HEALTH4MEN RESPONDS TO DRUG AD FURORE

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The ad that caused all the trouble

Health4Men has responded to claims that it is promoting illegal drug use through an advert targeting gay men who use drugs.

Published in the latest edition of Cape Town’s Pink Tongue newspaper, the ad shows the contents of Health4Men’s ‘drug harm reduction pack’.

The pack includes condoms and lube, as well as drug paraphernalia such as straws and a card to ‘cut’ lines plus a candle and foil to ‘cook’ drugs.

Titled “between the lines” the ad advises that “if you use recreational substances make sure you play responsibly – your health is on the line”.

Following a complaint by Donovan Steyl, Health4Men received stinging criticism from Christina Engela of SA GLAAD (South African Gay and Lesbian Alliance Against Defamation).

She said that the advert does “untold harm to the image of the Pink Community” by linking it to drug use. She also argued that the campaign and the harm reduction packs would “facilitate and positively reinforce [drug users] into continuing to use drugs”.

Glenn de Swardt, Programme Manager for Health4Men, which provides sexual health services to men who have sex with men, responded to the accusations to Mambaonline and explained the organisation’s rationale for the advert and its drug harm reduction packs.

He pointed out that research had shown that “our community has a serious problem regarding drug abuse” and that there is a “direct link between substance abuse and sexual risk-taking behaviour”.

De Swardt argued that, “There is considerable international research available indicating that harm reduction interventions do not increase drug abuse,” adding that, “The suggestion that Health4Men is promoting such abuse is ludicrous and totally uninformed”.

Below is de Swardt’s full response:

Health4Men has indeed introduced a harm reduction project in Cape Town, in partnership with Amsterdam-based Mainline and funded by AidsFonds. This follows our increasing concerns regarding recreational substance abuse within the gay population.

We know this from the thousands of men who have accessed our six clinics for free sexual health services, and we have also conducted focused research. During 2012 Health4Men conducted two online surveys among gay men. One focused on drug use among gay men in Cape Town, while the second ヨ the 2012 National online MSM Survey ヨ explored factors such as online cruising patterns, sexual roles and behaviours, condom and lubricant usage and the impact of recreational drugs on behaviours and sexual health. Ethical approval and oversight was, in both instances, obtained from the Human Sciences Ethics Committee at the University of Cape Town. 

The data confirm that, without any doubt, substance abuse among members of our community is hugely problematic.

I would go so far as to state that anyone denying that our community has a serious problem regarding drug abuse is out of touch with reality. Please note that I’m not suggesting that recreational substance abuse is more problematic among gay men than among straights ヨ I am however deeply concerned about the impact of drug use on the sexual health of gay and bisexual men.

There is ample irrefutable evidence of a direct link between substance abuse and sexual risk-taking behaviour. In this regard the key term is invariably ‘disinhibition’: the phenomenon of mind-alerting substances making users less inhibited and hence more likely to take sexual risks than they would do without the influence of such substances.

The advert that Donovan Steyl complained about is for our harm reduction project, officially called Tikking the boxes. The term harm reduction is internationally recognised and describes initiatives to mediate the harmful outcomes of specific behaviours, such as recreational substance abuse. A need for harm reduction initiatives is often indicated when a behaviour that is potentially dangerous is unlikely to cease. In this regard seatbelts in cars can be seen as a form of harm reduction against speeding.

The HIV epidemic has also seen harm reduction interventions introduced ヨ condoms! An early global response to HIV was the ABC model (Abstain, Be faithful to your partner, Condomise) which was a dismal failure, especially among gay men because changing peoples’ behaviour is never that easy.

Another example of harm reduction being utilised by Health4Men, as part of our combination prevention strategy, addresses the reality of many men choosing not to use condoms for anal sex. We’ve started teaching men who bareback about sero-adaptive behaviours ヨ ways in which they may be able to reduce the risks of either transmitting or acquiring HIV. These include HIV positive guys only having sex with other positive guys, and in a sero-discordant situation, the HIV positive partner being the bottom during anal sex. This does not mean that we’re encouraging barebacking ヨ it merely indicates that we’re aware of the realities of many gay men’s lives.

Similarly, we’re aware of both injecting and non-injecting drug use by gay and bisexual men and while we’re unlikely to stop this behaviour, we do need to address their sexual health in any way we can. Remember that guys who use drugs also have sex with men who don’t use drugs ヨ the associated sexual health risks therefor impact on all of us, not only drug on users themselves.

A crucial element of the harm reduction campaign is the dissemination of appropriate information ヨ each harm reduction pack therefore contains specially designed booklets. For example, hepatitis C (a nasty viral infection) can be transmitted by sharing a rolled banknote.

In order to be effective, harm reduction programmes need to be attractive to potential consumers. Regarding condoms, for example, we were aware than many men did not enjoy using freely available government condoms. We conducted research into this which culminated in our importing condoms which men report enjoying using. Our condoms are available in both natural and black, which has added to their appeal for many men.

Likewise, the content of our harm reduction packs was very carefully considered. We consulted with our Dutch colleagues and conducted focus groups with local gay and bisexual men. Initially we hadn’t planned to include tin foil and a candle, but this was specifically requested by gay men who do use drugs. As an organisation we have adopted an ethos of asking men what they need or want in order to make all our interventions more appropriate.

The plastic card contained in the packs was highlighted by Ms Engela ヨ the card contains crucial information on where to get help in the event of an overdose, and where to get counselling or help regarding drug use.

There is considerable international research available indicating that harm reduction interventions do not increase drug abuse. The suggestion that Health4Men is promoting such abuse is ludicrous and totally uninformed.

I accept that some people may find the concept of harm reduction for gay men who use drugs difficult to accept. This harm reduction project obviously wasn’t developed for the likes of Ms Engela ヨ it was very carefully designed and tailor-made for gay men who do use drugs and who are unlikely to cease this behaviour.

In essence it is aimed at improving gay men’s health by educating and supporting them to make appropriate choices.

Glenn de Swardt. Programme Manager: Health4Men

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