Explicit Ads Prompt a Review of U.S. AIDS Prevention Grants

Federal inspectors have embarked on a comprehensive review of AIDS prevention grants, spurred by fears among some legislators that the latest marketing campaigns aren’t working and exceed the bounds of good taste.

“Where’s the data that all the billions we spent over the last 10 years has slowed or stemmed the spread of this disease?” asked U.S. Rep. Dave Weldon (R-Fla.), a physician who strongly supports the inquiry. “Just because somebody wants the money--and claims it’s for a good purpose--does not mean we should necessarily keep giving it to them year in and year out.”

An initial audit, in October, led federal health officials to chide a San Francisco prevention agency for inappropriate and potentially obscene workshops, including two events called the “Great Sex Workshop” and “Booty Call.”

Inspector General Janet Rehnquist, daughter of U.S. Chief Justice William Rehnquist, found that the workshops by the Stop AIDS Project appeared to directly promote sexual activity. That, she said, would be inconsistent with guidelines adopted by the U.S. Centers for Disease Control and Prevention. Stop AIDS received $698,000 from the CDC in fiscal 2000.

In response to Rehnquist’s report, Health and Human Services Secretary Tommy G. Thompson promised more widespread audits.

Leaders of several AIDS prevention agencies say that they fear that the audits will squelch--or have a chilling effect on--creative campaigns that use sexually suggestive language and photos to promote safer sex. They are especially worried because under the year-old Republican administration, they don’t have the backing inside the White House that they once did.

“I am concerned that sometimes these politicians decide that they are against something because it’s a good press hit,” said Larry Kessler, executive director of the AIDS Action Committee in Boston. “But they have no real knowledge of what they’re speaking out against.”

Prevention groups insist that their programs work, although that is difficult, if not impossible, to prove.

“In the context of prevention . . . it’s much more difficult to identify success,” said Charles Henry, director of the Office of AIDS Programs and Policy for Los Angeles County. “How do you identify [infections] that didn’t happen?”

Advocates say there’s an urgent need for messages targeted at groups most at risk for HIV. For instance, in minority communities, prevention groups say that they must gear messages to men who identify themselves as heterosexual but still have sex with other men. Those men often are at risk of infecting unwitting female partners, as well as male lovers.

Need to Target High-Risk Groups

In addition, advertising aimed at the gay and bisexual community in general is often sexually provocative, so reminders about safer sex must be explicit to compete for attention, advocates say. Tiptoeing around the subject doesn’t do anybody any good, they argue, and expecting widespread abstinence is farfetched.

Groups such as Stop AIDS, for example, say it is more effective to combine prevention messages with positive images of sex. Stop AIDS program director Steve Gibson said his group’s own surveys show workshop participants go on to practice safer sex.

“Frankly, to be effective with this generation, we’re going to have to be really great marketers and use every bell and whistle that people who sell us athletic gear, alcohol and other creature comforts do to promote a certain type of social behavior,” said Lee Klosinski, director of education for AIDS Project Los Angeles.

Klosinski and others say they are suspicious of the motives of Republican legislators who want to reduce the amount of money spent on prevention programs. The government has budgeted $691.5 million on domestic prevention for fiscal 2002, a $38-million increase over last year’s budget.

Critics, meanwhile, wonder why the prevention message isn’t simple abstinence from anal intercourse.

“At some point, you have to say: What are we getting for our money?” said Weldon, who treated AIDS patients in San Francisco in the early 1980s.

Conservative legislators note that progress against the disease has slowed. New HIV infections occur at a now-steady rate of about 40,000 per year. The number of HIV-infected U.S. residents is estimated at a record high of up to 900,000.

Ad Campaigns Draw Fire From 2 Sides

Prevention campaigns have recently come under increasing criticism inside and outside government circles.

A San Francisco prevention campaign was deemed too provocative last year, for example, by forces in the private sector. An ABC television affiliate rejected a commercial containing topless gay and bisexual men and a transgendered person. KGO-TV Channel 7 officials said the messages and images were inappropriate for daytime television. They offered to run the ad after 10 p.m., but the group said no.

Flare-ups have occurred elsewhere, as well. In September, the mayor of St. Louis ordered eight billboards removed because they featured two bare-chested African American men in an embrace. The message: “Before the love begins, get tested. Know your HIV status.”

Ed Rhode, a spokesman for St. Louis Mayor Francis Slay, said the eight removed billboards, funded with a Centers for Disease Control grant, were too sexually explicit and not appropriate for the neighborhoods in which they were installed. They were replaced with less objectionable messages, he said.

“We just didn’t think it was very wise to have those types of photos in a residential neighborhood where children can see them, and near churches and schools,” Rhode said. “The folks’ hearts were in the right place. I just don’t think they went about it very smartly. They ran a bad campaign.”

Dana Williams, whose group helped develop the St. Louis campaign, said: “People need to take their heads out of the sand and get real about this issue.”

In June, a media company pulled 13 bus shelter ads sponsored by the Bronx Lesbian and Gay Health Resource Consortium, responding to complaints from local residents. The caption read: “I’m not gay, but I sometimes have sex with other guys. People don’t understand.”

The creative agency behind the rejected San Francisco commercial said some of its AIDS prevention clients are starting to censor themselves. Les Pappas, president of Better World Advertising, said clients want to tone down their own campaigns because they don’t want to be singled out for scrutiny in the new round of audits or face public repudiation. Pappas wouldn’t identify those groups.

“We’ve already seen a chilling effect,” Pappas said. “Just the threat of these audits and these reviews has made people a lot more cautious.”

Renewed Debate Over Explicit Warnings

The current debate over prevention messages aggravates old tensions over how explicitly the AIDS threat should be addressed. In the early years of the epidemic, AIDS activists derided politicians, including former President Ronald Reagan, for their failure even to mention the word AIDS. And in 1987, the three major television networks rejected a documentary in which a man demonstrated how to put a condom on a banana. The program ultimately ran on public television.

Prevention advocates say that the present dispute, however, is flaring at a crucial time, just as health officials and prevention agencies are urgently trying to combat a resurgence of risky sex behavior among gay and bisexual men.

Scott Evertz, the Bush administration’s openly gay AIDS czar, said Thompson supports giving local officials control over prevention efforts in their communities. Although Evertz said he is “not overly concerned” about the federal audits, he fears that organizations that are “really pushing the envelope” may bring unwanted scrutiny to prevention groups in general.

AIDS activists and conservative legislators say they share the goal of making prevention programs as effective as possible.

“There’s no question that what has been done is not working anymore,” said Roland Foster, an aide to the government reform subcommittee headed by Rep. Mark E. Souder (R-Ind.), who called for the audits. “Why don’t we consider alternatives that haven’t been explored?”

Gibson, of Stop AIDS, takes a different view, warning that the audits could bring about an overall retreat on AIDS prevention.

“If agencies feel like they’re going to be pushed to the limits [by auditors], they’re going to be less likely to take chances. Prevention will suffer in the long run.”