Petrelis Files

POZ's Strub: 
Death Anus Ad from NYC DOH

My friend Sean Strub, a longtime person living with AIDS and founder of POZ magazine, has extended the debate surrounding a creepy HIV prevention ad from the New York City Department of Health in a lengthy blog post. The stigmatizing video was launched in early December and my previous posts on the matter, including Larry Kramer's approval and my thumbs down, are here, here and here.

To be honest, I thought the controversy had run its course, would fade away and that there wasn't much new info to further this important debate. I was wrong and want to call attention to several points Sean makes, starting with the headline: Death Anus Ad from NYC Dept of Health.

Here's his radical notion of respecting the intelligence of the target audience of HIV negative gays, and not adding to the burdens of stigma faced by PWAs:

We can and should tell young people that HIV is very bad and they don't want to get it, but we can do that without condemning or stigmatizing people who already have HIV. And we can and should tell people with HIV that a diagnosis is not the end of their lives, that they still pursue their dreams and seek everything anyone else can extract from life without sending a message to young people that HIV is no big deal.

We need to convey both of these messages, at the same time, and not let one negate or diminish the other. That requires a more nuanced messaging, one that doesn't assume the intended audience can be manipulated by over-the-top fright messages, doesn't speak down to them and doesn't assume they are presently not caring whether or not they get HIV.

That last part is something that has long frustrated me about the fear-driven ads in San Francisco. The insulting belief that younger gays or negative gays of all ages don't give a damn about their health or that of their sexual partners, displays reckless arrogance and is not a safe building block for a discussion about gay wellness. Would it be too much trouble for the all smartypants people who create these social marketing campaigns to fully respect at-risk persons?

Also on Sean's mind relates to treatment as prevention, a topic that shouldn't be avoided as it was for years in supposedly cutting-edge San Francisco because AIDS Inc types only wanted to promote condom usage:

We also have failed in recognizing the role treatment plays in reducing risk. A person with HIV on treatment who has been undetectable for six months or more is unlikely to transmit the virus. It is not impossible, but the chance of transmission is dramatically reduced, for many that chance is reduced to the extent they are comfortable having unprotected sex with a person who is undetectable.

Our community's failure to have an honest discussion about this has resulted in people making judgments that are often poorly informed. We need to recognize the reality of how treatment does reduce transmission risk, even while also communicating that it does not eliminate such risk.

Speaking of honest discussions, I am not aware of NYC DOH holding any public forums after they dumped their creepy ad on the gays, to gauge its impact on the community and present research (if they have it) showing fearful ads work. The department's page for the ad omits info on follow-up forums. Such open meetings could further the influence of the ads objectives - reduce transmission, increase safe sex practices, drive up testing - and would bridge some of the divisions that have arisen since the ad's debut.

It seems NYC DOH followed the disgraceful example of the SF Department of Public Health unleashing stigmatizing campaigns, riling up the community and PWAs, and never coming out of their ivory tower to meet face-to-face with the community. This lack of built-in public feedback sessions is just more disrespect from the health officials.

And how does Sean tie all this in with his death anus headline reference? By articulating one of the images in the ad, with some old and always-timely wisdom from AIDS pioneer Dr. Joe Sonnabend, a true hero:

In 1983, very early in the epidemic, Joseph Sonnabend, MD, famously and courageously said, "the rectum is a sexual organ and it deserves the respect a penis gets and a vagina gets." ...

I couldn't help but think of this when I saw the close-up image of a man's anus, covered in cancerous lesions, in the NYC DOH ad. Anal cancers are preceded by genital warts, which are caused by strains of HPV, the Human Papiloma Virus. Last year, 4,000 women in the U.S. died of cervical cancer; in virtually every case the cancer was caused by HPV.

If the NYC Department of Health pursued a campaign to combat transmission of HPV, does anyone think they would, for a moment, consider using a close-up image of a horribly diseased vagina?

Two points. One, what Joe Sonnabend said about respect and the rectum is as true today as the day he wrote it back in the early days of the epidemic. Respect is a key ingredient missing from much of HIV prevention campaigns in the U.S.

Secondarily, I don't think the health department would make use of an infected vagina x-ray, just to start a discussion among at-risk women. It wouldn't be respectful of the health needs of women and would rightly be condemned, but there is little hesitation to employ such visual tactics when the issue is gay men and HIV.

If the NYC DOH wants my advice, it is that they quickly organize two town hall meetings about the current ad, any impact it may have on gay wellness, and engage in a respectful discussion about future prevention campaigns and messages.

After all, it's never just an ad, it's whole lotta other extenuating factors and emotions that arise from purposefully provocative ads. NYC DOH town hall forums when?