That's a question you may find staring you in the face as a provocative new media campaign on AIDS and sexually transmitted diseases gets under way in the aftermath of Gay Pride Week and the International AIDS Conference in Barcelona. Running over the next few months, the campaign—using billboards, bus boards, and print ads—is designed to combat a second wave of sexually risky behavior by gays and others believed to have become complacent in the face of effective new AIDS drugs.
"We wanted to try to break through the apathy by getting a little more in your face," explains David Richart of Lifelong AIDS Alliance, which coordinated a county-funded task force that has spent the last year working on the campaign. The task force believed the old approach—an image Richart describes as "half-naked guys touching each other"—had run its course.
The new ads look severe, with pithy white messages on a black background. They are meant to drive home the harsh realities of AIDS and STDs. The campaign also stresses a theme of personal responsibility that veers toward the accusatory. Says one ad: "We're doing a good job of infecting ourselves. So who's getting fucked?"
That approach is bound to be controversial. It is, even among task force participants, who ended a year of often-contentious debate by agreeing on messages that everyone could live with but weren't necessarily crazy about.
"My concern is that it may be a bit judgmental, that it may feed into the notion of shaming gay men," says Fred Swanson, executive director of the Gay City Health Project, which had a representative on the task force.
Quentin Welch, executive director of the Seattle Treatment Education Project, an AIDS group that also participated in the task force, worries that negative messages will compound the already low self- esteem of those with HIV and AIDS. He's grateful, at least, that the task force ultimately shot down an even more accusatory message: "AIDS is a hate crime."
Welch finds that message so offensive, conveying what he believes is a misleading notion that people with AIDS purposefully inflict their disease on others, that he can't even bring himself to repeat the words.
Longtime AIDS activist Kelly Scott, however, would have liked to see the campaign be even more controversial. Scott, a member of the Governor's Advisory Council on HIV/AIDS, questions the prevailing wisdom among public health types that playing on fear isn't effective for changing long-term behavior.
"When people were seen with oxygen tanks on Broadway and covered with lesions—fear worked," Scott says, recalling the days before the new anti-retroviral drugs improved the condition of those with AIDS.
There's a feeling of urgency to this mission. At the recent Barcelona conference, U.S. government officials called for a renewed fight on AIDS in light of new statistics. A study using data collected from six cities, including Seattle, shows that the vast majority of young gay and bisexual men surveyed and then tested were unaware they were infected with HIV.
The numbers are best in Seattle, where 40 percent of those surveyed were unaware. As many as 84 percent said the same in other cities.
Still, Seattle has problems enough. According to Bob Wood, the top AIDS doctor for the Seattle-King County health department, about 400 new HIV infections occur every year in the county. The infection rates are fueled by increasing sexual promiscuity among gay men. A recent survey found that those who use county AIDS services claimed an average of four sexual partners over two months time, up from two-and-a-half partners in the early '90s. Surveys also show an increase of more than 20 percent in the number of men who report unprotected anal sex.
Such risky behavior is spreading STDs besides AIDS. Syphilis, once almost eliminated, is back to pre-AIDS levels, most of it occurring among gay men.
While the ad campaign forges one line of attack, the Governor's Advisory Council on HIV/AIDS has proffered another. It recently published an open letter in gay newspapers throughout the state calling for a return to sexual responsibility.
Wood urges the same in a five-part "Dr. Bob" series of articles that ran in the Seattle Gay News. Wood doesn't mince words as he chastens the gay community for its behavior.
"Particularly scary," he writes, "is that we are the people who pushed broader community and governmental responses in the early years of AIDS, and are now turning our back on the problem."