Here’s something for your amusement. It’s a British take on the coming-out process. There are five clips combined; the fourth one in particular is priceless.

http://www.youtube.com/watch?v=7fEdyBdx_Ls

I should own up to the fact that this video is here mostly for its entertainment value - it strikes me as very, very funny. It has only a rather remote connection to HIV stigma, although it’s there if you look for it. (It’s about turning homophobia upside-down - and homophobia is often a contributing factor to HIV stigma, right?) Anyway, what’s more to the point is that it’s an attention-grabber, something that in the world of blogging is deemed a very, very good thing. It lures people in, one of the challenges that HIV-related blogs invariably face. Which is why we’ve been discussing here  - see my last post - techniques that make blogs that address ***shudder*** HIV issues  more attractive to gay men in general and neg guys in particular.

Here’s one tried and true way to catch the eye of the average gay guy. Liberal use of pics like this . . .

Yet another way to attract readership is the judicious use of tags and keywords - we’re talking filthy, raunchy pig sex talk here. Just ask Nico.

Turning to more - ermmm - serious matters, and on the eve of the Gay Men’s Sexual Health Summit in Toronto, I wanted to say a few thank you’s. In particular, I want to acknowledge some of our fine allies who’ve included promoting this campaign in their outreach work. I hope to hell I’m not missing any, but here’s a list of those who I know have gone the extra mile.

AIDS Committee of Cambridge, Kitchener & Waterloo (ACCKWA)

Africans in Partnership Against AIDS

AIDS Committee of Durham

AIDS Committee of London

AIDS Committee of North Bay & Area

AIDS Committee of Ottawa

AIDS Committee of Simcoe County

AIDS Committee of Toronto (ACT)

AIDS Committee of York Region

AIDS Niagara

AIDS Thunder Bay

Access AIDS Network

Africans in Partnership Against AIDS

Asian Community AIDS Services

Black Coalition for AIDS Prevention

Centre Francophone de Toronto

HIV/AIDS Regional Services (Kingston)

Ottawa Public Health Department

Peel HIV/AIDS Network

Peterborough AIDS Resource Network (PARN)

Prisoners HIV/AIDS Support Action Network (PASAN)

Honestly, this has been a great group effort. Thanks guys and gals.

And for those attending the summit, I’ll be there on a panel talking about this very campaign. Say a polite hello - or talk filthy raunchy pig sex talk. Your choice.

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?

If you’ve been following the discussions on this site, I think the links between criminalization and stigma must be pretty clear by now. But we haven’t really looked at who, besides Margaret Wente, actually supports criminalization.  Now we can.  And it’s kind of worrisome.

A new study out of the UK - and it’s a big study, with 8,152 participants - tells us what gay men there are thinking about criminalization.

Here’s the bad news. Most gay men (57%) there support criminalization. Only half of poz guys (49%) opposed it.! Ouch!

Sample quote from one gay man: “to have sex with with someone when you you know you are HIV+ without telling them is is one of the worst things that could ever be done.  These people should be given life sentences.”

Now, understand that the law is slightly different in the UK. and the questions asked reflected that. In particular, the UK researchers questions were soliciting gay guys’ views about punishing folks who transmit HIV; here our roughly equivalent laws seek to punish the act of exposure to HIV. There is a huge difference. Having said that, my impression is that people on both sides of the Atlantic are generally either for prison terms for non disclosure or against them, whether actual transmission occurs or just exposure to the risk of it. Read the internet chat and you’ll quickly learn that folks  typically don’t make any distinction between the two. So I’m thinking that the results of this UK research might be a pretty good indicator of what Canadian gay guys think about criiminalization, no?

If in fact the Canadian gay mindset follows the UK model, this sets me back a little. I said two posts ago that I suspected neg guys, and the population as a whole, are likely not yet convinced that criminalization is anything but entirely warranted. This research kind of backs me up.   But I hadn’t bargained for the high degree of support for criminalization amongst even poz guys.  Only 49% opposed?  Jeez!

But let’s look closer at the profile of those who support criminalization in the UK. Here’s what the research says . . .

• Gay guys who have never been tested were the group most likely to support criminalization. (Hmmm.)
• Gay guys who supported criminalization generally regard the responsibility to prevent HIV infections during sexual encounters as being vested solely with the poz partner (Hmmm).
• Gay guys men who support criminalization tend to have strongly stigmatizing views about HIV and appear to have little appreciation of the effectiveness of HIV treatment, so that infection is seen as a death sentence for anyone infected. (Hmmm).
• Few gay guys thought that prosecutions would help reduce the transmission of HIV, when most prevention experts insist that criminalization leads to more infections. (Whether gay guys buy in to the notion that criminalization increases infection rates isn’t clear. I almost hope they don’t. Otherwise we have to wrap our minds around the prospect of guys supporting criminalization even though they know it leads to more infections. And that sucks big time!)

