Jasmine Corazon, 37, entered the subway recently and noticed something new. It was an image of a Latino man cozying up to his girlfriend (or wife) from behind, hand on her upper arm and coming in for a nuzzle. Below the intimate image was the encouragement: "Be HIV Sure." And then the direction: "Be safe, be sure, and get tested frequently."
It's a far cry from the images related to HIV she's used to seeing in the subway: the wan, skeletal gay men, often white, meant to provide living proof of the ravages of the virus. Or, conversely, the hyper athletic he-men, brimming with health and meant to be a counterpoint to the stereotype. But nowhere were there images of the people she saw every day affected by HIV: straight, gay, of all races, living, loving and carrying on regular lives as people with HIV alongside the people who love them.
"These are normal-looking people," said Corazon -- not her real name, since her husband isn't out about having HIV -- of the ads. "It's a huge step in the right direction."
Not looking like they are ill or sad or afraid is the whole point -- and so is the intimation of intimacy and sex. The New York City Department of Health and Mental Hygiene launched the Be HIV Sure campaign on World AIDS Day in December 2014, as a new take on the old message: Get tested, get treatment, take precautions. But this time, it's without the layer of fear-mongering or sex-shaming that often accompanies such campaigns.
"When we designed this campaign, it was really important that we didn't stigmatize in any direction -- whether you are living with HIV or at risk of HIV," said Demetre Daskalakis, M.D., an infectious disease doctor who leads the city's Bureau of HIV/AIDS Prevention and Control. "And we want people to find what it means for them to be sure. HIV is such a personalized disease state. The care is personalized. The message should be, too."
The New Faces of HIV Care and Prevention
The new campaign features a number of couples: black, Latino and white; gay and straight. There's also a photo of Carmen Carrera, standing with her arms crossed, with a kind of "sisters are doing it for themselves" attitude. Daskalakis loves the image, mostly because Carrera, who came to public prominence as a contestant on RuPaul's Drag Race, is presented like any other beautiful woman. For the people for whom visibility and HIV prevention are so key, it's an affirmation.
"All I care about is that one transkid who knows who Carmen Carrera is," he said. "I love that straight men all over the world will say, 'That's a beautiful woman.' But then all the transkids will see it and know who she is, and think, 'They put this role model of mine on a poster, saying, 'Be HIV sure.' That's got incredible impact."
While Daskalakis loves all the images, he said he often finds himself riveted by the straight African-American and Latino couples. The way the man holds the woman; the way she looks softly into the camera.
"They're sexy," he said. "They're definitely touching each other. They look like a real couple."
They also look, he said, like one of them might be HIV positive and one might be negative. This "implication of serodiscordance" was intentional, too. The idea was to better reflect the contemporary reality. After all, data show that people with HIV live just as long as those who are negative, and many of those living with HIV are in relationships with people who don't have the virus.
Daskalakis' one regret is that the image of Carrera is of her solo. But, a magazine ad will correct that. The department is taking Be HIV Sure national, in OUT, The Advocate and HIV Plus magazines, and when it does, one of the images will be of Carrera with a man.
"We wanted people to be touching," he said. "What ends up happening, with this kind of sex-positivity, is a kind of neutrality. It's not about judgment or paternalism. It's just, 'Find your path, because your path will keep you healthy.'"
Images of Changing Times
Maybe it's no coincidence that the campaign comes along now. After all, a campaign about finding your own path to health wouldn't make much sense in the context of a single option. For years, the only way we knew to protect people from spreading HIV was to use a condom. Today, we have condoms, yes, but also Truvada, the HIV combination treatment approved by the U.S. Food and Drug Administration for HIV prevention (in a regimen called PrEP, or pre-exposure prophylaxis). There's also combination therapy for after exposure to HIV, called post-exposure prophylaxis (PEP).
And, of course, there's effective treatment, which, when it works, can reduce a person's viral load -- the amount of virus in one's system -- to undetectable levels. Those with undetectable viral loads while on HIV treatment are less likely to transmit the virus to a sexual partner, hence the term treatment as prevention, or TasP. Daskalakis said that 90% of his patients have undetectable viral loads. Today, he does as much care around high blood pressure and diabetes as he does around viral suppression.
"All of a sudden, there's treatment as prevention, there's PrEP, there's PEP -- a spectrum of prevention," he said. "I could just as easily say, 'Be Diabetes Sure,' 'Be Smoking Sure.' All of New York City should be whatever-you-need-to-be-sure-about sure. It brings the discussion back to what it should be, which is not HIV but care."
The ad campaign hasn't gone national yet, but its impact has. Daskalakis said the LGBT center in Washington, D.C., recently tweeted the hashtag #BeHIVSure in reference to its own HIV testing program. Individuals and far-flung HIV groups have tweeted the hashtag. Joe Bryant-Huppert, a medical student in Minneapolis, is one of those people.
"So many of the things you see [on HIV testing and prevention] are, 'Caution! Warning! Be safe.' Kind of … based a little in fear," said Bryant-Huppert, who tweeted the campaign as part of that city's Youth and AIDS Projects. "This one was more of, 'Just be certain. Be sure what's going on.' It's more uplifting."
And coming from what he described as "the not very sex-positive" Midwest, the campaign was a blast of warm air.
"It's a little cold [here] in a lot of ways," he said. "And not just because it's winter."
Couples Like Me
For her part, Corazon sees the current campaign as a better reflection of the life she's shared with her husband for the last 15 years. She met him when he was positive, but that wasn't the defining thing about him. For Corazon, her husband was just instantly "the most interesting person I've ever met." Often his HIV status is far in the recesses of her mind. He's been undetectable for years.
To her, Be HIV Sure is the right message, but it doesn't go far enough. There are still so many myths out there about how much risk you face if you're in an HIV-discordant relationship -- especially if your HIV-positive partner has a suppressed viral load. Corazon and her husband have three children -- all conceived naturally and all HIV negative. So the time for lingering touches and nuzzling aren't as abundant as they once were.
"There's still room for improvement," she said. "What about couples who have kids? That would be a daring campaign."