Housing Works President and CEO Charles King on why a controversial anti-HIV video featuring rotting brains and decaying bones is bad policy -- and doomed to fail.
Earlier this month, the New York City Department of Health unveiled a short campaign designed to convince young gay men to use condoms. It featured rotting brains, decaying bones and bleeding anuses -- the results, the campaign claims, of HIV. The spot is scheduled to run again in January. Housing Works joins a host of other groups, including Gay Men's Health Crisis, Latinos Unidos Contra el SIDA and the National Association of People Living with AIDS in demanding that the campaign never be used again.
The campaign is misguided for numerous reasons. The most obvious one is stigma: By flashing gruesome images, scary sound effects and somber-looking subjects across a screen, New York City is painting HIV-positive people as scary, disease-ridden vessels.
Even if such tactics didn't contribute to stigma, they still wouldn't be effective. Scare tactics -- alone -- don't work. Take the gruesome anti-smoking ads the city used to run. Yes, fear might have gotten you to think about stopping smoking, but when fear ran out, you had other incentives to kick the habit: The high cost of cigarettes or having to go out into the cold to enjoy your nicotine fix.
The Department of Health has defended the HIV prevention video, in fact, by citing the efficacy of that very anti-smoking campaign. So where are the comparable, citywide structural interventions to prevent HIV when the scare tactics wear off, efforts as far-reaching as the sin tax was for cigarettes or the indoor smoking ban? The health department is offering no new HIV prevention supports, such as greater funding for condom distribution or housing (more on that later).
There is also significant evidence that when it comes to HIV prevention, scare tactics don't work, point blank. The British social research group Sigma found that arousing fear was most persuasive to those already engaging in safer sex. But according to Sigma, when men who are not using condoms see fear-based campaigns, the campaigns provoke denial or "othering," a process by which viewers chose to believe "HIV won't happen to me."
Many saw through the city's scare tactics right away. What's been less talked about is how the campaign confuses HIV with HIV drug side effects and health problems that result from late treatment. HIV itself isn't associated with osteoporosis -- the HIV drug Truvada is. HIV may play a role in dementia and anal cancer, but people's best chance for preventing both diseases is early HIV detection and treatment. The city not only wasted money on a marketing campaign that won't work, but it confused and misled people about the way to fight diseases associated with HIV treatment.
What should be done? The Department of Health needs to ensure that there are sustainable structural measures in place to stop the spread of HIV. Ensuring that all homeless New Yorkers who are HIV positive (or at high risk of contracting HIV) are stably housed is a prime example of such an intervention. Stably housed people are less likely to engage in activities that put them at risk of contracting HIV -- like sex work or intravenous drug use. Those with HIV in stable housing have better access to medical care -- and are therefore much less likely to pass on the disease. The provision of stable housing and other structural interventions combined with an honest and pointed video campaign that encourages testing would be a more efficient way to fight AIDS.
Unfortunately, Mayor Bloomberg is simply not committed to combating HIV/AIDS in New York. He has consistently cut services for people living with the disease. In 2008, despite a city budget surplus, Bloomberg forced City Council to enact a $6 million cut to AIDS services, including HIV prevention. In 2009, he proposed $10 million in cuts. More than $6 million were enacted, largely to AIDS housing. And this year, he proposed crippling cuts to the HIV/AIDS Services Administration, the agency that oversees housing, nutrition and other benefits for 45,000 poor New Yorkers with AIDS and their families.
If we really want to address HIV in New York City, we shouldn't be shutting down the conversation with gory pictures of bloody anuses. We should be fully funding programs that lead to HIV prevention, testing and treatment.
Mayor Bloomberg and the Department of Health: Are you listening? Pull the scary ad campaign and focus on solutions that work.