Since the advent of protease inhibitors, HIV prevention workers and public health officials have openly bemoaned the diminishing fear factor of imminent death from AIDS, like in the 1980s. It's as if they developed only one psychological tool in their arsenal to fight HIV decades ago, absolute terror, and they are desperate to bring back the bad old days when F-E-A-R ruled gay men's sex lives.
Of course, medical advances have changed dramatically in keeping more people with AIDS alive longer, suffering fewer opportunistic infections, but too many experts are stuck in the mentality of fear as the key building block to gay men's health and prevention workers are sometimes loathe to embrace and applaud the advances, because to do takes away much fear.
This week, Eli Sanders writes in Seattle's alt-weekly The Stranger about four meth-heads who've contracted a treatment-resistant strain of HIV. And like one of Pavlov's canines, a public health leader is salivating over the opportunity to use a sexual cluster of four meth-heads all infected with the same difficult to treat HIV strain to put time and resources into stroking the fear element over gay sex, drug use and infections.
Sanders writes:
Referring to last week's announcement about the possible drug-resistant strain of HIV, Dr. Wood told me: "That's a main reason I want to put this out into the community—to put a little more fear and concern in the community."
Just what we don't need, another frustrated public health director falling back into the trap of resorting to the last refuge for failed HIV prevention policies and messages, increasing terror in gay men, using fear to create better homo-health.
A little more fear, Dr. Wood, on top of the accumulated fears of a quarter-century of AIDS, and for many gay men a lifelong fear of being bashed or killed by homophobes or fear of rejection by loving family members and friends, and all the other fears we face on a daily basis without full legal, marriage and military equality?
Thanks, Dr. Wood, but no thanks for your efforts to inject more fear into the gay community and gay men's sexual lives, or any part of the community. Surely you can be a bit more creative in approaching prevention, can't you?
More from The Stranger:
Dr. Wood looks at the static HIV infection rates and the continued high levels of STIs in the gay community over the last few years and, revising his department's earlier warnings, suggests that perhaps the gay community has simply reached a post-antiretroviral-drugs plateau, a "steady state" of unacceptably high HIV and STI levels that is going to be hard to change in this era of less fear, an era when HIV is no longer so immediately lethal and syphilis, gonorrhea, and chlamydia all remain easily treatable (if caught in time).
Um, at least the infection is not rising, right? Sounds okay enough to me, and yes, I wish it were declining, but it seems as though the last thing Dr. Wood wants is a level-toned, but frank, ongoing community-wide discussion about these STD/HIV issues.
Regarding the latest HIV epi stats from Dr. Wood's surveillance unit, infections reported through June 30, 2006, are of note because some numbers have decreased. Maybe the "steady state" ain't so steady.
A caveat: For unknown odd reasons Seattle doesn't breakdown its annual HIV stats by single years. It clusters them in three-years categories. That being said, here are the figures, which, due to reporting delays and such, are complete, but nonetheless all we have to look at, for King County:
Total HIV infections:
1997-1999
1,046
2000-2002
1,192
2004-2005
1,029
Gay/MSM HIV infections:
1997-1999
723
2000-2002
753
2003-2005
657
Gay/MSM IV Drug Users
1997-1999
86
2000-2002
94
2003-2005
72
As if the lack of yearly breakdowns weren't weird enough, the HIV stats from King County contains this footnote for the 2003-2005 cluster years: 119 cases diagnosed in 2006 are not included in this table.
Well, I would hope not, since those cases were diagnosed in 2005. 2006 stats should be in the 2006 numbers, right?
Perhaps his fear mongering is seen as melodramatic posturing, a throwback to old Joan Crawford movies, by the very at-risk people who've long ago tuned out the fear message.
Or maybe Dr. Wood should consider encouraging serosorting for HIV poz gay men, a practice that Sanders notes in his story has been the significant factor in seriously reducing HIV infection in San Francisco. He might even go so far as to recommend and educate the gay meth-heads to take Tenofovir, a PrEP, pre-exposure prophylaxis, strategy that has been shown to avert transmission of HIV.
Sanders also mentions a previous story of his that caused much controversy and predicted increasing HIV rates:
In retrospect, however, one thing was wrong with my article. It relied on the local health department's warning that local HIV infection rates appeared to be on the rise and would likely continue to rise. That turned out not to be true. What seemed like an uptick of new HIV infections in 2003 now looks to have been a momentary fluctuation in a local HIV infection rate that, four years later, remains as static as ever: about 400 new infections every year.
Oh, so the Seattle health department may have been crying wolf, when such a creature was not at the community's door? I hope Dr. Wood and his department take into account how continually using alarm, fear, terror and cries of wolf may contribute to at-risk sexually active gay men, especially those using meth, to go deaf when he and his prevention workers shout FEAR!
(I relish the idea of suggesting firing Dr. Wood for failed prevention work, hiring someone with better prevention programs, just to inject a dose of fear into him!)
I feel it's crucial in this debate about how to deal with STD/HIV amongst gay today, to cite a quote from the late gay thinker Eric Rofes, from an essay he wrote marking the twentieth anniversary since AIDS was first reported, that I think more than adequately sums up with the thinking of public health experts like Dr. Wood:
Health providers and activists alike — unable to consider big picture questions about gay men’s identities and desires — default to guilt tripping and fear mongering. The primary approach to education and prevention continues to be an attempt to re-create the crisis culture we inhabited in the 1980s. Absent the urgency linked to catastrophic decimation, commentators seem at a loss about what to do.
Am I the only one who’s had it up to here with bankrupt rhetoric attempting to explain a complex health challenge?
No, Mr. Rofes, you're not the only gay man who feels that way.
Finally, the words fear or fears appear seven times in Sanders' story, and the word love is totally absent. Make of that observation what you will.
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