“Just chatting,” I said. ”You must be HIV-positive,” he said.
This post responds to Kane Race’s invitation to comment on PrEP as a provocative object. As this is a blog about prevention strategy, I want to look at the discursive context in which this object is being offered to gay men. PrEP has been posed as part of a biomedical revolution in HIV governance.
The revolution is offered as the solution to three failures:
- Of condoms to completely prevent HIV transmission;
- Of gay men to use condoms all the time as required by (1);
- Of social marketing and community education to achieve (2).
The revolution is being sold to political purchasers (who provide needed funding, policy support, regulatory sign-off) as the way to achieve ‘bold targets’ — in the United States, an ‘AIDS free generation’, in Australia, ‘Ending HIV by 2020′.
The logic is that policy countenancing anything less than 100% condom use is politically unpalatable, but desperate measures are needed: crisis framing and battleground metaphors, you know the drill.
But premising the revolution on the failure of education leaves it in an odd position when it comes time to sell it to the population, i.e. the assemblage of social networks and identities formerly known as the Gay Community.
I’m reminded of two earlier revolutions:
- Negotiated safety, or the ‘Talk Test Test Trust’ campaign, led by ACON in 1996. The first time the HIV sector admitted to the gay public that non-condom strategies could be effective as HIV prevention. It followed intense debate in the HIV community sector over whether this was a step that should be taken and how to codify the strategy in a clear and simple message to reduce the risk of failure (McNab, 2009). Unlike in America, where some HIV doctors to this day recommend monogamy in and of itself as a prevention strategy, the Australian pedagogy on negotiated safety acknowledges and responds to the diversity of relationship types, different extents of being ‘open’, uncertainty (‘are we going steady?’), and ‘infidelity’, by emphasising both relationship agreements and ongoing communication.
- PEP roll-out, when the availability of Post-Exposure Prophylaxis was first publicised to the gay community in Victoria in 2005. The State Government funded the Alfred Hospital to develop a service, which initially saw gay men going to the Infectious Diseases clinic during business hours or the Emergency Department after hours. The Alfred then contracted the Victorian AIDS Council to develop a social marketing campaign after the fact. This treats social marketing as a fancy name for ‘advertising’, rather than a consumer-centred analytical approach that can contribute insights at every stage from designing an accessible service to motivating people to use it (see Lefebvre, 2013).
Social research has subsequently shown much higher awareness and uptake of PEP in Sydney compared to Melbourne, with Sydney providers welcoming ‘frequent flyers’ (as one clinic director put it, ‘better for someone who struggles with condoms to remain HIV-negative’), while Melbourne providers were more likely to be judgmental (‘it’s not a morning-after pill’). In Melbourne, doctors at gay community clinics now provide access to PEP in partnership with the hospital-based service, saving a trip to the E.D. and providing far greater ‘cultural safety’ to people accessing it.
The takehome message? Engage with community educators and stakeholders from the very start.
That’s not happening with the ‘biomedical revolution’. Why would it? See failure (2): ‘education has failed’.
The biomedical revolution in Australia has more or less ignored PrEP — it’s still subject matter for policy analysts, the position you have when you’re not planning to do anything. It has focused instead on early detection and early treatment.
Analytically speaking I’m a functionalist: I don’t look at what organisations say, I look at what they do. That’s essential in this era of strategic communications. Take focus groups, the mandatory starting point for any new project or campaign. It says ‘community consultation’ on the tin, but open it up: you’ll find market research, undertaken in private, intended to extract information, not have two-way dialogue.
Or take campaign websites, like the one for Ending HIV: the label says ‘interactive’, but the functionality is restricted: click here, add your name to a pre-written message, sign up to receive messages. Visitors are offered a subject position that is wholly passive: trust us, we’re the experts. Sign here to indicate your consent.
I think gay men are smarter than that, and I’d expect them to remain more or less disengaged from ‘revolutions’ that started without them. On a hunch, I did a quick free-text search on Recon.com, one of the largest sites for men into kink and fetish.
As any user of personals sites knows, meeting other men is only part of their purpose; they are equally important as a safe space for fantasy and identity play. I searched for the term “prep”, as the search functionality isn’t case sensitive. I was curious to see whether HIV-negative men are responding to PrEP as a provocative object by taking it up in this form of play, or as part of their ‘bid’ to other men to meet for different kinds of play.
- Eighty-eight profiles had ‘prep’ across two separate searches on username or profile text (I didn’t de-dupe, as I’m not doing research and didn’t want to make a table cross-referencing usernames–too creepy).
- Six profiles were clearly talking about PrEP i.e. pre-exposure prophylaxis, some inviting people to ask them about it, one describing his reference as (paraphrase) an obligatory community service announcement.
- Seventeen used it to mean preparing or preparation, sometimes as part of the sexual fantasy encounter.
- Fifty-one profiles referred to prep as a look: a conservative, buttoned-down aesthetic derived from ‘prep school’ and sometimes contrasted with other aspects of identity such as kink or punk or ‘jock’ (athletic).
