In an article for the Pink News, Ramsey Dehani questioned “modern” HIV prevention campaigns asking if they were failing younger generations. Observing that campaigns promoting condom use have more or less disappeared to be replaced by testing campaigns, Dehani noted that many people still die of ignorance and recalled a conversation he had with a 20-year-old gay student who was more concerned about getting gonorrhoea than HIV (statistically speaking, the youg guy in question was rather well informed).

Should HIV prevention campaigns target the blasé attitude of younger generations that have never known of close friends dying in hospital with HIV-related pneumonia? Spike Rhodes, an HIV activist who is HIV-positive, speaking to PinkNews.co.uk about HIV advertising and raising awareness among younger gays said “I don’t think scaring [people] will help. It will just cause people to turn off and ignore it. The only way forward is . . . to wake up the entire gay community.”

But how “to wake up the entire gay community” without scaring it? Beyond encouraging people to know their HIV status, because it has been associated with a change in attitude, Rhodes contradicted himself adding that “If you don’t know and are too scared to take the test… then one day you’ll get very ill, and suddenly find yourself in hospital with pneumonia and have no immune system left and then it may be too late for the pills. Then you could die. People do still die from this”. With mandatory testing people could no longer have “their heads in the sand.”

Meanwhile, Paul Burtson, author of a comedy (The Gay divorcee) added that “On the whole I don’t think [prevention campaigns] are meeting the needs of the people they’re targeting.” Attacking barebacking, a euphemism for unsafe sex, Burston added that “What we need is a much more clear campaign aimed at the [gay] general population saying ‘use a condom”.

But who is really at risk and who and what behaviour is driving the epidemic? We have here two commentators who agree that there is something wrong but can’t seem to reach a logical conclusion: Telling people that life under treatment is not always a life of leisure or that barebacking is not normal is shock prevention. What both Rhodes and Burston can’t spell out is that scaring people do work for HIV prevention (though Rhodes is in favour of shock tactic when it comes to HIV testing). If HIV was not that scaring anybody anymore why so few people are able to talk about it or to get tested? HIV may be a chronic disease (in the West), it is still very much a stigmatised disease as cancer was 30 years ago.

Instead modern prevention is all about information and choice, as Marc Thompson from THT explained, “What we try to say is ‘it’s your choice’. Here is the information to make it safer for you. It’s about giving out information… so that people can make informed, educated decisions for themselves.”

That is one of the problems with “modern” HIV prevention campaigns: they assume that better educated and better informed people will make the right choice when it comes to condom use. That’s wishful thinking at best, and burying one’s head in the sand deeper at worst. It is ignoring the complexities and contradictions that lead people not to use condoms, as much as ignoring basic epidemiology facts about HIV distribution and transmission amongst the population.

And what about the “younger generations” themselves? What are they doing to protect themselves? Must they always be considered only as the passive recipient of HIV prevention campaigns? If it is all about educating people, shouldn’t it be also about making them aware of their responsibilities? But responsabilising people requieres much more than providing options and information.

Discourses that approach behaviour and public health from a market perspective where needs need to be meet through options is very much characteristic of an era, that of Blair’s third way, that of giving people choice, that of a state not putting public interest first, but individualistic concerns at the heart of public policy, and in this case, public health policy. Unfortunately, an epidemic such as the HIV epidemic is not a matter of individual choices and options; it is a matter of public health, public interest and public action.

The question I’d like to see answered is not why people don’t use condoms, that I know, but why people do use condoms. The answer to this question would definitively help designing HIV prevention campaigns that work.

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