on the death of us

Twenty years on, the statistics on HIV infection rates are dismal. From 1 in 5 gay, bisexual men in US cities has HIV:

Overall, they found that 19 percent of gay men are infected with HIV. The study found that 28 percent of gay black men infected with HIV, compared with 18 percent of Hispanic men and 16 percent of white men.

Black men in the study were also least likely to be aware of their infection, with 59 percent unaware of their infection compared with 46 percent of Hispanic men and 26 percent of white men.

Age also plays a role. Among 18 to 29-year-old men, 63 percent did not know they were infected with HIV, compared with 37 percent of men aged 30 and older, the team reported in the CDC’s weekly report on death and disease.

Men who have sex with men (whether or not they self identify as gay or bisexual) account for more than half of people living with HIV, and for more than half of new HIV infections in the U.S. — but compose only about 4% of the post-pubescent population in this country (the more familiar 10% aggregates lesbians, bisexual women and probably transgender folk as well). Not only that, but the rate of new HIV infections in this group is increasing. New infections have declined among heterosexual folks and drug users. The largest rate of increase is among black men.

One statistic I don’t at all understand is that among this group of men, white men 30-39 years of age are accounting for the largest rate of increase after black men (between 13-29 years of age). What the hell? This is the tail end of the group who would have had first hand witness of the initial destruction this disease had in the late 1980s.

Other studies point to poverty as a critical correlation with new HIV rates, with a high rate of HIV infections “outside defined risk groups such as gay/bisexual men and injection drug users.” About “2.1 percent of heterosexuals living in high-poverty urban areas in the United States are infected with HIV,” which meets the criteria for “generalized epidemic.” Given the demographics described for the gay and bisexual men, I have no doubt poverty is playing a role here as well. And remember the homeless LGBT youth who are especially vulnerable to poverty and prostitution risks .

This information follows on the heels of this announcement: Truvada shows 44% reduction in HIV infection rate amongst men: study. But one thing to remember about this: these are expensive drugs. With a lot of side effects. And they must be taken daily. This cuts out people without health insurance, and without the stability in life to be taking daily doses of medication, and god knows, practicing safe sex and using a condom is much more practical & cheaper. But perhaps it points to a a growing sense of complacency: whatever else HIV infection and AIDS is these days, it’s not the killer it was in the late 80’s. People are living for decades without succumbing, in contrast to the mere months the early victims had. Certainly we keep hearing good news on the research front, the latest undoubtedly being this: Stem Cell Transplant Cures HIV In ‘Berlin Patient’.

In any case, these grim statistics probably sparked this ad provided by New York City Department of Health and Mental Hygiene:

[Captioned: unknown] (h/t Dan Savage) which has also sparked off debate as to its potential effectiveness and/or offensiveness. Savage opined that perhaps these harsh tactics should become more of a feature of HIV prevention campaigns rather than being slammed as a scare-mongering, anti-gay message.

Some are calling the ad offensive, saying that it furthers the stigma of associating the gay/bisexual man with AIDS. In particular GLAAD and GHMC issued a press release which said in part,

[T]he PSA creates a grim picture of what it is like to live with HIV that could further stigmatize HIV/AIDS, as well as gay and bisexual men.

“We know from our longstanding HIV prevention work that portraying gay and bisexual men as dispensing diseases is counterproductive,” said Marjorie Hill, PhD, GMHC’s Chief Executive Officer. “Studies have shown that using scare tactics is not effective. […]”

Timothy Kincaid, over at Box Turtle Bulletin points out quite correctly that the risk of anal cancer — trumpeted as 28 times as more likely in this ad — is extremely rare:

Anal cancer is very rare. In the US, about 5,260 people per year get this disease, of which about 40% are men (so, as you can see, women are 50% more likely to get anal cancer. Beware!!). About 720 patients die. Anal cancer is highly associated with HPV infection (though the vast majority of those infected with the HPV virus never develop anal cancer) and a vaccine is available which eliminates this risk factor.

and that it is a favored tactic of anti-gay groups to focus on anal cancer. Go read the whole thing: β€œOver than 28 times more likely to get anal cancer”.

One thing I’ve got to note — so many people I know conflate HIV infection with AIDS that I wonder if the point made (that you still have health risks if you have “only” HIV infection) is much of one or not. The two are conflated — and so the fact that people don’t immediately die anymore may well be conflated too. Nevertheless the issue raised — in the face of the discouraging CDC statistics — is a worthwhile one: what is the best way to reduce the rates of HIV infection? Ads? With what focus? Distribution of condoms, free testing clinics, what? Are ads like the above (er, without the anti-gay fearmongering parts) more effective? Or campaigns like this: Catchy Condoms a Hard Push to Prevent STDs? I suspect we need a larger mix of tactics. As has already been pointed out, what we’ve been doing so far clearly hasn’t worked all that well if we’re at one in five.

Many people are unsure whether scare tactics in ads really work or not — with some saying it depends on whether there are actual facts presented or just baseless scaremongering. (And of course whether the individual watching the ad is going to think it’s factual or manipulative scare tactics — or not even care.) And, certainly, different populations are going to need to be reached by different tactics (especially those subgroups who don’t identify as homosexual at all despite their sexual behavior).

Others are pointing out something else needs to be done, since clearly the tactics advocated by those protesting this ad haven’t made much of a dent among the gay/bisexual population in the last 20 years. Which is an unavoidably true fact. Plus which, scare tactics used in anti-smoking campaigns appear to have made quite a dent in the smoking population.

One interesting thing to remember: many of the advocacy groups are in the dual position of providing HIV and AIDS prevention information and providing assistance to those already infected. This creates a tension between tactics designed to prevent infection and those designed to support those already infected, and perhaps it’s time to separate those functions to avoid the conflict.

I’ve got to say, I’ve only seen stigma and shame at its height when no one talks about it. The more we talk about this, whether through this ad or others, or even debating over specific approaches, the better. My initial reaction was to wonder just how much of the usual outreach programs have been done & funded by groups comprised mostly of relatively affluent gay white males. It wouldn’t be the first time that particular demographic has derailed pro LGBT efforts by completely ignoring women, POC, and lower income folks. And again, different tactics are probably necessary, so this ad might not work well among the population that GLAAD and GHMC typically work with but might be effective with another subgroup. And clearly, when it comes to inclusion (or not) of minorities, specific ads can easily be problematic especially without the input of the minority groups.

As an aside, going over to google’s images and searching shows quite a range of approaches taken. I kind of like the one where the guy is sprawled in the middle of a forest, covered with trailing fluourescent green wrapped condoms…


Sources (in addition to the links used above):
HIV and AIDS among Gay and Bisexual Men (pdf)
CDC Study Reveals High HIV Infection Rates Linked to Poverty More Than Race
GMHC, GLAAD Call On NYC Department of Health and Mental Hygiene to Pull Sensationalistic and Stigmatizing HIV/AIDS PSA
Selling AIDS: Wiretap Mag On HIV Prevention Messaging

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