis to death rate for Black men is 6 years (2008) with treatment. I will grant that a crappy advertisement is a crappy advertisement (on countless levels) but how does a clueless DOH justify free reign of every ignorant person with an idea? Do you know anything about the epidemic in New York City? Doesn’t sound like it. The experiences of gay white men and their clout and access have nothing to do with HIV in meaningful terms or in population health any more; if they ever did. All they have done is continually eclipse the trauma that AIDS brings to Blacks and especially Black gay men who have the highest prevalence rates on earth. One could very well be under the interpretation that AIDS is a gay white disease, even though people of color were always disproportionately impacted by the virus even in the early 80’s.

It is clear that we are not all on the same side in this city or nationally when it comes to HIV. As a nation that never desegregated Blacks do not have access to medical care on any level insured or otherwise, rich or poor. Worse still HIV services are just as bad at serving Black HIV+ and LGBTQ HIV non-profits monopolize dollars and refuse to treat or serve Black clients. In 2008 93% of all LGBTQ dollars in New York State went to whites only agencies according to the state wide LGBTQ needs assessment. In the mean time, barred from services and surrounded by old gay white men who love to tell us what to do HIV has become a Black disease and we are all on the same side? When was the last time you actually talked to a Black person in one of the most racially segregated cities in the country? Did you see the 2010 census data for NYC? It’s as clear as the New York Times dot plot map of the new census data. We were never allowed in the house and now we are not even allowed in the clinic. All the while living under the disaster of HIV and neglect, harassment is taken for help; under these circumstances how can there be a question about MSM of color and HIV? We have a Black pandemic and no race, health disparities and no racism, and perhaps more obnoxious than an advertisement that has nothing to do with HIV+ gay white men is the endless commentaries about how the advertisement has nothing to do with HIV+ gay white men. What we have gained is a Black community without the church, without extended kinship networks and without poverty, preexisting co-morbidities and boot straps without shoes which we can not possibly pull on. Have you ever tried to find a condom at 2AM in BedSty? Are you sure you know what you are talking about?

Its not yours. We can own property now, and apparently contract retroviruses. What remains to be seen is what we can do about it, and by we I mean us, not you. Please be quiet and mind your own business.

Sean,

Awesome information! I have been undetetble now for 7 years and I was diagnosed with "AIDS" in 2002 with 8 t-cells, a viral load of over 200,000
and several oportunistic infections i.e kapi sarcoma (KS), wasting, thrush, Micro baterial avium (MAC) gastral intestinal infection, Pnuemosystic Pnuemonia, a hemoglobin of 4 and HPV. Today I am healthy, strong, successful, and enjoying life. I made it through the severly rough patch. However FEAR is what got me into this position, I was terrified to being tested. Afterall, I was not sick, a gym rat, and practised great nutrician. Testing is the key and returning to get your results can aleviate so much pain and loss. Until I read this article I didn't know about PEP. I watched this AD and was terribly offended, have we forgotten the "bug chasers" young men who seek out to get infected because in their mind all they have to do is take a pill and go back to doing what they do. We have a long way to go in the eradication of HIV/AIDS. Informative articles such as this, gives me further hope that this epidemic still gets the attention it needs and the public can get the correct information, not just a package of horror and fear and disrespect perpetrated through the media. FEAR is not the answer!

This is just more evidence that HIV positive people have always been seen as pariahs, even to the well meaning. We have become the underclass of not only the hetero community, but of the gay community. Just look at any gay sex site, and you will find statements like, "D&D free", "Last tested ....." "Neg only". This does not show that gay men are working together to end the spread of the disease, but more likely, that HIV negative men are seeing us as children of a lesser God, cast offs, lower castes, sudras (google it).

Although I've not seen the ad myself, I don't really have to, the silent reproach of HIV poz men has always been present in our society. The mind numbing blame of the victim has always been the safer way out. Keep away from the leprous mass of unethical beings.

