New York Times January 3, 2011
City’s Graphic Ad on the Dangers of H.I.V. Is Dividing Activists
The advertisement opens like a French film noir, showing portraits of melancholy-looking men standing against a shadowy black-and-white backdrop of menacing New York City streets. “When you get H.I.V.,” the narrator intones, “it’s never just H.I.V.”
To music that telegraphs calamity, the advertisement warns of osteoporosis, “a disease that dissolves your bones,” flashes a gory picture of anal cancer and delivers a punch line about the importance of using condoms.
The New York City Health and Mental Hygiene Department released the advertisement on YouTube and television in early December, intending to show that even though an H.I.V. diagnosis is no longer a death sentence, neither do H.I.V. drugs guarantee good health. But since then, several mainstream gay groups have organized against it, calling it stigmatizing and sensationalistic, and demanding that the city pull it from circulation. And in response, other gay activists have rushed to the health department’s defense.
“It’s about time,” Larry Kramer, the writer and a founder of Act Up, wrote in an e-mail to friends and fellow activists after seeing the spot. “This ad is honest and true and scary, all of which it should be. H.I.V. is scary, and all attempts to curtail it via lily-livered nicey-nicey ‘prevention’ tactics have failed.”
For New York, the H.I.V. advertisement is just the latest in a series of graphic YouTube public service ads tackling health issues like smoking, obesity and childhood poisoning, created to reach young people through a medium they understand.
The H.I.V. public service ad falls into a tradition of attention-grabbing messages going back to the high school driver’s education films of car crashes on rain-slicked highways, and the graphic films about syphilis shown to Army recruits. A more recent model might be the “Truth” antismoking campaign, which tapped into young people’s suspicions of the adult world, sponsored by the American Legacy Foundation, as part of the 1998 tobacco settlement.
Health officials said the spot had also appeared on television and would continue to run through mid-January on TimeWarner, Cablevision and FiOS cable networks, WNYW (Channel 5) and WPIX (Channel 11).
Some gay organizations are not happy.
“We know from our longstanding H.I.V. prevention work that portraying gay and bisexual men as dispensing diseases is counterproductive,” said Marjorie Hill, chief executive of Gay Men’s Health Crisis. “Studies have shown that scare tactics are not effective.”
Jarrett Barrios, president of the Gay and Lesbian Alliance Against Defamation, known as Glaad, said the advertisement “misses the mark in fairly and accurately representing what it’s like to live with H.I.V./AIDS.”
But city health officials say the advertisement was tested on focus groups of the target audience — primarily Latino and black men between ages 18 and 30 — and also reflected the city’s experience of what worked in its past antismoking campaigns, which included stomach-turning images of amputated fingers, tracheotomies and what was depicted as a dead smoker’s aorta.
“One of the points they kept making is you need to hit hard and do something to counteract the pharmaceutical ads that say having H.I.V. is a walk in the park,” Dr. Monica Sweeney, assistant commissioner of the city’s bureau of H.I.V. prevention and control, said recently.
Dr. Sweeney said the city stood by the advertisement and was pleased that it was getting attention, even if through controversy.
The campaign, which cost $726,000, was produced by DCF Advertising and financed by a federal grant, officials said.
In the last few days, the National Association of People with AIDS and the H.I.V. Health and Human Services Planning Council of New York have added their voices to the opposition. Another group, Housing Works, also opposes the spot, a spokesman said.
In a Dec. 17 letter to Mayor Michael R. Bloomberg, the planning council, which includes service providers and people living with H.I.V./AIDS, said that while it was true that older adults with H.I.V. might be at greater risk of developing cancer, dementia and osteoporosis, the ad “implies that young adults living with H.I.V. suffer from these conditions, too — and that is false.”
The letter said that getting more advice from gay men into how to promote H.I.V. prevention, and “acknowledging their resilience in the face of this epidemic, will be far more successful than perpetuating outdated images of sickness, dying and death.”
The advertisement’s critics cited research by Peter Salovey, a psychology professor at Yale, and colleagues, who found that threatening messages did not necessarily lead people to adopting healthier behaviors and could be counterproductive. The researchers also found that many preventive health behaviors, like using sunscreen, could be better promoted through positive than negative messages. In a 2002 paper, Dr. Salovey and his colleagues said, “One could hypothesize that condom use, because it is a preventive behavior, would be better promoted by stressing its benefits.”
But Dr. Salovey said he had also published research showing that negative-consequence ads did work better for some health campaigns, including one in which low-income minority women were urged to undergo H.I.V. testing.
He added that he could not pass judgment on
Dr. Howard Grossman, a
“Younger gay men are not making some kind of rational choice to have unprotected sex the way many activists are maintaining in this disagreement,” Dr. Grossman said. “These younger people are, like most young people having sex, living in the moment and making split-second, uninformed choices about unprotected sex.
“The point is that there’s a whole new generation out there who needs to learn that H.I.V. is a disease to stay away from, and so a fear-based ad directed at them is a whole new thing.”
Mr. Kramer, the author of “The Normal Heart,” an autobiographical play about AIDS in 1980s New York City, said H.I.V. treatment had bred complacency and a false sense of safety to gay men too young to remember a generation of gay men dying.
“Everybody thinks all you need to take is one pill, which is just malarkey,” said Mr. Kramer, who is H.I.V.-positive. “Nobody takes one pill. I mean, I take like 10.”