Comment: Killing us softly
Last week, Ramsey Dehani wrote about HIV campaigns from the perspective of a young gay man. Today, Gary Leigh, who remembers the “no nonsense” strategies of the 1980s, says the gay health charities have some tough questions to answer.
While significant breakthroughs in the progress of gay rights have been achieved in the UK over the last decade, the community has paid a devastating price with its sexual health.
Britain has almost twice as many new cases of HIV than any other western European country. Latest figures show that gay and bisexual men accounted for 38 per cent of all new HIV diagnoses in 2008, prompting the Health Protection Agency to join the deafening call for more to be done at community level to reverse the trend.
Since 1999 recorded HIV transmissions between men have doubled; from 1,450 to 2,830 cases a year. During that time, gay men’s sexual health charities hungry for funding forged closer links to government statutory bodies and began slavishly following their diktats and directives to secure taxpayers’ cash. As one sexual health worker told GT in 2007: “We have been working to NHS specifications since 2001.”
Consequently, the impassioned, no-nonsense strategies that once defined the sector’s HIV prevention efforts were superseded by a lumbering, bureaucratic, performance management-led approach which responds more quickly and efficiently to the market forces created by the needs of rising numbers of HIV-infected people than to providing timely and appropriate community responses efficiently targeted at those still at risk of contracting the virus.
The significant breakthroughs in life-prolonging anti-retrovirals over the same period that shifted the general perception of HIV/Aids from killer to chronic disease have only compounded the prioritisation of HIV management over prevention. Politically correct sexual health charities now call HIV/Aids a “manageable illness” and even claim that modern treatments can enable a normal lifespan – a strategy that has demonstrably served to fuel a climate of complacency and indifference around the virus.
Regardless of how HIV/Aids has been rebranded in recent years, it remains a terminal condition and life-long health risk with no cure in sight. Acquisition demands the abandonment of personal freedom and complete dependency on a regimented supply of costly, toxic drugs supplied by the state to survive and function. Fourteen per cent of HIV-infected people are resistant to some or all three of the most common classes of anti-retrovirals, and several hundred still die each year from Aids-related complications.
Whether HIV/Aids cuts short someone’s life by ten, 20 or 30 years, or they succumb to dementia, cancer or liver or heart disease arising from the terrible side effects associated with Aids drugs, common sense dictates that the message remains the same and is non-negotiable: HIV is not an option. However, state meddling and failure to ensure that HIV prevention funding is being properly utilised and targeted means that a very different message is being “sold” by gay men’s health charities today.
Where uncompromisingly upfront HIV campaigns once instilled the need to always “play safe” and use condoms, the last decade has seen that message cynically stripped down and diluted in a PC-driven fervour that has sought to soften, normalise and “sex-up” the virus’s image This approach has resulted in subliminally confusing, one-size-fits-all campaigns emphasising risk minimisation over prevention aimed at negative and positive men alike through fear of being perceived to be discriminating against, or judgemental towards, those with the virus. The morphing from the impactful pre-1999 HIV campaigns to today’s “sex positive” slogans and provocatively suggestive mixed messages and double meanings like ‘Reduce the Risk: Cum Outside’, ‘Enjoy F**king (Without Condoms)’, ‘Get It On’ and ‘From The Bottom To The Top’ correlates directly to the rampant rise in condom-less sex (barebacking) and doubling in HIV conversions over the same period.
“Instead of giving us a picture of what our lives could be like if we bareback, [the HIV charities] choose to ‘empower’ us,” wrote former Boyz news editor, Karl Riley, 23, in the Guardian last February. “They do that by saying: ‘If you are the active partner you’re less likely to get HIV’ and ‘If you withdraw, then you and your partner are at less risk of contracting HIV.’ When was the last time you were told that if you’re going to drink/drive you should opt for a bottle of wine instead of tequila slammers? Or saw the withdrawal method advocated to prevent pregnancy?”