In this Not-Research exercise I’m more interested in the diversity of usages, but the numbers tell a story as well — we’ve a long way to go before there’s anything like ‘revolutionary’ visibility of PrEP in relevant spaces like this one.
The danger is not that lots of people hear about PrEP and want to give it a go; the danger is that they don’t — that we miss this opportunity to discuss as a community what it will mean to live with endemic HIV.
Instead, we have a revolution from the top down — from the privileged speaking positions of biomedical science and population health — rather than one in which community is involved from the very beginning.
It is framed as an epic battle — ‘bold targets’ and fuck yeah science! — instead of as a mundane and everyday matter of epidemic governance and community health.
And instead of accepting that all prevention strategies are partially effective — including condom use — those who become positive are seen as signs of failure.
This isn’t revolution. It’s the unsustainable same old.
Just to bookend my post about the lame new safe sex ad from THT that somehow fails to sell condoms, here’s a condom ad from Ansell that doesn’t sell safe sex.
Niall over at Dangerous Minds considers this a terrible failure; I’m not so sure. Ansell are in the business of selling their condoms, not safe sex generically, and their strategy here is differentiating SKYN condoms from all the others. It’s sex-positive and it’s honest: it says no more than what most condom users feel about them.
Unlike the THT ad this one makes an explicit statement about benefit: they’re different, ‘this changes everything’, and of course there’s the name SKYN (‘skin’). If someone else who hates condoms sees this ad, tries the product and likes it, there’s your safe sex outcome.
And while I’m not wild about the sexy half-naked woman making ‘come hither’ eyes, I’m pretty damn sure this ad is targeted at men, who still (in this century!) tend to buy condoms. And at least it’s showing a woman who’s definite about what she likes and dislikes. Just… what is she lying on!? Is that bedspread denim?
Just one teensy-weensy little irony here… SKYN condoms are the worst condoms I have ever used. They’re the only condoms I have ever found actually painful. I get that for the receptive partner all condoms can dry out and get grippy and become uncomfortable/painful. The trick is to apply reapply a good water-based lube before you feel any discomfort.
BUT – and here’s where it gets weird – I was the penetrative partner. We used them several times, and I suspect the thinness of the synthetic latex enables it to fold, causing crinkles that pinch the skin.
At the time, we were heading towards a relationship but it was still casual and we hadn’t been mutually tested yet, and the sheer discomfort contributed to some occasions of unprotected sex — only the second time in my life I have done that. But that’s a personal experience and your mileage (inchage?) may vary.
Last night I celebrated a good friend’s birthday at his sister’s restaurant, and this morning I woke with a marvellous hangover. I love an occasional hangover because they’re so reliably easy to fix: toast with marmite and Oxford marmalade, strong black tea, soluble aspirin, Lupe Fiasco, a hot shower, followed by phở gà đặc biệt and cà phê sữa đá for lunch and an afternoon nap. All these little rituals create an enjoyable program for an aimless Sunday. At some point during breakfast, I replied to a tweet by Salman Rushdie.
I was moving pretty slowly at this point and it took me a while to even notice he’d replied. When I did, what I noticed first was the massive derpstorm erupting on my ‘Interactions’ list. You know at a public forum, when someone up the back asks a question, the moderator usually repeats the question so the rest of the audience can hear it? The Twitter equivalent is retweeting someone before you disagree with them, so others on your stream can make sense of your objection. But Sir Rushdie didn’t do that: he replied directly to my tweet and his followers gleefully piled on, all of them tragically mistaken as to what I had replied to him about.
It wasn’t about the word, ’heroine’. It was about his completely illogical argument:
Caster Semenya ran into trouble, if you’ll pardon a small sporting pun, because her performance on the field outstripped what’s expected of women athletes. An Observer article claims “The IAAF says it was obliged to investigate after Semenya made improvements of 25 seconds at 1500m and eight seconds at 800m – the sort of dramatic breakthroughs that usually arouse suspicion of drug use.” Yet the IAAF ordered gender verification testing and failed to protect her confidentiality in the process.
It’s impossible not to sympathise with Semenya over the ‘ordeal by gender’ she underwent. Nonetheless, to conclude that she was vindicated by gender verification testing would be to accord that process far too much credibility. It remains a deeply controversial procedure involving arbitrary line-drawing exercises amid the kaleidoscope of multi-factorial influences on primary and secondary sex characteristics. It was designed to pick out ‘impostors’ — people competing as women who were ‘really’ men — at a time when the sheer diversity and number of different intersex conditions was not well understood.
In the light of our new understanding of gender as a spectrum rather than a binary, ‘verification’ testing is begging the question. Let’s imagine the ‘verification’ test instead said Caster Semenya was intersex, or that her physical sex was male. To compete in the Olympics, she would first be required to undergo gender reassignment surgery. This is analogous to the social model of disability: the impairment isn’t purely physical; it’s equally caused by the impoverished concept of gender used in élite sport.