It’s hard not to think that the research findings paint a rather unflattering portrait of those who oppose criminalization. Indeed, a recent report on this research on the AIDSmap website that I drew on for this post uses the banner headline Ignorance and Stigma Provide Foundation for Gay Mens’ Support of Criminalization of HIV Transmission. It saddens me to say it, but it’s really hard not to agree. Anyway you can read the article here, and in fact I’d encourage you to do so, as it’s an important one : http://www.aidsmap.com/en/news/51C2CFFD-1979-4033-BD9E-38ABC51CDC33.asp

So where do we go from here? There has been some discussion on this site about strategies that might work to bring home both the injustice and ineffectiveness of the current judicial fixation with prosecuting people who are HIV-positive.  It’s been suggested here we need to start that advocacy work first in the gay community, as clearly we are divided on this issue right now.  One positive sign in the UK research is that about a quarter of the gay guys interviewed were “unsure” about criminalization.  We need to build on that.  But surely, efforts to convince the general public and ultimately persuade judges that criminalization is wrong will have one hell of an uphill battle as long as our own community lacks unity on this.

So perhaps it’s back again to the issue of building community, of finding innovative ways to strengthen it, how to listen to and educate each other, how even to work towards common values that have as their foundation a sense of caring about each other.

Meanwhile our foes exploit this divide. Who couldn’t notice, for instance, that Margaret Wente in that infamous Globe and Mail article, quoted only the lame views of a poz guy firmly opposed to criminalization.

And meanwhile, while it’s tempting, I refuse to view gay guys who support criminalization as the enemy. They are our potential allies, and we need them. But we’re not there yet.

What do you think?

The comments on the XTRA website in response to their front page story on criminalization (see my last post) are all over the map, and sometimes heated.  But they’re worth reading by all those interested in stigma and how it pans out - or not - in the real world.. You can find them here: http://www.xtra.ca/public/National/HIV_stigma_radiates_from_behind_the_bench-6193.aspx

Brian has commented on this too today; clearly stories like this tend to hit a lot of nerves. So pardon the duplication between our two blogs.

Anyway, here’s a selection of comments from both sides of the XTRA fence:

Male or female, gay or straight, you deserve to be sentenced for deliberately - or through deliberate negligence - giving your partner a lethal disease.

The very idea of “deliberate” infections should be challenged except in the tiniest number of sociopaths, because it doesn’t really capture what happens when two people of different status have sex.

The vast majority of HIV is spread “non-deliberately” by people who don’t know they have it.

There is a difference between criminal intent and just deplorable action. But I find it hard to sympathize with HIV-positive people who complain that being forced to disclose every time cuts down on the pool of potential sex partners. Too bad! This article talks a lot about the responsibilities of HIV-negative people and virtually ignores the responsibilities of HIV-positive people.

I am so sick of hearing this idea that (being forced to disclose every time cuts down on the pool of potential sex partners). This is not the reason people don’t disclose. The reason we don’t disclose is because you can’t control gossip and everyone around you can treat you differently when they know, from the workplace to the bar to family. It changes your life for the worse and that is not fair. A lot of negative folks say “that’s your opportunity to educate,” but that’s easy for them to say. I know many, many guys who regret how open they have been about their status. It doesn’t make stigma vanish. It makes life harder. Please believe me when I say that the risk of disclosure DOES NOT have to do with being greedy for sex.

I am ashamed that this is what the gay rights movement has degenerated to. Defending a rapist! Stop blaming the victims! It’s not their fault when someone lies to them.

HIV criminalization? That has got to be the stupidest thing I have ever heard. I completely understand that yes this man did and does have a legal obligation to inform his partners about his status. However they knowingly participated in unprotected sex, knowing with all the sexual education in the world and all the advertisements regarding sexual health, that they could have contracted the HIV virus. For them to do so was irresponsible . .”

I’m sure many people would turn down a sexual encounter if they know their potential sex partner has HIV. It should be criminalized - it most definitely is murder. I am truly disgusted that the community is willing to fight this charge.

