As I was writing what I thought would be an objective post in which I would not take sides on whether the ad was an effective or ineffective ad, I found myself admiring the willingness to shake up the status-quo and the use of shock tactics to wake up gay men - and particularly young gay men - out of the complacency that seems to have settled over the community when it comes to HIV/AIDS.
I've seen a lot of the leading gay bloggers write non-committal posts asking readers to express whether they find the ad effective or ineffective. But a few have taken sides.
..and, ehm, me? At least that's what I sorta said in my last post.
Expressing outrage about the ad were:
The Gay and Lesbian Alliance Against Defamation (GLAAD) and the Gay Men's Health Crisis (GMHC) which released a joint statement calling for the ad to be withdrawn
There are also all the telling pro- and anti-ad reader remarks posted by readers at Joe.My.God. and Towleroad, among others.
Tonight, though, there is a great opinion piece by POZ Magazine copy editor Trenton Straube which nails exactly why the ad has drawn such divergent reactions as well as why the hunger for a frank discussion of the issues that lead to HIV transmission among gay men in this day and age still do not excuse the use of scare tactics for the sake of it.
From his essay:
Personally, I oppose sugarcoating reality--if the facts are scary, then so be it--and I suspect that most people, especially young men who have sex with men, are oblivious to the accurate statement "It's never just HIV." Let's tell that truth. It's important, especially in light of the bareback pornification and sexualization of, well, most everything nowadays, and in light of the growing believe that HIV is a manageable disease (surely, all the recent news about Truvada as a pre-exposure prophylaxis will convince some folks that high-risk behavior isn't so high risk after all).
However, let's talk about the PSA's tone and presentation. This 30-second horror show is one thunderclap away from parodying those "Gathering Storm" ads that warned about the impeding dangers of marriage equality. Such melodramatic delivery overshadows the important message. I get that the campaign is in line with the city's other fear-based PSAs against smoking, which relish in images of clogged arties, diseased lungs and amputated fingers.
But do we really need to see a mutilated anus in association with HIV and men who have sex with men (MSM)? The ad does more to stigmatize anal sex than people living with HIV. Cigarettes and HIV aren't synonymous and the two shouldn't be treated identically in a campaign. As other online commentators pointed out, smoking, unlike sexuality, isn't part of your intrinsic identity as a person. Sexuality subjects you to discrimination in terms of human rights, religious equality, loving relationships, etc.
Read the entire piece here. It's certainly worth it. And my easily impressionable mind is back on the 'no to the NYC DOH ad' column.
If you've lived in NYC over the last few years, particularly if you are a smoker, you are probably highly aware of a series of increasingly graphic print and television campaigns the New York City Department of Health developed to discourage people from smoking and encourage smokers to quit.
In its first incarnation, you saw "Ronaldo Martinez" speak to the camera and talk about getting a cancerous growth removed from his throat and taking his ability to speak away without the help of a machine (surprisingly, I haven't been able to find the televised version of the ad anywhere except in a different version apparently appropriated by an anti-smoking agency in Australia of all places).
I'm not a cigarette smoker but that specific ad seemed to have a punch to it. Sure, I changed the channel every time it came on, but you could certainly understand the ad's plausibility when it comes to long-term cigarette smoking.
The ads made an immediate impact, specially among friends who smoked. They called NYC's #311 help line and ordered the expensive smoking-cessation kits that the Department of Health offered on a limited basis.
Researchers called the campaign a "huge success", at least in its early stages. But it's not clear to me whether they took into account that the Department of Health was initially offering access to nicotine patches for free nor the fact that the city was increasing taxes on cigarettes
Not that I'm complaining. As an infrequent cigar smoker, I can say that one of better legacies of the Bloomberg administration is having barred smoking in bars. And, apparently, some statewide programs still offer free nicotine patch or gum "starter kits" (click here).
