HIV: THE WAY FORWARD

WITH RATES of HIV transmission among MSM at crisis levels, in September 2009 LIFE OR METH commissioned an independent survey that exploded many of the deceptions and myths that have left gay men increasingly complacent and ignorant around the realities of HIV infection…

PART 1: DECEPTIONS AND LIES

JOURNALIST Johann Hari, writing in The Independent in 2006 about the rampant rise of barebacking and HIV-related health risks, quoted Martin Luther King: ‘Our lives begin to end the day we become silent about the things that matter.’ “For the gay community,” Hari added, “this is no longer just a metaphor.” Last August Pink News ran the commentary, Killing Us Softly, which openly stated what many believe has gone wrong with gay men’s HIV prevention over the past decade. It provoked major debate and a drumbeat for change has been sounding ever since. Three years on from Hari’s coded call to action, the silence is finally breaking.

To sustain Killing Us Softly’s momentum, LIFE OR METH decided to put several straightforward questions to gay men about their attitudes to HIV and safe/safer sex campaigning; of a kind never asked by the ‘official’ Gay Men’s Sex Survey (GMSS) but relevant in light of increasing social tolerance towards barebacking. The GMSS is conducted annually by Sigma Research, the main research and development partner in the CHAPS partnership of HIV organisations spearheaded by the Terrence Higgins Trust (THT); a role that makes its involvement in the GMSS far from independent. Indeed, Sigma’s often non-impartial summings-up of its own findings rarely if ever fault or criticise the sector’s efforts.

With that in mind, and as one of LIFE OR METH's final projects as a day-to-day operation, it commissioned an independent market research company with no subjective interest in HIV prevention to target 500 gay men attending September [2009]'s outdoor festival, Soho Live; typically QX/Boyz-reading scene-goers and the main recipients of the London HIV charity sector’s safe/safer campaigns. The multi-question GMSS, by comparison, quizzes upwards of 15,000 gay men of all ages and urban and rural areas across the UK, cumulatively blurring and diminishing the true scale of health threats specific to concentrated populations of gay men in the metropolitan cities.

LIFE OR METH's agenda, simply, was to cut through the bluster and hype of the GMSS – whose findings can take up to two years to materialise and then may appear skewed, selectively highlighted or trivialised to suit an outcome preferable to the CHAPS partnership – and provide the gay press with an instant snapshot of how gay men today are responding to safe/safer sex campaigns appearing within their print and online media. Ultimately, to determine whether the policies of those funded and entrusted to safeguard gay men’s health and wellbeing are aligned with the ‘Old Compton Street consensus’…

Countering the HIV sector’s insistence that their prevention strategies are properly targeted and effective, the Soho Live survey found that its “safer sex”/risk minimisation adverts – for example for the post-exposure “morning-after pill” PEP and “cumming outside” – have in fact influenced 6 percent of respondents to engage in unsafe sex “every time” and 22 percent “sometimes”. Among under-25s, 11% said “every time” and 35% “sometimes” compared to just 2 percent of 40-59-year-olds who said “every time” and 10 percent “sometimes” – a generational shift that can only be attributed to the 1980/90s style of hard-hitting HIV campaigns, whose sustained impact continues to influence many older gay men into taking precautions.

The HIV sector defiantly maintains that hard-hitting campaigns aren’t effective, that they stigmatise those with HIV and deter others from coming forward to be tested, and have long used these arguments to soften and normalise HIV’s image. But when asked if harder-hitting HIV campaigns – specifically depicting the downsides of living with HIV – would be more effective in persuading them to engage in safe sex than today’s campaigns, only 4 percent of respondents said “no” while nine times as many (36 percent) said “yes”, 32 percent said “possibly” and 28 percent were “undecided”. Only 4 percent agreed that harder-hitting ads stigmatise HIV-positive people and almost two-thirds disagreed with the HIV sector’s rhetoric that such campaigns would deter gay men from being tested (again, only 4% agreed).

“I think the advert is incredibly stigmatising to people living with HIV who already face much stigma and discrimination,” a spokeswoman for the National Aids Trust (NAT) said of [a recent graphic] Germany HIV campaign, “and may deter people to come forward for testing.” Such routinely parroted song-sheet theories originated amid the “gay plague” hysteria of the 1980s, when Aids stigma was rife and gay men were genuinely scared of seeking testing. To still be using them in 2009 as excuses not to run influential HIV campaigns is not only dishonest but profoundly irresponsible. Indeed, many survey participants expressed amazement that such PC myths still prevail when the objective, supposedly, is to minimise HIV infections.