Hence the challenge I posed to Sir Rushdie: why support the system of binary gender differentiation that creates this kind of dilemma?
The answer has nothing to do with honouring Caster Semenya. If you read it carefully, his tweet makes very little sense. How can Caster Semenya be a ‘bigger heroine’ than two people not capable of being called a heroine? Unless gender doesn’t matter to heroism — in which case, why even register the difference? It would cost nothing and make more sense to write about ‘greater heroism’, but that wasn’t Rushdie’s real interest.
No, the answer comes from the delighted outrage of his followers. Sir Rushdie wasn’t offended by my tweet; he wanted an excuse to rant about “PC language policemen”. He was primed and ready to respond and didn’t even notice my tweet wasn’t about word choice. We’ve seen this before, when Justin Shaw and Ben Pobjie wrote about ‘hysteria’. It’s baiting up a crowd, getting them ginned up for action. And they lapped it right up: huzzah, a chance to rant about political correctness and prove I think alike with Salman Rushdie! Many of his followers were so concerned about the decline of the English language, they forgot to use verbs.
It was Britain that created a television show for Grumpy Old Men. And a spinoff, Grumpy Old Women. Given the thrust of this post, let’s collectively noun them Grumpy Old People, and permit me to abbreviate that to GOP. (Which may give you a clue as to how such people are positioned in American society.) Although they needn’t be old, there’s a strong correlation of GOP-ness with increasing age and self-importance, along with Relevance Deprivation Syndrome.
While I could quite happily watch 12 hours of Clive James in a sitting, his brand of mordant critique isn’t the usual fare on such television shows: instead, they’re invariably full of whinging about the price of milk (increasing) and the standard of English (declining). No, the essence of GOP is trivia, and that’s what’s so sad about this little tiff on Twitter. It’s Salman Rushdie performing cheap tricks for the peanut gallery; the smallness of it is depressing. This incredible writer, brain the size of a planet, seeming unable to perform the most basic forward thinking about ‘how my endorsement of wider gender norms might reinforce the specific instance I’m decrying’. Going from trolling an entire religion (if you’ll permit the exaggeration) to trolling a couple of feminists on Twitter. And when challenged…
Britain’s largest HIV organisation, Terrence Higgins Trust (THT), has just launched a new safe sex campaign advertisement, misleadingly titled “Condom Moment”:
New it may be, but it feels awfully familiar. For reasons I’ll explain, as a piece of marketing it makes literally no sense, but as a safe sex advertisement, it’s totally recognisable. That’s interesting in itself: it suggests the safe sex campaign has become a genre. Like harrried-mum-with-air-freshener and car-on-a-winding-road-with-Sting-or-Enya clips. No longer trying to persuade anyone of anything, you’re just taking up time before you shove your logo in front of the audience to maintain brand recognition.
That sucks because it seriously constrains your options for future innovation. It’s like the joke about two old men who’ve been fishing together for so long they have numbered their jokes. ”No. 45! — and they both fall about. A new guy tries it on, “no. 92!” and they scratch their heads: “Are you sure you’re telling it right?”
As marketing this piece makes no sense because it’s a condom ad that fails to sell condoms. It starts with couples getting frisky in unusual places, then presents a slow-motion montage of grim faces, frowning, anxious, fearful, awkward, pulled out of the moment by a rising crescendo of worried whispered thoughts. As a fairly think-y person, this resonated with me; it often takes me a while to shut down my brain and just get in the moment. But then the ad ends and coloured text appears, telling the viewer to use condoms. And that’s not an ending, it’s a Powerpoint slide. Whatever happened to ‘show, don’t tell’?
The ad could have shown one of the partners whipping out a condom and the other showing visible relief and redoubled enthusiasm as their worries evaporate and they get back into the moment. You know, actually marketing the product, i.e. condoms, and the benefit, worry-free sex. Instead, they stuck to the genre of the safe sex PSA, concluding with an imperative textual instruction. At which point I was literally shouting at my screen and calling for the campaign manager’s head… I really need to dial back my coffee intake.
In the comments, someone objected to the stereotype of gay men getting it on in a toilet, and THT made a very telling remark in reply:
We agree it would have been fantastic to have more couples in different locations, but – with a limited budget and tight schedule – we understand why the team who donated the clip had to focus on the most visually compelling shots.
As a social marketer this rang some Big Ben-sized alarm bells for me. ’Donated’ is not a good word in this context. It’s hard enough getting an agency you’ve commissioned to stick to the brief, as I have personally and recently experienced, but it’s even trickier when the agency is donating the work. You need a lot of clarity in the roles each party will play in co-constructing the message.
In this film, there is some evidence of front-end input of focus group or interview findings on the reasons people give for not using condoms, but it flubs the ‘product P’ — one of the most basic elements of the marketing mix. It looks like the film maker was either briefed badly or didn’t take the brief, but it ends with the THT logo and so they’re ultimately responsible for it.