Black MSM focus of new HIV campaign

As the country's AIDS epidemic enters its fourth decade, the federal government has launched its first targeted effort to reach African American men who have sex with men about the need to know their HIV status.

The campaign, dubbed "Know Where You Stand," aims to increase HIV testing among black MSM ages 18 to 44. It is being launched in 14 cities, including San Francisco and Oakland where billboards have recently gone up featuring a photo of a 20-something black man alongside the message "Get Tested. Know More."

Banner ads carrying the same message are also running on several websites that draw a predominately black audience online, including LOL Darian, Black Gay Chat Live, and Downelink. The campaign will also have a prominent presence at numerous Black Pride events across the country this summer.

"I think the first action we hope everybody takes is to get into some kind of system of care that allows them to be HIV tested on a regular basis," said Ernest Hopkins, the San Francisco AIDS Foundation's legislative director.

Hopkins was part of an external consultant work group comprised of 19 black gay MSM community leaders, researchers, and key stakeholders the Centers for Disease Control and Prevention convened to help it conceive the campaign and its various components. He said it is the first time he can recall federal health officials establishing such a committee.

"I would say it is the first time they have gone through this kind of a process where they have intentionally brought researchers, clinicians, community-based providers, and advocates to the table to actually go through the literature with them and test campaign ideas to really begin to understand what would be needed in order to address this population in a culturally appropriate way," said Hopkins.

Another member of the CDC working group was Venton Jones, 27, a gay black man who lives in Washington, D.C. and is the senior program associate for communications and member education at the National Black Gay Men's Advocacy Coalition. Jones said the campaign's message of "knowing your truth" conveys to other gay black men that they need to not only get tested for HIV but need to pay attention to their own personal health.

"It is powerful just in the title itself to know where you stand and that is making sure you get tested, and if you are positive, to start treatment," said Jones, adding that the message for negative men is to be "tested every three to six months."

The Know Where You Stand campaign is part of the multi-pronged, multi-year national public awareness effort known as Act Against AIDS that was launched in 2009. The government is spending $45 million over five years on the campaign, which has numerous parts geared to different demographics.

Another campaign that also launched this year, and is also aimed at black MSM and other gay and bisexual men, is called "Greater Than AIDS." It features several San Francisco residents and is the first AIDS-related advertising campaign not associated with a clinical study or drug trial to be seen in the Castro in some time. [See story, page 4]

Due to scarce funding dollars, in recent years many local agencies either have been unable to afford their own HIV prevention campaigns or have scaled back the campaigns to be more targeted in their placements and not as widely circulated. The most recent campaign from the San Francisco Department of Public Health, according to its http://www.sfhiv.org website, was called "Disclose HIV" and ran in late 2006 through early 2007. It featured psychedelic-colored images of male couples and encouraged sexual partners to talk about their HIV status.

It has been 22 years since the federal government last funded its own nationwide HIV prevention campaign. A significant component of the new effort is aimed at reaching gay and bisexual men because they remain the group most significantly impacted by the AIDS epidemic in the United States.

Black gay and bisexual men are the most disproportionately affected by AIDS.

In San Francisco, African American men account for the highest incidence rates of HIV cases among men, according to the 2009 HIV/AIDS Epidemiology Annual Report, the most recent available. The report stated that while white men saw "a declining trend" in HIV case incidence rates between 2006 and 2009, the incidence rates for men of other race/ethnicity groups remained "fairly level."

In 2009, stated the report, the incidence rate of cases diagnosed with HIV per 100,000 population was 181 among African American men, 139 among Latino men, and 96 among white men. As of 2009, the city reported that 1,026 black men were living with AIDS, only 36 of whom identified as heterosexual. An additional 644 black men were living with HIV, with 24 identifying as straight.

According to a 2008 CDC study, one in five MSM in 21 major U.S. cities were infected with HIV, and nearly half (44 percent) were unaware of their infection. The study also found that 28 percent of black MSM were HIV-infected, compared to 18 percent of Hispanic/Latino MSM and 16 percent of white MSM. Of the HIV-infected black MSM, 59 percent were unaware of their infection.

"Obviously, the CDC has been concerned for some time about the impact of HIV on African American men who have sex with men in the United States," said Dr. Richard Wolitski, the openly gay deputy director of behavioral and social science at the CDC. "The epidemiological data has really driven our focus on African American men who have sex with men. That and other data really pointed to a need to increase HIV testing in these men."

Wolitski said the CDC has designated $2.5 million toward developing the Know Where You Stand campaign. It spent $900,000 to develop the first phase of advertising, with a second round to be launched in the fall.

The CDC is also conducting research in the black MSM population, he said, but has yet to publish its findings. And a separate campaign focused on Latino MSM is in the works, said Wolitksi.

"Obviously, the most urgent need is African American MSM given the disproportionate rates of infection," he said.

Simple message

The simplicity in the new campaign is in stark contrast to the infamous "Homoboy" ads the San Francisco public health department's HIV prevention section unveiled in 2005. In that campaign, the city's first targeted at young black MSM, ads and a website showed young black men decked out in hip-hop attire.

The controversial campaign used the tagline "Don't be a bitch," which was meant to encourage the men to not engage in unsafe sex. It provoked mixed reactions among health workers focused on that demographic.

Those behind the CDC's new campaign said there was no need to use visual gimmicks in the advertisements. Rather, they opted for simple designs that convey a powerful message.

"The genesis for this approach really came from that expert advisory group that very strongly felt we needed an uplifting and empowering message," said Wolitski.

That message, in Hopkins's eyes, is that black MSM have options and that HIV infection should not be seen as an inevitability.

"My hope is they will think about themselves and say I am worth protecting and I have a future and my future is going to be easier to achieve if I am not infected with a chronic disease that I have to manage for the rest of my life. I can live a long healthy life without HIV and that is what I prefer to do," said Hopkins.

Jones said he can see himself in the ads and hopes that other young black men feel the same sort of connection.

"One thing that was powerful to me is the CDC and the advertiser creating these materials were able to listen to black MSM who were part of the planning body for this," said Jones. "It really required some real thought into it."