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An Ounce of Prevention…

Driving through West Hollywood these days, I often see the banners on streetlights and telephone poles with the faces of the “HIV Stops with Me” campaign poster-boys. This public health awareness/HIV prevention program is certainly high-profile, and like everyone else, I hope it does some good to reduce the sadly high number of new HIV infections every year in this country. But I’m not convinced of this campaign’s effectiveness. Do these highly-public faces on posters of real, HIV-positive gay men raise awareness among gay men in West Hollywood and prevent new infections, or do they merely perpetuate stereotypes of “promiscuous” gay men and promote stigma against all those living with HIV as infectious, dangerous, diseased pariahs?

There are so many slogans and opinions bantered about regarding HIV prevention, especially in this era of “abstinence only” education and the debate around the distribution, use, condemnation, or rejection of condoms. But I don’t think enough people are talking about the psychological processes that are underneath these debates about approaches to HIV prevention. In my experience as a psychotherapist specializing in HIV mental health, there other considerations that need examination. Are the people who are “spreading HIV” deranged, sadistic, modern-day Typhoid Marys (pun intended), or are they people who just need to become more self-aware of how their actions affect others? From what I hear in my practice, new infections occur when: 1) HIV is not talked about at all; 2) someone is too drunk or high to remember to use condoms or other safer sex practices; 3) condoms aren’t available; 4) people don’t have the knowledge or skills to practice prevention, or 5) they are too depressed to be motivated to care about taking care of themselves or others. Notice how all of these factors could apply to an HIV-positive or an HIV-negative person – male or female, gay or straight. Implying (as the poster campaign seems to) that it is the sole responsibility of HIV-positive gay men to protect HIV-negative gay men from infection is like the old stereotype among sexually active straight teenagers that it is solely the girl’s responsibility for prevention of pregnancy. It absolves one side of the couple of responsibility when it usually takes more than one person to have sex. All partners could benefit from some self-examination.

My theory is that both positive and negative people need to look at where they stand on these psychological factors, because that’s where the “weak links” are that can ultimately result in new infection. People need to bravely confront themselves on exactly why they find it difficult to talk about HIV, especially with sex partners. They need to examine how substances change their behaviors and ask themselves if they are willing to accept the actions they take when drinking or using. They need to look at what kind of lifestyle habits they need to practice to increase the availability of condoms – put them on the grocery list every month? Pack a few in the glove compartment, gym bag, purse, or backpack? Learn to talk to a partner to ask him to use one? People need to ask themselves how much they know about HIV prevention and then ask someone who knows a lot about it (such as a doctor, social worker, nurse, treatment advocate, or peer advocate) to assess whether they really know enough. They need to be willing to ask themselves if they are at a point emotionally where they don’t care about taking care of their health or the health of others (depression), and they need to slow down long enough to think about whether their spontaneous or impulsive actions might have serious future implications beyond the immediacy of getting off.

This doesn’t mean to say that I’m against sex or that sex can’t be spontaneous and fun, but too many infections are happening nationwide because too many people are acting impulsively without ever bravely examining these tough questions. To know how to protect yourself (and others), you need to know yourself. We kid Michael Jackson all the time, but he really said something important when he sang, “I’m starting with the man in the mirror/I’m asking him to change his ways; and no message could be any clearer: If you want to make the world a better place, take a look at yourself and make that change…”

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