Saturday, March 06, 2010

Michael Scarce:
HIV Prevention Watchdog Needed

The radical French HIV prevention and treatment group The Warning, recently interviewed longtime gay heath writer Michael Scarce. Based in San Francisco, he's not one to shy away from controversial subjects that offend AIDS Inc, and his talk with the French activists raises issues near and dear to my agenda.

Scarce shoots a number of arrows of well-deserved criticism, at the right place:

[C]orruption has also become commonplace in HIV prevention, corresponding with an unprecedented lack of accountability in self-proclaimed “community-based” AIDS organizations. These are agencies and services born from grass roots activism that, over time, have systematically excluded, alienated, and turned against the very populations they claim to serve.

In terms of funding, Crisis = Money. Disease = Money. Risk = Money.

The more AIDS organizations can portray their communities as unhealthy, sick, and high risk, the more they are rewarded financially and politically.

That is exactly the thinking I have seen with prevention orgs, which still, despite a solid decade of rejection of their all-alarm/all-the-time approaches, never get around to giving the gay community credit for doing anything right on HIV prevention or taking care of our wellness. This situation also leads to the flourishing of stigmatizing, questionable HIV modeling from Sally Blower, which ain't healthy for us.

One would think San Francisco, my hometown, would be setting a better example, one that employs asset-based values in strengthening the gay wellness habit that already exist among us, but all we still get is alarm and fear-driven messages.

To further provoke AIDS Inc and activists like me, Scarce is putting out the call to the community to develop a watchdog to keep tabs on our orgs. I have only three things to say about that, after a month (decade really), of attempting to undo the damage done by Sally Blower and her ilk at UCLA/UCSF with their shoddy research meant to guide community-based prevention: Yes, yeah, yep.

More from The Warning interview, which is well worth reading in full:

Q: You have called for a national watchdog coalition for HIV prevention. Why ?

A: Obama has repeatedly emphasized widespread evaluation of programs and resources, and promises the elimination of programs that aren’t effective. I am convinced HIV prevention has not only failed most gay men in the past decade, but also surpassed negligence to the degree of consciously inflicting harm in many cases, damaging us in ways we are only beginning to understand. We have been bombarded with social marketing that blames and shames us, for example, including incredibly stigmatizing campaigns such as “HIV is no picnic” and “HIV : not fabulous”.

Hey Michael Scarce, keep talking up this prevention watchdog idea.

And everyone, be sure to check out the comment section, for a note from Duncan Osborn, responding to some of Michael's ideas. Let's keep the debate going.

One more reason to read the comments section is that Michael has replied to Duncan, so check out what they have to say.


Unknown said...

this came my way, from duncan osborn, who's back in brooklyn. glad to share his views, and keep the debate going:

This interview is notable for its complete lack of data or evidence to support the assertions Scarce makes and for his tired rhetoric. In one instance, he is entirely wrong.

"They manipulated interpretations of statistical data to herald the dreaded Second Coming of HIV infections. Several years later, they became baffled when the Second Coming of doom and despair failed to ensue as they had predicted," Scarce said.

Citing data from 29 states, the CDC reported in 2003 that new HIV diagnoses among gay and bisexual men increased 17 percent from 1999 to 2002, the last two years of Clinton’s presidency and the first two years of the Bush administration. The CDC reported that the growth was due to increases in new HIV infections and not just more testing. The 2003 data excluded states, such as New York, California, Illinois and Massachusetts, that have large gay populations and that at the time were seeing stable or increasing HIV infections among gay men. We have since had more data confirming this trend.

As to the San Francisco miracle of HIV infections falling while STDs and reports of unsafe sex increased, read this for -- -- for one explanation.

There are people in this country who are doing interesting and important work. They are in bathhouses, sex clubs, and private parties doing HIV testing and STD screening, making referrals to health providers, providing safe sex counseling, and supplying other health services. These people typically work for the organizations that Scarce accuses of corruption and being ineffective. Scarce is, apparently, entirely unaware of this work. He also appears to have no knowledge of the SIGNIFICANT body of evidence that links drug and alcohol use with unsafe sex and HIV infection.

As he did in the late 90s, he talks about the complexity of addressing these behaviors and then offers rhetoric, and not terribly interesting rhetoric at that, as a response. He complains about what he sees as ineffective bureaucracies and then proposes that we create yet another bureaucratic function as a solution. He then points to the failed gay men's health movement as a solution. We don't a need series of conferences.

We need to spend some serious money on delivering and expanding HIV testing, STD screening, needle exchange, and other health services to gay/bi men in the places where they gather to have sex. We need to give even more money to the AIDS groups that Scarce happily trashes so they can do more drug and alcohol counseling because those services have been woefully underfunded since the start of this epidemic.

Duncan Osborne

Unknown said...

here is michael scarce's reply:

Hi Duncan,

I've given a fair amount of thought to your comments, and wanted to take the time to respond to just a few points. First and foremost, I am a fan of your work, especially around meth. As a former meth addict who seroconverted, I am extremely familiar with the links and the literature you mentioned related to sex and substance use. I'm also grateful for your past writing on the MRSA mess. Along with others, I helped coordinate a local response to the MRSA misinformation when it emerged.

There are also a few things missing from the interview. Most importantly, that in some cases I am speaking primarily about San Francisco, not the nation as a whole, especially in regard to serosorting.

It might also interest you to know that I spent 2006-2008 employed as an outreach worker for STOP AIDS Project, so I'm well aware of both the good and the bad aspects of these organizations. You're correct in that I do not give them enough credit, at least the worthwhile organizations, and I regret that omission. I'm also a member of the San Francisco HIV Health Services Planning Commission, and I currently work as a researcher at the UCSF Center for AIDS Prevention Studies, so I have a solid understanding of the valuable aspects of HIV work being done.

I didn't make citations or references because it was an interview about my thoughts and opinions, not a peer-reviewed journal article. And yes, it's highly rhetorical. As for my work in the 1990s, I would refer to my book Smearing the Queer which offers evidence and more than rhetoric, including concrete ways of addressing these topics. I suppose we can agree to disagree about the value of the gay men's health movement, which I see in partnership with HIV work rather than in opposition to it.

Best regards,