In a 2008 survey, 82 per cent of Pink Paper readers voted for harder-hitting HIV campaigns, yet HIV charity workers programmed by a belief system that masquerades as progressive thinking, but which rigidly and forcefully opposes the mainstream consensus, defiantly insist that shock tactics don’t work. Yet official statistics record that the rate of HIV infections steadily declined to their lowest level by the mid-1990s when hard-hitting campaigns were the norm – not unlike today’s graphic anti-smoking campaigns which successfully encourage people to quit and, in turn, are self-financing because they reduce healthcare costs. Furthermore, between 2001-06 – the first five-year period during which the HIV sector worked to NHS specifications – the HIV infection rate soared by 58 per cent. Over the same period, Aids-ravaged San Francisco adopted hard-hitting campaigns depicting the harsh realities of living with the disease with taglines like ‘HIV Is No Picnic’ – a no-nonsense approach that elicited howls of anger and vilification from the city’s PC HIV lobby despite reducing infection rates there by 20 per cent!
As long as the HIV charity sector continues to “victimise” HIV-positive individuals, it will shun “stigmatising” graphic campaigns above the need to educate effectively about the devastating, life-eroding implications of contracting HIV. The fact that most HIV-positive people do take full responsibility for their condition renders HIV stigma a smokescreen that has served only to normalise and mainstream the virus. Indeed, most are more offended at being regarded as helpless victims than they would be by the “judgemental” or “scare-mongering” pitfalls of HIV/Aids being transmitted to those at risk if such messages empowered negative men to make better-informed decisions about the type of sex they have.
The HIV sector also cites “condom fatigue” and infers that gay men no longer take notice of safe sex campaigns, period, to explain away soaring HIV rates. Yet since these excuses entered circulation an entirely new, sexually impressionable generation of gay youth has emerged that hasn’t been around long enough to tire of condoms, let alone witness an effective HIV campaign. Clearly we are supposed to believe that gay men somehow agreed to ditch condoms and ignore safe sex campaigns in a universal pact of recklessness when, in fact, they have collectively been influenced into riskier behaviours by the last decade’s suicidal shift in attitude to HIV/Aids as expediated by the HIV charities themselves, who these days give every impression of jostling to find ever more brazen and inventive ways to soften HIV’s image and legitimise unsafe sex.
A year ago, for example, HIV prevention was turned on its head when government funds were diverted from mainstream campaigning altogether to projects instigated by the Terrence Higgins Trust aimed at London’s “underground” sex scene. Launched on the pretext of intervening in the spread of HIV “where it occurs”, the ‘Play Zone’ seal endorses gay saunas and sex-on-premises venues that sign up to a largely unenforceable “code of good practise”. It was quickly followed by ‘Hardcell’, a graphically explicit, no-holds-barred web site designed to educate “curious” men about the “thrills” and risks associated with humiliating and often degrading forms of extreme, high-risk sex that feeds on low self-esteem. Both projects were enthusiastically fan-fared in club mags aimed at 18-25 year-olds, thus bringing the growing breed of once marginalised sex clubs that cater for disempowering and dangerous forms of ‘tough sex’ above ground.
The right of such clubs to exist isn’t the debate. That they are loyally supported and fiercely defended by HIV/sexual health charities, which such clubs co-fund at World Aids Day fundraisers where condoms are routinely shunned, is. By association, the overall safe sex message only becomes further confused and diminished in the absence of unambiguous HIV campaigning targeted at the wider gay community, while those participating in the extreme sex scene play by their own rules and risk being driven even further underground by attempts to police their environments.
Today, no longer do those who wield the HIV prevention budgets even pretend to assume that gay men practise safe sex as a rule. ‘THIVK You May Have HIV?’ is one of several programmes that employs NLP techniques to encourage gay men to get tested on the statistical pretext that one in four already have HIV without knowing, itself a shameless admission of failed HIV prevention policy. Emphasising the inevitability of contracting HIV may seem like the ultimate betrayal of the pre-anti-retroviral era safe sex message, but one ongoing HIV campaign goes further still.
PEP (post-exposure prophylaxis) is a 28-day course of the Aids drugs Combivir and Kaletra that, if taken within 72 hours after exposure to HIV, “may” prevent the virus taking hold in the body. Originally provided to health professionals exposed to HIV, pressure from within the gay community to make PEP available after accidental exposure during sex initially met with resistance from a number of STI clinics, who warned that general distribution would lead to riskier behaviour.
