Notes from 10/19/01 AIDS class

John Messer visitor
Phone
523-7155
email:
jmesser@bloomu.edu

While working with AIDS, Messer studied the relation of self-esteem to disease response

In San Francisco in early 1980s, about time KS started showing up in otherwise healthy looking individuals (good looking, physically fit gay males)

Response of people when someone was seen with KS - like a physical stigmata, people would cross the street to avoid the person

Did some focus groups with self-identified gay and bisexual males, primarily as an information gathering tool for public health authorities.

3 Hour anonymous conversation between men who agreed to participate- tried to get a mix of social classes in the room at the same time. Were aware that the conversation would be observed by public health officials, met the observers after the conversation. Plus, wanted to keep partners separate-easier to talk about sexual matters when your partner is not in the room.

Challenge was to create a double blind study where anonymity was guaranteed (some men were still closeted, wouldn't have participated otherwise)

This createde a situation of transparent accountability---where it was clear to those be asked questions that the researchers were working in the respondent's self-interest and would not get them in trouble by calling in authority or violating their confidentiality. Respondents controlled the process and this was necessary to get them to be willing to talk.

After having run information gathering focus groups, Messer called participants back a couple of weeks later and found:
A lot had changed their sexual practices
None (or almost none) had actually made a conscious decision to do so.

Messer was only one of many who thought more safe sex education would be a waste of money: men already knew what they weren't supposed to do, but were doing it anyway-needed to figure out how to encourage people to act on this knowledge. Thus, their follow-up phone-calls produced a big surprise and important way to intervene on the epidemic.

Kept doing the project, ran 10,000 people (!) through in groups of 12 or less in a 6 month period. All run on volunteer labor (most of these volunteers later died either of AIDS or drug and alcohol related reasons)

Kept mixed demographics in group-sometimes learned a lot from sources least expected to learn from

Project Gained momentum.

Did some random sample surveys (1 1/4 hour survey-amazing- very long, still people agreed to do them)

Also, matched data to reported STD's in clinics (so not just rely on self-reported)

Tracked the changes: Went from 80% unsafe sex behavior to 80% safe sex in gay male population in 6 months in area (findings published in Scientific American)

Similar model used in Switzerland also got same results

Phenomenal change- weren't supposed to see such a dramatic change with any intervention.

Theory is that if you enable and empower the group to change behavior on its own, let them direct it, will get results.

Project slowly disintegrated over next 10 years, but there is a grassroots resurgence; must let the population direct for itself.

Attitude at the time among some gay men:

Straight world condemns me anyway, and now I've got to be scared of sex and wear a condom? No way, too much to handle, I'll go out in flames.

The project never pushed getting tested. Many individuals wanted to live in denial (well education men were especially good at that).

Attitudes and behaviors are widely varied

Subset of African American men "down low" resistance to public mobilization to stop unsafe behaviors. An example of how ethnic culture varies, this will also impact the behavior.

Definition of promiscuity: someone who has more sex than I do. People tend to condemn others.

Justifications/Reasons People use for High Risk behavior:

Just this once, what are the odds ? (Especially young people)
Distortion of public info - homosexuals are the only ones at risk
Demoralization of a group
Deniail- > engage in the behavior, but don't self-identify with it (i.e. turn tricks, but don't think of oneself as a prostitute) (there is a difference between who we are and who we think we are)

People who died the quickest: many were deeply involved in the gay liberation movement, had previously felt most repressed, both by others and by self (for example, if come from a conservative religious background and feel that one's own homosexual tendencies are wrong), then, when finally "came out" wanted to overcompensate for years of oppression.

Other factors for rapid death:

Gay men had discovered that taking antibiotics was a good prophalyctic for many STD's, but this might have compromised the immune system, making more vulnerable to HIV

Also, if you are considered "less than", will compensate in other ways.

Need to have compassion for self and for others- don't try to separate world into we vs. them. We all have our weaknesses- shouldn't blame others for theirs.

Question Session

We talked who the people are who engage in high risk behavior.

One takeaway lesson from Messer's talk is that there are many people doing risky things who are living otherwise regular lifestyles.

We are inclined to demonize IV drug users or gays or others who engage in behaviors judged by "middle America" as deviant and dangerous.

In doing this we imagine that they are some separate group with a strong set of special norms and a separateness from the rest of society.

Messer's story is that there may be a small core of such individuals, but that the vast majority of people engaging in risky behaviors are holding down regular jobs, have families and may be married with children, and they may be successful students.

This, of course, gives reason for us all to be careful about our possibly risky behavior.

It also tells us why it is foolish to stigmatize those who are HIV+. They are us: our friends, family members, and maybe ourselves.