But then came the other ads. The ones that said that smoking would make you lose your fingers (I kid you not). Or give you brain tumors. Or promote cavities. And I personally thought they'd gone off their rocker and gone punch-happy on negative messaging. Truthfully, the more graphic and preposterous it got, the less effective I felt the campaign was.
They even tried to replicate the scare tactics - laughably some may say - with campaigns to stem consumption of sugary drinks and the way they make people fatter. Gross, yes. Effective? Eh...
Which brings us to...
I've long been a critic of the public health policies developed by the New York City Department of Health under the Bloomberg administration and their reliance on scare tactics. And yet, I am inclined to like this ad. Why?
Well, it's certainly graphic and gross. But it speaks to the potentially horrible side-effects of being HIV positive. Does it say that everyone with HIV will develop these symptoms? No. But the ad does strongly imply that people with HIV are at a higher risk of being at risk of these illnesses - which I believe does act as a forceful HIV-prevention message.
Now, call me when the NYC Department of Health starts running messages saying that people with HIV are more prone to cut off their fingers as a scare tactic but, if memory serves me well, just a couple of years ago HIV prevention advocates were bemoaning that HIV prevention messages portrayed people with HIV as being all happy-happy and ultra-healthy when the reality of living with HIV wasn't nearly as cheerful.
Interestingly, a few of Michael Bloomberg's most vociferous critics seem to be backing this campaign while a number of advocates and organizations are calling for the Department of Health to pull the ads.
As the leading video attests, openly gay New York City Councilmember Danny Dromm is asking for the ads to be removed immediately as does the South Asian Lesbian and Gay Association (SALGA).
Tonight, they've been joined by the Gay Lesbian Alliance Against Defamation (GLAAD) and the Gay Men's Health Crisis (GMHC) which released this statement. An excerpt:
Gay Men's Health Crisis (GMHC), the nation's oldest HIV/AIDS prevention, care and advocacy provider, today joined the Gay & Lesbian Alliance Against Defamation (GLAAD), the nation's leading lesbian, gay, bisexual and transgender (LGBT) media advocacy and anti-defamation organization, to demand that the New York City Department of Health and Mental Hygiene pull a sensationalistic and stigmatizing television public service announcement aimed at gay and bisexual men.
The PSA, which is intended to encourage condom usage among gay and bisexual men, claims that those with HIV face a higher risk of bone loss, dementia, and anal cancer. While older adults living with HIV may be at greater risk of these conditions, the PSA creates a grim picture of what it is like to live with HIV that could further stigmatize HIV/AIDS, as well as gay and bisexual men.
"We know from our longstanding HIV prevention work that portraying gay and bisexual men as dispensing diseases is counterproductive," said Marjorie Hill, PhD, GMHC's Chief Executive Officer. "Studies have shown that using scare tactics is not effective. Including gay men's input, while recognizing their strength and resiliency, in the creation of HIV prevention education is effective. Gay men are part of the prevention solution, not the problem."
Both GLAAD and GMHC have reached out to the department to demand that the commercial be pulled and to offer assistance with framing the conversation around HIV/AIDS more accurately.
"While it's extremely important that we continue to educate New Yorkers about HIV/AIDS prevention, the sensationalized nature of the commercial, including its tabloid-like fear tactics, misses the mark in fairly and accurately representing what it's like to live with HIV/AIDS," said GLAAD President Jarrett Barrios. "It's our hope that the department will work with us to create a PSA that promotes safety and solutions, rather than stigma and stereotype."
The funny thing (as funny things go when discussing these issues) is that one of the top Bloomberg administration critics when it comes to HIV prevention seems to be bending over-backwards not to say a bad thing about this.
And that, my friends, is truly as bizarre as it gets. As for the ad... do you think it's effective? Do you think it sucks? I am inclined to like it but haven't yet made up my mind. What are your thoughts?