I’m am a closet HIV-poz guy. It’s the stigma and this kind of stuff (criminalization) that keeps me from coming out. The person who infected me (whom I know) didn’t say anything to me about his status. When I found out I was poz, I didn’t go running to the police. I was an adult who made a bad choice and I accept it.

Note that the comments I’ve selected, and the balance between criminalization supporters and naysayers, pretty well reflects the balance of what’s been posted to the XTRA website. It’s about a 50-50 split, I’d say. I don’t know if that split is representative of the views of the gay community as a whole.  But it strikes me, as an opponent of criminalization (was there ever any doubt?), that a lot of work needs to be done to win the day and persuade the court of public opinion if our own community is so divided on this one.

What’s your take on this?

As a footnote, I remember when this campaign first began, we talked as a group about whether the issue of criminalization was sufficiently relevant to the topic of HIV stigma to devote much attention to it here. Times change and so does our understanding. It’s become readily apparent, in fact, that there are very close links between the two topics, don’t you think? Certainly many of the XTRA commenters readily make the connection.

XTRA’s cover story yesterday was about criminalization, a treatment sympathetic to our cause by Sky Gilbert, which (mostly) hits all the right notes, even though he couldn’t resist criticizing at some length some of our community’s most vocal supporters. You can read the article here: http://www.xtra.ca/public/Toronto/HIV_stigma_radiates_from_behind_the_bench-6193.aspx

Predictably the article has already provoked a flurry of comments on the XTRA website, including the usual fodder for campaigns like ours. “Take the disease spreaders and hang them up” is one quote. Nice!

By chance, I had planned to revisit criminalization here today anyway, given its relationship to stigma, and the fact that it doesn’t seem to want to go away. I’d already noticed that some in our community continue to debate what is a suitable response to people being pilloried for having sex without disclosure.

Is a fairly simple issue becoming overly complicated through neo-conservatism and the power of hot air? To people living with HIV, I don’t see much appetite or even need for debate. Most of us recognize criminalization for what it is - an attack, an affront and a useless, counterproductive prevention tactic, always. From too many others - and I’m not talking about the Margaret Wente’s of this world but some of our “supporters” - the view is often heard that, well, maybe we poz folks need to feel the strong arm of the law, some of the time. Because, we’re told, some of us are “irresponsible”. Some of us are “deliberately infecting others”

Even XTRA raises this spectre in a side-bar,  by characterizng some of us this way,  although thankfully it’s challenged by at least one reader.

I could document where and when I’ve heard this notion of “deliberate infections” countless times, and from whom, but that would win me few friends. But in every discussion I’ve witnessed where criminalization is debated, it always - always - comes up.  Namely, what do we do with “these people” who intentionally infect others, the psychopaths. No matter that this phenomenon is virtually non existent, no matter that the criminal code quite handily deals with intentional harm anyway and doesn’t need laws on disclosure to do that, no matter that the debate on criminalization is not - or should not be - about “deliberate infections” at all, we go down this path ad naseum. It’s depressing.

Sometimes it becomes a stumbling block. I’m saddened that the community doesn’t seem to have a response to criminalization that’s universally accepted. Even the recent Ontario paper that recommended we re-examine the law and identify alternatives - hardly conroversial - gets bogged down in the debate about what to do about those non-existent psychopaths.

To repeat; the law deals with psycopaths already. It worries me that in discussions that should focus on the legal challenges that face normal, sexually active poz guys daily, we end up talking about psychopaths. I think that is very telling about our attitudes to poz folks generally.

It’s also telling that this debate is not usually within the poz community, or hardly involves us at times. We have few forums that would otherwise enable this, we don’t have the equivalent of NAPWA in the States, for instance. So community boards often devoid of poz folks, composed instead of well meaning folks with little knowledge of HIV, talk about us - but don’t get us.   Agency staff, who are better informed but often similarly devoid of poz folks’ involvement, sometimes fall in to the same trap. So perhaps it’s the lapses in implementation of GIPA (greater involvement of people living with HIV) coming home to roost. It’s hard not to notice that decisions about our future and judgements about our conduct sometimes reflect the mainstream views of the general public, which can be less supportive than we would like - rather than being inclusive of a poz view of the world. That’s why talking about the state-sanctioned stigmatization of people like you and me ends up talking about our role as psychopaths.

So I started talking about criminalization and ending up talking about GIPA. But there is a connection, and there is definitely a connection with both to the perpetuation of HIV stigma, don’t you think?

