Healthy skepticism
Condom Country campaign rides a wave of controversy

by John Kennedy

If advertising campaigns are judged by the amount of attention and discussion they generate then the AIDS Committee of Toronto (ACT) has a winner on its hands. The organization's new "Welcome to Condom Country" campaign - designed to encourage safer sex among gay men - is making headlines all over North America, resulting in more exposure than ACT could ever have imagined.

Some ACT supporters are worried, though, that growing criticism of the campaign and possible litigation is shifting the focus away from the important safer sex message.

ACT launched the $400,000 campaign with plenty of fanfare at a press conference held on the first day of Toronto's Pride Week. Aimed at "men who have sex with men (MSM)," the series of advertisements, posters and billboards are modeled after the long-running Marlboro Man ads in the US. The message is simple: "HIV is on the rise in Toronto. Ride Safely."

But ACT's own data, published in the official Action Plan, contradicts this claim. ACT states: "Last year, the incidence of HIV infections was seven percent higher than 1999 and 34 percent higher than 1996" although Table 1 shows no increase in HIV incidence between 1999 and 2000.

Dr. Robert Remis of the University of Toronto Department of Public Health Sciences, who compiled the data that ACT is relying on, says the organization has confused incidence (the number of new infections per year) with prevalence (the number of people living with HIV). The increase in prevalence among MSM in Toronto last year was actually one percent less than the increase between 1998 and 1999.

Carl Strygg of Health Education AIDS Liaison (HEAL) agrees that ACT has misinterpreted the numbers. "It's pretty clear that one really can't claim that there's been an obvious increase in incidence," says Strygg. "Clearly there's an increase in prevalence but that can be taken to mean there are more healthy people living with HIV, which is supposed to be good news. Given that this campaign was launched on Pride Week one would think good news would be worth celebrating."

Equally critical of ACT's message and its timing is Rob Steffler of ACTUP Toronto. "If HIV is not on the rise - which it looks like from their own data that it's not - then the whole campaign is a lie," he says. "In a way it's sort of sad. If, in fact, it's decreasing or staying the same why can't ACT celebrate that instead of associating an increase in disease with homosexuality during Pride Week?"

Nationwide, the number of new HIV infections has been on the decline since 1995. Last year there were 2,104 positive HIV tests reported to the Centre for Infectious Disease Prevention and Control (CIDPC) - down 136 from 1999.

"I tend to feel somewhat cynical about the objectivity of people whose livelihoods depend on inflated statistics," says Strygg. "The fact that the statistics that motivate the ad campaign are fundamentally flawed is very disturbing. I don't think the end justifies the means. We think honesty and integrity are fundamental to this kind of work and we don't see that in the ad campaign."

Strygg adds that HEAL is also opposed to the use of images that are so closely identified with the Marlboro Man. "It uses cigarette advertising to promote what ACT claims are healthy choices when cigarette smoking is so clearly linked to many health challenges. We find that kind of self-defeating as a message." The two original Marlboro men, Wayne McLaren and David McLean, both died of lung cancer.

Philip Morris, the US-based tobacco company that owns the Marlboro brand is also not amused by ACT's ads. Lawyers for Philip Morris are considering legal action against ACT and the agency that created the ads, Naked Creative Consultancy, under international copyright laws. Spokesman Robert Kaplan says the Condom Country campaign is a "blatant" rip-off of his company's long-running Marlboro Man campaign. "We object to any unauthorized use of our intellectual property," says.

ACT's executive director, Charles Roy, does not sound worried. "We have not received any correspondence from [Philip Morris] and I don't expect to receive any correspondence from them," says Roy, who is in Montreal until July 10 attending the Canadian AIDS Society conference.

Even before the Condom Country campaign was unveiled ACT found itself in damage control mode when an ad in the Official Pride Guide declared that "Toronto has the highest new HIV infection rate in North America." Inside the booklet, a message from ACT read: "Toronto now has the highest rate of new HIV infections in North America among gay and bisexual men, and other men who have sex with men." Only after skeptical journal-ists and AIDS activists began to question the claims did ACT issue a clarification: "This statement is inaccurate as Printed. It should have read 'Toronto has one of the highest new infection rates in North America.' ACT apologizes for this error, and regrets the inaccuracy of the statement as printed." ACT also published a clarification in its Summer newsletter.