Update: Via my friend Michael Petrelis, Larry Kramer chimes in:
to the nyc dept of health:
thank you. it's about time. this ad is honest and true and scary, all of which it should be. hiv is scary and all attempts to curtail it via lily-livered nicey-nicey "prevention" tactics have failed. dr hill knows this and her remarks below, once again, show her to be living on another planet. and since when is GLAAD in the hiv-prevention business? god help us if it is. gmhc is bad enough.
can we finally get real here? we are in the 32nd year, more or less, of a plague.
ONE OUT OF EVERY FIVE GAY MEN IN AMERICA IS HIV POSITIVE. AND FIFTY PER CENT OF US DON'T KNOW IT!
these are appalling statistics.
And dr hill and some dude at glaad is telling me that prevention efforts, as they are presently constituted, are working.
of course people have to get scared. i have said this since day one and i say it today. they need to be scared into using condoms. into getting tested, into being responsible human beings. nothing so far has been able to bring a sufficient result to these requirements. why can't anyone see that? why can't our oldest aids organization see that? to say as dr hill does below that "studies have shown that using scare tactics is not effective" is, i believe, an out and out lie. i have never seen such research. if it exists, then it is as irresponsible as dr. hill and mr/s glaad.
i see a lot of doctors regularly during the course of looking after my own health. every single one of them is telling me that they are seeing more and more young and usually white men who are educated and should know better, sero-converting.
and with all the hoopla over hiv negative people taking this new once-a-day truvada "miracle cure" just so they can have sex without a condom, is going to be a nightmare of the highest order. i firmly believe this.
just as i firmly believe that NO prevention efforts can be rendered with the sugar coating it has been receiving since 1981.
i congratulate the nyc board of health for finally getting real. i look forward to even more and scarier public service announcements.
larry kramer
Michael actually does not like the ad. For his comments, go over to his blog.
You might remember my reaction a few months ago when I first heard of plans by the New York City Department of Health to promote circumcision among the city's gay and bisexual Latino and African-American men as a means of HIV prevention.
This, based on a studies in Africa showing that "circumcision was shown to lower a man’s risk of contracting the virus from heterosexual sex by about 60 percent" according to an article in The New York Times which first broke news of the City's alleged plans.
“This is not something that has a lot of buzz,” said the City's Health Commissioner Thomas R. Frieden in discussing the study then but, as the Times noted, "he added that even 1,000 circumcisions in the right subgroups might slow the spread of AIDS."
At the time, back in April, I balked at the way the Department of Health seemed ready to promote public HIV prevention policies aimed at gay men of color in New York based on studies of heterosexual males in Africa.
As you might also remember Dr. Frieden later released a letter staring that the New York Times had misrepresented his words and that the Department of Health had no such plans in the pipeline and then appeared at a public forum where he said it was just a "discussion" on whether it made sense to explore such a policy.
Now comes word of a study published in the December 15 issue of the Journal of Acquired Immune Deficiency Syndromes that seems to indicate that the Department of Health was wrong in trying to extrapolate results from the African study to argue that it might make sense to circumcise gay men of color in New York.
Circumcision status was not associated with prevalent HIV infection among Latino MSM, black MSM, black bisexual men, or black or Latino men who reported being HIV-negative based on their last HIV test. Further, circumcision was not associated with a reduced likelihood of HIV infection among men who had engaged in unprotected insertive and not unprotected receptive anal sex
In short, "there was no evidence that being circumcised was protective against HIV infection among black MSM or Latino MSM."
In any case, some good news on the eve of World AIDS Day for uncut gay and bisexual men of color in New York: You may keep your hoodies! Merry Christmas and Happy New Year!
Chad Ferreira: The Bay Area Reporter continues it's coverage of the altercation in San Francisco's Castro district that led to the death of Chad Ferreira (pictured) in January of 2006.
Last week reporter Ed Walsh described opening statements made at a trial that will determine whether 26 year old Kyle Adams committed manslaughter by beating Ferreira so hard that he caused Ferreira to fall and fracture his skull when his head hit a sidewalk curb or if he is, as he claims, innocent and just acting in self defense.
