Can the graphic image of a cancer-ridden anus scare young gay men into using condoms? The New York City Department of Health and Mental Hygiene thinks so. In December 2010 and January 2011, it projected exactly that image into millions of living rooms and laptops as part of a media campaign titled “It’s Never Just HIV.”

Shot in the ominous tone of a horror film, the TV spot shows attractive and anxious young men along with gruesome images of physical deterioration as a voice-over warns: “When you get HIV, it’s never just HIV. You’re at a higher risk to get dozens of diseases—even if you take medications—such as osteoporosis…dementia…and anal cancer…. Stay HIV free. Always use a condom.”

The outcry—and applause—was immediate. Gay Men’s Health Crisis (GMHC) and the Gay & Lesbian Alliance Against Defamation (GLAAD) demanded the ad be pulled, saying the “sensa- tionalistic” and “stigmatizing” spot “creates a grim picture of what it is like to live with HIV.” Sean Strub, POZ founder and blogger, made the case against scare-based ads, also noting that the campaign demonizes gay sexuality and anal intercourse.

But the health department stood firm. It even expanded the campaign to include subway posters. “These ads are hard-hitting and some- times unpleasant—but so is HIV, and silence isn’t stopping the spread,” says the department’s Monica Sweeney, MD, in a videotaped defense of the campaign, adding that in the past decade in New York City, HIV diagnoses among men who have sex with men (MSM), and who are younger than 30, have risen nearly 50 percent—to 747 in 2009. (HIV diagnoses among older MSM declined 70 percent in the same period to 830 in 2009.)

Praise for the campaign arrived from Larry Kramer, legend of AIDS activism, who wrote, “HIV is scary, and all attempts to curtail it via lily-livered nicey-nicey prevention tactics have failed. Of course people have to get scared.”

Many POZ commentators agreed, which isn’t surprising: As Sigma Research shows, such fear-based campaigns appeal to people already practicing safe sex and supporting HIV prevention. And what about the target audience? Ads like this can raise awareness and encourage people to get tested, according to Yale researcher Peter Salovey, but they’re less successful at altering long-term behavior. In fact, research shows these ads can backfire, scaring young MSM into avoidance and denial—consequences that are truly frightening