Originally published in The Los Angeles Daily News, Susan Abram.

The Los Angeles City Council approved the ordinance in January, after a ballot initiative by the AIDS Healthcare Foundation appeared to be heading to voters in a costly election. But the city still must settle the details of enforcing the ordinance, which would require adult productions to pay a fee to fund inspections and an enforcement program.

"On a symbolic basis, it's extremely important that this ordinance was passed, but we have a lot of work to do," said Michael Weinstein, executive director for the AIDS Healthcare Foundation. Weinstein has long argued that condoms must be used on film sets to protect adult performers from contracting and spreading HIV and other sexually transmitted diseases.

He said that while the debates have cast a spotlight on safe sex for adult film performers, he remains concerned about the city's ability to enforce the law. That's why his group launched another ballot initiative in January that would order adult film producers to obtain a county public health permit. Last week, AHF announced 120,000 signatures have been collected, or more than half the 232,153 needed by June 5 to place the county initiative on the November ballot.

County officials have said enforcing condom use on adult film sets falls within the jurisdiction of the state's Division of Occupational Safety and Health.

Last June, Cal/OSHA invited members of the adult film industry to discuss tougher regulations that would be enforced by the state. A draft proposal was introduced that underscored the use of condoms as a way to protect against HIV and other sexually transmitted diseases. Technically, condoms on porn sets have been required under state law since 1993, but production companies have skirted the regulation.  But the state also proposed additional standards that include testing for sexually transmitted diseases every 10 days among those who perform oral sex without condoms, new rules for cleaning and disposal of clothing and fabrics on sets, and the availability of items such as gloves and eye protection.

A final proposal isn't expected for several months, a Cal/OSHA spokeswoman has said.

Meanwhile, several representatives of the adult film industry have warned that the city's measure could result in lawsuits questioning Los Angeles' authority to enforce workplace regulation issues. And performers have said the established industry protocol of testing for HIV and other diseases every 30 days works better than government interference. That protocol was co-founded by Sharon Mitchell, who began the Adult Industry Medical Healthcare Foundation in 1998. The protocol has since become overseen by the Canoga Park based-Free Speech Coalition.

Performers also have said the industry would move to Nevada, Arizona or further underground. But some, including William Margold, an adult film actor who began working in the industry in the 1970s and who also is a director and activist, disagreed that the industry would leave California. He disagrees with the city's condom ordinance, saying it has gone too far. A former director of the Free Speech Coalition who has advocated for the health and safety of film actors, Margold said the Freeman decision of 1988 made the making of pornographic films legal in California.  And the notion that the industry would move underground also is unfounded, Marigold has said. "There's no underground left," he has said. "The underground was eliminated the minute the computer was created." 

I finally understand the genius of the Village People. It took a few decades. Back in ‘78, I discovered my first pubic hairs moments before the comforting thrill of masturbation. Like the average pre-teen I spent after school hours in the basement bathroom of our banal suburban Ontario home. In the evenings my younger sister had a sick habit of walking in on my evening joystick sessions. Each night I patiently hid under the covers, right ear cozied up to the A.M. transistor radio. Invariably the DJ would make some snarky comment about the Village People before playing “Y. M. C.A.” I never got the remark, or the song. Feeling vaguely turned on by the album cover, I remember being repulsed by the seemingly nonsensical lyrics. I confess to flailing my arms in the same ridiculous manner other people did while dancing to it at weddings. They obviously didn’t get the man-lust reference to it either. A few years later, after visiting the downtown Toronto Young Men’s Christian Association and ‘flirting’ with several once famous now dead homos, the Village People started to make sense. 

Mid-flow forties and only now do I begin to truly appreciation the necessity of embracing queer history. Much of which is oral history. My Elders share with me what textbooks never could. They have taught me that we have always infiltrated mainstream society. We will continue to do so. Not just for us but for everyone’s benefit. Not as consumed by parenting we have the time and space to add our creative flavour to society’s evolving conversation of itself. The last few weeks have taught me the danger of not knowing where we come from. I am amazed how queer history has rapidly transformed from scintillating stories to medical nightmares before being reduced to culturally limiting statistics.

I workout at the Victoria Y. This sometimes amounts to a long soak in the steam room. The pattern follows: straight guys loudly banter on about last night’s game, give us all a headache then leave. Next the old-boys and their stock n’ bond prodigies talk money; (since Jack Layton died and the Wall Street protests however, they are finally a little more discreet about their greed.) Then around 6:30 as they too totter off to their family dinner other guys linger. I linger the same way I use to in T.O. twenty years ago. Sitting in the corner of the same steam-room doing the same stretches, crunches and other related poses, I pump-out the same amount of sweat I used to on the dance floor. 