Today, the Reporter describes Adams turn on the stand and his side of the story, some of which differs with witness statements and includes details were not originally provided to the police department when he was first charged.
The paper says that closing arguments after the print edition of the Reporter went to press and that the case went to the jury at 3:10pm yesterday.
Circumcision as HIV prevention: The New York City department of Health and Mental Hygiene held it's community forum on the issue of male circumcision as a possible HIV prevention tool. I was not able to attend but both Gay City News and the New York Blade covered the arguments and the reaction.
Alvaro Orozco: In February we told you about a decision by Canada's Immigration and Refugee Board not to grant asylum to a young Nicaraguan gay man, Alvaro Orozco, partly because they argued that if Orozco wasn't sexually active when he left Nicaragua at the age of thirteen, he could not assert that he knew he was gay then. The Orozco case and his ongoing efforts to appeal that decision receives a coverline in the current issue of The Advocate. For more on the case and on how you can help, please visit his website.
In United States political asylum news, Arthur Leonard calls an April 25th ruling that turned down an asylum application by a Miami-based Colombian gay man "Another asylum tragedy." Leonard says that the court not only denied asylum but also outed him in the process and now is sending the man back to Colombia despite having arguably shown credible evidence of fear of persecution if sent back.
Not sure I can make it to any of tonight's two meetings or even next week's meetings but...
Calling it the Queer Justice League (asterisk*) might be inappropriate because some people have reservations about the (*) name and it was supposed to be an interim name (*) anyway, but there's a bunch of people meeting at 7pm tonight at the LGBT Center on 13th Street. It's the 2nd meeting since a speech by Larry Kramer riled up the masses. I can't promise that the issue of whether to use Robert's Rules of Order will be resolved by meeting's end. Do try to take a chill pill beforehand so you can be in the right mood to deal with different levels of oppression and the tension level that a few hundred e-mail messages have ratcheted up. Maybe, just maybe, something will come out of it. If there seems to be consensus on one thing it's that they want some freakin' direct action, NOW! So at the very least maybe you too can throw your pet cause into the ring and see if it sticks. It's been billed as a "working meeting" to address some remaining process issues with a "full meeting" to follow at 8pm on April 26th, also at the Center. For updates click here [NOTE: Gay City News has more on what went on druring the first meeting here].
Not to be confused with the (non-asterisk *) ACT-UP meetings that still take place every Monday at 8pm also at the Center.
Tonight, though, ACT-UPers and ACT-UP allies can also head over to the City University of New York for "CLAGS LGBTQ Studies Panel: Discussions Around the History of ACTUP." That also takes place at 7pm tonight (not sure if some asterisks * will make it should the meeting at the Center end up early). What is the CLAGS meeting about?
"To mark the 20th anniversary of ACT UP, this round table discussion features Sarah Schulman and Jim Hubbard, co-coordinators of the ACT UP Oral History Project and co-founders of the MIX New York Lesbian and Gay Experimental Film Festival, and invited guests. The conversation will focus on the early history of AIDS activism in New York City, the birth and history of ACT UP, and the needs in/for AIDS activism today."
It's free and open to the public and will take place at the Skylight Room (#9100) of the Graduate Center at CUNY, 365 Fifth Avenue (at 34th Street) in Manhattan. Need more info? Call 212 817-1955 or click here.
Speaking of April 26th, you might want to make it to the Center a couple of hours earlier before the 3rd Queer Justice League (asterisk *) meeting: The New York City Department of Health and Mental Hygiene's Bureau of HIV/AIDS Prevention and Control and the Bureau of Sexually Transmitted Diseases (whew! THEY should have an asterisk!) is presenting "A Community Discussion on Male Circumcision and HIV Prevention."
If it turns out to be half as interesting as the one a few of us held with them a few days ago in the wake of this, it should be a hoot.
