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Monday, March 7, 2011

So What Do We Do About HIV?

The latest figures on HIV infections in New Zealand are not good news, with over a hundred new cases in the gay/bi male world in 2009 and a higher level expected over the coming years. Now of course, most countries would love to see a number this low, along with the estimated total of only 1,800 people living with HIV in the entire country. If we include the dead, we're probably at around 3,000 since the start of AIDS in NZ.

While every new infection is a personal tragedy, we actually have a tiny epidemic compared to nearly any other Western nation, and that is a good thing.

It's tempting to point the finger and blame people or organisations, and while blame is counter-productive, there are legitimate questions that must be asked.

The NZ AIDS Foundation gets millions of dollars of government funding every year specifically to prevent the spread of HIV among gay men, and has an Executive Director now paid in the vicinity of $150k per annum to achieve that goal. It is fair to consider just how well they are doing.

Initially the logic behind NZAF was  based on the assumption that an organisation that is run by gay men for gay men, that knows intimately how we live, how we love and how we fuck is best able to reach that group and contain the epidemic. As  has been pointed out again and again, gay men are not going to listen to straight people telling us how to live our sex lives. The Ottawa Charter and its ethos of care by the community for the community was integral to NZAF. That has been NZAF's reason for existence rather than for example,  relying on the Ministry of Health to run this. Family Planning have the job of dealing with HIV prevention in the straight world, and frankly, the Ministry of Health has been happy to have this all outsourced and turned into someone else's problem.

Remember - safe-sex is something that concerned gay men invented to deal with the crisis of AIDS, not bureaucrats in a Ministry or some party policy think-tank.

It is unfair and unreasonable  to expect the NZAF to be the AIDS Police, to be responsible for every time some man has unsafe sex and gets infected or infects another. There are a lot of deeply dedicated people working there who will be unhappy at these figures. But it is fair and reasonable to ask if they are doing the job as well as they could and using their resources in the best way. I along with many others around the country have a strong sense that while the organisation has focussed on improving management and being more professional, all good things,  it has lost respect in core communities, and it is far less engaged with the communities of men it needs to reach, and has less intuitive knowledge of the world of gay men and how we fuck. For example it has no visible HIV Positive staff or Board members. NZAF's strategy comes from the top, from the direction of the Board, and they need to ask themselves just what benefit all their meetings and  reports  have provided in stemming the increase in infections.

People often criticise the NZAF campaigns, but offer no alternatives, or suggest ones we know don't work. Trying to scare people into safe-sex is ineffective, it's been proved time and again that it doesn't work. And as someone living with HIV I get really pissed off with people who suggest campaigns associating us with illness and death. I am not Death walking among you. Having sex with someone who has HIV doesn't mean you will get it. Having unsafe sex with any man means you have the chance of getting it. HIV Positive people are not the problem. Fucking without condoms is the problem.

The NZAF is not to blame, I'd argue that infections would be even higher without it, but it does need to seriously consider what it is doing and ensure it is relevant to the groups it is funded to work among again.

It is unfair and unreasonable to blame the owners of sex-on-site venues: they can not be held responsible for what men do on their premises, and there is no point in shutting them down - men will simply go elsewhere to fuck: no-one would suggest shutting down the internet because so many men meet up there. But do they all do as much as they could to discourage unsafe sex? They take our money, but do they do the best they can to make their businesses conducive to safe-sex?

And how does anyone or any organisation effectively reach into the vast online world of man-on-man fucking and effectively promote condom use? This is where most guys are hooking up now, and it is an incredibly hard place to run a public health intervention.

The initial response to the AIDS crisis was so strong and powerful because it affected so many of us so terribly. It was personal. Our friends and lovers were dying, and no-one cared. Many seemed to think we deserved it, and we got together and fought back. We were criminals. We fought for our rights and made big gains while dealing with a huge communal tragedy of sickness and death. This dual struggle, fighting AIDS and the panic and disgust and prejudice it carried, and fighting for our rights to be accepted as full citizens helped bind together a pretty diverse group of people and push them into action.

There is little to bind together that diverse group of men today, and that makes it harder to keep the safe-sex message clear and relevant to everyone.

Remember, some of the very first safe-sex materials imported into NZ were seized by Customs and labelled pornographic, and at that time it was still illegal for two men to fuck.

Our world today is very different. Society has changed immensely - it's a different world and a lot of gay and bi men have no connection to that past, no understanding of what happened or why. For them, it's not personal. We are constantly told HIV is a chronic manageable condition, like diabetes. And that's true, for most people who get it, not for all though. Hearing this message, and no longer seeing men around us at death's door has an effect. I remember a few years ago how chilled I felt when an 18 year-old boy said to me "I dont see the problem, you've had HIV for years and you're fine."

It seems that very few guys who get infected are ignorant of the risks they ran or what they needed to do to prevent getting the virus. Maintaining long-term behavioural change in a marginalised and messy group of communities like ours is not easy, but it doesn't mean we don't try for it. We should do all we can to encourage everyone to keep practicing safe sex, and give our real and sincere support to those who become infected, not blame them.

The biology of HIV is the same, the way it is passed on is the same, and the ways it can be contained are the same. Condoms work. We know they work. We know how to use them. But sometimes for all sorts of reasons we don't use them.

Perhaps we need to accept that, just like diabetes, just like prostate cancer, just like meningitis, HIV is here to stay and we will always have some new infections every year. Perhaps the debate now should be just what is a reasonable number to expect every year, and what number should ring alarm bells.