IÂ remember reading this newspaper 10 years ago when it was filled with names and pictures of friends and lovers we’d lost to AIDS. Each of us knew someone who had died or was dying. Thousands of highly visible deaths reminded us that AIDS was out there and that the only thing which stood between a hot fuck and a painful death was a sliver of latex. Thousands of us marching annually with candles up Oxford Street reinforced the dire warning.
HIV education programs were relatively easy. Use a condom every time was a simple and effective message -“ a stark choice between life and death -“ and in a way in which heterosexuals never have, gay men took to condoms in the millions. Our reward was some respite. The overwhelming success of these HIV-prevention campaigns, together with effective combination therapies, meant that deaths from AIDS as well as new HIV infections plummeted. Our response to HIV/AIDS stands unmatched around the world.
But this is now at risk. It’s 20 years since the beginning of the epidemic and gay men have a much more sophisticated understanding of HIV. They know that sex without a condom is not safe but they also know that there are some things they can do to reduce that risk. They consider their options, calculate their risk, and take their chances. Unfortunately, some of these choices may not have been entirely accurate or may have been based on incomplete information (i.e. assumed HIV status). The potential for an increase in new infections has now happened.
But perhaps a far greater risk for us is that all this gets boiled down to binary opposites of those who are good and those who are bad. Â And now -“ with HIV infections rising, the temptation for some will be to blame gay men or their health organisations for complacency and irresponsibility in the face of everything they know. We will undoubtedly read examples of this in some mainstream media, hear it from the likes of Fred Nile and even see it played out in some health organisations and by some within our own community.
Health promotion campaigns seem easiest when they are based on fear, whether it’s seatbelts, drink driving, heart disease, or HIV/AIDS. The messages are familiar: do this, or this will happen to you. Any expert in health promotion will tell you that fear might be good at drawing attention but does little to change behaviour. Why do one in five Australians regularly smoke, even though they know it is the single greatest cause of death and disease?
The challenge for community-based health organisations like ACON is how we can sustain behaviour change over the long term without resorting to fear-based campaigns. We work with researchers and governments to implement programs based on evidence. We continue to tread a fine line between providing information that allows people to make up their own mind about risks and occasionally being more interventionist and telling people what to do.
ACON is taking the recent report of a rise in HIV infections extremely seriously.
Every single part of ACON’s work has been about fighting HIV in an environment where AIDS deaths have (thankfully) receded a little from view, as well as improving the overall health of PLWH/A.
Researchers are clear about the relationship between mental health and self-esteem, drug use, violence, STIs and HIV prevention. Focusing on these issues, as well as building the overall health of PLWH/A, will help prevent HIV infections through improving the health of the community as a whole. ACON has been building these broader programs in gay men’s health to support this goal and continues to do so.
After 20 years, gay men know that using condoms is the easiest and safest way to prevent HIV transmission. Over 80 percent of them do so most of the time and we will continue to encourage more of this. But research tells us that encouraging condom use alone will not be enough to prevent HIV infections. A large proportion of the new infections are among 30- to 39-year-old men, who have heard the messages about condoms for many years. Our programs must address the range of issues that impact on their decision making, not just shout more loudly at them.
Over the coming months our community must renew its efforts to fight HIV/AIDS, and this response must be textured and research-based. Around the world we’ve seen a reversion to simplistic notions. In the face of increasing infections, governments become increasingly conservative, shying away from the very measures which have achieved so much to date. Suddenly they refuse to approve or fund sexually explicit material and concepts of harm reduction are abandoned. We must guard against the same thing happening in NSW. In the past 20 years we’ve fought hard to secure the principles that have underpinned our success. Today we need to fight to maintain them.
Adrian Lovney is president of ACON.