Tuesday, April 14, 2009

Dissecting the News

All right, I've tried to play nice.
I've tried to focus just on 'Research Worth Reading', because I know that if I spend much time worrying about reporting that drives me nuts, it drives me nuts.

The following paragraph is nothing special. It is ordinary, standard reporting on HIV/AIDS. Which is perhaps a large part of why it is so frustrating.
It is basically a throw-away paragraph in the middle of a recent article in the Miami Herald on a somewhat related topic, but certainly not the main point of the reporting.

"Recent Florida figures show an increase of 48 percent in newly reported HIV cases in Miami-Dade County from 2006 to 2008 and 74 percent in Broward County. This might have occurred because of an enhanced reporting system, said [Spencer] Lieb [, Florida Department of Health Bureau of HIV/AIDS]. Yet, some of the gay population have increased HIV/AIDS complacency, which can lead to riskier sexual behaviors."

So, let me dissect this paragraph, and describe why I find this sort of banal ordinary coverage so infuriating that I can't stand to read anything about gay men's health in the mainstream press, and why over half the reporting in the gay press is equally frustrating.

The reporter notes that there has been an increase in reported cases of HIV in two South Florida counties. Whoa, you may think, why such a large increase, why are there so many new infections in South Florida?
The second sentence gives by far the most likely explanation: that these Florida counties have initiated a program to get more cases of HIV reported - not that there are so many new cases, just that more are being reported to county and state officials. This new program, coupled with the recent encouragement from CDC to do routine HIV testing, probably means that a lot of people who have had HIV for many years, got tested for the first time in the last two years, or got re-tested. And that's why there are so many new tests being reported.
You see the same phenomenon in any community that puts effort into getting more HIV reporting done, and we should expect to see increases in HIV reporting all over the country as CDC's recommendation to test everyone regardless of risk factors gets implemented.

But, the reporter couldn't leave it alone at that. Instead, he went on to find a way to blame gay men for the increase in HIV reports: "increased HIV/AIDS complacency". Why? Why not just keep it simple and to the point - that most likely the increase in new HIV case reports is about reporting procedures, not an increase in new infections. In fact, the reporting of more cases should be cause to celebrate - the main topic of the article is about disclosing one's HIV status to sexual partners. If there are more HIV case reports, then that by extension means more men know their status, and at least have the possibility of disclosing. What's not to love? More people know they are infected, and have the opportunity to use that information to make their lives better.

The first time I heard about gay men "becoming increasingly complacent" about HIV infection was over 15 years ago. I remember because I was among the people who tried to warn the gay community about becoming complacent about HIV.
But after fifteen straight years of becoming more and more complacent (if you believe what you read), one wonders if there is any room to get even more complacent.
It would seem that that gay men must be the most complacent people on the face of the Earth, especially when it comes to getting HIV.

So what's wrong with raising the warning about HIV complacency among gay men? And why is it such an easy scapegoat? A fast-and-ready explanation for any blip in HIV/STD rates that comes across the radar?

To describe someone as complacent (in the context of HIV prevention jargon) implies that they already understand the potential consequences of getting infected with HIV, but just don't care. The dominant narrative about complacency among gay men goes something like this: "I know I might get infected, but I know a lot of guys who are infected, and they look healthy to me. What's so bad about taking a pill every day? At least then I won't have to worry about getting infected any more." It is interesting to note that complacent in the dictionary means something quite different, but that's another story.
So, why this construction of gay men as knowledgable, but unmotivated to protect themselves so appealing?
From the dominant narrative of public health, clothes may make the man on the outside, but choices really make the man. Choices about sex, in this case.
And having choices implies having options. Having options implies having the information to make informed choices. Having information implies sufficient education about choices. And to complete the circle, making healthy choices implies that one values health above other concerns in life.
So, the 'failure' that gay men's supposed complacency highlights out of this network of ideas is that gay men are simply tired of making informed healthy choices.
What are the alternatives? Going backwards through my assertions, it could be that gay men don't value their health above all other concerns in life, implying that we are either saddled with a death wish, or our priorities are so debauched that health takes a back seat to some other need. OK, that's not an appealing picture to paint of gay men (though of course many do take that route, even I'm afraid to say, within our own community).
Perhaps there's a failure of education, that gay men just don't know what their choices are. Well, that implies that either the vast bulk of public health efforts in HIV prevention (educating gay man and others about their "choices") has failed. Whoa, we're not going there! Or, perhaps that gay men are just pain stupid, or naive. Again, kind of a no-starter (although there are plenty of people, even within our communities, who pull out these sorts of explanations regularly).
It could also be that gay men are making unhealthy choices because we're insane, crazy, irrational. Or, as the people who like to rely on these sorts of explanations often prefer to say, that we are so drug-addled that rational healthy choice-making is compromised.

Anyway, you're by now getting the point, that describing gay men as "complacent" about getting HIV is perhaps the least noxious of the explanations driven by the dominant narrative structure of public health.

But that still leaves out what's wrong with constantly describing gay men (or at least some subset of us) as complacent? First off, based on what? Note that there is no reference for the statement in the article, it appears to have just appeared there at the whim of the reporter (or his editor). Second, compared to whom? The implication is that gay men are now more complacent than gay men were in the past (or than men of the same age in years past). I don't know about you, but I don't think I've yet met a gay man who just doesn't give a hoot about whether he gets or has HIV, past or present.
So where are these complacent hordes of gay men?

How else might the reporter have handled this - well, the obvious one would have been to keep it to the point - there was no need to go into new HIV stats in this article. But having gone there, just stick to the most logical, likely explanation, that more tests have been getting done, and therefore more positive results have been coming in. Period. Or, if he really needed someone to blame, how about going after Federal prohibitions on HIV prevention money being spent in a way that might "promote" homosexuality? It's hard to avoid denigrating homosexuality when it's legally prohibited to "promote" it. How about going after "one-size-fits-all" social marketing campaigns that conflate homosexuality with drug use, HIV, and self-pity?
There are so many worthy targets outside the gay community, yet somehow it's easiest to bear the blame ourselves.
After all, we're used to it. Maybe we are complacent after all.

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