To determine the extent to which the cotton-wooling of HIV prevention has shifted general perceptions of the virus from a terminal to a manageable condition, the survey then asked respondents which of three statements best described their awareness of HIV. “With today’s medications, HIV is a manageable illness and infected people can expect to live a normal, healthy lifespan” is a statement popularised by the HIV sector, despite having little or no foundation in fact. Nevertheless, 27% of respondents agreed with it rising to a staggering 41% of under-25s and 44% of those aged under 21. Only 16% of over-40s agreed.

“HIV is a serious terminal condition and infected people can expect to endure debilitating side effects from the medications and a shortened lifespan of around 20 years” – a statement based on a new 43,000-strong US study which found average lifespans of newly-infected people to be 21 years shorter than their negative peers, and real-life experiences of people who have lived with HIV and antiretrovirals for many years – found favour with 45 percent of all respondents but only 24 percent of under-25s and just 19 percent of under-21s, indicating that the serious downsides of contracting HIV, long since airbrushed from prevention campaigns, are becoming lost among younger gay men. By contrast, two-thirds of over 40s agreed with this statement.

Most shocking of all, “HIV is no more serious than contracting any other STI like herpes, syphilis or gonorrhoea” was agreed by over a quarter (26 percent) of all respondents, soaring to 34 percent of under-25s. Only 14 percent of over-40s agreed.

PART 2: THE NEW RELIGION

Defending GMFA’s stance not to run harder-hitting HIV campaigns, Head of Programmes Matthew Hodson told Pink News in September: “The GMSS shows that there is almost universal agreement amongst gay men, irrespective of their age, that HIV is a serious medical condition. Therefore, campaigns that only tell everyone how serious HIV is would only be delivering a message that gay men already know.” Hodson was referring to a 2006 GMSS statistic purporting that almost all gay men of all ages (97%) perceive HIV to be a “serious medical condition”; a bizarre finding that seriously conflicts with the 27% of Soho Survey respondents who regard HIV as a manageable condition, and the 26% who regard it to be no more serious that catching any other STI. Only 45% in our survey correctly perceive HIV as a “serious terminal condition”.

As a taxpayer-funded entity, Sigma is obliged to explain how it arrives at such contentious findings which HIV sector personnel are citing as reasons to justify not implementing proven prevention methods, and to avoid suspicions that they've been “creatively extrapolated” at the cost of accuracy in order to portray the sector in a positive light.

Finally, Soho Live survey participants were asked what single factor is most contributing to the rise of barebacking. By a clear margin in nearly all age groups 21% said bareback porn; a significant finding given the deafening silence and indifference of the HIV sector on the subject. “I don’t like the thought of censorship, particularly that which discriminates against gay men,” GMFA’s gaffe-prone Matthew Hodson said of bareback porn last year, in marked contrast to IML (International Mr. Leather) President Chuck Renslow who told the US gay media in August [2009] that vendors at the annual Chicago convention – at which barebacking is the practised norm among many attendees – would no longer be permitted to sell or distribute barebacking materials.

“Too many in our community believe HIV is curable or manageable,” he said. “We believe it's our duty to inform and educate. We've an entire generation who may not fully appreciate or comprehend the severity of the situation. Greed and avarice must not supersede the health of our community.” We have surely reached a critical juncture when the foolish asides of a representative of the self-proclaimed “Gay Men’s Health Charity” are shamed by a veteran of the US underground sex industry…

“Lack of free condom distribution” and “Boredom of safe sex/condoms” were each cited by 18 percent of respondents, obliterating the fallacy that “condom fatigue” is the overriding factor influencing gay men of all age groups into having unsafe sex. “The increase in sex-on-site premises” came 4th (16 percent), two years after THT rubber-stamped such venues where condoms are routinely shunned while being recipients with GMFA of their World Aids Day fundraisers. “Ineffective safe sex education” was itself considered to be a main factor in the rise of barebacking (13 percent), more so than “disinhibiting recreational drugs” (12 percent).

