My friend Sean Strub has an excellent exploration of this issue at his Poz.com blog.
And while others are going to line up on either side of the prevention fence on this -- ie, does it or doesn't it work to show a blood anus encrusted with cancer -- I want to look at something slightly different.
In his blog, Sean writes:
Supporters of these ads claim HIV prevention has been a failure and they are angry that the epidemic has disappeared from the media and fallen off the list of priorities for LGBT organizations and others who once were leaders in the fight against AIDS.
I do not support these ads, in large part because fear does not work as a prevention tool, and in the remainder because the "factual" information is misleading, at best, about the health issues associated with HIV disease.
I do, however, believe that HIV prevention in the past decade or more has been a failure. The question is why?
The answer is Prevention for Positives. This is a misguided, albeit well meaning, move by health experts to control the spread of HIV. The thinking behind PoP is that if you teach people who are infected with HIV how to prevent the spread of the virus you will stop the epidemic.
It's a nice theory, but it is not a theory based in any sense of reality. The majority of new HIV cases are caused by people who are infected with HIV, but completely unaware of their infection. We know that those who know their status are more likely to be in care, more likely to be on successful ART and more likely to have low to undetectable viral loads.
Yet with the ascendancy to the Presidency of George W. Bush (Bush 43), the CDC saw directives to focus on abstinence only education and PoP as prevention messaging. As a result, the vast majority of gay men never received the information necessary to prevent infection. Worse, a presumption of the inevitability of infection with HIV set in with many young gay men. So, they reasoned, why bother to be safe if they are going to get it anyway.
Back when I first came out, in the very late 80s and early 90s, you could not attend a queer related event without seeing a giant fishbowl full of condoms. They were available at the bars, at MSU LGBT Council events, at pride... Basically, if it was a gathering of queers, it included condoms.
But that changed in the mid-90s with the advent of successful ART. We don't have condoms readily available at our events. In fact, we barely have the money for it. I recently spoke at Oakland University, and had to bring a brick of condoms with me to the University because staff there were unable to access free condoms from the health department in that county.
And why is that? It is simple. The vast majority of funds for HIV are focused on medical case management and access to antiretroviral medications. What small amount of money that is available for prevention is directed mostly at those of us already infected with HIV. In other words, we are shutting the barn door after the horses are already out.
If indeed public health authorities would like to address the HIV crisis as it comes roaring back, perhaps it should focus on efforts which worked in the early and mid-90s. Free condoms, widely available and always visible at LGBT events. That might start addressing some of these numbers.
Here is the PSA in question: