Stigma as Prevention: The Homophobia Behind a PSA

The unsafe behavior that produces AIDS is judged to be more than just weakness. It is indulgence, delinquency -- addictions to chemicals that are illegal and to sex regarded as deviant.

-- Susan Sontag, AIDS and Its Metaphors (1989)

If you follow the news about HIV at all, you've already heard about a controversial public service announcement (PSA) from the New York City Department of Health and Mental Hygiene (NYC DOHMH). Entitled "It's Never Just HIV," the PSA warns gay men that getting HIV will make them more susceptible to other diseases and conditions, like osteoporosis, dementia, and anal cancer.

To me, the PSA looks a lot like a trailer for a low-budget horror movie. It features a scary voice-over, lots of frightened-looking young men, and most strikingly, a hideously diseased ass. Yep. That's right. The NYC DOHMH apparently thinks that the way to get its HIV prevention message across is to show revolting images of an anus covered with lesions.

Dr. Monica Sweeney, NYC DOHMH's Assistant Commissioner for the Bureau of HIV/AIDS Prevention and Control, acknowledged that "not everyone is going to agree with it, but we hope they remember it." Having watched the PSA a number of times, I'm pretty sure Dr. Sweeney's hope will be realized, because this is not an ad you'll soon forget. Of course, what people will remember is another story, and that's what I'd like to talk about.

First of all, you can count me among those who don't agree with the ad. Frankly, as a gay man and as someone living with HIV, I find it deeply offensive. What's worse, I seriously doubt that it will be effective as an HIV prevention message. On the latter point, I have nothing to add to Kellee Terrell's superb dissection of the PSA's many flaws, and so I won't waste my time trying to say what Kellee has already said better than I possibly could. Instead, I'd like to focus on what seem to me to be some of the unspoken assumptions behind the ad and on the messages it sends.

To understand what I think is wrong with the PSA, one needs to realize that media images of gay men don't exist in a vacuum. Homophobia influences both how straight people see gay men and how we gay men see ourselves. Consciously or not, this PSA relies on at least two homophobic stereotypes of gay men. The first is that being gay makes one unhappy. The second is that gay sex, particularly anal sex, is deviant, disgusting, and diseased.

Let's look at the ad in the context of the first stereotype. Without exception, the models whose faces we see are beautiful young men. And every last one of them looks either scared, anguished, or just plain miserable. The message seems to be that, even if you're young and beautiful, it absolutely sucks to be gay. This might not be so bad if our media were filled with all kinds of positive images of happy, well adjusted gay men. But despite some recent progress on this front, that's not the image of gay men most Americans have. Even more important, that's not the image that a lot of young gay men have. Being gay, and the stigma associated with it, still lead far too many young gays to depression and despair. That being the case, should NYC DOHMH really be lending implicit support to that image?

The PSA's subliminal "gay = miserable" message is bad enough, but in my view, it's not what's most harmful about the ad. The most disturbing part of the PSA, as many have noted, is the brief close-up we get of a hideously diseased rectum. If you pause the ad at about 0:23, you can see it clearly. In the image, the patient's legs are splayed apart to expose his anus. Just to make sure you get a good view, a latex-covered finger on the left hand side of the frame holds the anus wide open, all the better to show the ravages of what is presumably anal cancer. There are black lines on the patient's skin that I can't identify, but that look like stitches or perhaps scars. This is the kind of image you'd normally see only in a specialized medical journal, and it's clearly intended to evoke feelings of disgust and revulsion.

Now if you think homophobia played no role in conceiving this part of the PSA, I'd ask you to ponder Sean Strub's question: Anal cancers are preceded by genital warts, which are caused by strains of HPV, the human papillomavirus. Last year, 4,000 women in the U.S. died of cervical cancer; in virtually every case the cancer was caused by HPV. If the [NYC DOHMH] pursued a campaign to combat transmission of HPV, does anyone think they would, for a moment, consider using a close-up image of a horribly diseased vagina? I think we all know the answer to that one. No responsible public health official would dream of depicting the consequences of heterosexual sex in such a negative fashion.

But when it comes to gay men, I guess NYC DOHMH figures that when all else fails, you can gross people out. I can see why the strategy would appeal to a bunch of straight people. After all, our majority straight culture works mighty hard to impart the message that gay sex, particularly anal sex, is dirty and disgusting. If you're trying to get gay men to stop having unprotected anal sex, why not use that almost instinctive disgust as a weapon in your depleted arsenal? Doesn't the end justify the means? I'd say no for two reasons. Exploiting internalized homophobia only adds to the psychological burden on gay men, while at the same time feeding antigay prejudice.

Growing up, gay men can't help but internalize the message that gay sex is unnatural and unclean. Given the role the anus plays in our excretory functions, this message has particular force when it comes to anal sex. Most gay men spend years trying to overcome discomfort and ambivalence about their perfectly natural sexual desires. Believe me, it's hard to have a healthy attitude toward sex when you've been told all your life that your most intimate sexual practice is something to be reviled. If there's one thing gay men don't need, it's another reason to dislike themselves or their sexuality.

Of course, gay men are not the only ones who'll see this PSA, which leads me to the second problem. Dr. Sweeney and her colleagues apparently didn't stop to consider the manner in which her hard-hitting message would be (mis)used by those on the political and religious right. She might be interested to know, however, that the American Family Alliance's Bryan Fischer has already cited the PSA as "proof" for his claim that gay people don't live as long as straights. Fischer writes that the PSA is "devastating for the homosexual agenda." Fischer is unlikely to be the only right-winger who'll cite the NYC DOHMH's ad to justify his homophobia. And he could hardly have hoped for a more credible source of support. What could be better than relying on an ad created by the public health department of what right-wingers regard as a notoriously liberal city?

I hope that in the future, NYC DOHMH will think twice before using an ad like this. Perhaps next time, the agency will try to be, as Kellee put it, at least "somewhat culturally competent." Perhaps next time they'll take it seriously when actual gay people express concern about the content of their ad. And I can only pray that next time NYC DOHMH will realize that stigmatizing your target population is no way to prevent the spread of HIV.

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