A Canadian campaign which asked gay men “If you were rejected every time you disclosed, would you?” appears to have raised men’s understanding of the dilemmas which men with HIV face. The campaign also succeeded in reducing the number of men who try to avoid infection by relying on men with HIV disclosing their status, researchers report in the October issue of Health Education Research.
The campaign was not intended to broadcast a ‘message’ or give instructions, but to stimulate dialogue within local communities. Moreover the authors suggest that the extensive community consultation which went into its development contributed to the campaign’s success.
Staff from frontline HIV prevention work, public health, government and academia participated in the consultation which identified HIV-related stigma as a priority issue. Moreover they focused on stigma within gay communities as it is manifested in the attitudes of some HIV-negative men towards potential sexual partners who have HIV. The campaign developers believe that there are links between the problems of stigma, disclosure, conflicting assumptions and risk taking.
In particular, some of those involved in this project have previously researched gay men’s sexual interactions in which “potential partners interpret risk by bringing sometimes conflicting and inaccurate assumptions to bear in making decisions about safe sex”. For example, men may make different assumptions about a partner’s willingness to have unprotected sex, with some HIV-positive men assuming that only another positive man would do so, and some HIV-negative men thinking the opposite.
To further complicate the expectations and understandings of men seeking sexual partners, the Canadian judiciary has also asserted that disclosure of HIV status is an obligation for people with HIV before any sex in which there is a significant risk of HIV transmission.
Given the incompatibility of these different assumptions, the campaign was intended to allow men to move beyond the conversations they had within their own social circles and engage in “a more broad based community discussion” about stigma, disclosure and sexual decision making.
The campaign drew attention to itself through press advertising, outdoor advertising, online promotion and community outreach activities.
It was centred on the question “If you were rejected every time you disclosed, would you?”. This question was intended to be sufficiently provocative that it would encourage public reflection and conversation.
Moreover a key part of the campaign was its website. Blogs on the website written by eight different HIV-negative and HIV-positive men invited men visiting the site to respond to the issues raised and to post comments.
Over five months, the web site had 20,844 unique visitors (80% from Ontario), who stayed an average of six minutes per visit. Some 4384 visitors came back to the site ten times or more.
The researchers describe the blog discussions as “lengthy and lively”. Topics included the sources, forms and consequences of HIV stigma; how to separate rejection of the virus from rejection of men who have the virus; the ethics and practicalities of disclosure of status; challenging stigma; and responsibility and consent in HIV transmission.
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