NEW YORK — Beneath Grand Central Station, the doors of a downtown 6 train open to reveal one of the New York City Department of Health's newest public service announcements: A simple poster with two young men embracing tenderly urges riders to take an HIV test.
When this train lurches away from the platform and another takes its place minutes later, a second ad makes an appearance. It's part of the same campaign and features a different person: Carmen Carerra, a television personality and transgender woman. A third iteration of the ad, scattered across other subway trains, features a heterosexual couple. The accompanying text on all three versions is stern yet not alarmist, reading, “Be HIV sure: One night can change your HIV status.”
The campaign’s goal — to heighten HIV awareness and stem the spread of the virus — is neither new nor unexpected. Experts have long classified New York City as an hot spot of the epidemic in the U.S. Over 110,000 residents are infected with the virus, and in 2013, 2,832 residents were newly diagnosed with the disease.
But the execution of this campaign is novel, a departure from the city’s past anti-HIV efforts. Previously, ominous and dramatic messaging reigned, akin to lurid anti-smoking campaigns. A 2010 New York City Department of Health video illustrated in macabre detail HIV’s ability to cause osteoporosis, dementia and anal cancer. The 30-second spot also featured a cast of distressed young men; no heterosexual couples or women were included.
Dr. Demetre Daskalakis, an infectious-disease specialist who now runs the city’s Bureau of HIV/AIDS Prevention and Control, has spearheaded the movement away from that dramatic tone. Daskalakis — who came from Mount Sinai Hospital — stepped into the role this September. But he’s hardly a routine bureaucrat. He identifies as a “gay health warrior” on Twitter and built a reputation as an advocate willing to deploy unorthodox tactics, like vaccinating for meningitis in nightclubs.
He played a major role in developing the city’s #BeHIVSure campaign, one of two efforts that launched on Dec. 1 — World AIDS Day — with the blessing of New York City Mayor Bill de Blasio. “We’re … focusing on health and less on disease,” Daskalakis said of the campaigns.
The change in messaging is part of a change in policy. Daskalakis is eager to engage the majority demographic that’s HIV negative in efforts to combat the epidemic.
“An HIV negative test is as much a call to action as an HIV positive test,” he said. “Just like there’s a continuum of care for people living with HIV, there’s a continuum of care for people at risk.” They should be educated, tested often and armed with prophylactics, he said. “That’s what #BeHIVSure is about.”
He is implementing the unconventional tactics he introduced as an infectious-disease doctor. He noted that the city will target those who seek intimacy on the Web — “the sex clubs of the future are online,” he says — and bolster messaging aimed at the city’s transgender population.
For the many New York City nonprofits dedicated to battling HIV, Daskalakis’ approach is welcomed.
“The former administration … was very into fear-based messaging,” said Terri Wilder, a spokeswoman for the AIDS Coalition to Unleash Power (ACT-UP). “Fear-based messaging doesn’t really work.”
The city’s new approach has an affinity with these nonprofits’ campaigns. Gay Men’s Health Crisis (GMHC) released a new set of ads on Dec. 15 that eschew alarming statistics; instead, they feature two young men canoodling and smiling. One poster hangs in the low-ceilinged network of tunnels beneath Grand Central that connect subway platforms. “We’re about trust, respect and commitment,” the pink lettering on the ad reads. “I love my boo.”
The campaign — titled “I Love My Boo” — is aimed at a high-risk demographic notoriously difficult to reach: African-American and Latino men ages 13 to 24 who have sex with other men. Anthony Hayes, a spokesman for GMHC, said the campaign looks to unstitch the long-standing scarlet letter tethered to HIV.
“These campaigns are meant to show loving, intimate gay couples in a different way,” he said. He’s quick to commend the city’s newest efforts. “It’s about reaching people where they are, whether that’s a doctor giving meningitis vaccinations in clubs or testing vans going around the city.” (Daskalakis is a former board member at GMHC.)
For those who have lost loved ones to the virus, this shift in messaging is a reprieve from the fear and guilt often packaged with HIV education. But there is apprehension that subdued messaging might belie a still dangerous epidemic.
Dina Wilcox was living in Manhattan’s Greenwich Village in 1988 when her eventual husband, Art, was diagnosed with HIV. When he died in 1991, they had been married just nine months. Art’s diagnosis dovetailed with the city’s unprecedented HIV scare. The number of AIDS deaths in the late 1980s and early ’90s was climbing rapidly and peaked in 1994 with over 8,300 AIDS-related deaths. As a result, Wilcox said, she and Art were met with animosity.
“He was treated like a guilty person,” Wilcox recalls. “The [doctor] said … ‘Start thinking about what you did to cause this.’” Later in the treatment process, one doctor nearly refused to touch Art, Wilcox said.
She said she witnessed HIV transform from a death sentence into a manageable disease — a massive step forward but also one capable of lulling New Yorkers into a dangerous state of complacency.
“Until the number of infections every year go down … we need to be a bit dramatic,” Wilcox said. “I don’t want to stigmatize anyone, but neither do I want anybody to make the mistake of thinking [the epidemic is over].”
“I also understand that living with the toxic drugs you have to take to survive the virus, and the side effects … it’s not an easy ride,” she added.
Daskalakis’ leadership comes at a pivotal moment for New York. The state is now in the unique position to quash the epidemic by bringing the number of new cases each year under 750. (About 80 percent of new cases in New York state are based in New York City.) The city has seen a steep decline in new diagnoses over the past several years, down from about 6,000 in 2001 to 2,832 in 2013.
“We actually, truly can end the AIDS epidemic,” said Jennifer Flynn, executive director of VOCAL-NY, a New York City–based organization that assists low-income individuals with HIV. “It sounds hyperbolic, [but] the rate of getting people onto treatment can for the first time ever outpace the rate of new infections, and we can get ahead of the epidemic.”
“In places even like New York — where it’s the epicenter of the epidemic in the United States — we can talk about getting to zero new infections within five years,” Flynn said.