Although inviting comparisons with the morning-after pill, PEP’s ability to lower the body’s tolerance to Aids drugs along with side effects including nausea, vomiting, diarrhea, severe headaches and stomach cramps makes it, in theory, suitable only as a one-off treatment. However, in 2006 the chief medical officer Liam Donaldson mandated PEP for “non-occupational exposure.” Public funds were thrown at HIV/sexual health charities to raise PEP’s awareness among gay men, and they did so with a frenzied urgency absent from any “pre-exposure” HIV campaigns before or since.
“We can saturate the gay press with information about PEP and there will still be men who need to know about it who don’t,” implored THT’s press officer Will Nutland as near-identical PEP campaigns by several charities began rotating in the same gay press, on dating and hook-up sites and gay teens resource Puffta to name a few, while PEP booklets were prominently positioned in bars and clubs and handed out to men cruising for sex in saunas and sex clubs. Despite the analogy with the morning-after pill, THT’s blazing red fire extinguisher campaign threw caution out of the window by declaring You must start PEP within 72 hours of unsafe sex or a condom breaking, effectively touting PEP as a “quick-fix” for premeditated sexual recklessness as well as genuine slip-ups from the outset.
Nearly three years later, PEP campaigns are still being rolled out by the HIV sector at the expense of prioritising condom use or educating about the flipside of living with HIV/Aids, the hyperbole now ramped up from “may prevent HIV developing” to “can”. THT defends its unwavering support of PEP by claiming that 80 per cent of users don’t go on to develop HIV, notwithstanding that HIV is extremely difficult to acquire in the first place and it’s scientifically impossible to prove the reason for a negative outcome. Beyond the hysteria, however, the fact remains: PEP’s efficacy is unknown. While at best it may have played a role in preventing some HIV transmissions developing following one-off emergencies, its growing reputation as a golden bullet to manage premeditated risky sex has unquestionably influenced more men into taking calculated sexual risks, using PEP and seroconverting than would otherwise have occurred.
As far back as 2005, a Sigma Research survey of sexually active gay men found that half had sought PEP following unprotected sex – a third with someone they already knew to be HIV-positive – as opposed to a condom breaking. Since then, hospitals and overstretched STI clinics across the UK have reported PEP being requested by repeat users attempting to “manage” unsafe sex. “I met an HIV-positive on the net who shocked me when he said he had f**ked a guy without protection, came inside him, disclosed afterwards, and then advised him how to get PEP,” wrote John Williams in Positive Nation magazine.
At what point does PEP go from being a drug all gay men “need to know about” to a disproportionate, thinly-veiled marketing exercise that overrides public health concerns and benefits only the charities funded to push the treatment on behalf of the pharmaceutical companies they are in bed with? GlaxoSmithKline, for example, makes Combivir and is a longstanding donor to THT. At around £600 per course, PEP is being liberally dispensed and abused at a time when the NHS has been refusing to fund vital cancer treatments and Alzheimer’s drugs costing a few pounds.
The impact of PEP overkill and all-round failure of sexual health education on the annual NHS drugs bill is mind-boggling. The Health Protection Agency estimates the cost to treat just one person let down by the breakdown in HIV prevention for the rest of their life at between £113,000-201,000; roughly the cost of blanket advertising a graphic, upfront HIV campaign in the gay and mainstream media that could prevent many more seroconverting in the first place, saving the taxpayer untold millions in treatment costs and welfare payouts.
“There hasn’t been a decent HIV campaign in years,” HIV specialist Dr Christian Jessen told the Metro in 2008. “If directed at those genuinely at high risk of infection, there is nothing wrong with harder-hitting tactics. If it protects health and saves lives, then the end justifies the means.” Yet the drumbeat for effective action against HIV continues to go ignored by the medically unqualified, media-trained bureaucrats and academics who manage the HIV sector gravy train with an iron grip as overstretched frontline workers daily dispense positive HIV diagnoses to vulnerable, sexually illiterate gay youth not long out of school and onto the sexually pressurised big city scenes, where they are failed twice over by a community that has learned little from its recent, tragic past.