Anyhow, I find the debate on criminalization disheartening and depressing.  One organization is asking me to come and talk to their board, to present a poz guy’s view of criminalization. It’s good that they welcome the dialogue. But honestly, I’m so pissed off with the whole thing, I hardly want to go.  I feel like I’m done with debating it. Some times the weight of oppression - and stigma - does that to you. And that’s not good.

From this month’s POZ magazine: In October 2008, the Centre for Disease Control and Prevention announced that the number of people living with HIV in the United Sates but who haven’t been tested and diagnosed fell from 25% in 2003 to 21% in 2006.

Why is this interesting? Well, it’s often been said in these here blogs, and elsewhere of course, that the primary source of transmission is not from guys who know they are positive, but from guys who don’t. I buy that. But is that pool of poz guys who don’t know they are poz getting smaller?

Not necessarily, I’d say.  Statistics like this have a habit of reinventing themselves periodically, sometimes in quite spectacular ways.  Remember when we had forty million people infected globally, and that number shrunk to 33 million overnight, because the WHO said we all got it wrong?  You’ll need to convince me that statistical errors aren’t happening here before we debate this.

Be that as it may, the related number most quoted in our campaign - the number of poz guys who don’t know it - is 30%. Is that going up or down? I haven’t heard. Do we know, I wonder?

I wonder too how much we know about this pool of “negative” guys who are actually poz. It’s a no-brainer that prevention efforts need to be directed there, but to do that effectively,  we need to know who are these guys.

Here are a few clues, entirely unscientific, based on surmise rather than hard data, (I admit I’m not too familiar with what the Polaris study, which looks at the newly infected, is saying on this.) My take though? Chances are these guys may have a bit of a lax approach to testing. Chances are they may be no strangers to fucking without condoms. Chances are they have more partners than most. Chances are they live in big urban centres. Chances are they are scared.  That’s a start. Ethnicity, age, etc. can be extrapolated from the epedemiololgy of new infections. So perhaps we know more than we think we know.

I’ve heard characterizations of this group, though, which aren’t very flattering, and that worries me. I’m concerned that we not demonize those folks. Because in our rush to judgement - to point out that people living with HIV are not the demons they are sometimes painted to be - pointing the finger elsewhere can easily demonize others. Now that’s just too weird for me.  In this case the “others” are poz guys who don’t know it. We “known” poz guys may be targets of stigma, but it’s unbecoming, unfair and unwarranted to stigmatize others, who in reality are pretty much exactly like us.

So let’s not, eh?.

/rant

Some folks write to the site, instead of leaving comments here. Their emails are an interesting read; they often voice opinions which wouldn’t otherwise have been heard.

Most people are pretty complimentary;  honestly, the word “amazing” appears quite often. One person used the words “disturbing, blunt and effective” - I liked that too. But there are also some criticisms and I wanted to deal with three of  those today.  These all incidentally revolve around disclosure. I’ll paraphrase them for you.

Accusation  # 1 : Disclosing is not a choice, poz guys have to disclose their status when having sex. You are nasty, irresponsible people for suggesting otherwise!

My reaction?  Clearly there is a bit of work to be done here, involving both poz and beg guys, in helping folks understand exactly what the law says. There seems to be a common perception that the law says disclosure is alwasy necessary  BUT a) that’s not true, and b) if neg guys think poz guys will disclose always, they are unnecessarily putting themselves at risk and c) we need to repeat that the greatest danger of infection comes from newly infected/infectious guys who don’t know they are poz, so disclosure isn’t the magic bullet that keeps everyone safe. In short, the law, and folks shaky understanding of it, have created a minefield of dangerous misconceptions.  In fact those who say the law results in more new infections, not less, are probably right. How we dig ourselves out of this mess I’m not sure, but more education on it will help.

Your reacton ?????????

Accusation # 2: Stigma makes poz guys lie about their status, therefore all sex is dangerous and scary. You are nasty irresponsible people for spoiling sex for me.

My reaction? Stigma certainly isn’t a helpful factor in having people talk openly about their status, but accusations of lying about it aren’t helpful either. I don’t really know whether many people lie; if they do I understand, but don’t approve. I suspect a much more common way of dealing with being poz though is just not talking about it. And that’s OK, in my book, if you’re not exposing your partner to risk, or not considering a relationship. But if some neg guys are relying on partner disclosure as their safer sex strategy, that’s just naive. Why not revert to the strategy of treating all partners as if they are potentially positive?  So that lying, if it occurs, is hardly an issue.

Your reaction: ?????????

Accusation # 3: You’re excusing poz guys who don’t tell their partners their status. You are nasty irresponsible people for encouraging dishonesty.

