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Fear and HIV Prevention Shouldn't Mix

Why the New York City Department of Health and Mental Hygiene's Frightening New Public Service Announcement Geared Toward Gay Men Does More Harm Than Good

December 21, 2010

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Think one part The Walking Dead, one part CSI and a dash of any anti-gay public service announcement (PSA) from the 1950s, and that pretty much sums up "It's Never Just HIV," the New York City Department of Health and Mental Hygiene (NYC DOHMH)'s newest PSA. In an attempt to raise HIV awareness among young men who have sex with men (MSM), this eerie and explicit PSA stresses that having HIV can make one more susceptible to developing bone loss, dementia and anal cancer.

View the PSA below:

Since its Dec. 7 television debut, "It's Never Just HIV" instantly polarized the HIV and LGBT (lesbian, gay, bisexual and transgender) communities. High profile advocates -- including Larry Kramer and Gay Men of African Descent (GMAD)'s Tokes Osubu -- have hailed this as a much-needed wake-up call for gay men. Kramer wrote, in a blog for ACT UP's Web site, "It's about time. This ad is honest and true and scary, all of which it should be. HIV is scary and all attempts to curtail it via lily-livered nicey-nicey 'prevention' tactics have failed." Osubu told NBC New York, "We're getting to the point where HIV is becoming the norm. It's okay, you can just take one pill and it will disappear. But that's not the reality."

Others are calling it a serious prevention failure. On Dec. 13, New York City's Gay Men's Health Crisis (GMHC) and the media advocacy organization Gay & Lesbian Alliance Against Defamation (GLAAD) called for the ad to be pulled from television because it is "counterproductive" and "sensationalistic." The NYC DOHMH refused GMHC and GLAAD's request and plans on playing the ad throughout the month of December and into mid-January. When asked about NYC DOHMH's decision, Monica Sweeney, M.D., the assistant commissioner for the NYC DOHMH's Bureau of HIV/AIDS Prevention and Control told FishbowlNY, "Silence is no solution."

The use of fear is not new when it comes to HIV prevention, and when looking at how far (or not far) we have come in the past 30 years, I can definitely understand why the NYC DOHMH may have relied on scare tactics to grab people's attention. New HIV diagnosis rates among MSM under the age of 30 are up 50 percent in the past eight years. Yes, that's a serious problem.

I also understand that a lot has changed since the disease was once called GRID (gay-related immunodeficiency disease): AIDS doesn't deplete social circles anymore thanks to antiretrovirals; the face of the disease has become more inclusive over the years; and Big Pharma markets living with HIV as painless and as easy as popping a pill every day. And despite everything we know about this disease and how to prevent it, we are still seeing naive and nonchalant attitudes among young men when it comes to HIV. Clearly, we have a lot more work to do.

But many of the large, national LGBT organizations -- the ones that have the most visibility, influence and funding -- need to take some responsibility for why HIV has fallen off their own community's radar as well. While some of these groups will occasionally lend a hand to HIV/AIDS organizations when it's convenient, they essentially have turned their backs on the epidemic and have taken up more "relatable" platform issues, such as marriage equality, adoption and "Don't Ask, Don't Tell." And while I understand that the stigma of the early days has helped shape homophobia and misconceptions about gay people, now is the time for LGBT people to let go of that hang-up and re-own this epidemic as if it's 1985. HIV is still a gay disease.

But even if the kids just don't get it and would rather remain fixated on Lady Gaga and Beyoncé, or even if Gay Inc. is too busy playing respectability politics with straight America, that doesn't justify what the NYC DOHMH has done.

This PSA is not the answer. Not even close.

First, it's misleading. The ad simplifies the science around the association between HIV and developing other ailments, such as dementia and osteoporosis, by making it seem as if these things are a definite and will happen immediately after being diagnosed. These are diseases that may not happen at all and if they do, most likely they will occur much later in life. It's not that plausible that a 28-year-old, HIV-positive man will go dancing at Splash on a Wednesday night and look down to see that his femur has snapped in half. Not to mention, this could actually deter people from wanting to get tested since the ad claims that antiretrovirals don't necessarily stop one from developing these diseases. Ignorance for many is bliss, especially if it seems as if modern medicine won't stop one's anus from being riddled with bloody sores or one's brain from rotting.

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More From This Resource Center

Undetectable Viral Load and HIV Prevention: What Do Gay and Bi Men Need to Know?

