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NYC's Public Service Failure

My fellow bloggers, Oriol Gutierrez and David Capogna, touch upon a very real issue regarding the new public service announcements from the New York City Department of Health and Mental Hygiene (DOHMH) bent on scaring people into reducing their risk of becoming infected with HIV: The stigmatization of those living with the virus. 

View the PSA here:

Public portrayals of HIV are a slippery slope and rarely done correctly. The reason for this is that there is no singular HIV experience. Just as there are undoubtedly people living with HIV who go rock climbing and run marathons after starting antiretroviral therapy, there are also people living with HIV who experience debilitating problems stemming from their medications, their HIV or comorbidities like cancer or hepatitis. There are also people who manage both--physically challenging feats and physically challenging frustrations--and, of course, a vast number of HIV-positive people who generally live the bulk of their lives somewhere between these two extremes. 

What we're left with are highly stylized snapshots intended to characterize the entirety of HIV-positive people's lives and experiences. The goal? To either manipulate people at risk for HIV into thinking that everything will either be sunshine and daydreams once they get tested and into care, or that living with HIV is fraught with dangers and that it (and by extension, those living with HIV) should be avoided, literally, like the plague. 

Well, from a public health perspective, you can't have it both ways.  

Over the past several years, many health departments, HIV organizations and information providers--AIDSmeds and POZ included--have worked independently and collectively to reach the one in five people living with HIV, but remain unaware of their status, with messages of hope without hyperbole. The take-home lesson: HIV is no picnic, but today's medical advances--including longer and healthier survival--and large number of helpful social services are only possible for those who look beyond the stigma, get tested and enter care. 

I fear that DOHMH's PSA campaign will set this effort back by years. I'm sure I'm not alone in thinking that people who are possibly infected but unaware of their status will think twice about testing for the virus after seeing this PSA. I mean, why test for an infection and knowingly live with media-driven thoughts of horrible manifestations that lay ahead? 

While the agency contends the PSAs are only intended for those at risk for HIV, not those living with HIV and unaware of their status, such messages have a funny way of being viewed by those beyond the intended "target" audience. Even if we had compelling evidence that scare tactics work in terms of preventing diseases--we don't--we certainly don't have a way of containing messages.  

As my friend Luis Lopez-Detres recently said, " Nothing says 'don't get tested' quite like this ad."


Show Comment(s)

Comments on Tim Horn's blog entry "NYC's Public Service Failure"

"As my friend Luis Lopez-Detres recently said, " Nothing says 'don't get tested' quite like this ad.""

Because waiting for pneumonia is such a better option...

You know what I am going to do don't you...yup, rock the boat. And those of your in the PC police squad may I kindly suggest you fuck off? I have been living with HIV for two decades and am pretty well respected HIV clinician, writer and advocate. This PSA ROCKS!

You want to know why I feel that way because I see over 20 people patients a days with HIV and deal with the DOZENS of people who use our free HIV/STD testing site on near weekly basis as means of "getting permission" to share needles and bareback. I do not sit behind of desk or climb the stairs in an Ivory Tower. The only thing I need a fucking red ribbon for is to use as tourniquet. The PSA has a message that is real and powerful. I have AIDS and I am at very high risk for everything mentioned in this PSA plus a dozen more clinical conditions.

Right now I have the "get your affairs in order" talk on a daily basis to people with end stage HIV and anal cancer, cardiac disease, and list is seemingly endless. I no longer cry tear but shed blood.

The biggest problem in HIV care - prevention and treatment - is that the "so called" leaders do not get their hands dirty. The read reports and go to conferences. Well that is really fucking nice but tell that to a my 25 year old patient who will likely (hopefully) be dead in the next few days because he did not understand what staying negative meant. So when he showed up with some belly pain and i pulled down his pants to exam him I was only mildly surprised to see clumps of "jelly like" clots hit the floor. He is 25 damnit and has ZERO T cells and KS in his gut. Just maybe a kick in the ass would have done some good.

If you want to be an AIDS leader in this country...come do a shift with me in my clinic and get a taste of reality. Who will have the balls to take me up on this? My email is Come brave; my patients certainly are.

