Time for new approach to HIV prevention
Dr Jennifer Power
First published on The Conversation on 20th August, 2012.
The Grim Reaper television commercial is infamous in Australia. Reminiscent of B-grade gothic horror flicks, the cloaked reaper stands in a foggy bowling alley poised to strike down a group of deadpan, but “ordinary” looking, people. As the people are bowled down, a voice booms, “at first only gays and IV drug users were being killed by AIDS, but now we know every one of us could be devastated by it”.
The Grim Reaper appeared on Australian television in April 1987. It was a phenomenal marketing success. Some 25 years on, just about everyone who saw it remembers it. In my mind, the Grim Reaper was part of pre-bedtime viewing throughout my childhood. In reality, the ad ran for less than three weeks. I probably watched it only a handful of times.
The Grim Reaper has come to symbolise HIV/AIDS in Australia. It captured the fear and uncertainty of a time when people were not sure what would happen with this virus. It wasn’t clear how large the epidemic might grow in Australia; there was certainly no sign of a cure and available treatments at the time were not particularly effective.
The Grim Reaper campaign was not without controversy. In some communities, gay men came to be associated with the Grim Reaper and were seen as a threat to the community, rather than being victims of the disease.
The campaign was immensely effective at drawing attention to HIV/AIDS. Politically this was important. The Commonwealth government had directed a lot of funds toward HIV prevention and, although the Grim Reaper was not devised as a political tool, the response to it justified this spending.
The Queensland government has decided to resurrect the Grim Reaper imagery in a soon-to-be-screened television campaign designed to inform Queenslanders that HIV infection rates are again on the rise. The ad features an actor dressed as the Grim Reaper costume while the voice-over laments, “we shouldn’t be having this conversation”.
The Annual Surveillance Report indicates that in 2010 Queensland recorded its highest ever rate of new HIV infections, having more than doubled in the past decade, from 2.8 per 100,000 people in 2001 to 5.4 in 2010.
The Queensland government has responded to this with a new HIV strategy, beginning with the Reaper ad. But at the same time, it has withdrawn funding from the Queensland Association for Healthy Communities (QAHC, the former Queensland AIDS Council) – the very organisation that leads HIV prevention targeting gay men in Queensland.
In Australia, the vast majority of HIV transmission occurs between men who have sex with men. This has always been the case. While heterosexual transmission accounts for several hundred new diagnoses each year, a large proportion of these occur among people who have come to Australia from high-prevalence countries, or whose partner does.
A population-based HIV prevention campaign makes no sense if the flip side includes withdrawing funding to the organisation that targets people most at risk.
The government argues that de-funding QAHC was a response to rising HIV rates — evidence of QAHC’s lack of effectiveness — not an anti-gay agenda. But it would be a concern if HIV prevention in Queensland was to become more conservative, with little acknowledgement of the needs or interests of gay men.
Australia is known as a world leader in HIV prevention largely because the federal government at the time had the foresight to see that community-led organisations such as QAHC were best placed to deliver targeted HIV prevention campaigns to the communities most at risk.
Alongside this, state and federal governments (for the most part) have resisted heavy censoring of safer-sex messages. Health educators have been able to talk openly about sex and produce sex-positive education campaigns. This has been more effective — particularly with lesbian and gay communities — than conservative or morally-driven strategies, such as abstinence education.
The Grim Reaper campaign worked at the time because of its shock value, and because it was accompanied by funding for targeted, community-led prevention campaigns.
The recent rise in HIV rates has occurred in a very different context. A complex combination of issues are contributing to increasing HIV infections, including “safe-sex fatigue” or people’s lowered perception of “risk” in an era where anti-viral treatments are so effective.
The Queensland government may have some success in putting HIV/AIDS back on the public agenda. But debate alone will not curtail HIV infections. What’s needed now are sophisticated prevention campaigns, driven by people and organisations, such as QAHC, that understand the complexities of HIV transmission patterns in Australia at this point in history.
Dr Jennifer Power is a research fellow at the Bouverie Centre, and author of Movement, Knowledge, Emotion: Gay activism and HIV/AIDS in Australia.