In late June, San Francisco usually looks like the queer Mecca everyone always calls it. The morning fog melts into a misty drizzle, which gives way to a brilliant sunny afternoon in the mid-70s. A crisp breeze floats off the Bay and everywhere in the Castro it's raining men -- model beautiful or just cute enough, under 17 or over 50, half-naked or leather clad -- all holding hands, kissing on street corners and playfully pinching each other's nipples.
This year, on Market Street, above Café Flor, a huge, larger-than-life billboard will leap out, with an image and text few gay bars in any other city would have the guts to hang even in their bathrooms. A guy, in mid-ecstatic groan, will hover in half-tone splendor above the throngs of pre-Pride celebrants. Men will stop to take in, maybe talk about the slogan -- Tops who bareback must be negative -- and the tagline -- How do you know what you know? -- because the sheer size of this explicitly erotic, intensely private sign will seize all lines of sight.
But will the hot type have any staying power? The most recent prevention campaign from San Francisco AIDS Foundation (SFAF), dubbed "Assumptions," made its debut in February, but the real coming-out party is reserved for the Gay Pride fest, which draws upward of a million out-of-towners and major media. The message on the billboard will reappear, along with others in the series, all over this most progressive city -- on bus shelters, Muni station walls and palmcards. Virtually impossible to miss, they will attract media, controversy and more media. But at the parties and parades that make Babylon by the Bay Earth's queer central, for at least a few days, will condom use or even negotiated risk increase?
"The reality of gay men's lives is that they are having sex in the midst of an epidemic," says Brian Byrnes, SFAF director of prevention. "And they have needs that we're trying to meet." For SFAF, as for ASOs from New York City's GMHC to Seattle's Gay City, that appears to mean abandoning the traditional marketing approach of "Safe sex is hot sex" and "Use a condom every time" for a more psychological one. After in-depth interviews with 200 local men who said they'd had unprotected anal intercourse, Byrnes says, "We're raising awareness around the unconscious decision-making, which is based on all kinds of information."
SFAF's prevention team observed a pattern in the logical but flawed assumptions the focus group's risk-takers made, such as that a partner's willingness to top sans latex meant, to HIV negative men, that he was also negative, while a partner's willingness to bottom rubberless meant, to positive men, that he was also positive. According to Byrnes, the goal of SFAF's campaign is to make these back-of-the-brain assumptions public and force a conversation not only between sex partners but in the larger community. "We're trying to increase the control men have over their sex lives," he says. These rhetorical questions about status and safety are answered, in part, at gay.laws.com/, where SFAF has marshaled what limited data exist to substantiate, for example, that it is safer to top than to bottom or to fuck with a low viral load.
A campaign on this scale, in this neighborhood, has an audience ranging from the most sophisticated, open-status guys to the misinformed who have no experience in broaching personal disclosure, still one of the touchiest topics in town. "People in this city have wide gaps in their knowledge," says Steven Gibson of Stop AIDS Project, a 17-year-old prevention group. "It's a challenge. You have to keep your message focused, simple and direct, while still reaching the high-risk audience. I applaud SFAF for having the courage to put the message in your face. It's larger than life."
But is this life as we know it? "Sexual risk decisions are far more complex than that," says Walt Odets, PhD, a clinical psychologist and author of In the Shadow of the Epidemic. "The people behind this campaign have the idea that perpetually raising doubts about whether or not everyone is positive or negative is the foundation for prevention. It's not. It's a foundation for hopelessness. It's better to teach someone how to determine a partner's status."
If any "assumptions" should be questioned, Odets has long argued to the consternation of the prevention establishment, it is those underlying campaigns like this one. While celebrated as a model of so-called new prevention, Odets sees merely the same old poop in a sexy, new package. Until 1985, it made sense to preach condom use for all men and all sexual activities, he argues. But with widespread use of the ELISA test, "One's HIV status can be determined with relative certainty. In an epidemic that engenders hopelessness and doubt about so many other issues, making men feel hopeless about even knowing whether they're negative is not a basis for taking care of themselves." SFAF scores points from many for its pro-sex, pro-gay take, but Odets says the breadth actually undermines the public-health nature of prevention efforts -- targeting the uninfected. "We've never been able to be clear about the basic fact that negative and positive men benefit differently from prevention. This talks to all gay men in the same way -- the more honest campaign would be, How do you know he's negative?"
One question that almost never makes it past the drawing board is the most elemental, Odets says: Did you ask him whether he is positive or negative? "A lot of people never think of something as obvious as that," he says. "Or they veto it. There's so much pain wrapped around this -- for positive men, when they're rejected, and for negative men, when they reject positive men. It's these painful, potentially divisive emotions that have kept us from doing better prevention."
TAKE IT FROM THE TOP
In January 2000, we asked a special focus group for their takes on the San Francisco AIDS Foundation's flower-power launch of their new prevention series. For the campaign's sequel, we returned to our sexperts for first impressions of the second coming.
Brian Byrnes, SFAF director of prevention
"Most of the guys we interviewed said they wanted a direct approach about assumptions. We're trying to develop a visual language for the sexual culture of the Castro, so we adopted a grittier look than last year's high-art campaign."
Steven Gibson, Stop AIDS Project program director
"The first thing I did was call Brian Byrnes and tell him, 'I have budget envy.' In the Castro, there are very few large-scale prevention messages to counter what pharmaceutical companies can afford for treatment."
Michael Shernoff, New York City therapist
"I think they're fabulous. It's risky, in the sense that it acknowledges what's going on. It encourages people to talk with their partners. And they provide a telephone number so you can get more info.The psychology of the message is sophisticated."
Michael Musto, Village Voice columnist
"It forces people to reassess the rationales they've come up with to forgive their own risky behavior. The net effect is, 'Wake up! You're either being complacent or misinformed. Stop assuming you're having safer sex!' The sexy image grabs you, and then the words make you think."