The Gay Men’s Sexual Health Alliance (GMSH) is a network of front-line workers, HIV researchers, public health, policy makers and community members responding to gay men’s sexual health in Ontario. The GMSH works to establish long-term, goal-oriented, evidence-based strategies, tools, policies and programs that will effectively assist all of us, committed to ensuring that gay and bisexual men in our communities enjoy healthy, full sexual and emotional lives.
John Maxwell is Director of Programs and Services at AIDS Committee of Toronto (ACT). He and ACT have been long-standing members of the GMSH Network and John is a spokesperson for the Our Agenda campaign.
Bob Leahy: Hi John. Thank you for talking to PositiveLite.com. I’ve just been having a look at the new GMSH campaign website, Our Agenda and the thing that has impressed me right away is how beautifully designed it is. But what’s particularly striking is how different a take this is on HIV prevention, which ultimately is, I suppose, what it’s all about. Tell me first about why you’re focussing on mental and emotional health. It’s research-based right?
John Maxwell: Absolutely! Research indicates that some of us can experience higher levels (compared to straight guys) of anxiety, depression, substance use, partner violence, and may have histories of childhood sexual assault/abuse. Some literature also indicates that some gay men who struggle with one or more of these challenges are at greater risk of HIV transmission. This is the case for those of us who are HIV negative or HIV-positive. Ron Stall called this “syndemics” - interacting and intertwining epidemics, or synergistic epidemics. Syndemics are found in many different populations, but are very commonly found in populations that are at high risk for HIV.
So putting this campaign in perspective, I imagine it’s also partly informed by what we’ve learned from previous campaigns - ones from yourselves and others. So thirty years in to the epidemic, what have we learned about what works and what isn’t so successful?
I think the main thing that we have learned is that there is no “magic bullet” when it comes to HIV prevention. No one message, no one campaign, and no single type of ‘intervention’ is going to reach everyone, or have the same impact – because we have so many different lived experiences. Instead, we need multiple and different types of messages and approaches. What we do know (not only from HIV but from other health issues such as substance use or smoking cessation), is that fear-based messages don’t work in the long term: they may cause people to change behaviours in the short term, but don’t sustain themselves. So, scaring (or shaming) people in order to try and get them to behave in a particular way won’t work.
We are of course a long way in Ontario from “use a condom every time” campaigns. But other jurisdictions – I’m thinking of New Zealand’s Get it on campaign in particular - have apparently been quite successful with condom-based messaging, even recently. Why do you think that kind of approach won’t work in Ontario, particularly as all the signs here seem to indicate that condomless sex is becoming more common?
I wouldn’t say it won’t work here – for some guys such messages reinforce what they are already doing, or help guys to use condoms more consistently. And, we’ve had plenty of messages that promote condom use. As I said above, we need a variety of different messages and approaches to reduce HIV transmission. And consistent condom use is certainly an effective way to do this! What’s unique about this campaign is that it wants to get gay and bi guys to start to think more about the ways in which our mental health can have an effect on our sexual health – in other words the link between how we feel and the sex we have.
Mental and emotional health struggles can be common – and are often due to external factors like homophobia, racism, or HIV-related stigma. We want guys who have these struggles to recognize they aren’t alone, and that there’s nothing wrong with them. And, we want them to know there’s nothing wrong (and everything right!) with being gay and that a strong and supportive community can help us to improve our health, support us through our unique struggles, and help us get the lives, and, the sex we want. In essence, we are trying to get guys to think more about the things that may influence their decision whether or not to use condoms when they fuck.
So how concerned are you about barebacking in the gay men’s community, John? And how does this campaign address that?
First off I think it’s important to deconstruct that term. In its broadest sense, barebacking simply refers to condomless anal sex. In the ’90s, still a time of loss due to HIV infection and prior to the advent of new HIV treatment, barebacking was seen as a real transgression against community norms. Today, while the rhetoric has calmed somewhat, the term barebacking remains problematic. Many people tend to define barebacking as intentional condomless sex when a risk of HIV is present. This differentiates it from, say, condomless sex between two people of the same (and known) HIV status.
