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Nicholas Little, an HIV prevention worker from Ottawa, has been a great supporter of this site. And today, not because I’m lazy, but because he says it so well, I’m going to quote, with his permission, a big chunk of a recent post on his own blog.

Nicholas says we need to do an about face; to turn our attention to those guys who assume they are negative but are in fact positive - and highly infectious at that - rather than continually focussing on poz guys as the problem, and by doing so, stigmatizing them.

Interesting. Even our own community has being doing a lot of work focussing on poz guys lately. I don’t think his line of thought negates the poz prevention work that is being done in this province, and which I strongly believe in. But it does suggest a new and highly productive avenue for poz prevention to explore further, by expanding its target audience perhaps. Anyway, here’s what Nicholas says . . .

A recent UK study shows that over 50% of recently HIV+ gay men leave UK sexual health clinics undiagnosed. FIFTY PERCENT. And of those men who also have another sexually transmitted infection (making them more infectious to others), 80% left the clinics without being tested for HIV. EIGHTY PERCENT.

This blows my mind. We waste outrageous amounts of energy pushing men who know they are HIV+ to the margins of society — straight into prison cells, in fact — while we ignore the real crisis right in front of us. Study after study confirms: too many gay men are not getting tested for HIV - especially those engaging in high risk sex who need to be tested most.

We know who our true target audience is: gay men under the false assumption that they are HIV-, who have recently sero-converted (making them more infectious because their viral load is higher) and who may also have another sexually transmitted infection (make them yet more infectious). This is who HIV prevention campaigns should be focusing on. This is who is most likely to pass on the virus.

Not men who know they are HIV+. Not HIV+ men who self-disclose about their status (the majority). Not HIV+ men who, with their partners, employ harm reduction measures to keep everyone safer (the majority). Not HIV+ men who maintain good general health (by eating well, building strong social support networks with friends, combating HIV stigma, nurturing self-esteem and getting regularly tested for other STIs, among other things).

The UK Study should be sounding alarm bells. The longer we play into the paranoia about people who know they are HIV+ wilfully infecting others, the longer this epidemic will go on. We are wilfully deceiving ourselves and paying a very high cost because of it.

Just this past weekend an Ottawa gay guy told me, I always take my own condom because I am afraid the positive guy might have poked holes in his condoms in advance. I asked him, Do you even know any positive guys? He shook his head no. You do actually. About 11% of your random hook ups are positive. About 11% of guys at the Ottawa gay bars are positive. And seriously, dude, do you honestly think these guys are sitting around in some kind of vengeful stitch n bitch poking holes in big batches of condoms? These guys have way better things to do with their time. Like grocery shopping. Like doing their laundry. Like laying on the couch missing the days when Bob Barker was the host of The Price Is Right. Because they’re fucking human beings, not vindictive aliens. They’re regular, boring, everyday gay guys like you and me. And for all you know, I AM one of those 11% of gay guys. So I’m going to put this condom on that I lovingly perforated for you at home and we’re going to fuck already.

He laughed. And we did.

You can read the full text of Nicholas’s blog post, including recommendations for the way to go forward. It’s good. It’s here:

http://ickaprick.blogspot.com/2009/01/50-of-hiv-gay-men-leave-clinics.html#comments

Thoughts, anybody?

Tags: condoms, nicholas little, sex, stigma

This entry was posted on Wednesday, February 11th, 2009 at 6:29 am and is filed under Uncategorized. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.

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Bob:
February 13, 2009 11:29 AM
Hi Elliott. I saw you were on live chat Monday night; I was too, but was having connection problems. Still I caught enough to see that you guys were doing a good job in supporting each other and allowing good exchanges of views. Well done!

As for Nico’s article, it strikes me as a bit of a wake-up call. I’d love it to be a catalyst for thinking where we go from here. That seems to me to inevitably translate to a new approach to seriously connecting with that “30%” we now know we have to reach to curb infection rates.

You’ll never get my support for mandatory testing, I’m afraid, though - it infringes too much on basic human rights - but I’ve often thought that cash incentives for testing might work, while offending only a few peoples’ sensibilities - and certainly not mine. Given the high cost to the health care system of each new infection, paying folks from high risk groups to get tested - say $50 a time - would likely be more than self financing. Combine that with the kind of pro-active outreach that Nico is doing - like hanging out in bar washrooms, if that’s what it takes - and you have someting that’s likely more promising than just tacking up “get tested regularly” posters, don’t you think? But yes, hacking away at stigma will help too.
Elliott in Ottawa:
February 13, 2009 10:15 AM
Good day Bob,
I have to admit that this article is shocking to me. I would never have suspected that the number would have been so high. However, it makes perfect sense, does it not? We have long held that stigma is reducing the number of people who wish to get tested. That added with the being deemed a criminal and being added to that damn public health “list,” why would anyone want to get tested? This campaign, by reducing stigma and challenging antiquated myths may in fact be contributing more to encouraging people to get tested then we think. I think focussed hIV testing campaigns are important but I think we are better served by campaigns like this one that reduces the fear around the actual test and the result. The indirect benefit of destigmatization in reducing HIV infection and increased testing is fantastic.

As an additional note, and I admit this is extreme, but a friend suggested in conversation the other day that the province should impose a mandatory HIV test for everyone. This way we would figure out that 30% easily. How do people feel about this?

PS- Keep up the good work Nick! You already know I am a fan.
Bob:
February 12, 2009 10:45 AM
Hey Nico. Thanks for this. I think you bring home the need to be way more innovative than we have been in our approach to reaching that 30% we all talk about. Prevention messages that increase the awareness of the need for regular testing are only a start. But we need I think to be a little more in your face, target more specifically those at risk, and invest big-time in outreach activities like yours.
Nicholas, Ottawa:
February 12, 2009 01:40 AM
Hi Bob, Nico here, thanks for the shout out. It’s 3am and I’m just in from the bar where AIDS Committee of Ottawa teamed up with Public Health to do testing right in the bar. People could give a blood sample without even putting down their beer. We need more of this kind of thing — making testing as easy and accessible as possible. I admire the nurses giving up their late nights to bring testing out into the community where it’s most needed. I sat by the bathroom on a stool asking people if they’d being willing to pee in a cup for me and donate just 30mL of their piss - since they were headed to the bathroom anyway.

Ontario has a lot to be proud of. At the pre-summit for gay men at the International AIDS Conference in Mexico City this summer, it seemed like about a quarter of the presentations were from our province — and this is a global conference. We are taking the lead in terms of poz prevention, we are taking the lead in terms of queer trans men, and I feel like this campaign breaks new ground in terms of breaking down the bullshit that is HIV stigma. I hope next we focus on testing and cutting in half (if not more!) that 30% of HIV+ men who don’t know their status.

Thank you for your dedication to this blog — you’re a real inspiration. See you next week!
Bob:
February 11, 2009 08:48 PM
Rodger, I agree. He strikes me as the gold standard for those doing this kind of work.

I’ve never met him though. But I’m looking forward to next week in Toronto.
Rodger:
February 11, 2009 06:37 PM
We need more guys out there like Nico. He’s an absolute hero as far as I’m concerned.

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