Being Alive - May, 2000
Walt Senterfitt

This is the slogan for a new HIV prevention marketing campaign in San Francisco, and the name of that campaign's Web site: www.hivstopswithme.org The campaign will feature prime-time TV spot ads and some associated radio and print advertising. The Web site currently features a survey about gay men's TV viewing habits that will help target the campaign's ad placements. The campaign is also soliciting applications from gay HIV+ individuals who would like to act in the commercials! All you under-worked or aspiring actors, tarry not in getting to the Web site for more information. (Though the campaign is limited to San Francisco, I see no reason why we in Los Angeles and elsewhere can't render advice and assistance to our sisters and brothers up north!)

The campaign is funded by the Centers for Disease Control as part of the national Prevention for HIV-Infected Persons (PHIP). A community advisory board in San Francisco chose the particular mix of "interventions' that would comprise PHIP in San Francisco. "HIV Stops with Me" is one of the major components.

The theme implies that we as HIV positive individuals can stop HIV both within our own bodies through appropriate treatment and/or health-preservation actions and can stop the spread of HIV beyond us, in our communities, by choosing to live, love and play protectively.

One aspect of the campaign and the Web site is a pledge that all positive men are encouraged to take. The site puts it like this:

Take It Like a Man...

Let's show the world that we've had enough of HIV! If you want to become part of the movement to stop HIV (both within your own body and from spreading to others), take the HIV Stops With Me Pledge!

I pledge to take responsibility for myself and my community by keeping myself healthy and by not transmitting HIV to anyone else.

Then one can click on a button that reads: "I take the pledge!"

It will be interesting to follow the response to the "pledge drive" and the general campaign in San Francisco. If it works, it may well be appropriate either directly or with modifications in many other areas and populations. What do you think of the campaign and the slogan? E-mail me at Wsenterfit@aol.com

Need for Positive Prevention Grows

Three recent events or articles underscore the growing need for effective strategies for living well with HIV while not unintentionally (usually) spreading it to others.

The recent syphilis outbreak in Los Angeles County is dramatic evidence that rises in sexually transmitted diseases noted earlier in Seattle and San Francisco have also come to Los Angeles. We plan detailed coverage of the outbreak and what is being done to combat it in our next issue. Even the simple punchlines of the story are stark. After a number of years of declining cases of syphilis among gay men, to virtually zero levels in fact, there has been a dramatic increase in newly discovered cases since early March 2000. There have been more than 55 cases, nearly two-thirds of which occurred in HIV+ men. A number of these cases have been traced to unprotected sex in bathhouses, but many others occurred in various areas and demographic groups around the County. Interestingly, a significant percentage of the positive men are already in HIV medical care and treatment (i.e., this did not occur as might have been suspected, primarily among men unaware of their HIV status).

The implications are clear:

1. Syphilis would not have been contracted or transmitted without the practice of unprotected sex.
2. Syphilis and other stds clearly activate one's immune system, leading to the sharply increased replication of HIV in the bodies of those already infected.
3. Activity that transmits syphilis is capable of transmitting HIV.
4. A number of people in our (HIV+) community are knowingly engaging in unprotected sexual activity with now-clearly-documented consequences. Other possible consequences will become clear over time.

The community is activating itself in response to this latest wake-up call. Get involved. Share your thoughts and ideas with the Newsletter and in other community forums.

Other Evidence

A newly reported study from France (in the March issue of the journal AIDS 2000) found that gay men were three times as likely to engage in unprotected insertive anal and oral intercourse after starting protease inhibitor therapy as they were before starting PIS. Furthermore, those within the study group who increased their unsafe practices tended to do so with partners who were HIV-negative or of unknown serostatus. Those with other positive partners tended to practice greater safety.

In the French study, the heterosexual men and women tended to slightly increase the safety of their sexual intercourse with other partners after starting protease inhibitor therapy compared to before therapy.

A somewhat different, though still worrisome, message comes from another new study, this one of 107 serodiscordant (one positive, one negative) heterosexual couples in the San Francisco Bay Area (March 10 issue of the journal AIDS). The worrisome news is that two-thirds of these serodifferent couples acknowledged they engage in unprotected vaginal or anal intercourse at least some of the time. The good news is that those couples in which the positive partner is taking combination antiviral therapy are 2.4 times less likely to engage in unprotected sex than those where the infected partner is not on antiviral therapy. However, 63% are not on therapy whereas 37% are. A significant proportion (40%) of both the seronegative partners and of the seropositive partners (33%) reported feeling less concerned about the possible consequences of unprotected sex than they did before the advent of HAART.

Work Ahead

As we all know, how to live well, satisfyingly and safely is not an easy question to answer. The PHIP demonstration projects (of which the San Francisco campaign described earlier is just one small part) and a few other current research projects are trying out and evaluating some strategies. However, it is ultimately going to take the involvement of almost all of us to ensure that, both inside our bodies and in our couplings and communities, HIV stops with me.

Note: I have been recently privileged to assume the position as National Coordinator of the PHIP Demonstration Project for the CDC in Atlanta. I hope to continue as a contributor to this Newsletter from afar, and continue to welcome your feedback, comment and participation in whatever way you can in keeping the HIV+ community a vibrant and effective voice. As always, the views I express in my columns are entirely my own! --Wsenterfit@aol.com

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