Do HIV-Negative Gay Men Need Condoms if They're on PrEP? Here's What I Tell My Patients

This article was provided by TheBody.
See Also
"I Talk Because": A Better Way to Do HIV/AIDS Awareness Ads
Fact Sheet: HIV/AIDS and Young Men Who Have Sex With Men
Quiz: Are You at Risk for HIV?
10 Common Fears About HIV Transmission
More Personal Views on HIV Prevention for Gay Men

Reader Comments:

Comment by: marissa (Canada) Sun., Oct. 30, 2011 at 12:53 pm UTC
what if someone newly dxed with HIV sees this ad?They might not have very good social supports or might not have even told anybody they have HIV. It could make them really really depressed and low. They might even become suicidal because this PSA depicts horrible effects from late stage AIDS.
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Comment by: Ed (Bronx, NY) Fri., Jan. 28, 2011 at 11:27 pm UTC
Thanks for this article. I cringe every time this commercial comes on and I have to change the channel. It's wrong on so many levels and now I'm convinced I have anal cancer.
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Comment by: Lhamo (Deerfield Beach, Fl) Sun., Jan. 23, 2011 at 8:19 am UTC
hetro white women living with AIDS since 1989. Dr. Kotler and Dr.Viera were my Dr. while i lived in NY for first 16 years of illness. they saved my life, as well as programs in NY and openess compared to flroida. Very ill during those years. Hospice 2 times. Now in florida, knew better, got stuck here, and dying from lack of good care, no resourses,after being one of the few of my firends who did not die! Got sick too early to get medicare..age live on SSI in floirda $674.00 with medicaid which is called testing, no drs, stayed with broken leg for 3 years for no permanent damage. No family and friends and son in money to leave here. Pity that i was always on reasearch study for not only myself but for other women to follow. Little know about women living 22 years past menopausal age with AIDS diagnosis. Raised a son being in NY hospitals almost all through the 90' i think only to die from backward treament in Florida!! Really backward..if one lives in one county.on medicaid.cannot go to Dr. in another county..i have one Dr. and if sick ambulence will not take me to this hospital even though in same county. I am very scared and would like to help ALL i did before. Was first women in GMHC..and member of ACT-UP..with Love Cheryl..aka Lhamo
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Comment by: Anonymous Sat., Jan. 22, 2011 at 1:04 pm UTC
Take care you only have a single life and body.
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Comment by: Peter (Washington, DC) Fri., Jan. 21, 2011 at 7:52 am UTC
I'm HIV+ having been diagnosed in 2004. I read The Body religiously. Firstly, let me say "Thank you!" for having this site as it has been a Godsend for me and others that I have referred it to. The information you put out is essential, especially for the newly diagnosed.

However, I think you've got it wrong on this one, even if I believe your intentions are good. I see way too many young people with no fear of HIV. People can absorb multiple types of information from different sources. Sources like yours give the positive and encouraging information. But, lets not whitewash this disease. It can be horrible and it can be avoided. Those two facts tell me that the negative implications of HIV needs to be in the kids thoughts, too, as they make life decisions. Not just that it can be managed.
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Comment by: Rick (San Luis Obispo) Sat., Jan. 22, 2011 at 12:56 pm UTC
Peter, all niceties aside, if fear were the be all and end all of prevention, how did you end up becoming infected?

Comment by: Tom (Spokane, WA) Sat., Jan. 15, 2011 at 3:23 pm UTC
How can we miscommunicate anal cancer as a direct consequence of HIV without even mentioning gardasil, then pretend we're even interested in public health?
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Comment by: Randy (New York) Tue., Jan. 11, 2011 at 11:56 pm UTC
I have had HIV for years now; and to see that there is a commerical telling facts about HIV/AIDS doesn't blind anyone. Somethings we should be considered about; HIV exposure is one of them. Everything I saw in the ad is pretty much the stuff I read on things on this site can be far fearful than that video. My complaint is HIV isnt just a Gay disease. Wish the ad was more universal. Tho it is true, Gay men have to worry about more. We cannot deny it; denying it causes the spread of diseases.
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Comment by: GiorgioNYC (New York, NY) Mon., Jan. 10, 2011 at 3:22 pm UTC
First of all, you HIV+ people need to get over yourselves. This ad wasn't aimed at you. It was aimed at uninfected young gay and bi men, mostly of color, whose infection rates continue to rise. None of the weak-kneed, "affirmative," unthreatening ads that the AIDS establishment likes to see has been effective in reaching this key demographic. The article here also is incorrect about the science. Anal cancer, osteoporosis, and dementia are indeed sequelae of HIV infection, and HIV docs are increasingly seeing them among their patients. Some of these conditions present themselves earlier than others, but they are being seen in men in their late 20s, 30s, and 40s. HPV is indeed necessary for anal cancer to develop. But most sexually active gay men, especially those in major cities, have HPV. They rarely develop anal cancer, though, unless they also are coinfected with HIV. Cognitive impairment also is increasingly being seen among HIV+ men, with age of onset varying. Some of the comments here just reinforce what I've felt for a while: for some, saying anything negative about HIV, saying in any way it is an undesirable condition, is somehow "stigmatizing." This is absurd. HIV remains a very difficult condition to live with, drug company propaganda notwithstanding. Social marketing that is hardhitting, in your face and yes, fear-arousing, most definitely can raise awareness and there exists a considerable body of research to support that claim. And I really don't get how some people are reading the ad, claiming the men in it look ashamed of who they are. They look concerned, worried, fearful, which should be obvious to anyone who watches the ad without a pre-formed agenda.
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Comment by: Byron (Long Island) Fri., Jan. 14, 2011 at 1:37 pm UTC
I agree. This is a PSA a prevention tool. People already infected should not be concerned with what is protrayed in it. Especially since everything shown is 100% true. I think alot of people that are infected are in denial with how deadly the virus can still be, even on medications. This PSA is supposed to be shocking and in your face, its supposed to get people to stop and think and talk about it, instead of sugar coating the reality. I applaud this route to get the message out there!
Comment by: Richard (Berkeley, CA) Sat., Jan. 15, 2011 at 1:57 am UTC
We consider it "stigmatizing" because no other disease...with the occasional exception of lung cancer...has its most morbid consequences shoved in people's faces on a regular basis. Dementia alone gets mentioned so many times that to a lot of newly infected, its beginning to sound like 1987 all over again. If there were any serious evidence that this fearmongering was preventative, you'd have a case on your hands that we need to get over ourselves for their protection. Most data, as well as most logic, point to the contrary, so it stands that our concerns are legitimate. In the current climate, its a wonder anyone bothers to get tested at all. Why on Earth would anyone choose dementia over pneumonia? HIV is no walk in the park, but the desire of some groups to embellish its most ghoulish manifestations in the name of "prevention" is highly suspicious. You mention that 20, 30 and 40 somethings are facing these comorbidities. Lets be honest and admit that the only people who face these comorbidities in their 20s and 30s are people who were infected as children, or who are so terrified of the result of their test that they defer testing until they're diagnosed in the ER with AIDS. Lets be honest that there is a vaccine which young people can, and will, utilize to avoid HPV. Osteopeorosis may be mitigated or avoided altogether with sufficient monitoring and medicine. Lets stop trying to pretend that their hips are going to abruptly snap on the dance floor. People find this commercial horrifying and stigmatizing because its filled with partial truths, and because it may scare the heck out of people who should be tested and treated, making it a cruel, self- fulfilling prophecy.
Comment by: Tom (Bethesda, MD) Sat., Jan. 15, 2011 at 3:01 pm UTC
"you HIV+ people need to get over yourselves"??? That quote, and the fact that it was published on a WEBSITE PRIMARILY FOR HIV + PEOPLE, speaks volumes about the alienation and stigma we live with.