I have been rejected by men after telling them that I am HIV positive. I think not only because I'm positive, but also because many of these men do not want to take the responsibility of using condoms, simple as that. Of having to be responsible for their own health. The responsibility to not infect others has always been thrust upon us; and many of us have sheepishly have accepted that role. Which has led many HIV poz men to withhold disclosure, after all how many people really want to be rejected? Moreover, how many people want to be seen as potentially lethal? It's human nature to protect oneself, yes, even if one is HIV positive.

I have worked with HIV poz people from all walks of life, both in NYC and in Washington D.C. The general experience I have witnessed ranged from guarded to acceptance to absolute fear. I suppose the latter is what the DOH is trying to work on. Going back to the future as a means of prevention. The boogie man approach. Placing more people in the extreme position of having to go underground in order to retain some level of dignity.

It isn't enough that the threat of illness is never far away, and the even more merciless threat of death hangs even closer. We also have to endure, and assuage the fears of people that are unwilling or are too stupid, to learn how to protect themselves without demonizing those of us who have muddled through, and are leading good and productive lives.

Homophobes always are the first to wish us death by AIDS, suggesting that we deserve the disease because of our ungodly behavior. In essence this is what the DOH campaign is expressing. Not necessarily from a non-secular perspective, it doesn't have to, but what they are doing is adding fuel to the brimstone and fire rantings, of those whom want us dead.

Men having anal sex is central to the disgust homophobes experience toward us. The sanctity of the male anus has historically been the battleground against gays. So why not use the anus as a way to not only promote HIV prevention, but to further incite the fear of anal pleasure; and while they're at it, why not issue permission of the gay "pozphobes", reason to fear us and further alienate their brothers and sisters.

Using this campaign to direct LGBT youth's attention to the dangers of unprotected sex, falls on deaf ears. The hubris of youth will always be a problem, young men and women, just don't think of death or illness being possible in their lives. The attitude is encouraged in a society that worships youth and beauty above all. Frankly expecting anything else from young people is unfair.

The ad is as irresponsible to HIV prevention as the campaigns against meth use was. Neither epidemic has gone away. Meth use still looms within the gay community, despite the numbers telling us that use has dropped. That's happened because many of the users have gone underground. In essence the DOH campaign will force more men to go underground with the disclosure of their sero-status.

It's an insensitive and brutal attack on people living with this disease, in the guise of scaring young people straight. A halt the campaign is what is needed. Plain and simple.

Very timely info & discussion. I have heard of these ads but had not seen them. The alarming thing is how over-sensationalized and anti-sex the messages are - sexuality is a vital function of life, straight or queer, we cannot life with no sexual outlet without horrible consequences. If you need a fear-based message, that's pretty scary. If you don't have sex you'll go nuts! Maybe that's the message that should go out. After all, the purpose of sex is clearly not reproduction - it is simply about stimulation and gratification. The fact is that there are a zillion different ways to stimulate and gratify ourselves & each other but only very few that will spread HIV or make someone pregnant. Avoid them and you're likely to be fine. My partner & I have been having hot & raunchy sex for almost 7 years. Only one of us has HIV - both of us are always very satisfied after the marathon love-making sessions we have together. We never use condoms - but we DO use our heads.

More food for thought (and, I expect, some indigestion):

1. Some fear is necessary, or why would anyone avoid the damned virus? There's a difference between "no fear" and "paralyzing fear." Where's the evidence that this is paralyzing?

2. No one seems to accept that NYDPH in fact did focus groups, and the ads went over well. I've seen a lot of hand-wringing..and to what end?

3. It's hardly an abstinence-only message.

4. Relying on data-free thinkers like some of the folks above has been remarkably unhelpful in reducing infections. I won't engage in personal attacks here by naming them, although it's a fair statement to say that many psychologists and pundits have an awfully hard time distinguishing between what seems to work for their own clients and friends, although never with any documented effect, and population-based approaches.

