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Interview: THT’s policy chief on gay blood, drugs and controversial campaigns

Tony Grew June 7, 2008

Sexual health charities are one of the most complained about groups working within the gay community.

While they broadly command the support of the pink press, there is consistent criticism of their ad campaigns, priorities and stance on issues such as the ban on gay men donating blood.

Terrence Higgins Trust is the biggest fish in the HIV/AIDS pond, and consequently comes in for the most criticism.

Recent campaigns such as Drugfucked and PlayZone are accused of glamourising drug use and underground sex clubs.

THT command considerable amounts from the NHS and other statutory bodies.

Their most recent report states:

“In 2006-07, we received income from 108 statutory bodies, funding both regional and national work. Of our total statutory income for the year of £8,031,000, £568,000 (7%) came from new contracts.

“Voluntary income rose in 2006-07 by £433,000 (12%) to £4,155,000, with a key increase of £139,000 (8%) coming from individual givers, through regular and one off gifts. Additional funding of £330,000 was also received from the Department of Health.”

So THT has the support of government and donors, even if there is disquiet about their strategies to reduce HIV infections in the UK.

The charity works with all people, not just gay men.

Approximately 2,700 men who have sex with men were diagnosed in 2006, the highest number since the epidemic began. 82% of these men probably acquired HIV in the UK. sat down with Lisa Power, head of policy at THT.

A gay activist since the 1970s, she has been with the charity for more than a decade.

In a frank interview, she revealed that THT is committed to becoming a mass membership organisation, defended their controversial campaigns and explained why she does not think the gay blood ban is discrimination. The first thing that we need to clear up is that a lot of our readers are under the impression that THT just deals with gay men.

Lisa Power: It would be reassuring to know in a way, since we seem to get a lot of complaints from gay men that we don’t deal with them enough, that we are giving too much time to somebody else.

We deal with HIV and sexual health, and HIV will always be central to our work, so a lot of our work is with gay men and a lot our work will remain with gay men.

But we also work, in terms of HIV, we have three target groups.

One is gay men, one is African migrants and the other is people with HIV, anybody who has got HIV.

In terms of sexual health it’s again gay men, because gay men have particular issues around sexual health, ethnic minorities, because there are a number of black men who have raised levels of problems with sexual health, and it’s young people.

We have incredible rates of things like chlamydia in this country and in fact we have the worst sexual health in western Europe, which is a bit of a disgrace really, and a bit turn up from the 80s when we had some of the best. received a lot of emails about a new website for gay men about sex and drugs, it talks about the effects of recreational drugs. How do you counter the argument that you are encouraging drug use.

We have been told that we had been encouraging all sorts of things right from the beginning, we started out with people like Mary Whitehouse saying we were encouraging sex.

The point is that you have to start of from where people are, and not from where you want them to be, and the fact is that a lot of gay men are using recreational drugs.

We’d rather they took them safely, and if they must take them we’d also rather that they thought about the kind of sex they want to have and to try and make that as safe as possible.

Our main aim is to reduce the transmission of HIV and poor sexual health, and gay men as a group have particularity bad sexual health.

We know that is linked with large amounts of recreational drugs taken and if we don’t do something about it we are seriously not doing out duty.

We know that it doesn’t work to tell people not to do it, we aren’t Nancy Reagan we are not going to go ‘just say no,’ we have to talk to people in the language that they use and in the manner they will be most willing to hear what we have to say.

If that means T-shirts that say drugfucked and special materials for that group and using the language that people who use recreation drugs use, then that’s what we will do.

Large amounts of immigrants, people who don’t speak English very well, are not getting, served the way English speakers are.

We would agree with that, and it’s one of the things that we have really started to highlight, we have just done the annual gay men’s sex survey again with Sigma and through the CHAPS programme.

There is some really clear evidence this year that we need to do more targeting of certain groups of gay men.

A key group of gay men who are themselves migrants, it’s not just African migrants, it’s also gay men who have come here from Latin America, from Eastern Europe and a whole range of other places.

