Bay Area Reporter - May 18, 2001
David Fraser

Ranging from bus shelter advertisements to a billboard that ran above the Cafe Flore in the Castro earlier this year that depicted a naked man having, well, a really good time, the ads have captured the imagination of many by showing nearly all.

They're part of the SFAF's Assumptions campaign for HIV/AIDS prevention and control that targets gay men at high risk for getting or spreading the disease.

A key focus of the campaign is to challenge assumptions that many gay men make about their sexual partners' HIV status.

Unlike the controversial "san francisco's first fcuk" sign (for French Connection U.K.) near Union Square in San Francisco, ads for the Assumptions campaign have drawn attention not from being clever but from appearing explicit.

In this year's part of the Assumptions campaign, called "How Do You Know What You Know?", ads carry sexually charged visuals of naked men with tag lines like:

o "Tops who bareback must be negative. How do you know what you know?"

o "He's a top. Tops can't get it. How do you know what you know?"

o "I don't have it yet. I must be immune. How do you know what you know?"

There are other ads showing couples, with the tag, "He'd tell me if he's negative. He'd tell me if he's positive."

Gritty and explicit

Designers have turned up the visual heat in this, the second phase of the campaign. Last year's ads featured abstract designs, which drew praise but also didn't go far enough for the target audience of men at high sexual risk, according to Brian Byrnes, the foundation's HIV prevention services director.

This year's Assumptions campaign cost $250,000, all of it from the foundation's unrestricted funds, Byrnes said. The first initiative last year cost just over $340,000. No government funding is involved.

Byrnes added that an ad similar to the "Tops" message will run on the billboard above Cafe Flore for Pride month in June. The foundation will also place its posters throughout the Castro Muni station.

"For the new campaign, we developed this look after evaluating last year's campaign," Byrnes told the Bay Area Reporter. "From the first phase of the Assumptions campaign, we found that men liked the more abstract design but a significant proportion didn't immediately understand the message was about sex lives and HIV."

Byrnes said the foundation "did about 150 street-based interviews, plus later hour-long interviews. So this year we turned our approach around, wanting to respond to the evaluation.

"Many of the guys told us explicitly in the evaluation that the campaign would succeed better if we used material that was grittier, with more sexually explicit visual language that would better reflect the sexual culture of the Castro and the target populations. The campaign is aimed at guys who are very active, with unprotected anal intercourse with multiple partners.

"So far we've had lots of e-mails and calls saying that guys noticed the ads more. There's been a lot of support [for the approach]. We will do another evaluation in July when the campaign's over. But guys seem to relate to the images, they see their own activities reflected."

The campaign's visual and textual approach contrasts with that of several pharmaceutical firms which make HIV/AIDS drugs. The HIV drug ads became magnets for controversy recently because they depicted sexually suggestive HIV-positive men while ignoring the physical and other consequences of the disease.

HIV activists, health officials, and politicians challenged the ads' implicit message, eventually prompting the Food and Drug Administration to ban the advertisements as misleading. The FDA told drug companies to make clear the downside of HIV infection.

Asked how the Assumptions and the HIV drug ad campaigns differed, Byrnes cited the responses received during SFAF's evaluations. He added: "For gay-related programs, there are hundreds of studies that showing behavior change among cohorts of individuals with the help of role modeling or skills-building programs.

"We've been doing prevention work for 20 years. We have an epidemic that's significantly smaller than it was 15 years ago, partly as a result" of interventions.

"Regarding the pharmaceutical stuff, it's one of many things that influence people's behavior."

Various approaches

The campaign is part of a set of long-term public education efforts by SFAF. One facet relies on sets of powerful, highly explicit ads targeting diverse audiences, primarily of gay men. Some are placed in sex bars and clubs; others, generally less explicit, run on bus shelters or the sides of buses. The evolution of the ads reflects benchmarks in the AIDS epidemic and shifting approaches over the years to prevention and control.

Said Byrnes, "HIV is a different thing than it was five to seven years ago, and that has had a profound influence on HIV prevention. My approach is to give people information for them to make fully informed decisions [on sexual behavior] with. When we were deciding how to do the second Assumptions campaign, we found that the idea of assumptions was very relevant, that it rang true for many of those interviewed. They find themselves assuming a lot of things including their partners' HIV status. "This current campaign boils the message down to the simplest possible terms," he added.

Another tool in the SFAF arsenal is a foundation-sponsored Web site that takes the same frank approach to the realities of gay sex for many. The site is at www.gaylife.org, and contains clickable thumbnails of the Assumptions ads.

Top/bottom

The Web site notes in part, "Many 'bottoms' who don't have HIV take refuge in the mistaken belief that all 'tops' are negative. While 'topping' does reduce the risk of getting HIV if you're uninfected, some men who 'bottom' use this knowledge to develop a faulty 'risk calculus' that supports their desire to have unprotected anal sex. Some of the uninfected bottoms assume that their top is also uninfected by virtue of the fact that he is a 'top.' Some positive guys save barebacking for other positive guys. Some use their viral load as a way to measure risk.

"Some people take viral load into account when thinking about what kinds of sex to have, like whether or not to use condoms. If you have HIV it will be in your cum and precum. If you pull out before you cum the risk goes down although he could still get infected from your precum. Some men with HIV who don't use condoms pull out before cumming to make it less likely HIV will be passed on. Some men who don't have HIV ask the man fucking them to pull out before he cums to make it less likely they'll get HIV."

No magic bullet

Byrnes warned that HIV prevention is complex and difficult.

"Behavior changes are a result of a number of different influences: there's no magic bullet. What you need is a complex interaction of interventions, to achieve behavior changes. The goal is to raise men's critical awareness when they make assumptions about their partner's HIV status.

"In the [next] evaluation, we'll measure whether guys are more aware à we won't know how well it's worked till it's done.

"We're working on an estimated set of data. We explore lots of data, then field test thoroughly, when we do a social marketing campaign."

The foundation, Byrnes said, has "a huge commitment with CAPS [the Center for AIDS Prevention Studies of the University of California, San Francisco]. This campaign was inspired by 200 interviews we did with men who had unprotected anal sex in the last six months.

"We worked with a team of social scientists such as anthropologists, and worked with social marketers through focus groups to refine the images." Often Byrnes added, "People make assumptions about the safe-sex issue. In reality, it's a bit of a mix. There are assumptions, and as such there is a fair degree of margin, a wide margin of error. For example, an HIV-positive guy goes home with someone, he sees Poz magazine on the bedside table, and assumes the other person is also positive.

"For many, it's so hard to raise the HIV status issue. A negative bottom may assume that his partner would not put him at risk, so they don't use a condom.

"Or he assumes the sex is very meaningful, and so assumes the same behavior by his partner.

"With other types of interventions as well, guys build confidence, build negotiating skills with partners, so they have increasing control over the situation."

For more information, go to www.gaylife.org or phone (415) 863-AIDS [2437]. The San Francisco AIDS Foundation's Web site is www.sfaf.org
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