Forum Asks: Will Graphic Images Scare Black Gay Men Into Using Condoms?

The fact that gay men are still, more than 25 years into the AIDS epidemic, seroconverting is disturbing. But the numbers are especially alarming among black gay men (or, rather, "men who have sex with men," as many would prefer).

To scare these men into slipping into latex, New York City's health department has been using highly graphic imagery of the consequences of contracting HIV and AIDS. The campaign was used once before, in San Francisco.

That city's health department had posters of men sitting on the john and more. Many complained that it stigmatized people with AIDS, but the models for the ads --�all of them HIV-positive gay men -- all said they wanted to show people that HIV was not just popping a few pills and going on with your life.

Will such tactics work with a minority community where many men have sex on the "down low," or at least don't want to acknowledge the presence of AIDS? Or is this the worst kind of profiling.

More than 100 people gathered at the Gay Men's Health Crisis' Manhattan headquarters on Wednesday, Feb. 23, to discuss the city's controversial HIV/AIDS prevention campaign.

The television and subway ad campaign, titled "It's Never Just HIV" features pictures of young men of color shown reacting to being told HIV will lead to osteoporosis, dementia and anal cancer (complete with graphic photos of the latter) alone. The campaign's opponents say its' scare tactics and misleading information may keep people from getting tested or even taking their HAART medications.

Sean Cahill, managing director of GMHC, moderated the forum. Tokes Osubu, executive director of Gay Men of African Descent; Daniel Rodriguez, program coordinator for the Black Men's Initiative, Harlem United; Oriel Gutierrez, Jr., deputy editor of POZ; Dr. Blayne Cutler, director of the New York City Department of Health and Mental Hygiene's Bureau of HIV/AIDS Prevention; Daniel Siconolfi, project director of Center for Health, Identity, Behavior and Prevention Studies; and Les Pappas, president and creative director of Better World Advertising were panelists.

"You can be honest without scaring the crap out of people," said Gutierrez, who opposes the ad campaign. "As long-term motivation, over time, people are just going to stop listening. People are afraid already. All you are really doing is fueling the stigma around HIV-positive people."

Rodriguez agreed. He said prevention was at the forefront of the Black Men's Initiative, but their social marketing had focused on positive messages and lifelong risk reduction.

"Using fear just to scare people into changing their behavior is a problem because it is unlikely to sustain change," added Pappas, adding he did not believe in protecting people from scary information that could affect their decision-making process.

Osubu countered. He said research revealed fear-based campaigns were effective among those already engaged in the targeted behavior.

"When the city asked me to comment on the campaign, I said I thought it was effective," said Osubu, who compared the HIV/AIDS campaign to the city's graphic anti-smoking initiative. "It speaks the truth to what living with HIV is. For many living with HIV, it is not just HIV; it is much bigger than that. You can't just say take a pill and it disappears."

Using the example of the city's smoking cessation program, Siconolfi added it was important to question where these campaigns were nested. He noted the anti-tobacco initiative meshed with a ban on smoking in public places and other shifts in social behaviors. Siconolfi further noted the city paired its anti-smoking campaign with efforts to provide smokers with quitting hot lines, patches and nicotine gum.

"You can't just scare people... you have to tell them how to make a healthy choice," said Siconolfi, adding the ads could scare people from getting tested for HIV.

Cutler said focus groups-she said several members were in the audience-deemed the ads effective. She also cited statistics that the number of new HIV diagnoses among men between 13-29 who have sex with men had increased 50 percent from 2002 to 2009. "The campaign has to be seen to have an impact," said Cutler. "You need to be direct and hard hitting."

The majority of those in the audience had seen the ads, which air regularly on television and are now on the subway. While some audience members did not view the ad as imparting anti-HIV stigma or scare tactics, the majority of those who voiced their opinions found it problematic.

"You are speaking of honesty, but these ads don't honestly reflect what happens when people become HIV positive and take their meds," said Bill Bahlman, a member of the Community Scientific Subcommittee of the Global Community Advisory. "These stats are not borne out by research. I am not as worried about scare tactics as I am about honesty."

Cutler, who offered to share a list of physicians involved in compiling the statistics, noted the commercial referred to increased risks. It did not claim, however, that every person with HIV will experience osteoporosis, dementia and anal cancer.

Other speakers noted anal cancer was extremely rare, and they further added dementia and osteoporosis were usually associated with people living with HIV/AIDS for an extended period of time.

Kellee Terrell, news editor for TheBody.com, was unequivocal in her hatred of the ads. "Fear only works for people who have options," she said. "Those men looked embarrassed and ashamed to be gay."

Terrell also questioned where the LGBT community was in this debate, saying she believed mainstream LGBT organizations were pushing HIV/AIDS off their agendas.

The back-and-forth dialogue continued, with some people saying the ads had caused young people to question why they were taking meds. Cutler rebutted, saying she had received many thank you letters from young people about the campaign. A man with HIV said the ads had caused his grandchildren to question whether he was dying.

When talk turned to what type of campaigns would be most effective, few participants had a clear idea. Several people said information about actual risk behavior individually and within a group would be most helpful. Cahill, pointing to GMHC's booklet, "Gay Men and HIV: An Urgent Priority," said research supported young gay men whose parents supported and accepted them are less likely to engage in unsafe sex.

Alan, one of the evening's final speakers, made a poignant observation. Saying that he was not outraged by the ad campaign, he recalled the beginning of the AIDS epidemic,

"I remember the ads, the campaigns," he said. "I remember the friends who died. I think any campaign that gets it off the back burner and gets people talking about HIV is good."