ONLINE EXTRA: More than 30 years into the AIDS Crisis, gay and bisexual men, along with other men who have sex with men (MSM), remain the population most at-risk for HIV infection. The Centers for Disease Control and Prevention (CDC) say 63 percent of new HIV infections last year were among MSM, even though gay and bisexual men account for just two or three percent of the general population.
Todd Heywood, a Michigan-based journalist and expert on HIV health, social and criminal justice issues, says AIDS service organizations and LGBT community groups have faltered on prevention outreach to gay men. The reason, he says, is a decades-long trend separating gay people and issues from HIV prevention work.
“I think we deliberately de-gayed the epidemic,” Heywood says, “And, we had to in the late ’80s in order to get the support in Congress to pass the Ryan White CARE Act and thus fund desperately needed programs such as end of life, group counseling, medical care, etc.”
But, even decades afterward, that “de-gaying,” Heywood says, “has allowed both LGBT groups and public health workers to ignore the LGBT community and specifically the MSM community.”
Part of that problem may be social pressure or some leftover legislative restrictions, especially in more rural or conservative areas or states, but a large stumbling block is simply a fear of negative repercussions from government and other funders.
“The problem is that there is a fear they can’t talk about it,” Heywood says. “That dates back to the ‘no homo promo’ stuff driven by [North Carolina Senator] Jesse Helms.”
In the 1980s, Helms led a successful push that placed restrictions on how AIDS educational materials could be used. In particular, all materials which used CDC funds during their development or distribution were required to be reviewed by local review panels. Those groups were charged with ensuring the educational and prevention materials were not “offensive” to groups outside the target population and did not directly encourage or promote sexual activity.
Helms’ never made secret his agenda and push for funding restrictions. He wanted gays effectively silenced in public discussion around issues of sexuality, sexual health and HIV. “I wish they’d shut their mouths and get their mentalities out of their crotches,” he once said on the Senate floor.
And, thus, began the Heywood’s alleged “de-gaying.”
Those Helms-era restrictions hit AIDS service groups and advocacy organizations across the nation, including right here in Charlotte. In 1990, a gay-themed poster originally developed by the San Francisco AIDS Foundation was shelved for local use by Metrolina AIDS Project’s local Program Review Panel. The poster depicted two shirtless young men draped in a flag and holding a condom. Text on the poster read “Life Liberty and the Pursuit of Happiness.” The panel found the poster “offensive” and prohibited its use, along with the use of a wallet-sized brochure with frank discussion of oral and anal sex and sexual fetishes.
Those restrictions were later overturned in a 1992 federal court case brought by the American Civil Liberties Union and the Center for Constitutional Rights. Similar restrictions, like anti-prostitution guidelines first passed in 2003, were overturned by the Supreme Court as recently as this June.
“But the chill remains,” Heywood says. “We don’t want to talk about queer folks. Just look at the messaging being done and is the messaging being directed to the LGBT community? It’s not.”
Generalized, non-specific messaging, Heywood says, is ineffective when attempting to reach a small target population.
Heywood wants to see a much more progressive prevention message targeted directly to the gay and MSM communities, one which stops relying solely on condom use.
“Let’s be realistic,” he says. “Since the dawn of monitoring MSM and condom usage, studies have consistently shown that half of MSM don’t use condoms during anal sex.”
Yet, prevention work has long relied on that condom-heavy messaging.
“It’s kind of an irrational message to say to queer men that for the rest of your life you have to have a barrier between you and your partner,” Heywood says. “It’s unnatural and it’s just not emotionally healthy.”
“Is the ‘condoms only’ prevention message working or is it time for the states, AIDS service organizations and LGBT organizations to create a new safe sex message?” Heywood asks.
Heywood thinks groups have other options for stressing risk reduction among MSM. He says studies show that sero-positioning — or an HIV-negative person taking a “top” sexual role when a partner is HIV-positive or unsure of their status — can reduce risk of infection. Another is chemo-prophylaxis and Pre-Exposure Prophylaxis, the use of drugs like Truvada by HIV-negative individuals to prevent future exposure to HIV.
Most importantly, Heywood says the LGBT community at-large must begin to take a stronger stand in order to complement the work of AIDS service organizations, many of which are limited by the government funding they receive. Seventy-five percent of federal funding, he says, is directed toward already-positive individuals. Other LGBT community groups could help fill in the gaps on educational programs and awareness projects to reach those who are not yet HIV-positive but at higher risk for infection.
“When I’m teaching 18 and 25 year olds about the basic anatomy about the anus and rectum and why HIV is so relevant, we have a problem and we aren’t doing our jobs,” Heywood says.
LGBT groups can work to decrease stigma and prejudice, too. Doing so, Heywood says, could increase HIV testing rates. When testing rates increase, new infection rates will decrease.
“The person who does not know they are infected is three-and-a-half times more likely to transmit their infection,” Heywood says. “Within a year of infection, the newly-infected person is likely to infect at least another person during that time frame if they don’t know they are infected.
If the community steps up, Heywood believes the face of today’s HIV/AIDS epidemic could drastically change.
“We have all the tools and knowledge today to stop HIV infections in the next 10 years,” he says. “We could literally stop the epidemic in its tracks. The question is, do we have the education to be able to do it? The answer is no.”
more: Read more in our special Life, Positively World AIDS Day coverage at goqnotes.com/lifepoz2013/