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
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.
Second, the men in the ad look utterly miserable and ashamed of being who they are. By demonizing gay sex, being gay and being HIV positive, this PSA only pushes HIV/AIDS back into the closet -- something the NYC DOHMH claims it doesn't want to do. How does this empower anyone to take responsibility and respect himself enough to use a condom? How does this lessen the stigma around HIV? I fear this ad will just feed into the fatalistic and self-hating mentality that some young gay men have: Why use condoms when I am destined to have HIV because I am gay?
Most importantly, this ad is problematic because it's completely insensitive to the fear that many LGBT people -- not just in New York City, but across the country -- face on a daily basis by being out with their sexual orientation or gender identity. There is the fear among some that they could lose everything because they can be legally fired in the state in which they live for being gay. Or the sheer panic that overcomes many transgender people when they walk out their front door because of the harsh reality that they may never make it back home alive. Or that menacing pit that lives in the stomachs of our LGBT youth when they pull up to school and realize that they have to face another day of torment.
We live in a society that has more contempt, than it does compassion for the LGBT community.
This October, it was that exact sentiment that Joseph Jefferson, a 26-year-old, Brooklyn HIV/AIDS advocate, conveyed on his Facebook page right before he hanged himself. He wrote, "I could not bear the burden of living as a gay man of color in a world grown cold and hateful towards those of us who live and love differently than the so-called 'social mainstream.'"
This PSA, however unintentionally, plays into that legacy of hate.
And even though the NYC DOHMH uses fear to raise awareness around other health issues, such as smoking, influenza and binge drinking, it must be noted that HIV and sexual orientation carry a hell of a lot more cultural, political and emotional weight than having one too many cosmos and not getting a flu shot. And while it's not the NYC DOHMH's job to unpack and sort through all of the LGBT community's "baggage," the agency does have a responsibility to be somewhat culturally competent. Perhaps if it had been more aware, we would have seen messages about other barriers to condom use, such as homelessness, low self-esteem, sex work, economic instability, substance abuse and a lack of condom negotiation skills.
Remember, HIV is never just about complacency.
Most likely, this campaign will fail, especially since numerous studies have found that fear-based campaigns don't really alter people's behavior in the long run. But even if "It's Never Just HIV" were to be successful at doing what it set out to do -- scaring the shit out of gay men in order to get them to use condoms -- that public health win would come at a high personal price. Because to sell HIV prevention using fear (as opposed to using love and validation), does nothing but inflict more unnecessary trauma upon the same vulnerable and at-risk community that the NYC DOHMH claims it wants to protect.
And in the end, that's a lose-lose for all of us.