5. There has,for much of the epidemic's history, existed a tension between not wanting to stigmatize HIV-positive folks and wanting to make sure that HIV-negative folks know what to avoid. We clearly need both. And there's frankly no easy solution. It's totally understandable. But just years of saying 'gee, please wear a condom,' have gone - well - not very far. And remember the protests that pharma ads glorified being HIV+ too much? It's a see-saw. Quite literally it's damned iif you do, damned if you do.

6. PEP and PrEP are lovely, but horrendously expensive alternatives which will do nothing, as others have pointed out, to reduce racial disparities. With all the other things we could be spending money on, are we sure we want to turn our resources and advocacy to that? Maybe. If you take the money we currently spend on behavioral interventions - and IF you can target the folks most likely to get infected - you could save. But that's a BIG if. God knows that if you could cut from the military's requests one bomber, which would be a much larger redirection of resources, that'd make a substantial contribution to buying drugs, but our community is reluctant to ever engage in that kind of advocacy. For some understandable reasons, but with results that make me both happy and sad, we've spent more time trying to get INTO the military than protesting its huge waste and benefits accruing to a bunch of Republican contractors.

Scary stat: ADAP costs 12,000 a year in drugs (exclusive of monitoring) and PrEP (also exclusive of monitoring) 14,000. Do the math.

7. Where are we shoring up, and calling for, gay men's responsibility to protect ourselves and our partners? Where is community leadership? Frankly, Larry Kramer is one of the few people who's yelled about that (See, "The Tragedy of Today's Gays," and that was even yesterday!) outside of the AIDS organizations - and even most of them don't do much of that anymore. Face it: there is a substantial abdication of leadership on this issue, of gay men taking responsibility for their own safety and for their partners.

8. Why do we insist that social marketing works (or protest vehemently at ones we don't like, which still means we attribute to them a high level of effectiveness) when we never criticize any of the frequently-emitted gay sex industry messages that promote unprotected sex? I sadly suspect it's because we engage in wishful thinking to our peril: we want our cake and to eat it too. We want sex lives as if no virus exists, and we want the end of the virus. Sorry, we can't have both.

I've gone on long enough and look forward to hearing more from others. My apologies for not being able to sign this. You'll just have to trust that I can't, even if you disagree with what I've said.

To our health.

Very informative post Sean, as a long term survivor of almost 29 years, I will be starting medications in the next few weeks.

Although here in the Midwest, ad's such as though currently being used by NYC DOH have not appeared and I very seriously doubt they will. I sit on our Community Advocacy Committee and the Planning Council, and our approach would never be to scare the hell out of a person in such away as these ad's seem to do, if anything these ad's would only drive those effected deeper into the fear of seeking out Linkage to Care.

As far as Larry Kramer's comment, I might be carrying a potential LETHAL WEAPON between my legs, but I can say I am intelligent enough to know when, where and how to stick anywhere.

I would much rather have a lethal weapon then a bulls eye.

Sean I am with you on this one. Its important to get 'a message out' regarding prevention but this ad isn't it I found it brought out a stigma factor and I had to gulp at my negative response when I viewed it.

Keep up the good work Sean. Your the best.

John B
New York

As someone who was there at the beginning, I believe it's about time the truth is told in this ad. HIV-positives today may have been saved from the deadly opportunistic infections of the early years of the epidemic by HAART, but they are now beginning to see the ramifications of long-time (and, in some cases, relatively brief) HIV infection and/or antiretroviral use. There has been much recent (but only recent) observation and interest in the hastening and acceleration of the aging process among HIV-positives: brain fog, neurocognitive difficulties, cardiovascular problems, bone problems, co-morbidities and cancers (lung, liver, anal, lymphoma, etc.). It is possible that 30-, 40-, 50-, and 60-year-old bodies are succumbing to the medical depredations of 80-year-olds.