For many gay under-25s today, barebacking is accepted and even embraced, and the thought of contracting HIV is no more of an inconvenience than any other STI or even catching a cold (a recent survey of Puffta members aged 12-19 found that 47 per cent claim not to always practice safe sex and 53 per cent don’t know their HIV status). Most 20-year-olds contemplating “raw sex” naively assume that access to free anti-retrovirals are an automatic right, not pausing to consider what future government policy may dictate nor where imminent pubic services cuts will strike (the government is demanding £2.3 billion in savings from the Department of Health alone).
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In March 2008, BBC Newsnight reported on three such men who contracted HIV shooting a scene for a DVD catering for the growing trade in bareback porn. Rather than confront the underlying issues behind why bareback porn has become so popular or speak out against an industry that is profiteering by undoing years of safe sex campaigning with the same forcefulness it uses to discredit those calling for a hard-line approach to HIV prevention, the HIV sector has remained remorselessly tight-lipped. “If gay men don’t want porn stars to risk their health, they should stop buying bareback porn,” was the response of Matthew Hodson, head of programmes at GMFA, the self-dubbed “Gay Men’s Health Charity”, which itself has arguably contributed to the rebranding of barebacking as an acceptable lifestyle choice and helped popularise the image of HIV among naïve youngsters like those infected shooting condom-less porn. One, a 22-year-old named John, told Newsnight: “I knew the risks from the start and I was happy with that.”
Terrifyingly, the true cost of contracting HIV is fast becoming lost on an emerging generation of gay men who are being encouraged to take bigger and bigger risks with their health by those mandated to protect them. “I volunteered to help GMFA build a web site to educate the seemingly ignorant generation of gay and straight youth on the issue of HIV/Aids,” a contributor told Homovision TV in April. “But I was shocked when I was told they wanted a ‘How to minimise risk when having unsafe sex’ section. You can imagine the uproar if a publicly funded anti-gun crime site had a section on ‘How to reduce risk playing Russian roulette’.”
In February, Time Out’s gay editor Paul Burston organised a public forum to discuss the rise of bareback porn, but THT and GMFA stayed away. “Better to stick with ads that say ‘So you’re HIV, now what?’ and feed the idea that HIV is somehow inevitable,” Burston lamented. “It’s not, and the last thing we should be telling the younger generation is that it is.”
“Lots of people are making money out of normalising barebacking, whether through porn or clubs offering ‘raw’ nights,” warned Johann Hari in the Independent back in 2006. “Crystal meth is also spreading on the gay party scene. It makes you horny and lowers your sense of risk – a recipe for unprotected sex.” Nevertheless, the need to emphasise crystal meth’s unparalleled correlation with HIV conversion and the considerable damage it inflicts on the immune systems of those already compromised by HIV has been vigorously resisted by the HIV sector.
Such insanity is mirrored in other Western countries where well-meaning but misguided HIV organisations singing from identical PC songsheets preaching “personal freedom” and “non-discrimination” are sleepwalking gay communities into public health disasters. “Follow the money,” says Michael Weinstein, president of California’s AIDS Healthcare Foundation. “Tens of millions are being spent to promote a lifestyle that drastically increases the chance of becoming infected with HIV. We have become co-conspirators with the virus. We fight for money to treat HIV but do virtually nothing to prevent it. Let’s raise the bar and demand of ourselves that we stop this epidemic before the next generation becomes infected.”
It will take a monumental gear shift to begin reversing the normalisation of HIV and barebacking when the latest THT campaign supposedly intended to tackle record STI rates features sexually provocative slogans like ‘Come Again And Again’, ‘Huge Satisfaction’ and ‘Fast Mover’, and the mainstreaming of unsafe sex is being taken to a whole new level by HIV sector workers who are now openly demonising anyone who dares speak out against the sexually irresponsible while vigorously defending those criminally prosecuted for deliberately or recklessly infecting others with the virus.
The total lack of accountability and open and honest debate on the governance of the gay community’s sexual health has, over the last decade, allowed HIV to spiral out of control. As the chorus call to get tough with the virus all over again reaches fever pitch, that debate must finally begin in earnest. Failure to do so will make today’s infection rates seem like a drop in the ocean in years to come.
Gary Leigh is the founder of Life or Meth.