San Francisco Examiner - April 15, 2002
Tanya Pampalone Of The Examiner Staff

The evidence is everywhere. The latest figures from the Department of Public Health show that estimated rates of new HIV infection in The City's gay community doubled last year to 800 from the reported 400 per year in the late '90s.

Meanwhile, a recent Centers for Disease Control and Prevention study found that 14 percent of gay men intentionally engaged in sex without a condom in the past two years.

The reports have put AIDS-prevention workers in a quandary. Should they tone down their risqu messages and slide under the conservative radar to avoid funding cuts?

Or should they rev up with hard-hitting ads so those who are blas about the disease will realize the seriousness of the epidemic?

While they struggle to find a solution, the majority of prevention workers agree that the current policy is a failure.

No fear

In the early days of the epidemic, many in the gay community were confronted daily with the prospect of death. Now, with the aid of medications, many HIV-positive people are living relatively healthy lives, but there is a downside.

"Only fear made (HIV prevention) work in the first place," says Marcus Conant, head of the Conant Foundation, and one of the first doctors to work with AIDS patients. "The messages didn't make it work."

The urgency to stop infections was removed after 1996, when AIDS drugs began to combat the disease, prevention specialists say.

But that's not the only shift. Steven Gibson, Stop AIDS Project spokesman said beyond the evaporation of urgency is the plain fact that sex without a condom feels better.

His organization began to shift prevention strategies two years ago, when studies revealed there was an increase in risky behaviors. They began to target their messages to the most affected communities with workshops like Trannyfags, which is geared toward transsexuals, a group with a high infection rate.

Still, Gibson maintains that a small number of infections should be expected.

No way, says Tom Coates, the director for the Center of AIDS Prevention Studies at UCSF.

"Why is that we have allowed ourselves to say a certain level of infections are acceptable and we are just going to live with it?" he asks. "It ends up hurting the community and spreading more HIV around."

Prevention politics

Currently, what is hurting the HIV-prevention community the most is pressure from the federal government.

Reverberations of the investigation that found the Stop AIDS Project workshops obscene are being felt across the country. Nationwide, AIDS groups are double-checking their materials and self-censoring themselves when they get too close to the edge, afraid of having their funding yanked.

AIDS organizations argue that HIV prevention campaigns aimed at the gay and bisexual community have to be sexually explicit in order to be effective, and the more risky the group, the more risqu the message.

House Whip Nancy Pelosi defended that stance at the March meeting of the American Foundation for AIDS Research in San Francisco. She defended the sexual overtones of HIV prevention, and took shots at the Bush administration's abstinence-only sex education policies.

"Anything that has to do with sex, they have a problem with," Pelosi said of her conservative counterparts.

But it is not just the sexually explicit messages that are under scrutiny.

The House Subcommittee on Criminal Justice, Drug Policy and Human Resources launched an inquiry into the Stop AIDS Project last week. In a letter obtained by The Examiner, the committee asked the CDCP how a weekend trip to the zoo helped people to stay HIV-free.

Prevention workers maintain that these social outings are aimed at fostering a community, but conservatives are honing in on AIDS spending. They want to know exactly how the money is spent in a city that tops the AIDS funding charts.

Back to basics

"We have all these programs and HIV prevention people are scratching their heads saying, 'How can we help people with HIV?' " Coates says. "When it is all is said and done it's up to the community to say 'we just don't want HIV to spread.' "

One solution, Coates says, is to make condoms available in bars and shops, which will force the gay community to be responsible for itself, as it was in the early days of the epidemic.

It is a plan that Castroguys is working on providing.

With private funding from Bristol-Meyers Squibb and matching funds from The City, the gay health group will have $2 million to kick-start what they call a "grass roots" project.

By working directly in the Castro, Michael Siever, adviser to the Castroguys program, hopes to revive the sense of community in the gayest neighborhood in town.

"AIDS prevention has gotten so professional, so slick," Siever said. "There are so many posters and ads that people don't even listen to them anymore. We need to grab people's attention and get them involved."

Castroguys hopes a holistic approach to health will combat HIV infection, and they plan to provide basic health care services, HIV testing and counseling, STD screening and treatment and vaccinations for hepatitis A and B.

The fact that Castroguys has no federal funding will keep the group out of the federal investigation mire. And solving the HIV prevention problem will be left with the community.

That is where Siever and the mayor's AIDS adviser Michael Shriver hope the answer lies.

"How do you get people to care in a short period?" Shriver asks. "It's not rocket science. Someone in the community is going to figure it out."

E-mail Tanya Pampalone at tpampalone@sfexaminer.com

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