City Knows Best

The debate on the New York health department’s latest ill-advised AIDS campaign is exposing soft-headedness among all players in this debate. I hate sounding like a centrist worse than anything, but in this case both sides of the battle are stuck jerking their knees without displaying any of the original thinking that the the third decade of HIV requires.

The controversy arose a few weeks ago when the city launched a TV and YouTube spot [below] to encourage sexual caution. The ads display gross imagery of anal cancer and bone deterioration among melancholy actors playing gay men to remind people that getting HIV is no treat despite the advent of successful treatments. The campaign is an explicit attempt to counter drug company adverts that show comely HIV-positive guys sitting on mailboxes or climbing mountains with a smile thanks to the miracle effects of their Truvada or Atripla therapies.

It’s also taking a leaf from the city’s anti-smoking campaigns that use pictures of people missing fingers or talking through a hole in their throats. Officials say they believe that what works for one disease will work for another.

You can also use a carwash to take a bath, but that doesn’t make it a good idea.

The city defends itself by saying it ran these ads past focus groups of gay men who thought it was important to hit the topic hard and remind people that getting HIV is really serious and no fun at all. Oh really? I wonder how many of the focus group participants handing out that sort of advice for all ‘those [other] people’ who have too much sex have recently dealt with someone newly diagnosed with HIV. I can assure them that the news is not tossed off casually. A person getting that slip of paper immediately will look for the silver lining and want to know about medication advances, but that doesn’t mean it’s all a big laugh.

What the campaign intends to encourage is people focusing on the bad news before it’s too late, and that’s also a nice goal—good luck achieving it. Bipeds are expert at pushing off the idea that they will have bad luck even while recognizing that unpleasant things might very well happen—to others.

In a Times article Amemona Hartocollis quotes a typical Manhattan internist as saying, ‘Younger gay men are not making some kind of rational choice to have unprotected sex the way many activists are maintaining in this disagreement’, Dr. Howard Grossman said. ‘These younger people are, like most young people having sex, living in the moment and making split-second, uninformed choices about unprotected sex’.

Doctors are often very smart, but anyone who can talk about sexual behavior in these terms is living among a species whose genitals behave quite differently from those I’m familiar with. Earth to Dr Grossman: ‘Split-second, uninformed choices’ about sex happen about 8 billion times per minute, and it’s not just dizzy-headed young people making them.

Curmudgeonly playwright Larry Kramer was quick to cheer the city’s campaign as it fits well with his belief that gay men (himself excepted) are largely jerks and have to be shamed into behaving properly. ‘It’s about time’, Kramer said, in an e-mail cited by the Times. ‘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.’

Thanks for the vote of confidence about ‘all’ those efforts, Larry. By contrast, your beat-‘em-up approach has worked so well in which country?

What the city health poobahs, as well as Mr Kramer, reveal with this lame effort is how much they remain stuck in an individualistic paradigm of isolated personal responsibility and decision-making untouched by communal influences. Given that this is the reigning ideology of our times, they can be expected to do so despite the reams of analysis available that suggests this approach hasn’t worked so far and won’t in the future either.

It’s true people are lulled into complacency around HIV infection and AIDS, and I applaud the city’s efforts to restart that conversation, which has completely evaporated. Where once people calculated risk and considered their behavior in a context of a community protecting itself and its members, we’re now back to every-man-for-himself in a neo-liberal paradise where, as hateful old Madame Thatcher would say, ‘Society doesn’t exist’.

But no one talks about HIV in those terms anymore, or in any terms for that matter, except to remind themselves to make that annual contribution to the agencies so that people with the HIV diagnosis get what they need.

In fact, the local AIDS providers promptly trashed the campaign in terms recycled from the last 15 years of post-treatment AIDS. They criticized the ‘scare tactics’ and the unfavorable treatment of gay men as ‘dispensing diseases’. Or they said the ads don’t accurately portray what living with HIV is like.

But none of the groups had much to propose as an alternative message. They were unable or even unconcerned about how to restart the lost conversation about safety in sexual relations or how to reawaken shared responsibility for mutual protection. After all, the agencies exist to serve sick people or those who might get sick, and there's no shortage of those, with or without prevention campaigns.

That restarted community buzz, even if temporary, could be a positive outcome of this campaign, and I suspect the city knew and planned for the controversy to exactly that end. Even so, if manipulation was on their minds, it’s a pretty cynical way to treat your supposed community partners.

It’s too bad that no one in the huge AIDS industry managed to persuade the city to try a different approach in its social marketing. Would it be that hard to pull all those affected—agencies, gay advocates, harm reduction specialists, homeless service providers, substance abuse counselors, the HIV-infected, educators—into a broader discussion about what concepts should guide a public education campaign in 2011 with AIDS a permanent feature of our landscape?

But no, City Knows Best and will act accordingly. That fits nicely into a Bloomberg universe free of distasteful ‘political agendas’, meaning other people’s incorrect ideas.