We're Not Getting Serious
The new HIV/AIDS prevention campaign from Lifelong AIDS Alliance continues to miss the mark.
This campaign comes to you courtesy of Public Health--Seattle & King County, which paid for the ads by funneling more than $80,000 in federal money to one of Seattle's largest gay community health agencies, Lifelong AIDS Alliance. The ad campaign launched during the Gay Pride celebrations two weeks ago, and comes at a time when the health department has been asking gay community leaders to show more leadership--and gay men themselves to show more responsibility--in the face of dramatic increases in the rates of syphilis, gonorrhea, chlamydia, and HIV among gay men in the Seattle area.
The ads come in three different versions and are circulating not only on the sides and interiors of Metro buses, but also in posters at gay venues, newspaper ads, and gay Internet chatroom pop-ups. Here's what the three versions say:
Version one: "We aren't conquering homophobia to be defeated by HIV or syphilis." (Accompanying picture: gay men staring at you.) Version two: "We aren't surviving HIV to go blind from syphilis." (Accompanying picture: gay men staring at you.) Version three: "We aren't staying up all night to be infected by syphilis or HIV." (Accompanying picture: party boys and a drag queen having a blast.) Below each of these slogans is a call to get tested, and an STD hotline number.
What are these ads telling gay men? Two things. One is to get tested for STDs--which is good, but old hat. We've heard this message before, and though we should still listen, it's not exactly groundbreaking. Plus, imploring gay men to get tested is not the same thing as telling them to behave safely.
The second thing these ads are telling gay men is that life is going great for us gays--we're conquering homophobia, we're surviving HIV, we're having lots of fun using crystal meth and staying up all night partying. What's missing from the ads is any clear sense that something's amiss in our fabulous gay utopia. That something is rising rates of HIV infection and syphilis. But how big a deal are these diseases? The ads don't say. Are the rates of HIV and syphilis rising or falling locally? The ads don't tell you. Am I at risk for HIV infection? How do I catch syphilis? How should I behave? No help from the ads. Which gay guys are getting these two undesirable diseases, and where are they getting them? Again, no answers.
It's not that people at Lifelong and the health department don't know the answers to these questions. As we will see shortly, they have a pretty good idea of where the STD problem in Seattle lies--among a core group of badly behaving gay men, many of them HIV-positive, whom our gay leaders don't have the courage to criticize publicly. They also know how you should behave if you don't want to catch an STD or HIV from one of these core group members; they just aren't telling you in their very public ads, paid for with our very public money.
Instead, Lifelong is using vague slogans that end up promoting the sense that HIV is survivable and therefore no longer a big deal--a false sense that public health officials believe is largely responsible for the increased unsafe sex practices among gay men. In addition, the slogans and ads send a rather counterproductive normalizing message about what it is to be gay. They say: "See these men in the picture? This is who we are. We gay men use party drugs. We gay men stay up all night. We gay men don't worry about homophobia or HIV anymore."
Chuck Kuehn, the executive director of Lifelong, should know that AIDS and HIV are still a big deal. He should also know that when it comes to the rise in new HIV and STD infections, we are not the problem--that in fact it is a few among us who are the problem. He should know this because it's exactly what he wrote in a recent op-ed in the Seattle Times: "The AIDS crisis is not over," Kuehn wrote on June 20. On the subject of how to respond to the rising infection rates, he wrote, "Most gay men try very hard to protect themselves and their partners.... The real question is how do you get the attention of the minority of the community who have the power to infect themselves and others through irresponsible behavior?" In other words, how do you target the irresponsible core? His answer: Focus on the idea of "personal responsibility."
Kuehn's op-ed came about a week before his agency put out this new ad campaign, which promotes not personal responsibility but collective responsibility ("We are not doing this to get that")--which doesn't tell you that it's "the minority of the community" who are the problem, and which promotes not a sense that there is a continuing "AIDS crisis," but rather a sense that HIV and AIDS are now easily survivable.
The contradictions between Kuehn's public statements and his agency's public ad campaign make one wonder how much leadership Kuehn is actually showing within his organization. They also raise this question: Why isn't the health department--which controls the purse strings for this ad campaign--paying closer attention to what Kuehn is doing with its money? If it wanted to, the health department could say to Chuck Kuehn, "We're not funneling you tens of thousands of dollars in public funds to put out this crap." So why isn't it?