Sure it's true that osteoporosis is a disease of the elderly, but what is it when it keeps occuring in relatively young HIV-positives? Full-blown dementia may no longer be as prominent as it was, but what is it when so many HIV-positives are beginning to complain of "brain fog"? Yes, anal cancer is caused by HPV, but why are there now 174 annual cases per 100,000 among HIV-positive gay men, but 40 cases per 100,000 among HIV-negative gay men, and 2 per 100,000 in the general population? It used to take many years for anal cancer to develop from HPV-related lesions; now the many years have become few.

It is disgraceful that GMHC and others are condemning this video campaign. I remember in 1982, when I was trying to edit for GMHC what would have been the first publication about GRID (Gay-Related Imuno-Deficiency, as it was then known), and GMHC (EXCEPT for the estimable Larry Kramer), opposed to promoting safer-sex campaigns, said that "we can't tell people how to have sex." How many lives were lost in those first few years because GMHC would not embrace safer-sex campaigns? They have truly learned nothing.

Social science research has demonstrated repeatedly that fear-based campaigns seldom work. However, I see merit in the concept of trying to educate people that there are other consequences.

You are incorrect to dismiss brain atrophy and bone density losses. Sticking with our research-based outlook, these are both now recognized as significant issues for all long term survivors. Anal problems are also a growing concern. And they didn't even address hardening of the arteries--now seen as almost a given for long-termers. You are not correct in dismissing these as problems for "older people with HIV, or those who are not diagnosed until later stages of the disease." Controlled studies of those with and without viral suppression, as well as long-termers with naturally low viral loads, shows that these other ill effects are pretty equal, and highly significant, across all those with HIV over time.

Most researcher say it more simply--most organs of someone with long term HIV appear to be from someone 15 years older than the person actually is.

Again, I don't think the campaign would be effective, and I agree with many of your concerns. But their objective is totally correct. Far too many young people I know think of HIV and just another health problem that can be solved by a handful of pills each day. Their jaws drop when you have the opportunity to explain these other problems.

Thank you for writing such an amazing response. You show me a whole new perspective. As a caucasion individual in a caucasian dominated society I'm ashamed to admit I haven't known about the racist aspects of this. I'm going to search out more information and add my drop in the bucket voice. Thanks for expressing yourself so well.

Thought provoking as he'll. Sex is more powerful than intellect. I love Larry Kramer for his influence on my intellect decades ago, but see this current generation not impressed. After reading Sean, and the amazing comments following him here I'm rethinking my previous views.

One point that stands out immediately is the homophobia still so involved.

I was surprised to hear Dr. Oz say that a mans g spot is his prostate. That scientific statement says that a mans anus is a sexual organ.

Sean, I congratulate you on your sound point of view and measured way you make things clear.
Induced fear never works - it has been tried for centuries, so people should have learned from history. It's a shame lots of people still think in their self-righteous, Anita Bryant-way of thinking they can order others to live their way.
Your are right that PEP should be readily available. It's a pity (euphemism) it didn't work out for me. I never was conscient of the moment, never thought I would get it, after a life long history of anti-hiv activism (the humane way of course). I suppose I'm not the only one. Proper hiv education is scarcely out of the egg in the US. Can you imagine how it is here in retarded France!

I'm struck by the contrasting points of view cited by Salovey, and disappointed that they weren't cited by the ad's critics. Good reporting job, and if only the prevention folks were willing to explore the same nuance. Seems to me like this may be willful ignorance rather than real ignorance; and reflects wishful thinking on the part of the critics. It's a simplistic notion that fear never works, that only by reinforcing resilience will we all win. I don't buy it. And I think this may be what Dan Savage called when describing some of the Seattle prevention efforts, "The inmates running the asylum." Debate is fair enough - but why the urge to only adhere to one side of it and not even quote the other?

From the NY Times article:

The advertisement’s critics cited research by Peter Salovey, a psychology professor at Yale, and colleagues, who found that threatening messages did not necessarily lead people to adopting healthier behaviors and could be counterproductive. The researchers also found that many preventive health behaviors, like using sunscreen, could be better promoted through positive than negative messages. In a 2002 paper, Dr. Salovey and his colleagues said, “One could hypothesize that condom use, because it is a preventive behavior, would be better promoted by stressing its benefits.”