No matter how its devastating findings are interpreted or its “ambiguous” questions discredited by the HIV sector, the Soho Live survey represents a damning indictment of failed HIV prevention strategies. Most of all it emphasises that if gay men’s health – particularly urban scene-goers' – is to be safeguarded into the next decade and HIV prevented from entrapping a new generation of gay men, blind faith and trust must stop being placed in the HIV charity sector which continues, year after year, to squander public funds while clinging to the same out-of-touch policies and well-worn myths.

The unpalatable truth is that it is no nearer to delivering the solutions that are blindingly obvious to gay men on the street than when it started out because it has become the central problem, subverting and co-opting HIV prevention to the point where its methods are blatantly allowing the virus to spread.

Political correctness entered the mainstream psyche with good intent; to stamp out hate and ensure fairness for all. Its relentless, unrestrained march, however, has overstepped all reasonable boundaries into many areas of public life, inflicting ridiculous levels of paranoia and bureaucracy upon – and immeasurably weakening, dehumanising and paralysing the democratic power structures of – once great institutions, not least the HIV charity sector whose central failing is its pervasive PC doctrine that a hardline approach to HIV prevention would run counter to its dishonest spin that HIV is a manageable condition and those infected can enjoy healthy, normal lifespans. As long ago as 1990 medical journalist Oliver Gillie, writing in The Independent, warned that the Terrence Higgins Trust THT was “rent with political discord and pursuing political correctness at the expense of medical accuracy, and sometimes common sense.”

What is so pernicious about political correctness “gone mad” is how it transforms into quasi-religious disciples those who kneel at its altar and never stray from its doctrines nor admit they are wrong, no matter how nonsensical or destructively insane their theories are proven to be. For years gay men have been contending with the spread of not one but two viruses, HIV and PC. But as irrefutable evidence supporting a return to hardline HIV prevention snowballs, a growing band of dissenting voices including TV doctors Chris Jessen and David Bull and author Paul Burston are finally being heard above the dismissive putdowns and denials of the HIV sector.

In campaigning long and hard these past seven years for greater awareness around the unparalleled HIV-correlated health risks associated with crystal meth, and more recently in calling for harder-hitting HIV campaigns for no self-interest other than to protect the health and wellbeing of those it may never meet, LIFE OR METH has rarely encountered anything so deeply disturbing as the ferocious amount of energy HIV sector personnel are willing to expend attacking, suppressing and dismissing all criticism of their approach, nor the manner by which they aggressively smear, bully, discredit and intimidate all opposing viewpoints into submission.

The sector surpassed even itself in March 2008 – two days after Dr. Chris Jessen told The Metro “There hasn’t been a decent HIV campaign in years” – when Boyz journalist Paul Steinberg was invited to the annual CHAPS conference to deliver his well-researched case for harder-hitting HIV campaigns. In the event his speech was ambushed by a heckling, jeering mob of prominent HIV sector staffers, and when Steinberg dared to quote Dr. Jessen he was humiliatingly shouted down by one who screamed: “What does he know? He’s only a doctor!”

PART 3: THE ONLY WAY FORWARD

The Soho Live survey exposes catastrophic failures and appalling degrees of negligence at all levels of HIV prevention so ingrained and endemic that if the suicidal shift the sector has implemented this past decade to soften up and normalise attitudes to HIV is to be reversed and the virus’s unrelenting march stemmed by a ‘tough love’ approach that zooms in on the harsh realities of living with the virus – as favoured by most of the 500 gay men who participated in September’s Soho Live Sex Survey – then HIV prevention must be placed in the care and trust of those motivated more by a sense of service to others than a calculated career move; who don’t eye gay men as potential pill dispensers, future support service users and components of a strategic business plan; who don’t speak in the cold, bureaucratic language of “measured outcomes” and “qualitative assessments” but from a place of compassion, feeling and an innate grasp of the enormity of the task they are confronted with; who aren’t immune to criticism and wallow in obfuscation but are fully transparent and accountable; and who have the courage and conviction to say out loud that “a life without HIV is a life best lived”. It isn’t rocket science, just plain common sense.

Ultimately HIV prevention has failed because HIV has become an industry in itself and the purpose all of industries is to grow, prosper and dominate their respective markets. By comparison charities, by definition, comprises volunteers who raise funds independently for their causes, devoid of external interference. THT, Europe’s largest HIV services provider, ceased being a charity in the true sense of the word when it allowed substantial government funding tied to conditions and diktats to form its core income, essentially resembling a quasi non-governmental organisation – quango – in the process.

