This campaign isn’t being wound up yet by any means, but nevertheless some of us are in contemplative mood, trying to summarize for ourselves and others what major themes have emerged. In fact I have to talk about some of these at a Gay Mens’ Health Promotion summit coming up next month in Toronto. The intent is to share with prevention workers from across Ontario some of the things we’ve learned. Some of that material will be derived from the discussion that’s happened on this blog, and on those of the other seven facilitators.

Here’s my attempt to summarize one of the major discussion areas:

Pox and neg guys tend to think differently, particularly on disclosure issues. Many report encountering disclosure very infrequently; it just doesn’t happen a lot in many venues, it seems. But neg guys expect poz guys to disclose. Poz guys don’t have a single approach, but a significant number seem to follow the practice of not disclosing when risk of exposure is not significantly present. Neg guys also aren’t so committed to maintaining the confidentiality that poz guys require about their status, and this bugs poz guys. And poz and neg guys alike are all over the map when it comes to whether not being uncomfortable dating a poz guy constitutes stigma or understandable apprehension. There is a general consensus that more dialogue is required on all of this.

I think there are other things that have emerged - the mainstreaming of the view that poz guys are less responsible for new transmissions than untested “neg.” guys, and that if you’re going to sero-sort, you’re perhaps safer with poz guys than so called “neg” guys. There’s been interesting discussion on the joys of condom-less sex too, and how we deal with those. And on whether rejection is a big deal.  But I’d like to hear from others. What do you think has happened here, if anything, that has advanced our knowledge of how we think and relate to each other?

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 And on an entirely different note . . .

 Obama, the president that’s vowed to take on HIV Stigma (see my previous post), is taking early action on the AIDS front.  Now he’s asked PEPFAR pres Mark Dybul to resign.. That may cause a yawn here in Canada, but for anyone who follows AIDS politics this is big!

Read about it here: http://www.kaisernetwork.org/daily_reports/rep_index.cfm?DR_ID=56599

The significance is not only that Obama is putting his money where his mouth is on AIDS policy but that this likely marks the end to all that abstinence-based crap we’ve seen emanating from our neighbours to the south for way too long.

Can tackling HIV stigma be far behind?

Frequent commenter Rodger drew my attention to a fascinating post on barebacking by well known - and uber-cute - blogger Joe.my.god. It’s here: http://joemygod.blogspot.com/search/label/Eric%20Leven

There’s an anti-bare backing video there from filmmaker/activist Eric Leven that’s well worth a peek (it’s NSFW) but the real attraction is in the hundred or so comments to the post, which if you have time, I’d encourage you to read. Everybody, it seems has an opinion on barebacking. It wasn’t my intention to cover that topic in detail, But in the myriad of reasons offered for why guys bareback, despite all the messages telling us not to, the two biggies seem to be:

a) self esteem issues

b) it’s become mainstream - and a calculated risk, just like a lot of other calculated risks we take in life with potentially dire consequences. Like smoking. Like being overweight.

Anyway, Rodger was alarmed, I think, by the anger and the entrenched position in the comments. I agree that’s concerning. That was the theme of my last post too, our inability to get along. But if there’s cause for optimism, I think, it’s in the bright and committed people in our movement, including some who visit Joe.my.god’s blog.

In the debate on barebacking, there’s much talk about the effectiveness of past and present prevention messaging. More than one person makes the point I’ve made in my own blog - that the fear- based prevention messaging that was the stuff of the 80’s and 90’s never really worked. HIV is so horrid, it essentially said, that it’s to be avoided at all costs, so use a condom, always.  That approach unavoidably says something negative about the life of poz folks; it tends to paint us as having  wretched, valueless lives in fact. Given that this stigmatization  - and that’s what it is - leads to new infections (the raison d’être for the hiv.stigma.com campaign) we’ve had prevention messages out there in the past that arguably spread the disease, not contained it.

Thankfully, we’ve moved on to more focussed messaging - or more correctly, a variety of messages - which look at behavioural issues and try to address those behaviours, rather than scare us straight. (Poor choice of words there, I know.) But there are still proponents of the fear- based approach out there. One commenter on Joe.my.god says “I think we need public service announcements with poz folks for whom the meds are no longer working, or who have to wear diapers or some other measure due to the fact the meds give them constant diarrhoea. I think the consequences of not wearing a condom need to be shown for any impact to be imparted.”

But another commenter says the reverse. “We do not need public service announcements with everybody dropping dead or shitting a diaper because of their meds. Not only will that make life worse for the people already living with the disease by perpetuating stigma and returning poz folks to being ‘untouchables’, it also fails to prevent a damn thing the moment some otherwise educable person sees a healthy poz person who’s either doing well or not yet in need of them. That counterexample kills the credibility of those who rely on fear for prevention.”

Me, I cringe every time I hear poz speakers use the “scared straight” approach to prevention with school kids and others. I just don’t like what it says about me - or, of course, that it doesn’t work.

As an aside, I mentioned smoking earlier, and how it’s been compared to barebacking. There are also comparisons to be had as to how we as a society have tried to get people to quit smoking. Fear-based prevention messaging there has reigned, of course.  Effective in getting people to quit too, by all accounts, but we’ve also seen how those campaigns have stigmatized smokers. Those folks really are pariahs now. In this case, I think the end justifies the means. Or am I, as a reformed smoker, showing my biases here, and running rough-shod over smokers’ rights?

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In other news, and on a more optimistic note, this comes to us from the brand new White House website:

 “In the first year of his presidency, President Obama will develop and begin to implement a comprehensive national HIV/AIDS strategy that includes all federal agencies. The strategy will be designed to reduce HIV infections, increase access to care and reduce HIV-related health disparities. The President will support common sense approaches including age-appropriate sex education that includes information about contraception, combating infection within our prison population through education and contraception, and distributing contraceptives through our public health system. The President also supports lifting the federal ban on needle exchange, which could dramatically reduce rates of infection among drug users. President Obama has also been willing to confront the stigma — too often tied to homophobia — that continues to surround HIV/AIDS.”

Cool beans, I say!