But Dr. Salovey said he had also published research showing that negative-consequence ads did work better for some health campaigns, including one in which low-income minority women were urged to undergo H.I.V. testing.

He added that he could not pass judgment on New York’s condom advertisement. “As our research shows,” he said in an e-mail, “there are situations when messages stressing benefits are more persuasive and other situations when messages stressing the risks of not taking action are more persuasive.”

Bravo Sean! that was an excellent deconstruction of both the actual ineffectiveness of this offensive ad campaign, and the underlying homophobic motivations feeding into this campaign. your HPV/cancer-rotted-vagina example casts the visceral homophobia into stark relief.

Monica Sweeney lacks the vision to produce *gay-affirming prevention campaigns that work*, she's very much locked into ancient prevention paradigms no matter how damning the evidence against them. as for Larry Kramer, let's not forget that just a couple of years ago he was promoting The End Of Anal Sex altogether! As if our lives were something he could direct with his rhetoric...

continuing the shrillness theme here, Nick posits that there are "whites only" lgbt groups in NY, a comic absurdity...and then claims that blacks are banned from major AIDS service organizations. any visit on any day to GMHC, Bronx AIDS services, Project Momentum or most other NYC ASO's would put the lie to Nick immediately...blacks are well-represented. it is sad to see Nick graduate from strong language to inflammatory falsehood.

Nick, i do not believe you addressed any of Sean's actual points. you merely told him to "shut up", which nobody will be doing on your account. I find it telling that you fail to address poor medication adherence due to distrust of pharmaceuticals in the Black community, as you yourself only write contemptuously of "pills, pills, pills".

You might also add "internalized homophobia" to the list of compounding factors facing NYC blacks at risk for HIV...this ad will make that worse.

Thanks Sean for, at the very least, bringing rational & non-dogmatic arguments to the debate (the larger one than just the NYC ads). Yours is the 1st article i've seen that discusses both sides of such a hot & difficult issue, rather than preaching how one simplistic answer fits all & how nasty or dumb the other side is.

I've long wondered at the simplistic ads i see on this issue. As someone who's admittedly more intellectual than most, i've wondered whether the smash-them-over-the-head-with-a-blunt-instrument approach has really proven to be more effective than the reasoned information that i've craved (& might've prevented my seroconverting).

I don't want to try to dissect what you've written, since it speaks so well for itself. But, from my perspective, the 2 things that stand out about this article are (1) the distinction between when fear-based advertising is effective & when it isn't, & based on at least one study, not just hypothesizing, & (2) how such advertising can be counterproductive, something i've long felt but had no reason to feel was more than just my concern, since health agencies seem to have long promoted simplistic messages which, to a greater or lesser extent, suggest we're angels or devils, depending on which of only 2 choices we make, & never giving us the info we need to make individual choices on what risks are acceptable & which aren't.

I have a strong sense of what led me to take the risks that led to my infection, & those have never been addressed in any campaign i've ever seen. The ads & "information" have all just seemed to say "do this or you're evil (if poz) or stupid (if neg)", & have never acknowledged that there are other rational choices than all or nothing (which can lead some of us to choose nothing, in despair), let alone that there are real issues we each must deal with, in making sexual choices.

My despair with public health ads & even "informational" pamphlets is that those i've seen don't give any real info. In effect, they don't give us the respect of acknowledging we can actually make reasoned decisions if we have the data. And thus i can fully believe that (as happened with me), people just gave up trying to figure out where is a rational place to draw the line for oneself. When i seroconverted, i had no idea about relative risk, though i sought it, & i just wanted to duck-&-cover from the ads telling me to "just say no" to anything except condoms (& which totally ignored the reasons why i would engage in risky behavior, so i had no basis for making the kind of distinctions that would have been reasonable for me). Thus i felt i was just a hopeless freak & my issues with the all-or-nothing approach were of no concern.