They are not as clued up around sexual health as people who have been subjected to all the materials for the last few years, sometimes it’s a language issue, sometimes it’s cultural issues, sometimes it’s about getting to people in the right place, and we are very well aware of that and it’s some of our key aims for future work.

We always work on the evidence base, and the evidence is clearly there, and we would agree that people have been saying that do you that we need to do more work.

An argument often put forward is that the approach that you are taking in your campaigns isn’t working you need to start scaring people.


How short people’s memories are.

The 1980s advertising campaign frightened the crap out of the entire country and what we then had to deal with was the most enormous backlash from people who genuinely hadn’t been at large risk, and in fact we spent years mopping up the problems.

For us there are some very serious issues, I think that gay men’s health promotion work needs to be constantly challenged, constantly renewed, constantly reinvented, because you can’t use the same message over and over again.

However just scaring people we know doesn’t work with the people who are most at risk.

Drugfucked is talking about the kind of people who are not going to listen to a ‘don’t do it’ or an abstinence message.

I think it’s always worth having a strong debate, in fact I think we have missed debate in the country.

One of the things that I see at the moment is a lot of questions, renewal and evidence checking.

In fact we have something on the website which is called ‘gay men’s course of action,’ which makes a series of pledges of what we are going to do over the next year, to renew gay men’s health promotion and to renew those messages to gay men to have safer sex and sexual health.

We are also going to be doing a lot of work over the next year to get other groups of people who are involved with gay men to be making similar types of pledges.

Gay businesses, the gay media, we are going to be talking to all of you about what we can all do together and what each one of us can do with our own strengths.

One of the things we’d like to see is a lot of debate in the gay media about these issues, and I think we have to be honest with people and sometimes that means being blunt.

But actually just scaring them isn’t what it’s about, and I was actually around when those campaigns came out, and though they did a lot of useful things I also remember the way that the gay switchboard nearly collapsed under the weight of the worried well.

I remember a grandmotherly sort of voice, clearly an elderly woman, who was terrified from reading the government leaflet that her cat might get AIDS if it bit a gay man.

We have to tell the truth in ways that people can use, and I do agree that some health promotion in the past has not been clear enough.

It must be evidence based.

The CHAPS programme is tested before it goes out, it’s incredibly well researched, it has to be related to needs and after it’s done it has to be evaluated.

What is THT’s view on the current ban on men who have had sex with another man giving blood?

We support the current attitude of the National Blood Service, we do think they could go a lot further to explain themselves.

There is a perception that THT is supporting a policy that is discriminatory.

They need to actually think why would we do that, since we come from the gay communities, being part of the gay community.

I myself have been a gay activist for over 30 years, and I didn’t understand it till I sat down at length with people from the National Blood Service and really went into it very carefully and now I understand it.

I don’t blame people who don’t understand the ban and think it’s all about prejudice, because 99 times out of a 100 when someone tells someone they can’t do something because they are gay it’s prejudice.

The ban around blood is a real problem, and it needs to be constantly checked.

Our view is that we support the blood service as long as they keep reviewing the evidence and we recently had a meeting with the NBS, two months ago, and they are currently going into another review.

They are looking at all the evidence and they are going to be sharing it with us.

They also finally understand they they haven’t done enough with the gay community.

I would say to any gay organisation which has tried to engage with the blood service in the past and failed because the NBS hasn’t wanted to engage with the community, I would say go back and re-engage.

If you want you can come and ask us at THT about who to talk to.

Get in touch with the blood service, get in touch with the right people at the top and persuade them that they need to explain themselves better.

We now have a FAQ policy about blood donation which is on our website, which tries to explain in as simple terms as possible.

Now sometimes people don’t like what we are saying, literally last week we had a phone call to our department here from a gay man who was very upset about the blood policy and said how dare the blood service refuse the blood of gay men.