Before we get to the answer to that question, let's look at what Public Health knows about the local STD situation. To begin with, Public Health knows that syphilis, gonorrhea, chlamydia, and HIV are not spread evenly among the estimated 40,000 gay men in the Seattle area. Instead, the diseases are each concentrated in a core--or multiple cores--of gay men whose unsafe behavior puts them at greater risk of infection.
When Dr. Hunter Handsfield, the county's director of STD control, tries to describe how a core group fits into the rest of a population, he talks about a "dark black kernel" at the center of a circle. That kernel is the unsafe core; the rest of the circle is the rest of the population. As you move outward from the dense kernel, the colors move from dark black toward increasingly lighter shades of gray (safer and safer sexual behavior) to finally white at the outside (celibacy).
The core is never stable or fixed. People move in and out of it, some linger longer than others, and bad behaviors within it vary. And core members don't just have unsafe sex with each other. They also have unsafe sex with non-core members--which is how the behavior of an unsafe core group can spread disease throughout an entire community. Still, cores are usually a minority of the population they are affecting, and in Seattle that is certainly the case with the unsafe gay core. A rough estimate of the total number of local gay men infected last year with either syphilis, gonorrhea, chlamydia, or HIV might be 1,000 people--only 2.5 percent of the 40,000 local gay men--which gives you a sense of how relatively small the core of unsafe gay men could be.
This doesn't mean that all the recent fuss about rising gay STD and HIV rates has been blown out of proportion. That estimate of 1,000 people actually represents an extremely high number of new infections. Consider the syphilis data that went into it, for example: There were about 60 cases of syphilis among gay men last year. That sounds low until you consider that there were zero cases of syphilis among gay men in 1997; there are expected to be as many as 100 this year; and last year, there were only two cases of syphilis among King County heterosexuals (who vastly outnumber gay men). Further, the core group is larger than the total number of people who contracted an STD. Some core group members got lucky and, despite engaging in unsafe behavior, managed--for now--to avoid infection. We undoubtedly have a gay HIV and STD problem on our hands, and it is undoubtedly driven by a core of unsafe gay men.
Dr. Handsfield believes that the data on Seattle's syphilis core group tells us a lot--not just about the core group for syphilis, but also about the characteristics of the core groups for other STDs, for which there is less data. So what do we know about the local syphilis core? According to Public Health's data, a member of the core is likely to be white, in his mid-30s to early 40s, HIV-positive, living on Capitol Hill, and having lots of unsafe sex with multiple partners in bathhouses and sex clubs. It's also likely that he uses drugs such as crystal meth, poppers, Viagra, or Ecstasy. In other words, he is likely to be staying up all night.
This data explodes some common myths about the current STD and HIV problem among gay men. It's not just young gays who missed the worst years of the AIDS crisis that are the problem, and it's not just minorities. At the core of the problem, data indicates, are aging white gay men who are "surviving" HIV--and are only too willing to infect others.
Handsfield says this data has been shared with gay community agencies such as Lifelong--making it even more bizarre that Lifelong is putting out an ad campaign that seems to cheerlead for the very kinds of behavior (staying up all night on crystal meth) and assumptions (having HIV is no big deal) that fuel the current problem. Lifelong is aware that a badly-behaving core exists, and the agency could have chosen to challenge the core. Or, if core group members can't be reached, Lifelong's campaign could have focused on gay men who aren't in the core, encouraging them to refrain from core group behavior and to avoid unsafe sex--or sex, period--with men who do engage in core group behavior. Instead, Lifelong opts to pay gay men compliments (we're surviving! we're conquering!), and goes so far as to normalize a highly risky core group behavior (we're staying up all night!).
Dr. Bob Wood, the director of the health department's HIV/AIDS program, defends Lifelong's current campaign. He says he believes this new campaign is "an appropriate intervention" that "was developed in good faith," using the input of public health experts, an advertising agency, a community advisory group, and focus groups of gay men.
However, Stranger sources who attended two of Lifelong's focus groups didn't find them very focused on what members of the gay community had to say. The focus groups were held on June 10, just two weeks before the campaign launched (the late date for the groups makes it clear they were a last-minute formality). Our sources say the "We aren't staying up all night" ad was widely disliked in both groups. Group members said it was unclear, ineffective, and lame in its use of hackneyed party-boy imagery. They also say the focus group facilitators appeared uninterested in this criticism. "They were so out of touch it was amazing," one of our sources says. Aside from a few cosmetic changes (a red background became a purple background, for example), our sources say the current ads are basically identical to the ones shown to them on June 10.
