Scary NY HIV Video

posted: 20/12/2010

New York City's Department of Health is defending a controversial ad that uses rotting brains, decaying bones and bleeding anuses to convince young gay and bi men to use condoms.
 

"I am completely comfortable with what we put out here. I have talked with many young men who are HIV positive," said Dr. Monica Sweeney, assistant commissioner for the city's Bureau of HIV/AIDS Prevention and Control. "This is not fabricated. These are real conditions that affect people even though their viral load might be under control."
 

'Offensive and dishonest', or 'Prevention shock value'

The ad has split people – many are offended by its scare tactics and call the campaign dishonest – but others think the video's shock value could prevent the spread of HIV.
 

"I reject portraying my life -- 15 years and counting with HIV -- as a hellish nightmare," said Jim Pickett, advocacy director at the AIDS Foundation of Chicago. "Has it been tough? Yes ... living with HIV is challenging, but it is not one big long scream of agony for most of us. But nuance isn't eye catching or sexy, is it?"
 

The controversial NY City Department of Health video ‘It’s Never Just HIV’

Scaring people about HIV does NOT work
There is no evidence that scaring people works for HIV – and much evidence to show it does far more harm than good – the recent UK review of all the evidence, the Role of Fear in HIV Prevention, shows the use of fear fails.
 

Does using fear of HIV work?
Would using more fear in HIV prevention work? ‘The role of fear in HIV prevention’ is written as a guide for gay men’s HIV prevention workers, but many other people, including people with HIV, are very interested in this and have strong views about it. It is an interesting and informative read, on four illustrated pages.
 

It looks at the scientific evidence for whether fear works or not, considers the ideas behind it, and looks into the unforeseen consequences and risks of using fear in HIV campaigns.
 

Fear is for the Fearless
The evidence shows that fear only works with people who are not already frightened by HIV. But 98% of gay men say (in Gay Men’s Sex Survey, 2008) they agree or agree strongly that “HIV is still a very serious medical condition.” So almost every single gay and bi man is already fearful of HIV. Perversely, adding to that fear can make things worse for the men at more risk of HIV.
 

As Adam Bourne says:

“It will remain a constant challenge for those promoting sexual health and well-being to attract the attention of their target audience among the many other advertisements that compete for their attention.
“The temptation is to produce shocking or explicit imagery, which may stand a better chance of being noticed or being remembered.
“However, it is doubtful whether it will actually be successful at influencing behavioural choices.
“Most gay men and other men who have sex with men are already motivated to avoid HIV, but some still lack the knowledge or the power to do so.”
________________________________________
“Inducing fear is not an effective way to promote previous HIV relevant learning or condom use either immediately following the intervention, or later on.
However, HIV counselling and testing can provide an outlet for previous HIV-related anxiety and, subsequently, gains in both knowledge and behaviour change immediately and longitudinally.”  Earl & Albarracin, 2007

The role of fear in HIV prevention, Adam Bourne, 2010, Sigma Research Briefing no.1 for the CHAPS gay and bi men’s HIV prevention partnership

Source

More information and comment from The Body (leading USA HIV website)

The NY City Department of Health video ‘It’s Never Just HIV’

No Fear in HIV Prevention

posted: 09/11/2010

Using fear as a tool for HIV prevention, like in the 1980s British AIDS tombstone and icebergs campaigns, causes more harm than good, according to a recent review of the evidence.

The idea behind the AIDS tombstones and icebergs was that making people fear death would encourage self preservation by using condoms. Similar fear approaches to HIV prevention were used in the United States, and in Australia (with images of the Grim Reaper).

Following the success of HIV treatments, fear arousing campaigns have picked out some unwanted treatment side effects (for example, facial wasting and diarrhoea).

Attention Grabbing, but does fear work?
Campaigns arousing fear are good at grabbing public attention by using graphic imagery, simplistic language and shocking statements. Fear campaigns are often very memorable.

Recently the use of fear has increased in other health promotion campaigns highlighting the harm from smoking, excess alcohol use, and drug use. The public has great faith in the use of fear to change behaviour.

Frustration
The media, including the gay press, have been calling for more emphasis on harm from sexual risks. The public and campaigners are frustrated at high rates of HIV and STI infection in the UK and the lack of progress in reducing these. That is often behind the calls for what seems to be an ‘obvious solution’.

Does using fear of HIV work?
Would using more fear in HIV prevention work? The role of fear in HIV prevention is written as a guide for gay men’s HIV prevention workers, but many other people, including people with HIV, are very interested in this and have strong views about it. It is an interesting and informative read in four illustrated pages.

It looks at the scientific evidence for whether fear works or not, considers the ideas behind it, and looks into the unforeseen consequences and risks of using fear in HIV campaigns.

Fear is for the Fearless
Fear only works with people who are not frightened by HIV. But 98% of gay men say (in Gay Men’s Sex Survey, 2008) they agree or agree strongly that “HIV is still a very serious medical condition.” So almost every single gay and bi man is already fearful of HIV. Perversely, adding to that fear can make things worse for the men at more risk of HIV.

As Adam Bourne says: “It will remain a constant challenge for those promoting sexual health and well-being to attract the attention of their target audience among the many other advertisements that compete for their attention.

“The temptation is to produce shocking or explicit imagery, which may stand a better chance of being noticed or being remembered.

“However, it is doubtful whether it will actually be successful at influencing behavioural choices.

“Most gay men and other men who have sex with men are already motivated to avoid HIV, but some still lack the knowledge or the power to do so.”

“Inducing fear is not an effective way to promote previous HIV relevant learning or condom use either immediately following the intervention, or later on.

However, HIV counselling and testing can provide an outlet for previous HIV-related anxiety and, subsequently, gains in both knowledge and behaviour change immediately and longitudinally.”