Steam Room Fever 

We’re both distracted. The young guy busts a move right in the middle of a meaningless conversation I’m having with this long-term queer acquaintance. A decade younger than us, he starts massaging his body and as if he were on some solo tantric-trip. He circulates his hands to all parts of his lithe, attractive body. The Scorpio tattoo underneath his thigh becomes more visible as his routine takes up more physical space on the slippery tiles. My curiosity is more than piqued, so is my friend’s. The door opens and interrupts; towels quickly swish over our excitement. We expect this; factor it into the erotic experience. Titillating but that’s about it.

Towelling off in the dry sauna the younger guy compliments me on my body part and suggests I meet his partner sometime. I smile. Then he asks, “You clean?”

So much happens between the split second of a much-hated question and the stilted response. I look into his eyes to see if he has caught me over-thinking my comeback. “I get tested every 3 to 6 months for STI’s.” Cool, he says. Before the moment’s lost and because I don’t want to be sent to jail, I say, “And in the spirit of transparency, you need to know I’m undetectable.” Then he affably responds by saying, “Oh, so that means you’re clean/clean.” Setting aside the double offence I am polite, “Do you mind if I ask how old you are?” Twenty-nine years old, a year younger than the discovery of the virus. The guy has never heard the term ‘undetectable’. Clearly sexually active, in an open relationship, he hasn’t a clue what undetectable means. I inform him. He leaves. He now knows. It takes a village to raise a fag.

Cold Sweat

An anomaly? Here’s an attractive, uneducated guy sheltered in a relationship where he doesn’t know his condom-covered dick-head from his well-lubed asshole. Then I think back to a week earlier and a conversation I had on Grindr. Again, a highly attractive smart kid, twenty-five and working in an upwardly mobile, affluent career. I say something about queer community. “What’s that?” he says. Disoriented I say “You don’t know what ‘queer’ is?” He laughs, “No, I’m gay. It’s the ‘community’ part.” The kid has NEVER heard of or put the two concepts of ‘gay’ and ‘community’ together. If I weren’t so angry I’d break out in a cold sweat. I piece together anecdotal evidence of the past several months since moving back to the Victoria, B.C.

Gay Rights? “We’ve made it. We’ve got everything we asked for, we won.” I’ve known this friend for a quarter-century. He came out to me at the same age I am now. “I see these younger men fitting in, they don’t need to define the same way we use to. It’s just not an issue anymore.” I think of the book The End of Gay that I refused to read. I desperately need to catch up.

Only recently returning to the city from a quiet rural life I’m troubled to find out many gay men here don’t have gay friends. The only party going seems to be the annual Pride event and a monthly drag show. I learn that the homo programs only have a few guys showing up. “I have more in common with my neighbour’s garden than I do other gay men,” says one former wanna-be trick. I chat with him on Squirt. “Is gay even relevant anymore?” asks another middle age man. He confides in me that members of the local Prime Timers even told him to go back in the closet if he wanted to get a job in Victoria. My blood sours. I want to hurl. Not in anger or disgust, all of which I feel, but more out of fear. Having taken care of my Poz body and my Poz-bodied man for so long in welcome rural isolation I never would have imagined gay culture to slip so quickly into the dark ages again. Others argue that we live in enlightened unlabelled times. We’ve got Glee. We’ve outgrown our past and that’s that. I’m nauseous because like any member of a minority I know that to forget our history means we risk our future and the future of those for which we must stay vigilant. Is gay relevant? Bet my sweet ass it is!

“Help! Fire!”

Privilege puts people asleep. So to lovingly slap folks awake again I forcibly tell them about the latest harrowing statistics: compromising safety and education, 64% of queer Canadian youth do not feel safe at school. Like chalk scraping down a blackboard I press on about the suburb kid who committed suicide two months ago, that no one knew he was gay until a friend of mine, his teenage lover, went to the 23 year old kid’s funeral, and outed himself to the blabber-mouthed, bottle-blonde haired cousin who asked him who he was and why he was there.

I tell the gay-naysayers amongst us about the latest hanging of two young 18 year old boys caught kissing. Right now, consensual queer sex between adults are illegal in about 70 out of the world’s 195 countries (approximately 36%); in 40 of these, only man-on-man sex is outlawed; State-sanctioned murder of our kind. I remind them that historically, before the end of an era, such as the late 20’s in Gay Berlin we fags were all the rage before thousands of us got scapegoated, too.

