More Carrots, Not Sticks: Fighting HIV with Empathy, Not Fear

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A screenshot of Miyako Izabel’s Facebook post

Bakit ba ang anti-HIV campaign sa Pilipinas ay puro pagpapa-cute?

On July 10, 2015, a woman named Miyako Izabel dropped the bomb.


The public Facebook post was a lengthy and impassioned caption to a photo from a 2004 campaign by French organization AIDES.ORG. Shown in the photo which Miyako uploaded was an emaciated, bedridden Wonder Woman, with the phrase “On est tous concernés par le sida” (“AIDS is everyone’s concern”) plastered below the image. 

Miyako gripes that HIV campaigns being done in the Philippines feature beautiful, healthy people, instead of dying AIDS patients. It is something which disturbed her (and that is putting it lightly.)

(Full disclosure: I am the Administrative Head of local HIV advocacy organization The Red Whistle, which recently worked with celebrities Solenn Heussaff, Dominic Roque, and Tom Rodriguez to promote our HIV education drive in Boracay.)

Miyako rants: “Ano ba ang gusto nilang iparating? Na kahit may HIV ka tuloy pa rin ang pagnanasa, ang paglalaro, at ang panghahada? Na maganda at kanais-nais ang HIV kaya huwag matakot? Na dapat magiging happy tayo sa sakit na ‘yan kaya keber lang? Dapat ba tayong magsaya parang nasa picnic, party o orgy? Mukha yatang napakaglamorosa ng tingin natin sa virus na ‘yan. Parang welcome na welcome siya sa ating mga katawan.

Pagod na ang mga mata ko sa kakatingin sa mga hubad, guwapo, at maskulado na umuukupa sa mga napakalaking espasyo sa mga anti-HIV campaign poster. Masakit na rin sa utak. Nanlilito at nagsisinungaling ba sila? Ayaw ba nilang ipaalam sa madla ang katotohanan na pangit at nakakapangit ang HIV? Ayaw ba nilang katakutan at iwasan ang HIV kahit na nakakamatay ito? Bakit di ko nakikita sa mga poster ang mga sakit na ito na nararanasan ng maraming taong may HIV kahit umiinom pa sila ng mga medisina?

As of this writing, her post has garnered 97 likes and 50 shares on Facebook. It has also sparked a heated debate on the Filipino Freethinkers group page which Miyako has jumped in as well.

In the group thread, she further stresses her belief that there is a massive conspiracy to censor images of AIDS patients in throes of agony, and that the only way to combat the rising HIV cases in the Philippines is by scaring people—the youth, specifically.

The question is, is her proposed scare campaign valid–or will pushing for it only serve as a roadblock to the work that has already been done by HIV advocates here in the Philippines?

Gus Cairns, in his aidsmap.com article “HIV prevention: does scaring people work?”, states:

When it came to sexual risk behavior, scare tactics only tended to have an effect on the people who were already ‘low risk’. It might, for instance, cause gay men who were already careful about HIV to avoid sex altogether.

But scare tactics don’t work, they found, on people who are already ‘high risk’; they only scare them further into being fatalistic. While citing ads with positive effects, it found some had negative ones, such as an Australian ad featuring HIV as the Grim Reaper. After that was aired, risk behavior actually increased in gay men who’d seen it.

What people reporting high-risk sexual behavior need instead are positive messages: you can adopt healthy behaviors, there will be positive consequences. Such ‘gain-framed’ messages have been found to work better – at reducing unprotected sex – for high-risk HIV-negative gay men than for HIV-positive ones.”            

Creating unjustified fear of HIV only reinforces the stigma against People Living with HIV and gay men, to which HIV is closely connected with. Also, it further promotes the prudish idea that sex is awful, and abstinence is the only way to prevent HIV.

Promoting abstinence alone (as the Catholic Church loves to do), especially for young people, likewise ignores the nagging biological incentive to gratifying the impulse.

By discouraging sex with excessive conservatism and scaremongering, we will cause harm to the HIV advocacy, as we infantilize the conversation not unlike old people warning children: “H’wag mo’ng gawin yan–sundin mo na lang at h’wag ka nang magtanong!

After all, as economist Steven E. Landsburg says in his controversial but insightful Slate article, “More Sex Is Safer Sex”:

“Reducing the rate of HIV transmission is in any event not the only social goal worth pursuing: If it were, we’d outlaw sex entirely.

What we really want is to minimize the number of infections resulting from any given number of sexual encounters.

He even goes as far as to argue that increased activity by so-called “sexual conservatives” can slow down the rate of infection and reduce the prevalence of AIDS:

“Suppose you walk into a bar and find four potential sex partners. Two are highly promiscuous; the others venture out only once a year. The promiscuous ones are, of course, more likely to be HIV-positive. That gives you a 50-50 chance of finding a relatively safe match.

But suppose all once-a-year revelers could be transformed into twice-a-year revelers. Then, on any given night, you’d run into twice as many of them. Those two promiscuous bar patrons would be outnumbered by four of their more cautious rivals. Your odds of a relatively safe match just went up from 50-50 to four out of six….

If multiple partnerships save lives, then monogamy can be deadly. Imagine a country where almost all women are monogamous, while all men demand two female partners per year. Under those conditions, a few prostitutes end up servicing all the men. Before long, the prostitutes are infected; they pass the disease to the men; and the men bring it home to their monogamous wives. But if each of those monogamous wives was willing to take on one extramarital partner, the market for prostitution would die out, and the virus, unable to spread fast enough to maintain itself, might die out along with it.”

It is a revolutionary proposal, one that will make a lot here raise their brows and clutch their pearls—but the solution which Landsburg proposes at the end of his article is what everyone should divert their energy on:

It is often argued that subsidized (or free) condoms have an upside and a downside: The upside is that they reduce the risk from a given encounter, and the downside is that they encourage more encounters. But it’s plausible that in reality, that’s not an upside and a downside–it’s two upsides. Without the subsidies, people don’t use enough condoms, and the sort of people who most value condoms don’t have enough sex partners.

The topic certainly deserves a lengthier debate, and it is a discussion that should be tackled on with all the key stakeholders involved. But if there is one thing that we must acknowledge, it is that sowing fear of sex and HIV is not the best way to curb the epidemic.

Educating people about the consequences of the disease (minus the sensationalism), enc
ouraging them to practice safer sex, and making HIV testing and condoms both widely accessible and increasingly normal among the youth, will be a better, more sustainable solution to stopping HIV.

There is no need to further fuel HIV stigma and the discrimination of People Living with HIV. What we need in this time of great need is empathy—not fear.
                                            
Like my Facebook page, Writer in Manila, and follow me on Twitter: @evanaguilartan

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