The creative use of statistics is common at non-profit organizations that rely on ongoing funding from governments, corporations and private donors. In 1997, the Canadian Foundation for AIDS Research (CANFAR) came under fire for using misleading statistics while promoting a fundraising concert featuring female artists. CANFAR's press release warned that straight women under 40 were the highest risk group for HIV infection and stated that "a woman dies of AIDS every two minutes." The statistics, taken from World Health Organization data, may have been true globally but did not come close to representing reality in Canada, where CanFAR's dollars stay.

ACT supporters insist there is some good coming out of all the controversy surrounding the campaign - gay men are once again talking about safer sex and condom use. But critics disagree. "Gay men are always talking about condoms anyway. It's always an issue when you're having a sexual experience," says Rob Steffler of ACTUP. "There's always some sort of negotiating going on whether you choose to use them or not and I don't think this campaign is going to make people talk again. We're already saturated. You're never going to get everybody to use condoms all the time - that's impossible."

Carl Strygg at HEAL agrees. "I think you can encourage people to talk about healthy lifestyle choices, and you can encourage people to talk about whatever options a given organization feels need to be presented without being dishonest," he says. "I think using dishonest means to accomplish that end totally invalidates the entire effort because it's based on a false premise. You don't need to lie to encourage people to talk about the choices they are making in their sex lives."

Letters to Fab, July 19th:

Numbers game

The inaccurate statement in the copy for ACT's insert in the Official Pride Guide was an innocent error that resulted from the speed with which the piece had to be put together and our naivete as an agency in trying to pull off an emergency request for a new client.

The deadline for submitting material occurred less than a week after we were appointed as ACT's advertising agency, leaving only a few days to conceive, write, design, produce and approve the ad. We apologize for the widespread concern that this mistake appears to have caused. Needless to say, ACT have been scrupulous in their attempts to remedy the matter.

On the other hand we are immensely proud of the commotion that the Condom Country campaign has engendered both here and abroad. The sole goal of the advertising was to reinvigorate discussion and top of mind awareness of the need for safe sex practices. The fact that the press, both gay and straight, has chosen to focus on peripheral and frankly specious criticism of the creative concept is disappointing in terms of journalistic credibility, but nonetheless gratifying in terms of heightened exposure for the message.

Simon Billing
naked creative consultancy inc.
Toronto

You are correct in reporting that in one of our documents, the terms "incidence" and "prevalence" were transposed. We apologize for the error and have corrected it.

It is misleading to lull the men in this city into a false sense of security. The bottom line: the prevalence (total number of those living with the HIV) has increased by 34 percent from 1996 to 2000. Yes, this increase is due in part to decreasing mortality rates. However, it is also due to new infections.

Our job is to educate. Either way you look at it, incidence or prevalence, we have a serious problem in Toronto which our Condom Country campaign attempts to address. Everyone must practice safer sex. This is the point of our campaign and the goal we are working toward.

Charles M Roy
Executive Director
AIDS Committee of Toronto

Your article states that "nationwide, the number of new HIV infections has been on the decline since 1995." This is not true. The numbers quoted refer to the number of new diagnoses, not the number of new infections. Incidence is the measure of new infection occurring in a given population. Since persons may be diagnosed many months and sometimes years after they become infected, the number of diagnoses cannot be used as an indicator of incidence. In fact, the Centre for Infectious Disease Prevention and Control estimates that, nationwide, HIV incidence among gay men increased 30 percent from 1996 to 1999.

The estimated HIV incidence among gay men in Toronto of 1.5 percent is very high, in fact about four times greater than the incidence of 0.34 percent observed in 2000 in the Omega Cohort of gay men in Montreal. Among 96 US metropolitan centres studied in 1996, HIV incidence in gay men was greater than 1.0 percent in only five centres.