I remind them that their tax dollars are being used by the self-called “Harper Government” to build future privatized jails (my dark prophecy) that have to be filled by someone. All this in a time when crime is at an all time low and the court system is backlogged and throwing out cases. Then I put it all in the context of criminalization of HIV Poz people: our kind thrown to the neo-con lions of small town judges and going to jail as sex offenders only to be starved and regularly beaten by Poz-phobic brutes. This is what the inmates tell me. I can be persuasive. Their faces remain impassive.

“Undetectable, what’s that?” Maybe an acceptable question many generations from now. “Gay community? What’s that?” Never. I never want to hear that question again. Lives, past, present and future depend on us to keep our stories, symbols and society-refreshing silliness alive. Help! Fire! Where are the Village People when you need them? Are they all dead? We need sassy-cultured, stereotype twisting, super-queer weirdoes now more than ever! We need the play, pleasure and partying of a consciously loving community in order to keep the spirit of our people alive. Gay culture needs a renaissance now. 

 I was given several small books, which I still have to this day and I keep them as a reminder of what was going on then for children versus the improvements in North America now.

Upon reading books, I found that I quickly had to stop because reading about the possible infections was extremely frightening and the thought of Katie getting any of them was just sickening.  Among those listed were blindness and possible club hands and feet.  At that time, when a baby got HIV and had a bad CD4 count when they were very young, there was no turning back. You were told what age they might live to - in Katie's case, two years (she actually died at 9 months - 3 months after her diagnosis).

I remember reading medical journals and trying to struggle through the medical jargon to understand what was going on.  When I went to the Vancouver 1996 World AIDS Conference and listening to Dr. Robert Gallo speaking to a standing room only room, I came out not having understood most of what he had said.

I believe it was the same conference that a group of young people got together and did a "translation of the medical jargon".  It was hilarious because all of us in the room agreed it was much needed.

After the conference, together with Abbotsford Mennonite Central Committee, the AIDS Community of the Fraser Valley and the Okanagan AIDS Society I went on to teach children in schools about HIV.  We usually went out in two's, preferably a man and woman, because it was easier to field questions.

Upon entering one school in Surrey. B.C., I had been warned about the school district and so I asked the teacher if it was a problem saying the "C" word.  She asked me what that word was and I told her "condom", she said "no, that's fine!  Just don't mention the "G" word!" I looked at her inquiringly and she said "Gay".  At that point, I was not sure whether to turn around and leave but decided the teens needed the education.

Many young people asked me why I wasn't coming into their schools and they also told me about how many girls were getting pregnant.  Unfortunately, we were unable to visit schools without the Principal specifically asking the District if we could come in.  There was no curriculum that included us and I still feel this was a big mistake and a disservice to the teens.

I soon found that translating what you know to teach young people is quite a feat.  It helped enormously that Youthco was at conferences to show us how.  There was one conference at the Western Bayshore Hotel in Vancouver, where Youthco had a workshop on how to teach young people. We all crowded in, doctors and everyone, because it was such an effective way of teaching.  It introduced young people to all the fluids in the body by calling them their street names: nasal fluid = "snot", urine = "pee", vaginal fluid and semen = "cum".  In the process of writing the words on a flipchart, kids became engaged and realized this was not going to be an authoritarian view of AIDS but something fun and interesting to listen to.  Once they were captivated, it was easy to move onto the rest of the presentation and gain their trust.

Recently, at a Toastmasters' event, I had to do a speech which was simple in language and cut out jargon and so I did my HIV training for them.  I think many of them were surprised at how little they knew and it was obvious that they would not have been able to teach their children about HIV.

I believe that groups like Youthco, which teach peers about HIV and do counselling, are one of our most important assets and funding to such bodies is essential if we are able to practice prevention and reach youth in a way that they feel comfortable learning and that best suits them.

Bob Leahy: David, thanks you for agreeing to talk to PosittiveLite.com. I want to talk about how you as a professional athlete came out. This happened quite recently, right, in November 2011 on Radio-Canada?  Why did you choose that moment and what did it feel like?

David Testo: I chose that moment because I got to a point in my life where I felt comfortable with all of my surroundings and myself.  I no longer felt like living a double life, and I also wanted to be an example for others out there who might be struggling with the same issue.  It felt a huge weight off of my shoulders and it made me realize exactly how much I was keeping inside from everyone…

BL: You said at the time “I really do regret not having come out earlier. It’s something that I’ve struggled with my whole life and career”. Do you want to talk about that struggle and what that felt like?