Dr. Wood says that because the process followed the rules, the product must be fine. But David Richart, Lifelong's education director, admits that the ads targeting crystal meth users will probably not be understood by the wider community. "No, I don't think that the general population will get the particular ad," he told me. So Lifelong has put an ad out into the general population ("We aren't staying up all night to be infected by syphilis or HIV") that it knows will be misinterpreted, that its focus groups said was bad, and that in the context of the other ads ends up sending the wrong message about who we gay men are (i.e., we're all using crystal meth). This is an "appropriate intervention"?
When defending Lifelong's latest efforts, Dr. Wood and Richart both note that the new campaign is putting out messages other than those overtly stated in the advertisements--messages such as "Condom use is expected for anal sex," "Be respectful of each other," "Play safely and fairly," and "HIV-positive people are not the problem, spreading HIV and STDs is." (This last message is wrong, by the way. As the syphilis data and studies of local gay men clearly show, some HIV-positive men are a big part of the problem.) But to receive these other messages, gay men have to call the hotline mentioned in the ads. This is totally backwards.
Public Health and Lifelong have some things they want to say--"Condom use is expected for anal sex," "Play safely and fairly"--so they put out an ad campaign that doesn't say that? "Condom use is expected for anal sex" fits on the side of a bus. Yet Lifelong is hiding this and other good messages on the other end of an STD hotline they know for a fact few gay men are likely to call. Last year, the health department funded a $60,000 Lifelong ad campaign that included no concrete information about rising STD rates and generated fewer than 50 calls to the same STD hotline the new campaign is promoting. The Stranger called the hotline and got great, directive advice--use condoms for anal sex, if you don't disclose your HIV-positive status you're doing something unethical and illegal--but it's absolutely crazy that Lifelong is limiting the number of people who are going to get these messages to those who will see the ads and then call the hotline (especially considering that most people probably call STD hotlines after they've behaved unsafely, not before).
HIV prevention campaigns don't have to be this lame. In San Francisco, prevention agencies have recently been handing out wallet-sized cards that read, "Syphilis is spreading among gay men in SF." Simple. Informative. Cheap. The card goes on to tell you the symptoms for syphilis, how to prevent it, and to get tested if you've been having a lot of sex--a message that targets the core. It doesn't make you call a hotline to find all this out. In New York, some 5,000 renegade prevention fliers are being handed out by people who think current prevention efforts there aren't working. "If you haven't been tested and aren't wrapping it up you have some explaining to do," the fliers state. They challenge gay men to behave better, and state clearly, "We DO have responsibilities to each other." Directive. Challenging. Cheap.
We could have had these types of campaigns in Seattle for $80,000. But instead, we have the health department talking about process, and defending Lifelong's inane and--if the recent past is any guide--sure to be ineffective bus ads. And gliding by us in traffic, we have uninformative, empty slogans that cheerlead for the wrong kinds of behavior and require gay men to write down a phone number, go home, and call an STD hotline to get the messages they really need to hear.
When are local AIDS organizations going to get serious and start putting out tougher, more informative messages? Perhaps when our public health officials get serious and stop handing large checks to lame AIDS agencies, and stop making excuses for their counterproductive STD-prevention campaigns.
Pissed off by the lame health messages churned out by cowardly gay leaders at chickenshit AIDS agencies? Like those gay health renegades in New York City, do you think YOU can do a better job?
WANT TO WIN CASH DOING IT?
Public Health--Seattle & King County recently tossed Lifelong AIDS Alliance more than $80,000 in federal HIV- and STD-prevention funds, and the result was yet another mealy-mouthed prevention campaign that is, yet again, lame, lame, lame. The Stranger is betting that a few local gay health rebels with big balls and $200 of our money can produce guerrilla STD/AIDS education campaigns that are more effective and more challenging than Lifelong's tacky bus ads and Gay City's judgment-free programming.
Want to be a Stranger-backed guerrilla in the battle against HIV, STDs, and limp local gay leadership? Send your proposals for gay health posters, hand-cards, picket signs, or other subversive ways of promoting gay health messages to firstname.lastname@example.org. We'll pick the best three concepts and give each team $200 for materials. The gay health renegades who do the best job getting their message out in front of Seattle's gay men win an additional $500. ENTER NOW!