Column: Politics inhibit HIV prevention efforts

Back in December, New York City public health officials ran a television ad warning against diseases whose prevalence is escalated among HIV-positive men. Osteoporosis, for example, is described as a disease “that dissolves your bones” by a narrator with a low, gravelly voice. Anal cancer is depicted not just through its greater statistical frequency, but through a highly unsettling picture of the cancer itself.

To be blunt, the commercial is fucking terrifying. The fear-provoking aspects of the ad are explicit, if not entirely excessive, yet the message it sends is quite clear: that gay men who seem unafraid of having sex with HIV-positive men need to realize the actual consequences of being HIV-positive.

While I find the commercial’s over-dramatization lacking in taste, I think its message operates under quite accurate observations of the gay community’s attitude toward HIV.

With increased access to anti-retroviral treatments (ARVs), a culture that promotes living with reckless sexual abandon and the idea that condoms make sex feel “less good,” gay men have become increasingly complacent about being HIV-positive. The idea seems to be that HIV isn’t AIDS; it’s not a disfavoring disease that kills you, it’s merely an invisible disease that makes you take a pill every day. Rather than questioning the HIV status of their sexual partners or wearing a condom, gay men seem to assume that HIV-positive partners are taking their medication and therefore must have quite low levels of infection.

This lack of concern is further exacerbated by a society that creates comfortable truths about HIV/AIDS, rather than acknowledging harsh realities.

In short, the sexual transmission of HIV is essentially determined by how many partners one has in the very short spaces of time at which the virus is at its peak, and this is most frequently in the initial stages of infection. This implicitly requires us to discuss certain groups of people having more sex than other groups of people, and these sexual patterns are considered stigmatizing toward the gay community.

The fact is, men who have sex with men annually account for the highest proportion of new HIV infections, and this is traceable not just from a public health perspective, but from observations of sexual networking. This statement is not controversial in fact, but is made controversial by those who refuse to recognize certain behaviors of certain groups of people.

This fear of stigmatization has been extremely evident in gay rights groups’ reactions to NYC Health’s public prevention campaigns, claiming the commercial depicted gay men as “disease ridden vessels”. Some activists even called for the ad to be pulled.

Gay rights groups are accurate in thinking HIV-prevention efforts should not be McCarthy-esque in their targeting of gay men; HIV prevention is not about certain people being morally transgressive or social deviants. It is not about sex being right or wrong (because frankly, lots of sex is quite a good thing). However, to simply deny that certain groups are more susceptible to the disease for socio-political reasons is unhealthy, and an ignorant obstruction to the extremely vigilant efforts of public health workers.

As epidemiologist and global AIDS worker Elizabeth Pisani said in her 2010 TED talk, we need to get real about HIV/AIDS if we ever plan to reduce the annual number of new infections. There are too many good people dying every year, and the fact that prevention efforts are obstructed for political reasons to me is fucking infuriating and disheartening.

Large-scale efforts like the aforementioned commercial aren’t destructive to the cause, but they lack the ability to instill positive incentives for wearing condoms. Waving medical statistics in the faces of young men to scare them does not do enough to compel men to make conscious decisions during sexual encounters. Inspiring these decisions within intimate relations is an extremely difficult task to achieve through large-scale efforts, and we must not allow this difficulty to keep us from discussing the actual issues at stake.

While ARVs have been miraculous, we must not assume treatment alone is effective prevention. If we are truly to care about at-risk populations, we must advocate for the expansion of funding for HIV prevention while continuing to expand accessibility to ARVs and any other treatment therapy.

This cause is especially close to my personal life as a gay man, but this conversation applies to anyone. HIV/AIDS is killing us, and there are ways to stop it.

I’ve provided the link to Ms. Pisani’s TED talk, as I have found her thoughts to be extremely inspiring and informative in the context of the gay community, and also regarding global HIV/AIDS efforts. I hope my column and her talk will open up discussion, and I invite you to initiate conversations in our comment box, particularly if you have found the arguments presented incomplete, inaccurate or offensive.

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