Sorry, Ric... but your HIV doesn't stink any more than anyone else's, particularly other long-timers who were infected at a time when all we had were truly gruesome (read: real-world) images of HIV/AIDS. And if you honestly believe that only those who work as clinicians in urban clinics are in a position to critique public health campaigns, I hope you'll rethink this -- some of the most important contributions to the preventive and therapeutic response to HIV/AIDS in this country (and elsewhere) has been from people with HIV who live and breath the very stuff you're talking about here... many of whom, might I add, have done shifts in clinics next to health care providers such as yourself.

And if your idea of rocking the boat is telling those who may disagree with you to 'fuck off,' then I suggest you rethink how 'well respected' you truly are.

Let me say I still believe the PSA is very valid and stand behind my position. What I will also say is that my "fuck off" was inappropriate and uncalled for. I just am getting tired of how so many people can die of AIDS related complications (anal cancer, brittle bones, dementia, and on and on and on...) in the age of advanced therapies. I have never been PC and often times rude so I owe you, the readers and even myself an apology.This "viral warrior" is just getting too tired and old. Simple as that. Not an excuse for my response but an explanation.

To Richard Ferri:

I'm glad you apologized to Tim Horn. You do say however that you "stand behind your position." What you do not do, in the rant, is *argue why* that's your position. Rant away by all means; but do not pretend then that that is an honest engagement with the reasoned points made in Tim's post or in Oriol's either. A gruesome list of suffering that you've witnessed, and continue to witness daily, does not entitle you to claim an unimpeachable moral ground from which you can denounce -- without, as I said earlier, of even taking a second to contend with arguments made against the PSA -- those who disagree with you. That's the "I've suffered more, therefore I'm better than you, therefore you don't know crap, and I win no contest" sort of position.

How about an explanation of why this is an *effective* PSA -- telling us why it is you disagree with Tim and Oriol, point by point?

And, since you claim the rhetorical privilege of never being PC, I'll suggest, in a non-PC way perhaps, something: that, in order to better serve yourself, your patients, and your readers, you do *something* to defuse, confront, or somehow channel the boiling-over anger I've seen in your writing, and which mars (indeed scars) that writing -- sometimes to the point of incoherence.


Jay...yours and Tim's comments are extactly the major issue that is the subtext of my position. What makes YOU (All mightly and holy yourself) think I have NOT considered other view points. I offered mine and it differs from the "polictically correct" old guard. When someone disagrees with the "etablishiment" the best offense is a good defense. So kick away buddy, I can take it.

this psa campaign is just all out silly and doesnt really hit any point. As a nurse and a marketing major i would say "who is you audience" you are trying to target? It seems only young gay people. And as for stating dozens of causes of death.....three is not a good representation. a Boniva?

the fact stands clear that people do not die of hiv and aids. the news and statistics are skewed as they now die of other causes related to their original diagnosis.

After reading all comments and went back to watch the PSA campaign, I like the message. It's designed to reaching out to non-postives to be protected. What's wrong with it? I don't get it?

I am living with HIV for over 20 years and what the PSA campaign shows I have all, dementia, brittle of my bones, anal cancer that I had surgery and on top of all that I am dealing with rapid aging with lipodystrophy/lipoatrophy. Showing truth and using "fear" as a tactic for prevention champagne, I am good with that.

I was a HIV testing counselor for over 10 years and saw very young people tested negative but later tested positive. All the information to protect are there but infected unfortunately. It's very sad.

The number of HIV infections is raising. All the attempts to spread the virus are not working so far. Using "fear" to reach out mostly work as we saw how president Bush used fear to start this war.

I am good with any way to stop spreading this virus. I have seen enough unfortunate young ones.

Coming up on my 19th year since diagnosis, I have to say this PSA takes the wrong approach — way wrong — and only further stigmatizes and marginalizes people living with HIV.It does not address the problems associated with HIV/AIDS.

I just read this blog, watched the ad, and then read the truly mean spirited attacks from several people here--that means you Tim, Richard, Jay, et al. The interesting point is that you argue that the ad promotes fear, then you attack (all of you) to make your point. Doesn't that also promote fear, just in a different way? You all make this pretty personal, and disappointing for a reader who is trying to look at this impartially. Why don't we all grow up and have a discussion rather than an attack?

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About this Entry

This page contains a single entry by Tim Horn published on December 17, 2010 12:09 PM.

Onward and Upward with PrEP, Cautiously was the previous entry in this blog.

2010 Treatment News in Review (Part 1) is the next entry in this blog.

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