At a sustained HIV incidence rate of 1.5 percent, a gay man in Toronto aged 20 would have a 36 percent chance of being infected with HIV by age 50.

Robert S. Remis, MD
Associate Professor
Department of Public Health Sciences, University of Toronto

Letter submitted to Fab on July 27th:

To the Editor, Fab Magazine;

Apparently University of Toronto HIV researcher Dr. Robert Remis is not satisfied that the declining number of new HIV diagnoses indicates a decline in new infections. "This is not true", says Dr. Remis in a letter to FAB July 19th. I assume he prefers the fuzzy logic Health Canada uses to argue there has been a rise in new infections since the early 90's. In their publication "National Trends of AIDS and HIV in Canada"* (December 2000) they describe the trend in the number of incident HIV infections from 1975 to 1999 in Canada, as outlined in their Figure 2. They estimate annual new infections "peaked during the mid-1980s at > 5,000", "leveled off to 2,500 to 3,000 per year for the period 1989-1994 before increasing again to approximately 4,200 per year in 1996 and 1999". The problem is they used three distinct methods of calculating estimates for each of the three phases of their trend: "The curve up to 1989 was done by back-calculation, the average for the period 1989-1994 was calculated by a difference in prevalence estimates, and the point estimates for 1996 and 1999 were calculated as discussed in the text." This is foolish nonsense. The fact that each phase of the trend corresponds to a different means of measurement implies that the whole exercise was hopelessly flawed.

As for calculating annual HIV infection trends among various exposure categories, such as "MSM" (men who have sex with men), it is worth noting that by far the biggest exposure category is "Not reported". I recall Dr. Remis said, "It's hard to know. We're basing it on a certain amount of estimation. You're sort of guessing, really." (EYE June 21st)

Robert Johnston
HEAL Toronto

* http://www.hc-sc.gc.ca/hpb/lcdc/publicat/ccdr/00vol26/dr2623ea.html

ACT calls for media censorship of AIDS debate

Dear Community Members, Last June ACT launched the "Welcome to Condom Country" campaign. I'm sure you've seen and heard about it. Most of the comments we've received have been favourable. Some community, members have raised issues about some aspects of the campaign. We appreciate both the compliments and the constructive criticism. But some of the criticism reported in fab and elsewhere is not constructive or valid. It comes from a tiny fringe group that denies that HIV causes AIDS, even that AIDS exists. They are reluctant to state their views clearly so people can decide for themselves how valid they are. But they are always ready to scoff at scientific studies, attack ACT and others who are fighting HIV/AIDS in our community, and make false claims. Their activities suggest they lack of interest in your health and your life. The HIV/AIDS epidemic has caused ter-rible suffering in our community. It has killed thousands of our partners and our friends. Fourteen years ago I was diagnosed with HIV. In the past ten years I have lost two partners to AIDS-related illness. I will not be silent while others claim this illness doesn't exist or that it isn't killing our loved ones. I know only too well the need to confront HIV/AIDS. In 1996 the HIV incidence in Toronto's gay community was 350. That means it is estimated that in that year 350 gay, bisexual or other men who have sex with men (MSM) in Toronto were infected with HIV. Only four years later, in 2000, HIV incidence among MSM in Toronto was 700 - an increase of 100%. Another way of looking at the increase is HIV prevalence. This is the number of people living with HIV in a particular community at a particular time. In 1996 it was estimated that 6,800 MSM in Toronto were living with HIV. In the year 2000 HIV prevalence among Toronto MSM was esti-mated at 9100. That is an increase of 2,300 MSM living with HIV in Toronto. Recent Toronto HIV infections in MSM occurred largely in two age groups. Men aged between 25 and 44 years accounted for 76% of new HIV infections among Toronto MSM. Men aged 30-34 accounted for 24% of new HIV infections among Toronto MSM. These facts point to a tough reality: HIV/AIDS is still with us. It is on the increase after years of decline. It is hitting gay men and other MSM hardest. We do not yet have a cure or a vaccine. I strongly believe that our community can take effective action to head off further increases in HIV infection. We have done it before - which is why there was a steady decline in the numbers for many years. We are not powerless in the face of this disease. We do not need to hide in a fantasy world of denial. I believe that it's time for renewed commu-nity and individual action on HIV/AIDS. You can help stop the spread of HIV/AIDS by using a condom when fucking. Say no to those who want to put you and others at risk by having bareback sex. Challenge those who spout ridiculous claims that HIV/AIDS does not exist, or that HIV does not cause AIDS. Write to the editors of newspapers when they put our community at risk by giving fringe groups a platform to promote dangerous, unfounded theories. Take the time to volunteer at one of our local AIDS organizations. Become better informed by taking part in programs and services at ACT and other organizations fighting HIV/AIDS in our community. Talk to your friends about HIV, about condoms and other safe sex practices. The best way we can show our pride in ourselves and our community is by doing what is necessary to stay healthy. Let's build a proud, healthy community. Sincerely, [signed] Charles M. Roy, DSW Executive Director AIDS Committee of Toronto