DT: In those moments you just do what you have do to get by.  You live a part of your life in denial or survival mode.  I tried not to think about it, but now looking back I would never want to be in those situations again (meaning, where I just couldn’t be myself and truthful to everyone.)

BL: Many people knew you were gay, but it wasn’t “official.”  What happened that made you want to change that?

DT: I was tired of the stigma of gays in sports.  Also recent teen suicides I couldn’t shake out of my mind.  It’s not right and I’m still speechless to this day that we are losing great people from something that is completely normal and not a choice.  I have a strong enough support group with friends, family, and co-workers where I felt comfortable enough to take that next step into the public eye.

BL: The story of your coming out was big news.  Do you think it should have been big news?

DT: Not at all.  I dream of the day it isn’t.  It however is a process and any journey starts with a first step.

BL: You’ve said that before your big announcement most of your fellow players knew you were gay and that they were good with that, but that you also experienced some insults. How hard were those to process?

DT: Initially I took a lot of comments to heart.  I remember even in my last days of playing and traveling I had to make sure I was roommates with a teammate that I knew was comfortable with my situation.  I’m glad I’m not going to have to deal with that anymore.  Not saying I’m retiring, but it’s looking more and more likely…  When I was younger I would react on the field and let it get into my head, but now, I would just laugh and respond with a “Thank you” and “You’re so wonderful or thoughtful”.  It made me laugh.  It changed a lot of other players minds about me to.  I think a new level of respect was won.

BL:  Is there a downside in coming out in sports?  I’m thinking career impact and how easy is it to get signed up if a team manager knows you’re gay.

DT: Definitely a downside.  Until society accepts gays as equal as everyone else there will always be a stigma for gay men and women to fight.  It also puts a target on your back for ridicule. Not everywhere in North America are they as accepting as here in Montreal and Canada.  You have to be aware of that and ready to handle the added pressure.

BL: Do you have a message for other gay athletes who remain closeted?

DT: Yeah I do.  You’re not alone.  Build yourself a support group of friends you trust.  Slowly grow that bigger and bigger and hopefully one day include your family.  When you feel comfortable and ready you will take the next step into the public.  It’s a process, stay strong!

BL: How did you come to get involved in the Male Call campaign.

DT: They approached me, I did the survey and we are both on the same page.  We want to shed light on the community and bring awareness to the public.

BL: Tell us why you think it’s important?

DT: The more awareness we can bring to society and the gay community the healthier we can make it.  We can save lives.  People can participate anonymously and confidentially by calling 1-855-846-MALE (6253) or visit the website www.malecall.ca for more information.

BL: New HIV infections are continuing to occur in gay men in alarming rates, despite years of prevention messaging aimed at them.  Why do you think this is so?

DT: I honestly think it’s because we need to normalize the gay society.  We need to bring light to it.  We need to let the younger generations know it’s okay to be gay.  To love a man or a woman, there is no difference.  Love is love.  Once we can show this and allow them to love whoever they want without a stigma we can start forming healthy relationships and have role-models for them to see and live their lives by.  Now it’s too dark, too hidden.  Even myself I learned to express my liking men in the dark, hidden, anonymous places.  It’s sad but true.

BL: It’s reported that you are single now, after quite a while in a long term relationship. What’s that like? What’s your ideal evening?

DT: Being single was great.  I might have stumbled into someone special now, but it’s still very early…  My ideal evening is a nice cooked dinner at home, a movie, bath, book, and lots of cuddling.  I’m very in the moment so I generally have fun doing anything.  If you catch me out, watch out as well.

BL: Thanks David.

The Male Call Canada study is led by the University of Toronto and supported by national partners including the Canadian AIDS Society, the AIDS Committee of Toronto (ACT), l’Université de Quebec à Montreal (UQAM) and the University of Windsor. This research will collect data about the attitudes, knowledge and sexual behaviours of men who have, or have had, sex with men and will help inform future public health and HIV prevention strategies, help build heal their communities and ultimately save lives.

Testo joins researchers from universities across the country, community partners and a national advisory group to help promote the study, which aims to recruit 6,000 men for a confidential, toll-free telephone survey. Potential study participants can call 1-855-846- MALE (6253) to confidentially and anonymously take the survey. The lines will be open until the end of January 2012.

