Looking back, look forwards

Ross Duffin, AFAO Educators Conference

Some impressions from coming back into the field Positive Life Project Educators divided loyalties Constant demand for more “prevention

education” Professionalism and the loss of gay / HIV-

positive voices Dominance of thinking that social marketing

as the core strategy Generational shift – transfer of knowledge

Some impressions from coming back into the field (cont’d) Two conversations i) gay men – when and under what

circumstances can we stop using condoms ii) educators – how do we encourage gay

men to stick to persistent condom use

Then - The mythical golden age of prevention Extraordinarily rapid behaviour change Gay organisations seen as incredibly effective and

gay men as ‘good’ and incredibly good at prevention education

The confluence between government, public health and gay community

Being sex-positive in a sex-negative era Mass media coverage The threat that HIV/AIDS was seen as to the

emergent (and recently legal) gay community (cf sex work and IDU)

Everyone was involved in the same conversation about HIV/AIDS (which soon began to splinter)

Now – A period of stasis

Behaviour change going in the “wrong” direction

Public health, AIDS organisations, Gay men and their collectivities, and Governments all have different interests – many masters and confusion from targets

Hard to get traction and program participation The more usual situation for prevention

education – much more difficult task Sexual caution instead of pro-sex

This talk

What lessons can be learnt out of 30 years of practice that lend themselves to practical recommendations

1. Always focus on the big picture

Example of TB versus HIV drug education in Sth Africa

Golden era (and the myths it created), Post-AIDS Now – normalisation, Internet, individualism, HIV

infection endemic, no AIDS epidemic, HIV and Ageing

Practice recommendationsi) Reflective spaces focussed on the big pictureii) Plenaries / conference sessions on broader culture

and contexts

2. Use core educational theory and practice Curriculum, pedagogy Adult education principles Curriculum

How HIV is transmitted (less?) How HIV is treated (less) What characterises HIV disease (less) Technologies of HIV prevention (condoms, biomedical, testing) (variable) The lived experience of being HIV+ (less) An ongoing conversation about appropriate ways to use this information

(problematic) The invisible curriculum

Ways of being / doing gay Normalisation versus sexual cultures

Recommendations Promote and use HARM more (and/or NAM) Regular basic information production Training Strategies to make public the modern lived experience of HIV+

3. There is an ethical obligation to convey information ‘without bias’ Oral sex and re-infection examples Gatekeepers? HIV and Ageing, Undetectable viral

load Spin – and HIV statistics

Recommendations Make public information on HIV and Ageing Produce a regular ‘state of the epidemic’ report

4. Try to work in the current conversations and practices – not in the past

Gay men ‘when and where to give up condoms’ versus ‘how to keep gay men wearing condoms’

1984 – one conversation, 1987 – divergence – testing , negotiated safety – educational response 7 years later. Late 1980s – people using HIV status in sexual negotiations (still no effective response) 1996 – new treatments, gonorrhoea returns, risk reduction outside of regular relationships 1999 – syphilis returns. Education had a decade long struggle with incorporating risk reduction education.

Research documents the past – handing over too much to research (eg syphilis action plan)

The need to take risks in the absence of perfect knowledge or data

Recommendations Set up professional spaces to talk about the current conversations /

issues Develop and document collaborative response to these issues

5. Find the balance between ‘professionalism’ and ‘personal experience’

1980s – sort of rejection of ‘professionalism’ – dominant mode – activism (overlap with Ottawa Charter)

2010 – ‘health professional’ dominant mode – lack of a ‘gay voice’ or ‘positive voice’.

Original reason for funding CBOs (still exists with government) was personal experience

Relationship between connection with constituency and professionalism? Making the constituency ‘other’ and increasing stigmatisation What a gay voice brought to the table (oral sex) and its absence didn’t (syphilis)

Recommendations Practice appropriate places to speak with a gay voice (eg here) (gay men as

‘other’ in the program) Incorporate personal experience into professional practice Organisational policy in regards to disclosure of personal experience ‘Community development’ projects - reconceptualisation

6. A generalist or a ‘specialist’

A number of specialist disciplines and practices impact on HIV Education – education, personal experience, biological sciences, psychology, sociology, social marketing, epidemiology, health promotion, cultural studies…(the scope of what an HIV educator is expected to do and does is way too large)

My experience is that people who pick and choose the appropriate application of these knowledges to particular problems do best at working in the current moment

Recommendations Reality is only a few people with have the skills, ability and

knowledge to work across many disciplines – find them, support them and use them

Management / organisational role to better define some jobs

7. Beyond social marketing

Social marketing has become the most visible and talked about strategy of education – (mainly because in the sector it is used as a vehicle to talk big picture). Our reliance on it comes at a time when it is harder and harder to get attention and because of its familiarity / brand no matter what it actually says is usually read as ‘wear condoms’.

The purpose of social marketing is to create social spaces to talk about relevant issues

A whole set of the ‘toys’ in the health promotion toolbox have been deprioritised

8. Because we care

Why do we still do HIV education? Does it matter?

Not because of a commitment to the past and the ghosts we walk with

Why HIV still matters Individualism versus a ‘culture of care’ The stuff we don’t talk about in regard to

living with HIV being endemic – trust, disclosure, fear….