Often times, surveys of gay men show about 50% of guys reported at least one time when they didn’t use a condom for anal sex. What’s often missing is the context – are they in a monogamous long-term relationship with a guy of the same HIV status? Are we talking about a six-month time period, or one year? Was it only once out of 50 times? Or 50 out of 50 times? Context is key. Are all these guys then ‘barebackers”?
But to answer the question – this campaign will hopefully reach those guys who intentionally have condomless sex too – this just may include self identified barebackers, or not - to get them to think about the motivations behind the sex they are having and to examine whether or not how they feel may in fact be influencing how they fuck.
OK, I get that then. Now I like the name you’ve chosen for the campaign “Our Agenda”. It strikes me as edgy and a bit provocative - which is always a good thing. But tell me about the thought process for choosing this.
We talked about the (potentially) provocative nature of the campaign name - “Our Agenda” - within the GMSH network. We recognized that some may find it political, but we wanted to make the link between the impact of homophobia and heterosexism on our health and wellbeing (including our sexual health). We know that some gay guys experience mental health issues as a result of rejection from family, friends and society. And that can have negative effects on our overall health. We knew that the term “the gay agenda” has been used to suggest that there is something insidious about LGBT people and our fight for social justice. So we chose to reclaim the term and say that we do have an agenda - to create a place where we can strengthen ourselves and our communities, build on our strengths, get the sex we want, help us to make informed decisions and respond to the social issues that influence our ability to enjoy equitable, empowered health.
OK. One concern, John. I’m not seeing a lot specific to poz guys here, yet don’t they have their own set of emotional, physical and mental health issues which impact their own sex lives, perhaps even more than neg guys? Or do you think what you’ve given people here applies equally to poz and neg guys? What’s your answer to that type of question?
When exploring the research – particularly the notion of syndemics – what became clear was that the issues identified apply to both HIV-positive and HIV-negative gay men. Overall, we are hoping to encourage gay men, both poz and negative, to build and/or maintain “good” mental health and we suggest a wide range of strategies for coping with mental health issues or personal disruption in their lives. Ultimately this will enhance their ability to build stronger supportive relationships – and by extension, stronger more supportive communities.
And, as the campaign develops and the website grows, more voices are going to be added through blogs, articles, and interviews. Having poz guys share their own experiences, strategies, and stories will definitely be a part of the campaign to watch for in the coming weeks and months.
Tell me about the wellness wheel. It strikes me as quite unique.
It’s a tool we built to draw visitors into the website and, when using this tool, make a connection between how guys are feeling when they visit the website and the information we have in the site. The wellness wheel is something that guys may or may not want to use, but it can be used to give you a “bird’s eye view” of how you may be feeling in-the-moment and paint a picture about what’s really great in your life now, and, what you may want to pay more attention to. Tools like this can help us reflect on ourselves.
Strategy-wise we see a fair amount of campaigns with a relatively short shelf life - six months isn’t uncommon, and I guess that is in part a function of funding constraints. I’m hearing that you are in it for the longer haul, though. How do you keep things relevant and fresh in that kind of scenario?
The campaign covers a lot of ground in taking a broad look at factors that influence gay men’s overall health and well being – including our sexual health. There are so many interconnected issues that impact how we feel, the sex we are having, and our sense of community. While this first campaign takes a “bird’s eye view”, as the site develops and future initiatives are launched we want to begin to drill down (pardon the pun) and look more closely at many of those issues more closely. As we do this, we will be looking at social media, community engagement, and other ways to keep the conversations going in our communities. So keep checking back!
Guys, we like it. Thanks John and good luck with the campaign. We’ll be sure to follow along.
Our thanks to Owen McEwen of GMSH for arranging this interview.