Today, I wanted to talk about HIV prevention in Canada, in all its infinite varieties  – how we do it and where, with a very personal view of what works and what doesn’t.

As you've probably heard, Science magazine named HIV "treatment as prevention" the number one scientific breakthrough of the year. Time magazine named treatment as prevention its number three medical breakthrough of the year. Big news!

For those who haven’t kept track of research, the Science citation referred to the much publicised HPTN 052 trial that showed a 96% reduction in transmission rates through the use of ARTs.  Treatment as prevention has now taken on a new slant, though, embracing as it does PrEP  (pre-exposure prophylaxis).  Explained Time magazine “Increasingly, studies have shown that the same drugs used to treat existing infections can also help protect HIV-free people from becoming infected. This year, two groundbreaking trials  , , showed that HIV-free people were significantly less likely to become infected with the virus if they took the antiretroviral drug Truvada every day.”

So, yes, a major firming up of what we think might work has occurred.  Is that reflected in the kind of HIV prevention work that Canada is doing?  Well, it depends on which Province you live in.  Each has its way of doing things - and those disparities are making national news. Inevitably some provinces perform better than others and while some will – and do - balk at this, the epi stats which tabulate new infections are a good measure of how well each provincial prevention strategy is working.

You can read the latest all-Canada epi data here. 

A where-to-go list for the provincial breakdowns is found in this CATIE summary.

So why isn’t there just one prevention strategy which works?  There has been a  thirty-year struggle to find a winning formula and perhaps we haven’t found it yet. But a multi-pronged approach to HIV prevention has been the norm for years. Are some prongs better than others? Let’s take a consumer’s look at the main ways authorities – public health, NGOs  and AIDS service organizations -  try to stop the spread of HIV.  We’ll look at gay men’s prevention in particular, as historically more new infections have occurred in the MSM (men who have sex with men) population than any other.

So here they are, in lay-persons terms.

1.You don’t know when to use a condom; we’ll tell you/show you how to use a condom

I suppose there is a time and a place for this – young people’s needs come to mind - but honestly, most of us, gay men in particular, know about condoms. Backwards. Typically this is no longer the stuff of provincial campaigns; we've outgrown it. But there is some amusing stuff out there, like this which both educates and entertains

2. You don’t know the facts; we’ll give you lots to read so that you do.

This  approach is alive and well - the recent TheSexYouWant.ca.campaign from GMSH is an example we featured here. This approach recognizes that with factors like viral load impacting transmission rates, HIV is more complicated than it used to be, so providing written resources  caters to those who like to investigate. One could say it doesn’t reach others who like the short, punchy and sexy messaging that researchers like Simon Rosser say is the way to reach gay men online, including the many who just don’t like to read.  But information-based sites are good, too and needed by many of us..

3. HIV is horrible/a death sentence/causes anal cancer.  Scared yet?

The  best recent example of this is of course the nasty NYC Heath Department’s  “It’s Never Just HIV” campaign. Despite getting the OK by screening panels of approving community members, it was scorned by almost everyone else, including GMHC in particular. (CATIE provides a good review of the evidence surrounding fear based prevention here,  by the way.) Interestingly playwright Larry Kramer (The Normal Heart) applauded this campaign saying “this ad is honest and true and scary, all of which it should be. HIV is scary and all attempts to curtail it via lily-livered nicey-nicey "prevention" tactics have failed”. Trust Larry!  I love him, but . . 

4.You need to get tested. Period.

This makes a lot of sense, doesn’t it, considering that the majority of new infections, at least in the MSM population, are coming from those who don’t know they are infected? (Those unknowing ones, in the early months of their infection, have incredibly high viral loads.)  Many jurisdictions have picked up on this and are pulling out all the stops to spread the testing net as wide as possible. We featured BC’s wide-ranging “It’s Different Now” testing campaign, for instance, here. 

5. We will turn you in to a healthier person, able to make better choices

The new black in gay men’s health promotion, this approach is responsible for spanking new buzz words like “resiliency”, “syndemics”  and “strength-based approaches”. Essentially this approach looks at the whole person, the impact of multiple psycho-social factors and at the social determinants of health to formulate strategies which ultimately result in better decision making. Puzzled by the jargon?  CATIE has a great article which explains all.  While promising, this focus on gay men’s health in a wide sense as opposed to the nitty-gritty of sex acts is inherently ambitious and unless sustained and wide-reaching will have an uphill struggle to make an impact on the population as a whole. But many of the provinces and elsewhere in the world too have their money on this one. Worth a try, I’d say.