[NOTE: This statement was sent out to community activists in .pdf form earlier today. I have not been able to find a direct link to the statement at the Health Department's site but the LifeLube blog also received the document and has uploaded and made it available for download here]
THE CITY OF NEW YORK DEPARTMENT OF HEALTH AND MENTAL HYGIENE Michael R. Bloomberg, Mayor Thomas R. Frieden, M.D., M.P.H., Commissioner
Recent media reports misrepresent the Health Department’s response to recent studies showing that circumcision significantly reduces HIV transmission in some contexts. We do not yet know what impact circumcision could have on HIV transmission in New York City, and we have not suggested or planned any initiative or campaign. Quite to the contrary, I indicated in an interview with the New York Times (the source of the misrepresentation) that I very much doubted that even 1% of men at high risk in NYC would undergo the procedure.
As a result of rigorous studies, we now know that circumcision reduces risk of female-to-male spread of HIV by about 60%. There is some evidence, but no proof, that circumcision may reduce male-to-female transmission. There is also some evidence, but again no proof, that it may protect men who engage in insertive anal sex from male-to-male transmission.
Our goals are the following:
• Inform the community of the facts regarding what is known and what is not known about circumcision’s effects on HIV transmission; • Promote discussion among community groups and health care providers to explore how circumcision may be relevant in New York City; • Increase access to circumcision for men who want the procedure.
The need for new effective prevention methods is urgent. But even if circumcision is as effective in preventing male-to-male transmission as it is in preventing female-to-male transmission, it does not by any means eliminate the risk of becoming infected with, or spreading, HIV. Any new approach, including circumcision, needs to be seen as an addition to our existing portfolio of proven HIV prevention strategies, including reduction of unsafe sexual encounters and consistent condom use.
There will be a community forum in the next few weeks to discuss these issues and we hope you can attend.
Sincerely, Thomas R. Frieden, M.D., M.P.H. Commissioner
If it wasn't for Vivir Latino on my blog roll, I might have missed this tidbit from Spain's 20 Minutos.
Turns out that even before NYC health commissioner Thomas Frieden spoke to The New York Times on plans to promote circumcision as an HIV prevention method for men "at high risk" of HIV transmission in the city, the head of another health department a few thousand miles away had pretty much rejected that same idea based on the same studies that Frieden used to support his push.
On March 28th, the World Health Organization and UNAIDS released a joint statement recommending that "male circumcision should be part of a comprehensive HIV prevention package."
In the statement Dr. Kevin De Cock (love the name), Director of the HIV/AIDS Department at WHO, said:
The recommendations represent a significant step forward in HIV prevention. Countries with high rates of heterosexual HIV infection and low rates of male circumcision now have an additional intervention which can reduce the risk of HIV infection in heterosexual men. Scaling up male circumcision in such countries will result in immediate benefit to individuals. However, it will be a number of years before we can expect to see an impact on the epidemic from such investment.
In addition the statement warns that before implementing the plan among other populations further research was needed:
In countries where the HIV epidemic is concentrated in specific population groups such as sex workers, injecting drug users or men who have sex with men, there would be limited public health impact from promoting male circumcision in the general population.
Not heeding those caveats, the Times says that Frieden told them that "it is logical to assume that circumcision would offer protection in some types of gay sex."
Enter Brazil: Known for their groundbreaking HIV prevention programs, particularly in gay populations, Mariángela Simao - the technical advisor of the Brazilian health ministry - told news agency EFE that the studies did not provide any data that circumcision reduced the risk of HIV transmission among gay men.
She also pointed out that the recommendations only were applicable in countries where HIV incidence reached more than 15% of the population which would leave out every Latin American country.
Simao expressed concern that circumcised men might get the message that it is OK for them to have unprotected sex without any risks of HIV transmission and said that she feared that, based on the recommendations, developed countries would now devote current international HIV treatment funding towards circumcision surgery procedures instead of proven methods.