I suppose i should add that your explication of the homophobic aspect of public "service" messages is sobering, to put it politely. I can easily imagine that some have promoted messages that effectively say gay sex is disgusting, without even realizing it themselves. Still, while i don't know whether you're right here, i applaud you for raising the issue, & those who put out such ads need to consider ALL the consequences, not just the ones they're hoping for. Despite my dis-ease with much of the public service ads, I myself never realized how much such images & subtle sub-texts of anti-AIDS ads might've even affected people like me to perhaps sub-consciously think i wasn't worth saving from infection, let alone how those ads could fuel the general public's disgust for gay sex (& thus of gays, as less than fully human).

Strub vs. Kramer is the latest round in a three decade debate on how to most effectively communicate queer health issues to queer men. The problem of new HIV infections is and always will be rooted in systemic violence, including an anti-queer world history. As a result of HIV and internalized homophobia queer men are an immediate, historical, sexualized embodiment of the age old theme: man v.s. man.

When such polarizing positions (S v.K) agitate, one against another, I often wonder what it takes to create defined spaces where competing perceptions can safely/creatively begin to hear one another's POV.

[I appreciate the level of communication generated as a result of Sean's powerful posting. Please keep it rolling, Sean.]

With daily HIV diagnosis compounded by unimaginable loss and grief, compounded with staggering world-wide HIV related issues of social oppression (sexism, racism, homophobia, poverty...) how do we create a state of amnesty amongst ourselves -an open, inquisitive space that makes room for the issues that divide HIV +/- queer men free of blame, shame, attack?

At the heart of all conflict is a desire for connectivity and shared gnosis (knowing). Where and how and when will we allow ourselves to be vulnerable enough to recognize that intrinsically we are connected despite (and maybe even because of) our differences? What mutual skills do we need to further navigate our queer/sexual/health landscapes? How many archival layers down through the historical, cultural collective, the psycho-social patterning and intimate personal, until we claim a common desire for connection?

Authentic, loving community connection: Pollyanna? Myth? Assumption?

Perhaps.

However, during the formative years of the AIDS crisis, the queer community (inclusive of non queer identified allies) rose up to respond and reform the political, medical and socio-cultural landscape. The crisis gave us meaning, purpose and a profound sense of belonging. Those brave warrior/esses advanced GLBT issues well beyond the now iconic Stonewall era. On the waves of sexual liberation came front-line life or death, self sacrificing activism. What wave of activism do we offer/represent in 2011?

The process of healing (war or illness) is generations long. When acknowledged as a process, as well as an end goal, healing occurs. The destination is shared health as a result of shared intimacy. Men loving men is possibly one of the world's greatest conceivable expressions of health there is.

At times queer men appear to be the furthest away from and occasionally closest to a world of health and well being.