We said you have to understand that gay men are disproportionately at risk of HIV and then he started shouting at us ‘how dare you pick on gay men, how dare you say we are disproportionately at the risk of getting HIV.’

But the fact is that in this country gay men are massively at risk, and what the blood service does, which they have been scared to admit in the past, is they play the odds.

They look at how much blood they need and they look at how many risks they need to take to get the blood they need and what kinds of blood, and they don’t take any more risks that that.

Though the risk is relatively low, that something could go wrong, there is risk there.

When we talk to people about this, they are surprised to find out that that no-one from England can give blood in the US, because there is a tiny risk from BSE.

And it wouldn’t matter if you are a vegetarian, and for a vegetarian to give blood in the US is like the gay man being refused to give blood here in England.

A big part of your job as the largest and most prominent HIV organisation must be to take a lot of flack.

We are the big kids on the block, we provide more services to more people around a lot of issues and there will be a percentage of people who don’t get what they want out of us.

I think the issue is how do we handle complaints.

What do we do to engage the communities that we work with, and how do we go about trying to keep improving ourselves, which is one of the reasons why we are now going into proper mass membership.

We have always had membership at THT but we haven’t ever advertised it, frankly we haven’t been doing anything to promote it for the last few years – we have actually got around 1,000 members at the moment.

We want anyone who cares about HIV and sexual health to become a member, it’s going to be free, we would be letting people take part in surveys, giving us feedback about what they think of the organisation.

We would also like to offer more services to people with HIV, specific services, but that would depend upon the plans of the coming year and accessing some more funds.

This need for increased membership – does it come from the perception that you are not as connected to the community as you should be?

I think it comes from the perception that we need to demonstrate our connections to the community.

I think the community assumes that HIV organisations are all run by someone far far away out there, but when we explain to them that the majority of our board is elected by our members, people are astounded.

They don’t realise that THT has a democratic base, but it’s only as democratic as the people we get into the membership, so we are going for mass membership, and one thing that the membership would do is elect our board.

And hopefully what it shall also do is the increased membership, with more ordinary active members, will help you push forward the political agenda as well.

We already have campaigners.

You may have people who read who don’t know about our campaigners network which has 1,000 people in it.

Now not all 1,000 write letters to their MP, in fact we only ask people to write a letter every couple of months, but all you need to do to become a campaigner with THT is to go onto the website and click on the link which says campaign with us.

Take something like the entry ban to the US on people with HIV, we have a couple of times asked our campaigners to the write to their MP.

We ask the MP to write to the embassy or to the Foreign Office, to put pressure on, and we give a template letter.

The most influential thing with people like members of parliament is actually their own constituents and with primary care trusts is the people using health care in their area, and so that kind of local campaigning is vital.

It’s going to be even more important over the next few years.

The government is pushing down a lot of power down to the local NHS, with the worry that primary care trusts or health boards in Scotland and Wales don’t tend to prioritise HIV and sexual health.

In the NHS public health is at the bottom of the pile of priorities, within public health sexual health in at the bottom of the list of priorities and within sexual health HIV is at the bottom of the list of priorities.

We are not now in the 80s when everybody was talking about HIV, and there is only one strategic health authority in the country that has HIV as priority and that is London.

What does THT lobby MPs and political parties for?

It’s a variety of issues – sexual relationships education …

People would be surprised it’s already not there.

It’s party policy for everybody except for the Labour party now, we actually recently had a meeting the junior minister and said ‘you do realise that even the Conservatives now have sex and relationships education as a policy now’ and he was very shocked.

Good sex and relationships education actually means that when people start having sex they are safer, because they are making their own decisions and they have thought it through.

That means that more of them behave in a more careful and responsible manner, because most of them have thought it through and have had a chance to debate and explore and they have demythologised all the stuff you get in the playground, which is actually where most young people are learning their sex education.

It also supports them in identifying abusive behavior with adults when they are young.

How are your relationships with the political parties, has it become more and more difficult to get HIV and sexual health onto the agenda?