Comment by: fogcityjohn (San Francisco, CA) Fri., Jan. 7, 2011 at 12:54 am UTC
Amen, Kellee. I'm all for aggressive HIV education and prevention, but this ad is just disgusting. I don't think that making HIV (and those with it) seem terrifying is necessarily going to work as a prevention tactic. Walt Odets criticized this notion way back in the 90s, but I guess the public health folks haven't learned much since then.
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Comment by: Mark S. King (Fort Lauderdale, FL) Wed., Jan. 5, 2011 at 10:54 pm UTC
You go, girl. This ad actually made me feel SHAME as a man living with HIV. Like I was diseased, or dangerous somehow. Imagine if I were also younger, sexually active, and unwilling to risk being judged by others. I might just lie about my status to avoid feeling this shame.

Fear as a motivator for gay men's behavioral change stopped working about the time our friends stopped dying every week. But that doesn't mean gay men are unwilling to listen to rationale arguments.

Thank you for this thoughtful article, Kellee.
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Comment by: JB (NYC) Thu., Jan. 6, 2011 at 1:09 pm UTC
You are diseased!! You have a disease! ITS HIV. Gees. What's wrong with you people!! And this isn't a FEAR tactic this is real life, I'm sorry you people would rather sugar coat a still deadly disease than face the truth.
Comment by: TW (NYC) Fri., Jan. 7, 2011 at 11:02 am UTC
JB- I am offended by your comment. It is rude and disempowering to people living with HIV. I hope you don't work in HIV social services. Your clients would feel terrible about themselves. People who are LIVING with HIV are stigmatized everyday and you stating that "you are diseased" removes the fact that they are human beings. People with HIV know that HIV is in their body but do not need to be referred to as a disease...they are PEOPLE (first) living with HIV/AIDS. They are not "HIV"...they are human beings. Might I enourage you to read the Denver Principles. No one is avoiding the truth...people with HIV live with it every day.
Comment by: marissa (canada) Sun., Oct. 30, 2011 at 12:48 pm UTC
There's a difference between having a chronic illness and being a disease. You don't say Hey HIV + dude. You call him buy his name. A person is a person no matter what chronic illness they have.

Comment by: Louis (NYC) Fri., Dec. 24, 2010 at 1:05 pm UTC
Great article! Teaching safe sex is so much different than this fear-shame based ad.
Spreading fear is big business, especially in the US.
There is NOTHING educational about this ad.
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Comment by: Wayne (Detroit, mi) Mon., Dec. 27, 2010 at 3:41 am UTC
Have you seen some of the horiffic European ads? Pozzies portrayed as spiders, as freaks hiding in teddy bear costumes, even as hitler. We in the states hardly have a monopoly on serophobia.

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