My reaction? This all seems to stem from that slogan “If you were rejected every time you disclosed, would you?” which has been much discussed here. Some folks whose opinions I respect have questioned the wisdom of choosing this slogan for this same reason - that it appears to condone,. perhaps even encourage, nondisclosure. Regardless of the fact that disclosure isn’t always required by law (see above), I must admit it does concern me that folks have interpreted the campaign that way. So was that slogan a wise choice? Can we afford to have negative interpretations of it out there? Honestly, I’m not sure.

Your reaction:????????

Let’s hear from ya!

Who’d have thunk that Darren James, star of Black Dicks in White Chicks III and scores of other similar - errmm - entries (honestly, his filmography goes on and on: http://www.adultfilmdatabase.com/actor.cfm?actorid=2226) would have something to say about HIV stigma. But in this month’s POZ magazine, he does, and it’s quite enlightening.

Although Darren’s name was unfamiliar to me - largely because Black Dicks in White Chicks III isn’t exactly my niche, as it were - he is apparently notorious in the adult film industry not only for becoming HIV positive but for infecting, unwittingly it seems, a number of his female co-stars. He’s since retired, and talking about the experience. Good for him.

Read the POZ interview here: http://www.poz.com/articles/darren_james_porn_hiv_2271_15639.shtml

What interested me particularly about the article were Darren’s comments on the reaction to his diagnosis. “Many heterosexual guys with HIV experience a double stigma, which is different from that of our gay and female counterparts. Not only do you have HIV (big stigma there), but everyone you run into, even people within the positive community (even those who profess to be knowledgeable about transmission), will insist you must have gotten it some other way. They might not say it to your face, but they’re usually thinking it. That part about living with this disease as a heterosexual guy really sucks. A lot of positive women don’t want to believe you when you tell them you got it from a female.”

That comment, more than slightly homophobic, really sucks too.  Darren is saying that not only do people know he’s HIV, but - jeez, they’re thinking poor James is gay too. How yucky is that?

Having said that, he makes a point worth dwelling on that has nothing to do with Darren’s neuroses. Namely, that many folks with HIV experience stigma from more than one direction. Darren is HIV, but he’s also a porn star (one who didn’t use condoms) and he’s black, and girls think he’s a fag. He was also diagnosed in the “age of enlightenment” when it’s considered by many to be downright dumb to contract HIV.  That’s a lot of stigma to handle, isn’t it?

But he’s not alone in this stigma-piled-up-on-stigma state of things. Myself, I’m pretty lucky. Why? I’m positive but I don’t have Hep C. I don’t have a prison record, a drug habit, work in the sex trade, nor am I homeless. But I’ve worked with many poz guys who share more than a few of these attributes. Letting the world in to see even a fraction of that burden must be exceedingly difficult, a brave act indeed. Yet people do it.

I guess I’m suggesting that HIV stigma is seldom a stand-alone concept. Many of us are HIV and gay, which combined, carries its own stigma, albeit perhaps reduced from days gone by. (Remember when there was a distinction between “innocent victims” of the epidemic -  the blood transfused - and us gay men?)  But so many out there have it worse, much worse, dealing with multiple layers of stigma, and I’m beginning to think that if we just tackle the HIV stigma alone, and don’t address the “cofactors” which compund that stigma, we are kind of missing the boat.

Wadyya think?

I’ve been more thoughtful over this new year’s holiday  than most.  I don’t usually make resolutions, or even dwell much in the past, but the passing of this last year feels different somehow.

2009 will likely be the year I let go a lot of the work I do in the AIDS movement. Fifteen years feels enough, but more importantly, it’s really time that younger folks stepped up to the plate.  How can I speak for twenty-year olds?  True, there is one area I could take on; there is, after all, a sore need for HIV ageing issues to have a voice.  (They largely go un-noticed, despite what I suspect will be their rapidly escalating importance for many.  And I’m sure that I could write piles about the special stigma of those being diagnozed with HIV late in life - and boy, is that happening.  But not today.)

Moving on, this image isn’t meant to depict “Six Feet Under“.   It’s actually a photo I took of a field I keep an eye on, not far from where I live.  Observing nature is inextricably linked with the passing of time.  But this one speaks to me of  the future, bright and shiny and optimistic - and much less obsessed with all-things HIV than I am now.

But come what may, I will likely still be addressing HIV stigma in some fashion for years to come.  There are many ways to do so without shouting about it from the tree-tops.  Living a normal life, out and proud about our status, is a good one, I think.