It is difficult and we have to do it by a variety of means, we have always manifested good relationships with all the political parties.

Because of the age of THT it has worked with both Conservative administrations and Labour administrations, both of them have their strong and weak points.

They are surprisingly similar at times, but we maintain good relationships with all the parties whether they are in power or not, also as decisions get more and more localised you can have a range of players at the political level that can be important.

You have already had to make connections with the Scottish National Party.

Absolutely. The SNP are in power in Scotland, and I think that came as a shock to some of the people in the sector up there.

It’s very foolish to put all your eggs in one basket, and to be honest the parties have got different things to offer around these issues, and it’s important that people look at things like people’s voting records.

Look at not just what politicians are saying now but what they have done.

And I think that it’s important for us to maintain good relationships with the parties and civil servants and sometimes that means the people think we are in the pockets of governments.

Our experience with most governments is that if you just shout at them they turn down their ear flaps and stick the ear plugs in and won’t listen to you again.

We firmly believe and realise that you need to talk to them in a way in which they would understand, just as we would do our local promotion with different groups of gay men.

There are issues of over which we are incredibly critical of the government, particularly of the way that in England they deny free access of HIV treatments to a range of migrants, which is absolutely stupid.

We have shown it’s better for public health and it’s cheaper for the country to give people HIV treatment rather than letting them become more infectious.

The government would not change their minds, purely because they are going to come across as looking soft on treatment tourism, so they’d rather do a illogical expensive thing, than something that’s good for the country, just because they are scared of the PR against it.

Infections are at their highest level since the virus appeared. What can be done?

It’s vital we have a good sex education for young people, whether they are gay or straight, but actually the group of gay men who are getting HIV are in their 30s and 40s.

That’s actually when you are at a high risk of getting HIV. These are the gay men who were very small they saw the iceberg.

When they were coming out in the 90s they didn’t see people dying, they didn’t see their friends dying, nowadays HIV is nearly invisible because treatments keep people well most of the time.

There are gay men who are HIV negative often unaware who in their sexual circle is positive.

We have identified particular problems with people making assumptions that if the other person doesn’t say they want to use condoms they must be HIV negative, whereas the people who do want to use a condom must be HIV positive.

We have problems with people who are serial risk takers.

They take a risk now and again, and they think “oh mustn’t do that again”, but every now and then they get drunk, or they think “oh I can’t find the condoms never mind it’s only once.”

The more risks you take over a long period of time eventually you are more likely to end up positive, particularly in London where there is a relatively high level of HIV positive gay men in general population.

For a long time we haven’t told gay men what illnesses the majority of people get when they first get infected.

We feel that the time has now come where HIV is at the level of prevalence that any gay man who has been having unprotected sex and has flu-like symptoms like a rash or a sore throat should actually go their doctor and say:

“I might have contracted HIV,” and look at how you can minimise the effects.

We are still seeing gay men getting diagnosed when they already have AIDS, regularly being diagnosed with CT4 count up to 200, people who have had symptoms of what we used to call AIDS, people who have had really obvious signs that they might have HIV, their GP has ignored it, other specialists at the hospitals have ignored. It is a real problem.

We don’t want to leave the interview on a depressing note, although the figures are bad you must be confident that you can make inroads.

We are fighters at THT, otherwise it would never have existed in the first place, because many of your readers will remember what it was like in the 80s.

Gay men were highly unrespectable.

We are aware that there are some real issues that need to be dealt with, that we need a renewal of how we work with gay men because the rates are bad, we need more resourcing.

We need it to be used in a very canny way , we need to be talking in a variety of ways, and to people who have heard the messages 10 or 15 years ago.

These days they go into a gay bar and they see our leaflets and say ‘done that’ and they go out, get pissed and have unprotected sex.

Or they think ‘he looks nice he couldn’t possible have HIV’ – we need to get through to those people again, you cant do it once and for all, you have to keep renewing it.

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