The Blog

Stop Sentencing Us to Fear

We can achieve it by testing, so as to minimise the number of guys who don't think they have HIV, but do. We can achieve it by maximising viral suppression and getting as many HIV+ guys on treatment as possible. We can achieve it by using PrEP, not just because it works, but also to take the anxiety and rabbit-in-headlights paralysis out of gay dating.

The gay and HIV positive campaigner and writer Tyler Curry has recently put a column in The Advocate, the US's oldest, biggest and most influential LGBT publication, that has sparked a furious reaction. It's called "6 Life Sentences That Come With HIV".

A great title, and certainly passes the provocation test. Curry explains, in response to hostile reactions, that it's designed to alert gay youth to the fact that, as the old (and awful) campaign has it, HIV Is No Picnic.

It's natural for the average gay or non-gay reader who is not, unlike me, sad enough to spend most of the time worrying about HIV prevention, to think: "Oh yes. Gay Youth. Hapless. Complacent. Dim. Time we scared them again."

You might even think "AIDS industry. Political correctness. Refusing to face uncomfortable facts". But you'd be wrong.

I want to say why I think this is such a bad piece, and why I think we should stop writing such pieces.

A Lazy List

Firstly, it's a lazy hack job, below Tyler's usual standards. It must have taken him all of 20 minutes to write the first draft. It uses a list, the easiest option of any clickbait space-filler, and a poorly-researched one at that. Disappointing from someone who has been the author of many positive initiatives in the past, such as the HIV Equal website.

For instance, it repeats that people with HIV age prematurely. This is at least disputable. In mortality terms, this is belied by research that tells us that if you take HIV treatment before you reach AIDS and stay on them (as most do), you'll have a normal or even above-normal life expectancy.

Then there's the issue of healthcare. He's right, this is indeed an issue in the US, a country that still only manages to get less than 1/3 of its gay HIV+ population on HIV treatment and virally undetectable (and therefore non-infectious), compared with the UK's and Australia's 2/3. Oh, and Rwanda's 2/3 too, come to think of it.

A better approach to that might be to engage the energy of gay youth to get angry about the disaster of the US healthcare system and campaign for change nationally and locally (San Francisco and New York manage to get above-UK rates of viral suppression) rather than tell them to accept this as a glum inevitability.

As for the terrible, job-threatening burden of visiting your clinic three times a year: oh, come on!

Fear F***s us all

Then there's the stuff that actually is true: routine rejection by fearful dates; a life of chronic hypochondria and anxiety.

Exactly what contribution does Tyler's article has made towards addressing those issues? A negative one, I suspect.

Research has found that fear-based, loss-framed messages such as his are actively counterproductive in the context of sexual behaviour change. They make people feel less in control of a doom such campaigns come close to portraying as inevitable. As any researcher into abstinence-only-till-marriage messages will tell you, what little immediate deterrent effect they have is outweighed by future fatalism and inability to make positive choices.

How not to talk to gay youth

So if I were to write a message addressed to gay youth to alert them to HIV, what would I do?

Well, I wouldn't write it. I'd turn it over to someone under 25 to write. I've just spent three days with UNAIDS on how to get PrEP in Europe and one of the speakers was a fantastic gay youth advocate from western Ireland. In that context, he suggested three things.

The first was tackling Ireland's alcohol culture and drunk sex. The second was to pursue delaying the age at which gay men start to have anal sex. The third was the related one of tackling the exploitation of gay youth by older men. The latter is a huge elephant-in-the-room in gay society, a documented, active contributor to HIV incidence, and an issue that has been a staple part of addressing HIV in the African, heterosexual context.

None easy to achieve, and capable of misfiring if not done well. But that's not the point. What he came out with was unexpected, thought-provoking and edgy - unlike Tyler Curry's lazy list.

Crying wolf - again

Lastly and most fundamentally, the piece tries to do something that, if not already impossible, will get less and less possible over time: to make people scared of HIV. And the problem is, with people like me hanging around, 30 years HIV-positive, in boringly good health, that that will just get harder and harder and harder and HARDER to do.

I entirely respect the experience of some of the commenters who have had a grim time with HIV. I do believe that it has darkened their lives.

But I'd empathically suggest that a large part of what they are suffering from is the very oppression and depression that pieces like Tyler's serve to make worse. That the epidemic we most urgently need to start tackling in gay culture is our epidemic of poor mental health. That one step towards doing that would be to make it unacceptable to publish pieces designed to make gay men feel worse about themselves and more fearful of their destiny.

As for stigma: pieces that use the stigma against HIV to influence gay men not to catch it are, in my opinion, examples of stigma. They use, as a tool, what they deplore.

How to stop HIV

Of course we should still stop people catching HIV. It's by an order of magnitude the worst sexually transmitted infection and, as Tyler does rightly point out, all the above advantages are dependent on you taking pills for a lifetime (rather than, say, a year or two of PrEP). Were you to abjure treatment entirely, it would still kill you slowly and horribly, as I have seen.

But I think we have to stop crying wolf about HIV and trying to get people to behave by saying it's awful, because the lived experience of having it is, for the majority, not awful, and for the minority, of an awfulness largely redeemable.

Instead we need to concentrate on crushing HIV out of the system. We do that by making it impossible to transmit, emasculating its viral potency, ensuring that every person infected is a dead end in the chain of infection. That's always been the aim of prevention, but the problem is that behaviour change, in the gay community, has never been enough to do that, because of our far greater biological vulnerability to HIV.

Now, however, it is achievable entirely biomedically and politically, and will only be more achievable in the future.

We can achieve it by testing, so as to minimise the number of guys who don't think they have HIV, but do. We can achieve it by maximising viral suppression and getting as many HIV+ guys on treatment as possible. We can achieve it by using PrEP, not just because it works, but also to take the anxiety and rabbit-in-headlights paralysis out of gay dating.

I wish Tyler had complied a list of these 'sentences to life' now available to HIV positive and negative gay men alike, as the US Centres for Disease Control does, succinctly and charmingly, in its new Pride vids.

Lastly but most importantly, we can achieve it by using information, anger and empowerment, to ensure we tackle HIV within what has been called an 'HIV-competent' community - one in which facing down HIV is not dependent on remaining in fear, but instead on taking control.