Comment: The way forward for HIV prevention

Gary Leigh November 2, 2009
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Earlier this year, Gary Leigh wrote an article for attacking the HIV prevention centre for not doing enough to tackle the threat of HIV. His article provoked anger from some HIV charities, while dividing opinion among our readers. Leigh recently commissioned an independent survey to find out more about gay men’s attitudes to HIV.

In 2006 journalist Johann Hari, writing in the Independent about the rampant rise of barebacking and HIV-related health risks, quoted Martin Luther King: ‘Our lives begin to end the day we become silent about the things that matter.’ “For the gay community,” Hari added, “this is no longer just a metaphor.” In August, ran my commentary, titled Killing us softly, which openly stated what many believe has gone wrong with gay men’s HIV prevention over the past decade. Three years on from Hari’s coded call to action, the silence is finally breaking.

To sustain my article’s momentum, I decided to put several straightforward questions to gay men about their attitudes to HIV and safe/safer sex campaigning; of a kind never asked by standard gay men’s health charities.

With that in mind, at my expense I commissioned an independent market research company with no subjective interest in HIV prevention to target 500 gay men attending last month’s outdoor festival, Soho Live; typically QX/Boyz-reading scene-goers and the main recipients of the London HIV charity sector’s safe/safer campaigns.

My agenda, simply, was to cut through the bluster and hype of other surveys and provide the gay press with an instant snapshot of how gay men today are responding to safe/safer sex campaigns appearing within their print and online media. Ultimately, to determine whether the policies of those funded and entrusted to safeguard gay men’s health and wellbeing are aligned with the ‘Old Compton Street consensus’…

Countering the HIV sector’s insistence that their prevention strategies are properly targeted and effective, the Soho Live survey found that its ‘safer sex’/risk minimisation adverts – for example for the post-exposure ‘morning-after pill’ PEP and ‘cumming outside’ – have in fact influenced six per cent of respondents to engage in unsafe sex “every time” and 22 per cent “sometimes”. Among under-25s, 11 per cent said “every time” and 35 per cent “sometimes” compared to just two per cent of 40-59-year-olds who said “every time” and ten per cent “sometimes” – a generational shift that can only be attributed to the 1980/90s style of hard-hitting HIV campaigns, whose sustained impact continues to influence many older gay men into taking precautions.

The HIV sector defiantly maintains that hard-hitting campaigns aren’t effective, that they stigmatise those with HIV and deter others from coming forward to be tested, and have long used these arguments to soften and normalise HIV’s image. But when asked if harder-hitting HIV campaigns – specifically depicting the downsides of living with HIV – would be more effective in persuading them to engage in safe sex than today’s campaigns, only four per cent of respondents said “no” while nine times as many (36 per cent) said “yes”, 28 per cent were undecided and 32 per cent said “possibly”. Only four percent agreed that harder-hitting ads stigmatise HIV-positive people and almost two-thirds disagreed with the HIV sector’s rhetoric that such campaigns would deter gay men from being tested (only four per cent agreed).

To determine the extent that HIV prevention has shifted general perceptions of the virus from a terminal to a manageable condition, the survey then asked respondents which of three statements best described their awareness of HIV. “With today’s medications, HIV is a manageable illness and infected people can expect to live a normal, healthy lifespan” is a statement popularised by the HIV sector despite having little or no foundation in fact. Nevertheless, 27 per cent of respondents agreed with it rising to a staggering 41 per cent of under-25s and 44 per cent of those aged under 21. Only 16 per cent of over-40s agreed.

“HIV is a serious terminal condition and infected people can expect to endure debilitating side effects from the medications and a shortened lifespan of around 20 years” – a statement based on a new 43,000-strong US study which found average lifespans of newly-infected people to be 21 years shorter than their negative peers, and real-life experiences of people who have lived with HIV and antiretrovirals for many years – found favour with 45 per cent of all respondents but only 24 per cent of under-25s and just 19 per cent of under-21s, indicating that the serious downsides of contracting HIV, long since airbrushed from prevention campaigns, are becoming lost among younger gay men. By contrast, two-thirds of over 40s agreed with this statement.

Most shocking of all, ‘HIV is no more serious than contracting any other STI like herpes, syphilis or gonorrhoea’ was agreed by over a quarter (26 per cent) of all respondents, soaring to 34 per cent of under-25s. Only 14 per cent of over-40s agreed.

Finally, Soho Live survey participants were asked what single factor is most contributing to the rise of barebacking. By a clear margin in nearly all age groups 21 per cent said bareback porn; a significant finding given the deafening silence and indifference of the HIV sector on the subject.

‘Lack of free condom distribution’ and ‘boredom of safe sex/condoms’ were each cited by 18 per cent of respondents, obliterating the fallacy that ‘condom fatigue’ is the overriding factor influencing gay men of all age groups into having unsafe sex.’“The increase in sex-on-site premises’ came fourth (16 per cent). ‘Ineffective safe sex education’ was itself considered to be a main factor in the rise of barebacking (13 per cent), more so than “disinhibiting recreational drugs” (12 per cent).

I believe the Soho Live survey represents a damning indictment of failed HIV prevention strategies. Most of all it emphasises that if gay men’s health – particularly the urban scene-goer’s – is to be safeguarded into the next decade and HIV prevented from entrapping a new generation of gay men, blind faith and trust must stop being placed in the HIV charity sector which continues, year after year, to squander public funds while clinging to the same out-of-touch policies and well-worn myths. The unpalatable truth is that the sector is no nearer to delivering the solutions that are blindingly obvious to gay men on the street than when it started out because it has become the central problem, subverting and co-opting HIV prevention to the point where its methods are blatantly enabling the virus’s spread.

HIV prevention has ultimately failed because HIV today is an industry in itself, and the purpose all of industries is to grow, prosper and dominate their respective markets. By comparison a charity, by definition, comprises volunteers who raise funds independently for their cause, devoid of external interference.

The system has been allowed to work against the best interests of those it purports to serve for years thanks to a culture of indifference and silence. The Soho Live survey findings have merely made the elephant in the room visible to those concerned enough to see, exploding the disinformation, deceptions and myths spun by the HIV sector while simultaneously withholding facts about the potential chronic implications of HIV infection – a contemptuous abuse of the human right to honest and accurate information from which to make informed choices around personal health, and without which many have been wittingly and recklessly contracting HIV.

For sanity’s sake, if we are to secure the future health and well-being of thousands of gay men then HIV prevention must be hived off into a totally independent entity, staffed by those committed exclusively to reversing the rate of HIV transmissions by whatever means necessary.

If there is still such a thing as “gay community”, as Johann Hari described in 2006, then it is the only way forward.

Gary Leigh is the founder of

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