I went surfing over the summer break. If you think that means I stuffed my scrawny 50-year-old body with my lipo tummy into a wetsuit, got into a Kombi van and spent my days hanging around the Great Ocean Road with my surfie mates, then you’ve got the wrong end of the surfboard.
No, I went surfing the internet as part of my role as a Board member of PLWHA Victoria to find examples of what HIV agencies around the world have done to involve positive people in campaigns to help prevent HIV transmission. PLWHA Vic is interested in putting proposals to the AIDS council and government on programs that we could be involved in.
At a recent planning day for our organisation, the positive people on the Board said they want to do something to help reduce the rising number of infections in our state. They spoke of their frustration with dealing with gay guys on the internet who are either negative or unsure of their HIV status but are seeking bareback sex, seemingly indifferent to the consequences. They also want to help other positive guys through some of the difficulties around sexual disclosure and negotiation that are such a common part of many of our lives.
The first site I visited was probably a lesson in what not to do. A campaign by San Francisco’s Stop AIDS Project, HIV is no Picnic features dramatic photographs of pos guys with huge bellies, sunken cheeks, skinny arms and legs: the telltale signs of lipodystrophy. Other posters feature pos guys talking about diarrhoea, night sweats and the other unpleasant side effects of taking HIV antivirals. The slogan is “Don’t get me wrong — I’m glad to be alive — but HIV is no picnic.”
There may be some merit in this ‘shock! horror!’ approach but I doubt it would be appropriate here — particularly because of the risk that it could turn positive people off treatments.
Surely there are ways of discussing the realities of living with HIV without sending unconstructive messages to positive people. Treatment side effects are important, but there are enough issues for us to fill a dozen posters: sexual disclosure, living with uncertainty, fear of discrimination, rejection by partners and so on.
Campaigns directed solely at pos people — maybe using messages from other positive people — are a relatively uncharted territory for educators in Australia. It has been a ‘no go’ zone for AIDS councils and PLWHA groups because of the risk of further stigmatisation of positive people if people read into the campaign the message that we are the main cause of the spread of the virus. No one wants a repeat of that horrible period of scapegoating of pos people that occurred in the gay community when HIV first came along in the 1980s.
HIV Stops with Me has taken a different approach. This group, which started in San Francisco, has produced a series of slick advertising messages made by positive people to reach a positive audience on prime time TV and press ads in large US cities.
It’s thought to be the first time that HIV-positive people have been the target of a public media campaign about HIV transmission. Producers dealt with fears about further stigmatising pos people by suggesting that they were the main reason for the spread of the virus by saying that these messages are going out in big US cities where there is a large population of gay and positive men and marginalisation is not such an issue. The ads have created a group of positive role models who travel around participating US cities meeting with pos groups and local media organisations.
Some of the messages from the positive models (five men and one woman) in the TV and in print ads include are “Life’s important to me — even the lives of guys I don’t know,” “I still feel good the day after,” and “Before HIV I didn’t want to use condoms — now I do.”
The TV commercials were aired during shows believed to have large gay audiences, like Will and Grace, Buffy the Vampire Slayer and Star Trek Voyager. On-line pop-up messages from the campaign were used on internet chat sites, local mainstream and gay newspapers ran the print ads and postcards were distributed around gay venues. Seven US cities adopted this campaign with what seems to be remarkable success.
An evaluation of the San Francisco campaign in 2002 said that 79 percent of gay and bisexual men were exposed to the campaign messages three or more times in its six-week duration. Of these, 71 percent said it had had a positive impact on them. Among positive men, 54 percent said they were more likely to use condoms with HIV-negative or unknown status partners after seeing the ads, and nearly 43 percent said they were more likely to disclose their HIV status to partners before sex.
These results sound rather incredible and might have some educators asking why we aren’t getting the TV cameras warmed up right away! The first problem might be funding: the millions of dollars given to this campaign by the US government’s Centres for Disease Control (CDC), supplemented by local governments with large gay populations, might not be so easy to find here. Australia has much smaller, highly concentrated positive populations, so a mainstream media campaign would probably not be the most cost-efficient way to reach them in any case.
While campaigns like this have their place, some HIV activists worry that they could detract from the shared responsibility message. In the US, the Bush administration is being criticised for pushing too much of the responsibility for curbing transmissions onto positive people, and there’s a possibility that more punitive measures may be developed against positive people who have occasional unsafe sex.
The internet must be one of the most powerful and probably underutilised means of getting safe sex messages across, including to pos guys. In Canada, the AIDS Committee of Toronto (ACT) has a section of their website entitled Bareback Sex and You, which is remarkable for its no-nonsense language and lack of value judgments:
Some men choose to have ‘bareback sex’ (anal sex without a condom). At ACT, we encourage men to practice safer sex by using latex condoms and water-based lubricants for anal sex. This is the best way of avoiding HIV infection, reinfection with a strain of HIV, or infection with other sexually transmitted infections. However, we also respect the decisions men make for themselves. Our hope is that men can make fully informed and conscientious decisions based on accurate information, if they choose to engage in anal sex without a condom.
This approach is clearly trying to reach individuals who are not going to respond to the ‘Don’t do it’ or ‘Stop Doing It’ premise that the HIV Stops with Me campaign is working on. Maybe it’s controversial to us this approach which seems to condone unsafe sex (sometimes) but it clearly is trying to reach people — particularly those already taking risks — with language and thinking which they can readily relate to.
I think the answer below, to a question from a guy about barebacking, is probably an effective approach.
Q. I feel guilty whenever I bareback. Why do I sometimes slip up and have unprotected sex?
A. We’re all human. Nobody is perfect. Try to better understand the situations in which you get involved in barebacking. Where are you usually? How are you typically feeling? What reasoning do you use to make it acceptable to yourself? Does your partner pressure you to bareback?
The reality is that some men feel that sex without a condom is more carefree, more pleasurable and more exciting. Others are worried about rejection or losing an erection. If you want to use condoms for anal sex (and there are good reasons to do this!), there are ways you can experience intense pleasure and intimacy without barebacking. There are ways you can learn to wear a condom and keep your penis hard.
This straight talking, no bullshit, approach should be tried here, in my opinion — providing answers to difficult questions about barebacking. Some Australian HIV organisations are already doing good things in this regard. PLWHA NSW has commenced an extensive health promotion campaign for pos guys under the title The Words to Say It. Promotional material has been distributed around venues and sexual health forums are being held in suburban and regional areas of NSW. The forums aim to get pos people discussing difficulties around sexual disclosure and negotiation as well as discrimination, rejection and sexual health questions.
The AFAO and NAPWA Education team (ANET) recently produced two excellent publications, Having a Life and A Positive Diagnosis, which provide good advice on coping with a positive diagnosis and the pressures of living with HIV, including sexual health questions. See www.afao.org.au for more details. We are providing messages to address positive people’s broad health needs. More work needs to be done though by HIV organisations around the country to involve positive people in HIV prevention efforts and to provide us with support to discuss issues around that all important subject: sex.
Now back to my surfie mates.