Earl & Albarracin, 2007

Read The role of fear in HIV prevention, Adam Bourne, 2010, Sigma Research Briefing no.1 for the CHAPS gay and bi men’s HIV prevention partnership 
 

Fear and stigma fuel hepatitis C among HIV+ gay men

posted: 01/10/2008

Stigma fuels the sexual transmission of hepatitis C virus amongst HIV-positive gay men, according to a small qualitative study. The fear and stigma surrounding hepatitis C means that gay men tend to have sexual activities with a high risk of hepatitis C transmission and are reluctant to disclose or talk about hepatitis C infection.

Deal with stigma and provide sex risks information
The study advises making efforts to end the stigma around hepatitis C amongst gay men, and providing targeted information about the risks of sexual transmission of hepatitis C to gay men with high risk sexual behaviours.

Outbreaks of sexually transmitted hepatitis C have been reported amongst HIV-positive gay men in the UK and across Europe. Sexual behaviours linked with the sexual transmission of hepatitis C in this population are fisting, group sex and unprotected anal sex.

It is thought that hep C infections are partly fuelled by many HIV-positive gay men having sexual partners who are also HIV-positive, known as “sero-sorting.” There are good reasons for sero-sorting – there’s no risk of infecting the partner with HIV, but it means the risk of other sexually transmitted infection, including hepatitis C can be much higher.

Both HIV and hepatitis C are stigmatised because they are potentially life-threatening illnesses that are linked with supposedly “deviant” lifestyles.

Earlier research suggests that the stigma affects whether people with HIV or hepatitis C tell others.

emotional pain pilot

A pilot study looked into the emotional experiences of stigma of HIV-positive men who have or had hepatitis C. There were six in-depth interviews in London with men aged 32 – 43. All the men had risk factors for the sexual transmission of hepatitis C, including fisting, unprotected anal intercourse and group sex. These activities often occurred within the context of private sex parties where recreational drugs were consumed. Sero-sorting was reported by all six individuals.

All the men attributed their hepatitis C infection to fisting, although this activity had occurred within a context of other activities that potentially involve a risk of hepatitis C transmission, including group sex, and the sharing of lubricant, sex toys, and tubes to snort recreational drugs.

Feeling stigma is worst

“Feeling” stigmatised because of hepatitis C was common amongst the six men. One individual reported that these feelings were often worse than the physical effects of the infection: “I think how it makes you feel is worse than the actual thing itself…The fear of rejection, the fear of the stigma and all that is actually more toxic than the disease itself.”

Fear Factor

The study participants said that fear was the most important factor leading to the stigmatising of hepatitis C. This fear was attributed to a lack of knowledge about hepatitis C, fear of contagion, fear that hepatitis C would complicate existing HIV infection, fear of the impact of hepatitis C on lifestyle behaviours such as drug and alcohol use, fear of hepatitis C treatment, fear of rejection (particularly sexual rejection), and fear of death.

“I think that hep C is the big new white elephant in the room”, said one participant, “I think that gay men are afraid of hep C and I think that’s because they don’t seem to know much about it, except maybe it kills you.”

Rejection

One man told of his sexual rejection because of his hepatitis C infection: “the guy who rejected me had heard about the implications of co-infection. It’s very bad news because you have to stop drinking and taking drugs.”

Diagnosis with hepatitis C was associated with shame and guilt, adding to its stigma. One individual told the investigator: “I felt grubby. I felt skanky. I felt isolated. I felt lonely…it’s the shame: the shame, secrecy, stigma and everything else.”

Outsiders, even among others living with HIV+

A diagnosis of hepatitis C was perceived as excluding men from the “cameraderie of just being HIV-positive.” This was illustrated by the comments of one of the study’s participants: “Hep C is not yet owned by the gay community like HIV, and if it isn’t owned, then it is outside and more stigmatised… Even within the gay community, and the HIV community too, it has created a ‘them’ and ‘us’ type situation.”

Silence and Secrets

Stigma meant that men were not discussing hepatitis C with their sexual partners or disclosing their infection. One man said that HIV was not considered a “such a big deal” for HIV-positive men engaging in sero-sorting behaviours. However, “this hep C thing is a big issue. People are scared of it but nobody is talking about it.”

Another individual said, “I’ve never had anyone disclose their hep C to me yet in a sexual situation.”

There was also confusion about hepatitis C, with some men reporting that men in their sexual milieu were confusing the infection with hepatitis B.

Several of the men indicated that stigma was silencing discussion of hepatitis C amongst HIV-positive men with a high risk of sexual exposure to the virus. “Stigma silences things and that allows more stigma to build in that silence”, said one individual, “but you can understand why people have to remain silent because the stigma is there in the first place.”

Although the investigator acknowledges that the small size of his sample is a limitation of his study, he believes it “adds depth” to the evidence showing that HIV-positive gay men require health promotion information about hepatitis C.

hepatitis C whirlpool

Based upon his research he suggests that what is going on is that the fear of hepatitis C causes hepatitis C to be stigmatised by HIV-positive gay men. This fear leads to sexual rejection if hepatitis C is disclosed, with this sexual rejection leading to shame and more fear, which in turn leads to silence and non-disclosure. “This creates transmission risk in situations where HIV-positive men have sero-sorted and have unprotected sex.”

Dr Owen concludes that more needs to be done to counter the stigma surrounding hepatitis C amongst gay men and that HIV-positive men should receive targeted information about the risks of hepatitis C transmission from fisting and other sex practices that can cause mucosal bleeding.

Reference

G. Owen. An ‘elephant in the room’? Stigma and hepatitis transmission among HIV-positive ‘serosorting’ gay men. Culture, Health and Sexuality 10: 601 – 610, 2008.

Source