The pioneers who started THT 27 years ago did so with one aim in mind: to halt and reverse the spread of HIV. They never set out to become the Tesco of sexual health; a multi-million pound conglomerate managing and commodifying all things HIV while opportunistically exceeding their remit into other financially rewarding areas of sexual health (THT recently received £432,000 of National Lottery funding to provide sexual counselling to children as young as ten). But while THT was busy absorbing and streamlining dozens of regional HIV organisations to become the predominant HIV support services provider – effectively assimilating GMFA, which began in 1992 to counter THT’s then headline-making excesses, along the way – its sideline prevention efforts routinely failed to impact and stem HIV.

[In 2008] the THT won the lucrative three-year Pan-London HIV Prevention Programme contract, boosting its annual income to almost £16 million. “It’s in everyone’s interest, not just the gay community’s, to see the number of HIV infections reduced,” Kensington and Chelsea Primary Care Trust Chief Executive Diana Middleditch said on awarding the contract. So why, with two years still to run, has this funding so far been spent on yet more campaigns pushing PEP for premeditated unsafe sex instead of accidental exposure, and which our survey shows is persuading a significant proportion of gay men to dispense with precautions; the ‘Drugfucked’ web site, which has provoked accusations of trivialising, glamorising and incentivising drug use; campaigns urging HIV-testing above prevention and which blatantly utilise NLP techniques to reinforce the inevitability of contracting HIV; and advertisements for THT’s own HIV support services in Positive Nation magazine? Surely not even the most efficiently media-trained spokesman within the HIV sector can claim this to be an effective or well-coordinated strategy for HIV prevention?

Clearly, the palpable failure in one part of THT’s remit (HIV prevention) is creating vast demand in the most profitable part of its core business (HIV support services). Is this the “achievement” that saw THT’s six-figure-salaried Chief Executive/Stonewall ‘Hero of the Year’ nominee Nick Partridge awarded his MBE within days of the last batch of HIV figures showing conversion rates falling off a cliff? Who, over the past 18 years, has politicised and transformed THT into a corporate gravy train too busy running itself and jumping through Government hoops to fight HIV? Who, in 2007, absurdly declared: “It's frightening that 25 years after Terry Higgins’ death this level of confusion exists. It's time to get our facts straight”? And whose staff continue to wait at the foot of the cliff, clipboards in hand, to dispense services and Aids drugs to the never-ending conveyor belt of casualties instead of taking whatever action necessary to prevent them falling in the first place?

How can it be morally, indeed ethically, acceptable for an organisation that thrives in supplying vital HIV support services and which receives funding from leading antiretroviral manufacturers to also be tasked with preventing the spread of the same virus?

Is it cynical or conspiratorial to point out such blatant conflicts of interest, or to question THT’s zealousness in urging the same men to whom it has deliberately and consistently downplayed the serious downside of HIV infection to now get tested on the pretext that one in four HIV-positive men supposedly aren’t aware that they are infected?

This insane system has been allowed to work against the best interests of those it is funded and purports to serve for years, aided and abetted by a culture of indifference, silence and the complicity of much of the gay media who have routinely run the HIV sector’s ineffective and inappropriate campaigns and reprinted their press releases verbatim without question while grabbing their share of the HIV prevention budget in return. What price their silence?

The Soho Live Sex Survey findings merely make the elephant in the room visible to those with eyes wide open enough to see. Some sectors of the gay press are keeping their blinkers firmly attached despite being presented with the hard evidence that explodes the HIV sector’s liberally spun disinformation, deceptions and myths while simultaneously withholding the truth about the chronic implications of HIV infection – a contemptuous abuse of the human right to honest and accurate information from which to make informed choices around personal health, and without which untold numbers of gay men will continue to contract a serious terminal illness with abandon.

The solution is simple and glaringly obvious: if we are to secure the future health and well-being of gay men into the next decade then HIV prevention must be hived off into a totally independent entity, staffed by those committed exclusively to reversing the rate of transmission by whatever means necessary, leaving the THT and other ‘one-stop HIV shops’ to do what they do best; ruthlessly exploit the virus’s commercial potential.

If indeed there is still such a thing as “gay community”, then it is the only way forward. •