Nothing good can come from fear. Fear leads to hostility and aggression and acting before thinking. And the way that ad was described sounds like hysteria and chaos control. (A picture of an asshole scorned by cancer? Really? I wonder who let themselves be photographed this way?) I contracted HIV a few years ago because I was afraid. I never was quite sure if I was really, truly alive or not. I was afraid of everything. And I guess I needed something like HIV to guide me. I don't necessarily like having HIV and sometimes I detest the idea of being rejected or judged because of my status. And there were times when I wanted to lash out and infect somebody else because I was angry and because I felt like nobody was listening to me. I could go on and on. Shame, anger, bitterness, resentment, hate, self-doubt... Blah. These are the types of feelings that begin and end with fear. Controlling someone's behavior with fear tactics may work in the short-run. Maybe. But in the long run fear will produce HORRIFICALLY negative results. Always does. Every time. Open a book and have a looksey. If I were told by the voice of doom that I absolutely had to wear a condom - under threat of whatever-it-is-you-have-in-store-for-me-God-on-down - then I would be so terrified that I would cease to live rationally. I would think this is how anybody would react to such a fear-borne message as this. And doing anything 100% of the time with supposedly no room for a misstep is very intimidating. Fear. Does anybody really want to attend their own witch trial? Then I started listening to myself. I never did anything to deserve this kind of self-torture. I was just different. So I started questioning things more and more until I got to the point where I now question just about everybody. I don't know Larry Kramer at all and I am sure he has served as a positive role model for many gay men, and that's awesome, but I was not impressed by what he said. We all have to die and everything happens for a reason. Going on "before and after", I think I could say that HIV has been a positive thing for me (pun intended, duh!) because I didn't have A CLUE before. Paradoxically, it has given me so much new life. Sure, I don't want to feel sick all the time, and I still get to feeling sorry for myself soemtimes when I am craving something old and familiar, but those things slowly get better. The guy who infected me lied to me about his status, and I can still remember his face. I still get a little creeped out whenever I think about him and what he must have been feeling at the time. But looking back I think a part of me must have known what this guy's intentions were. And I feel sorry for a person who has this much fear and anger inside him. But nothing happens by accident. It's as real as spirit. I don't blame him because if I did I would feel like my life didn't belong to me and I would go insane. Literally. And I would want to infect other people. Now I have gotten to the point where I will tell a guy beforehand that I am HIV positive. I try not to make a big deal out of it, but at the same time I am very proud of myself for being able to do it because it takes a lot of courage for some people and that is one thing I never had before. Once, I disclosed my status to this guy, who did turn me down, but went on to say that I was a "man of integrity" and that he had a lot of respect for me. I started to cry. (It was all e-mail, so I could cry my heart out in the relative comfort of my own room) It was one of the most affirming things I had ever heard about me. I will say that it felt 10000% more wonderful than any magnificent big, hairy cock has ever felt. So, I got rid of my fear. La-dee-dah, la-dee-dah. Yeah. But I had it for a long time. "Lethal weapon"??? Sure, if that's the way you CHOOSE to look at it. Hands are lethal weapons, too. So are words. So are feelings. Look inside.

I think this debate of social marketing messages is very healthie in the two sides of the story concerning HIV and prevention. I sm concerned that the debate needs to go futher in addressing men in conversation and action concerning honor,loyaty, and building loving relationship within the gay community and beyond. You see I believe condoms are important, however now that Gay Holy Unions and Adoption of Children are on the main stream of many of our communities their is a need to express long term goals with in a loving relationships. I think in the conversation of honoring one's lover or life partner. It is difficult for a sub culture that are shunned, and dismissied as having loving relationships to heal from the past and push foward for the goal of truth and honor. Most gay folks have live in lies to protect their homes, jobs, livly hood and self imagine. Times have changed and the need to charish one another with out excusses to live and love is a truth that needs to be on the agenda. Let's change the conversation to building loving relationship that incluides healthie loving sex for a fuitfull life and legency of love.

I must suggest all the sensitive guys to get their heads out of their sensitive anus. You sensitive guys sound like the loud mouth leftist gay guy call Micheal Angelo on radio in NY that mirrors Rush in selfishness, where no other course of action is allowed, if it doesn't set well with them and has no insite or will to hear the other side of the debate or to compermise. Me Me Me and taking selfish position that realy don't care about any one except themselves and infated ego. Wake up, for their are other people on the panet too and they all have an anus. The US Navy has ran sexually graphic films to the miltary for 30 years or more about STDS to teach young men and women what could happen without a condom and has work for many of the miltary. The truth in learning is a good thing. For the HIV people and gay men that allow this PSA to create their self imagine, please get help, for the cartoon is not about you, it is about helping youth stay negative and hopfully to help create a healthie relationship with his or her future life partner.