If you wish to make your views heard you can write to:

fab magazine
jkennedy@fabmagazine.com

AIDS Committee of Toronto
ask@actoronto.org

If you carbon copy us at we will post your letters at the HEAL Toronto web site.

Dear Mr. Roy,

In a recent advertisement dated August 30, 2001, placed in "fab" magazine, you wrote that dissident groups "are reluctant to state their views clearly so people can decide for themselves how valid they are." This unfortunately is a misrepresentation of the dissident groups, and a typical half-truth used to describe this growing group of people who are seeking to examine AIDS from, I feel, a more inclusive perspective. The dissident information is widely available to all who choose to investigate it thoroughly...but none should go looking for easy answers or quick fixes. Such a statement on your part leads me to believe that you have not seriously investigated the thousands of scientific abstracts and reports written by doctors, researchers, chemists, virologists and retrovirologists, mathematicians, etc., from all over the world on alternative explanations for AIDS and HIV.

Let me next state that I have been HIV+ for 13 years, I too have lost friends and lovers to AIDS, and I also worked for years within the AIDS service organizations. Just like you, I too know something about AIDS. In your advertisement, you attempt to use similar arguments to discredit the dissident groups while establishing for the reader some semblance of your expertise in the matter of AIDS. Unfortunately, none of these sad facts about your or my AIDS experiences makes either of us any more an expert about AIDS, AIDS science, or AIDS statistics than the countless thousands of other gay men and women who share these same experiences. It is a truly ineffective tactic to use this style of argument against dissident groups...in an attempt to discredit them or their theories. A critically-thinking audience should be able to see through this schmooz easily.

Your personal unwillingness to look further into these matters is your own choice, I understand, however in your role as Executive Director of an AIDS service organization, you have an obligation to the community you serve to be better-informed about a subject before writing such damning statements, then presenting it to a public that relies to a certain degree on your objectivity in these matters. AIDS service organizations and those who work for them ought to be more willing to admit that they don't know, if indeed they don't know (and it is apparent that you don't know on this matter). As a member of the community you serve, I could care a less about what you "believe" to be true. I could never stand up with integrity and tell the public, "I know this to be true about AIDS because I have had lovers die of it, I have it, and this is what I have been told about it." Where is the credibility in this? I would trust a doctor that told me, "I don't actually know..." more than any doctor who smugly told me, "You must do this...I am right" (and I have experienced many of these). When I served my AIDS community, I gave them complete access to all ideas about HIV, AIDS, etc...including dissident information...so that they could make truly "informed choices." As I understand it, wasn't it a dissident organization that publicly opened up the misrepresented statistics used in your recent ad campaign? Where is the disservice in this?

I look forward to the day when we can finally close the doors to all of our AIDS service organizations across the world. Don't you? I cannot understand how we can until we all become more willing to hear and objectively examine all ideas that exist behind AIDS, its causation, and its successful treatment.

Sincerely,

To contact us:
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