Shining a light on campaign strategy

Who knew it could be so controversial calling for HIV prevention campaigns tailored for gay men under thirty?

I’m saying gay men under thirty have different prevention information needs, and good campaign strategy shouldn’t wait until infection rates begin rising before investing in campaigns tailored to meet those needs.

That’s just common sense, and not a very exciting news story, until the AIDS Council disagrees — and then there’s a fight and quick, everybody, gather round! Place your bets and let’s get ready to rumble… In yesterday’s edition of MCV, by Rachel Cook, I read:

‘”Anyone who understands anything about health promotion wouldn’t attempt to blame the ads,” Kennedy said. “We do not agree with Daniel’s analysis and his claim that VAC does nothing for young, gay men is just demonstrably false.”‘

I don’t blame the ads for rising infection rates, and I don’t claim VAC does nothing for young gay men. Putting words in my mouth doesn’t help Mike’s credibility in responding to my concerns.

The hostile response does illustrate why I don’t place much weight on the feedback VAC quotes in support of the porn image campaign’s relevance to men under thirty. When they react with such hostility to criticism, it’s little wonder they don’t hear it much.

In my case, it’s a massive overreaction, since I am broadly supportive of that campaign: infection rates have steadied in the age brackets it was designed for. I’m concerned about a lack of campaigns targeted for men under thirty, and the porn image campaign doesn’t cover them.

Apparently, when they’re not in the country, Mike Kennedy, Colin Batrouney (health promotion manager) and Jason Asselin (health educator) are happy to agree with me. For example:

Kennedy M, Batrouney C, Asselin J (2008) “Shining a light on gay anal sex: community reactions to an explicit campaign promoting condom use for anal sex with casual partners” AIDS 2008 XVII International AIDS Conference (Abstract THPE0387).

They describe holding “focus groups with the campaign’s target population, men in their 30s and 40s” and later conclude “prevention campaigns will need precise targeting and generalised campaigns will be less effective”.

In their own words, the campaign was not developed for (or focus tested with) men under thirty, campaigns need precise targeting, and you can’t rely on a single campaign to fit everybody.

Again, quoting Mike’s own words, the porn image campaign achieved only 40% recognition among men under thirty at Midsumma Carnival. (Okay, the “only” part is mine.)

Coming back to how VAC receives critical feedback: the abstract states “Community responses were generally very positive but an interesting subset of negative responses was demonstrably tapping into internalised homophobia triggered by images of gay sex in public media.”

This makes it clear the authors interpret positive feedback as the general rule and critical feedback as the exception. It concerns me that the Executive Director of an organisation that provides counselling feels it’s okay to diagnose internalised homophobia in men he’s never met, simply because they don’t identify with images/themes in a campaign, and to dismiss their responses on that basis.

Some audience members do experience internalised homophobia; in fact, it’s something we all struggle to overcome. Research by the American psychologists Michael Ross, Simon Rosser and colleagues (2008) in AIDS Education & Prevention has shown a strong connection between internalised homonegativity and increased rates of unsafe sex.

Kennedy, Batrouney & Asselin’s abstract admits the porn image campaign does not meet the needs of those men.

Continuing the theme of VAC not taking critical responses seriously, the abstract suggests “Campaign design should include draft responses to such negative criticism”. In other words, community debate is met with message management and canned public relations messages.

I’m going to conclude with a question: if Mike is right and there was no lack of campaigns targeting young men specifically, why did they just accept Department of Health funding to develop one?

Rising infections in gay men under 30

If current rates continue in 2009, new cases of HIV in gay men under 30 will be double their number in 2007. That goes against the overall trend for gay men in Victoria, which levelled off in 2008.

I have expressed concern in a couple of interviews about the lack of campaigns targeting gay men under thirty — I think the last one was in the nineties. That gets taken as an attack on the current Victorian AIDS Council campaign using porn images, but I actually think the plateau in overall infection rates shows the current mix of campaigns is doing good.

I also acknowledge the Victorian Government Department of Health for funding and coordinating a reinvigoration of our state’s HIV response.

While I think the explicit sexual imagery matches the sexual confidence and sophistication of men in their thirties and above, it doesn’t work as well with younger men, who are generally less confident, more conservative, and dealing with different issues, like coming out and the gay scene.

Not invariably, but generally.

That’s not just my opinion: it shows up in the social research. Garrett Prestage from the National Centre in HIV Clinical and Epidemiological Research has reported that while they have around the same total number of sexual partners as men in older age brackets, younger men tend to organise their sex lives differently, practicing “serial monogamy” (long strings of short, supposedly monogamous relationships).

Campaigns targeting young gay men need to include relationships and the scene as themes, and they need to address prevention issues relevant to guys in relationships.

Older men might remember the campaign advising men in relationships to close out the HIV test “window period” before they stopped using condoms with each other, but there hasn’t been a campaign about that since the nineties; how is a 23yo guy supposed to know that?

I feel quite uncomfortable raising the alarm about rising infection rates, because I don’t think infection rates should be the focus of campaign strategy in the first place.

The cultural processes that influence sexual behaviour are like a P&O cruise liner: they take a long time to stop. So by the time infection rates begin to rise, you’ve got a big job ahead of you, just trying to turn them around; and you are no longer doing prevention, only damage control.

In their report on The Contemporary Context of HIV Infection in Victoria, researchers Sean Slavin and Marian Pitts quote one young newly HIV-positive man saying:

Then I had my risk re-evaluation. I think a lot of people have it in
their early twenties. As a teenager I was really a safe sex fundamentalist. I redrew my risk profile a bit and started taking more mid-level risks, which were fine by themselves. They probably wouldn’t have caused me to convert. Then I started to top bareback. (p17)

Many of the attitudes our campaigns target in men aged 30 plus were formed in the intense sexual and social learning process men undergo in their twenties. It’s just good sense to invest in campaign work specifically targeting gay men under 30. I am only forced to make a fuss about the infection rate because that good sense has not yet been acknowledged.