 6. Poz? We'll get your viral load to undetectable so that you're not infectious.

This crudely summarizes the "treatment as prevention" approach which I led off this article with.  While adopted by jurisdictions as prominent as China, New York City and San Francisco (and  the United States has said treatment as prevention will become a pillar of its international program) the prime mover and shaker here is Dr Julio Montaner of the BC Centre for Excellence. His province’s “aggressive policies” have an impressive record – the best of all Canadian provinces in fact – of reducing new infections, a fact which has even garnered the attention of the New York Times.  (In contrast, infection rates continue to rise in Canada's most populous province, Ontario and others, and Montaner is making increasingly pointed comments about this.) But the approach isn’t without its detractors (including me, although I’m softening fast) who worry about protecting the rights and long term health of HIVers on meds, or whether PreP makes sense.  So not all provinces have bitten, although there are HIV doctors everywhere who are believers in starting treatment immediately on diagnosis, rather than following current HIV treatment guidelines.

7.Poz? We need to put you in jail if you have sex without disclosing.

Horrible I know, but this counts as a prevention strategy if the Canadian judicial system  is to be believed.  It is after all one of the foundations of criminalization of non disclosure of HIV status.  Does it make sense? Hardly. With its perceived burden on the positive person for negotiating safer sex, leaving the negative partner with no responsibility,  it's counterproductive and leads to more infections, rather than less.  So as a prevention strategy - shout it out loud - this is a dog.

8. We will help you understand why you make risky choices.

Largely missing in action until recently. I’ve always wondered why we don’t examine more closely WHY people take risks, given their knowledge of condoms, HIV transmission and of the consequences of risk taking. Bill Coleman in Xtra said it best “we need help understanding why we make decisions that sometimes put us at uncomfortable risk. Without the emotional dimension of HIV transmission, we’re still missing a big part of the decision-making picture. And we’re still just fucking in the dark.” We are also missing out on hearing why men really like to fuck without condoms, why exchanging semen can be hot, and why we suspend rational decision-making in the heat of the moment. Newer interventions, for instance Ontario’s GPS aimed at positive gay men, sometimes explore these more complex issues, but we have much more to learn in this area.

9. What you are doing is risky, but we’ll try to reduce the harm.

We’re talking harm reduction here, much of which riles the conservatives  - but who cares.  Bring on the safe injections sites, needle exchanges and crack pipes, proven winners all of them.  Even our least progressive Provinces are leaving the States in the dust on this one.

So . . What more can be done?

This comes from one who has opposed it  for years, but treatment as prevention  warrants a second look from the naysayers as a pontential life-saver. That second look includes safeguarding HIVers' rights and grappling with the potential impact of long term exposure to ARTs, which I see in my own body and those all around me, and which treatment as prevention advocates don’t talk much about. But honestly, can we ignore the kind of results that BC is pulling off?

Secondly, testing has to be a huge priority of all provinces.

Thirdly we need to recognise that campaigns, which frequently run for a six month period, or even less are unlikely to produce a sustained result.  We need strategies which are visible over the long term, which work over the long term, but which somehow remain fresh. That’s do-able, isn't it?.

Fourthly we need to be more honest with each other, treat each other as grown-ups and cut back on the paternalism that permeates HIV prevention. There are too many examples of risk data not being shared by educators because we consumers are not trusted with how we will use it.  Examples available on request.

Fifthly we need to be wary of group think, or perhaps more specifically regional group think.  It’s pervasive and it’s costing lives.

Heresy I know, but six, we need to be cautious about prevention campaigns which tackle the social determinants of health as a means of reducing HIV infection. These are societal issues with societal solutions. It is just too ambitious to expect small-scale initiatives to produce large scale results.  Let’s use the HIV sector’s limited resources not to change the world (we advocate for that in other forums) but where they produce the biggest bang for the buck, like for instance, ramped up testing and harm reduction.

Finally we need to take a serious look at RISK from a variety of perspectives. We need to properly evaluate it – and share the results. We need to better understand WHY we take risks and build strategies around those (that’s all of us) who do.

So there are my seven stabs at moving forward. Let’s not pretend this is easy work though. If I’m implied that HIV prevention work isn’t in good, knowledgeable and committed hands, I’ve erred.  But HIV-positive people in particular, it’s my belief, have a lot to contribute to HIV prevention work, whether they work in the system or not. Their lived experience should inform ALL prevention work, in fact.  Hence this post.

So what do YOU think works best?