The Bay Area Reporter - July 21, 1998
Stephen LeBlanc

"At one time we gave people basic information," recalls longtime AIDS activist Hank Wilson, "like the necessity of condom use, not sharing needles, the importance of hygiene when using sex toys.

"Then we made a quantum shift to programs that attempt to enhance self-esteem or deal with psycho-social aspects of HIV use," he continued, "but I think we left the field of the basic prevention information that needs to get out there - although I think the Crissy Campaign directed at speed users, and some other targeted campaigns, have been good"

A series of campaigns launched by the San Francisco AIDS Foundation, partly funded by the city of San Francisco, shows the shift. In September 1995, SFAF launched "Good Dog," a campaign that was described at the time as "starting to look past the AIDS epidemic. The name is taken from the wish list - 'a good dog ... a nice apartment ... a life that doesn't revolve around HIV.'" On March 15, 1997, SFAF launched an advertising campaign for its Compass Prevention Project. Bus shelter ads and posters featured two buff, naked men, with a few words, such as "isolation sex anger grief fear rejection," plus a logo and a phone number.

Less than a year later, the Compass Project vanished, replaced by the recent "Gay Life" program. Each project was launched with a new media campaign, new brochures, new logos, and each spent tens of thousands of dollars on advertising. And they all avoided any specific messages about safe-sex or HIV transmission or treatment.

Activists contend that they would be less concerned that these flagship programs were not directly addressing safe-sex if other media campaigns were filling that gap. Unfortunately, that has not been the case.

Last week, the San Francisco AIDS Foundation ventured in that direction by placing informational ads in gay publications about the implications of multi-drug resistant (MDR) HIV. Before that, observed activist Don Howard, who just returned from participating on a World AIDS Conference panel discussing how recently-documented transmission of MDR HIV should affect prevention messages, "for two years, HIV-negative people have seen friends getting better, read misinformed headlines about the cure, or heard about the inaccurately-named 'morning-after' treatment, but no one in San Francisco has produced prevention messages about what these changes mean to people staying [uninfected]."

"Other communities are far ahead of us in getting this information out," he pointed out. "Boston's 'It Ain't Over Yet' campaign emphasizes the continuing importance of safe sex. In Amsterdam, I saw posters in gay establishments showing a pile of anti-AIDS drugs in one corner and a condom in the other, with the saying 'you decide.'

"Meanwhile, data in Geneva documented that the number of men reporting unsafe sex has grown from about 20% to 40% in three years, with many men citing a belief that HIV is not the death sentence it use to be."

Is prevention anti-sex?

One seven-year veteran of AIDS prevention work, who spoke on condition of anonymity, points to many factors leading to the vagueness of AIDS prevention messages. "There is a battle going on in San Francisco as to what we believe everybody knows or doesn't know. Prevention workers feel a lot of pressure from some strong voices in the gay male community that in everything we say we have to be celebratory, sex-positive, pro-gay, and we can't give direct warnings about high-risk behavior.

"In the last few months, I've talked to men who were invited to barebacking [unprotected sex] orgies while walking out of Costco - these are totally anonymous club card-style invites to $10 bareback parties where you are not allowed to ask anyone's status and not allowed to have safe sex. This is very different from discussions three years ago regarding changing safe-sex standards with long-term partners of the same serostatus. But, when prevention workers raise an alarm, a few people scream, 'You can't do that.'

"Transmission of drug-resistant HIV has been documented for years; a solid 15% of new HIV infections are AZT-resistant. But prevention workers are told that to tell people about that is too alarmist, too sex-negative, not today's trend. It's been lovely not to have people dropping like flies, but by the most conservative estimates, several hundred gay men in San Francisco will get HIV in 1998. Rectal gonorrhea is up. The number of people who report imperfect use of condoms is up. But, boredom and battle-fatigue has set in. There is this wild millennial thing going that says Party At All Costs. Sometimes, I feel that we all should be in a revival of Cabaret; the Nazis are coming but the party must go on.

"Then there is this collective fantasy that only people under 25, or who are non-white or low-income, are at risk any more. But it's all fantasy. Somehow all gay white men who are employed are not at risk for HIV because we say so. It's fabulous, willful denial."

(A recent study commissioned for the Gay Life program reported that in fact, most new HIV infections in gay men are of men in their 30s. Also, the actual number of people testing positive for HIV at San Francisco testing sites is higher than some previously published information would suggest. HIV Prevention Planning Council member Shawn O'Hearn reports, "After months, I finally got an answer out of the Department of Public Health about how many people in San Francisco tested positive for HIV in 1997. It was 1,350, far higher than I had been led to believe.")

At the recent World AIDS Conference, doctors from the University of California at San Francisco reported a case of a person newly infected with multi-drug resistant HIV. The person was not able to control HIV viral load with any available drugs. According to Project Inform's Martin Delaney, several other cases from Europe also documented transmission of MDR virus.

Delaney, speaking at a recent Project Inform Town Meeting in San Francisco, also reported that "the old idea that people already infected with HIV were somehow immune from reinfection has been largely abandoned. This idea came from a questionable interpretation of old virology theories. But researchers have documented cases of patients infected with different strains of HIV that originated in different people. We don't know the clinical effect of someone HIV-positive being re-infected with drug resistant virus, but it is theoretically possible that an HIV-positive person could fail drug therapy by being re-infected with a drug-resistant virus."

980721
BR980703

Copyright ©1990, 2000. ÆGIS. All materials appearing on ÆGIS are protected by copyright as a collective work or compilation under U.S. copyright and other laws and are the property of ÆGIS, or the party credited as the provider of the content. Feedback/Contact Us.