In other words, Brazil has officially rejected circumcision as an HIV prevention method amongst gay men - until specific studies are done - and says that they would rather concentrate their prevention funding on promoting condom use and the free availability of HIV treatments for those that test positive.
Updates: In his statement to the New York Times Commissioner Frieden said that he had consulted gay rights and helth service organizations before speaking to the Times but in the April 6 edition of The New York Post, Tokes Osubu, Executive Director of Gay Men of African Descent says "For anyone to think there is going to be a long line of men in their 20's lining up to have part of their anatomy chopped off, it's ludicrous" and Michael Robinson of People of Color in Crisis says "I can't imagine us going around encouraging adult men to have adult circumcision. It's just too painful."
If these are the reactions of two top gay African-American leaders in the city I wonder which gay advocacy and health service organizations the Commissioner did reach before speaking to media. An April 7 New York Post editorial criticized Dr. Frieden for the proposal (but it should be said that the Post has previously assailed Frieden for some of the City's sound health policy projects including the indoor public space smoking ban and a proposal to ban trans-fats from being used in restaurants throughout the city).
On April 6, the New York Times printed a follow up article in which Mayor Michael Blooberg seemed to distance himself a bit from Frieden's statements.
The Agenda blog also points out that the New York City Department of Health and Mental Hygiene posted a brief response to some of the criticism that sprung over at the New York Times political blog, The Empire Zone (read comments here).
In the brief statement Geoffrey Cowley, a spokesman for the Department of Health, denies that agency is ready to launch a campaign to promote circumcision as an HIV prevention tool in New York City but says that, considering the results of the research in Africa, the possibility is worth exploring.
The Department of Health has also said that they will be organizing community town-hall meetings on the issue to get some feed-back.
Let's say that earlier yesterday I had an interesting con- versation with someone that read somewhere that few people in Colombia, my home country, were circumcised. This in light of a report earlier this week from the World Health Organization and UNAIDS recommending that "countries with rampant AIDS epidemics should begin offering free or subsidized circumcisions in hopes of preventing millions of new infections and deaths" (according to the Washington Post).
The person, who shall remain anonymous, expressed interest in "discussing" whether it made sense to formulate campaigns in Colombia to make people aware of the HIV transmission risks for uncut men and encourage them to get circumcised or, pushing it a bit, whether there should be campaigns to get Colombian immigrants in the United States on the same path to circumcision.
Let's just say that I thought this person was kidding.
"But the research shows...!" the person said, and I knew it wasn't a joke.
Let's clear up some things: No, I am not circumcised. No, I don't have anything against people who are. No, I don't get why some fret so much about not having foreskin. And no, I don't get people who seek foreskin reconstruction either. In plain terms, dick is dick! Enjoy what you have and don't fret so much!
But it turns out that the person who made the comments is also indirectly related to the New York City Department of Health which now makes me wonder if he knew more than he was letting on: Today the New York Times reveals that "New York City Plans to Promote Circumcision."
Hm. All of a sudden it does not seem as random a conversation. Still, I am aghast that the NYC DOH would seek to promote invasive surgical interventions for adult males as an HIV/AIDS prevention strategy.
Yesterday I tried to argue that there were other variables such as country-specific hygiene practices and HIV prevention strategies that had to be taken into account. Colombia might have a high number of uncircumsized men but it lags behind some African and Asian countries in terms of HIV incidence.
But when it comes to public policy and HIV prevention sometimes a bad idea just captures the imagination and becomes, for lack of a better word, "fashionable" to fund. As with other bad ideas, this one will probably take a couple of years to run its course before a new hot topic arrives.
In the meantime, where are those other prevention dollars? No need to get rid of foreskins. Just fund programs that make men at risk - and particularly gay or bi men (whether uncircumcised or not) - feel that they are worth something which is at the core of a person's ability to protect themselves from HIV/AIDS.
UPDATE: Joe.My.God readers have left a few choice comments as well here.
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