I am livid that the Dept. of health said I
d be dead by 1995, and I have waited for 25 years for this 100 percent certainty has NOT happened. In 1995 I was drugged & Bellman gave me meds for 2 years and when I went OFF of them I had a VL of 77. It is now 11 yrs. later and my Viral Load id undetectable. No VL no meds, so what do I get in terms of compensation or turning down marrying millionaires & having kids. All my friends died & I got a Ph.D. Did any of you have the balls to NOT take drugs? I've had 90n T4's for a few years & that hasn't killed me. Only one Dr. has said I'm not either misdiagnosed (2 positive tests by NYCDOH) or untreated. Gee, maybe Duesberg was right in the GL Center in 1987. Were any of you there? Has anyone else knowingly refused to take meds till they were told they didn't need them? I don't think they should be allowed to get married, have unsafe sex or make a single plan. They starved & worried me so I don't have a stomach anymore, but I'm still waiting to die as every Dr. but two said so many times I got fed up & said "Let's see- I'll gamble I can live without meds- I was right, but everyone I loved is dead.

Frederick, I don't understand your complaint about "sensitive guys"; what I address isn't about sensitivity but about what actually will work and effectively and constructively change sexual behaviors over the long-term. The point I make, which I believe is supported by the research to which I provided links, is that this campaign may be counterproductive, leading to more new infections rather than fewer. What may have worked short-term for members of the military is very different from what will work over the long-term for MSM.

Sean I understand your positions and all of them are excellent in the concept of different aproaches to different social groups. The PSA that is beings discussed on a couple of bloggs by many are using the arugument that fear doesn't work in social media for it is not sensitive. I understand this PSA is protraying gay men in a bad light and needs to be tweeked a bit. However, I don't think one focus group is science, come down to the south and show a graphic flim of all stds, with real life pictures and case studies to 50 young gay men not in college and then ask them at the end of the presentation does this realty of these STDs help you understand why a condom is a handy prevention tool. The other problem of using a condom all the time message, which is a great message, however in truth, it is like the abstaining from sex message , not very realistic, for most people like nature sex and want to have nature sex. Don't you like natural sex? Sean we need to get more real with the communication and straight forward message is my point for so far nothing in the past or future has completly stop new HIV cases. However I believe young people need to know the truth about STDs and not to surgar coat the problems. Again Sean, all you bullet points in prevention is worth a try and to keep tring. How about a new one like Over the Counter Rapid HIV Screening Kits forsale in CVS, Walgreens and in local Super Markets for self screening in the privacy of one's home, for this might help all in our community to face HIV, discuss healthy sex and to get treatment if needed, while helping to stop the spread of HIV. What do you think Sean about OTC Rapid HIV Screening Kits being put on the open market?


To Frederick Wright and Sean,

I agree with both of you, The US Army also would show us photos of men and women with horrible STD's, The only issue that I have with that PSA annoucement is that they should show more women and they should also show more after effects of AIDS and other STD's. It does make gay men look like they are the only people contracting these diseases, which in turn will send out mixed messages, like in the past.

Its real out here, they have to get the message across somehow, because nothing else is working!!

They should focus on finding cure for the disease rather than lying about what HIV carriers are prone to, because as long as the disease lives, it will indirectly or directly gets at you. You are not alone in the world, you can take responsibility of your action and try to be as careful as you could to stay negative, but that’s not a yardstick to be confident of staying negative. HIV is not only spread by gay men. There are other mistaken or accidental means of contraction, Blood transfusion and etc. It could be your love affair with that beautiful decent girl look that looks too good to be carrying the virus, and then you hit it unprotected.
Some viral infection if left untreatable could penetrate through our CNS and attacks our brain cell, but I can assure you that HIV viral attacks on brain does not go beyond mild depression. And temporal forgetfulness which are sometimes seen in healthy people also.
Apart from the seniors dementia which is known as age related disease, If a dementia symptom of HIV qualifies that as seen in Alzheimer’s patience, then the person is simply co-infected with Alzheimer’s and should not be blamed on HIV. One should put into consideration the state of brain of those using illicit drugs and dangerous chemicals.

Thanks

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This page contains a single entry by Sean Strub published on January 3, 2011 11:47 AM.

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