As you probably know, the World Health Organisation is the agency of the United Nations charged with improving international public health. It has its fair share of critics and has been involved in a few controversies (allegations that it greatly exaggerated the ‘swine flu’ epidemic being the most prominent, recent, example) but it can claim quite significant victories too (it led the eradication of smallpox, for example). The Organisation lists its responsibilities as:
…providing leadership on global health matters, shaping the health research agenda, setting norms and standards, articulating evidence-based policy options, providing technical support to countries and monitoring and assessing health trends.
That ‘evidence-based policy’ bit is pretty crucial – it’s not just a bunch of UN politicians pushing whatever pet obsession they may have but doctors, scientists, researchers and more looking at what’s happening and how best to address it. Again, I’m sure there are legitimate criticisms to be made here but that’s for another time.
It’s for another time because last week the WHO released their updated guidelines on the treatment, diagnosis and prevention of HIV. This document “brings together all existing guidance relevant to five key populations – men who have sex with men, people who inject drugs, people in prisons and other closed settings, sex workers and transgender people – and updates selected guidance and recommendations.” The report itselfstates that this approach was necessary because the previous approach of issuing separate guidelines for these populations “has not adequately addressed issues common to all these key populations nor has it addressed countries’ needs for a coherent approach informed by situational analysis”. It includes a section devoted to explaining the methodology and process, wherein we’re told about the range of expertise and experience which fed into the guidelines “including appropriate geographical, gender and key population representation.” The report then explains how it reviewed and assessed current evidence and how this was fed into the resulting guidelines, which were then assessed by “73 peer reviewers from academia, policy and research.”
So how was this report of over 180 pages, covering the entire world and every group affected by HIV, reported in the press? Like this:
Pretty much every report of the new guidelines fixated on one, new, guideline concerning pre-exposure prophylaxis (PrEP). As explained in the WHO report, this guideline came from reviews of hundreds of research outputs and looked at the effectiveness of PrEP, the possible side-effects, the feasibility of it as a treatment, the cost-effectiveness and the openness of people to using it (amongst other things). They ended up with the guideline as follows:
You may have already noticed that this guideline mentions ‘gay men’ absolutely nowhere. ‘Men who have sex with men’ is a term common to the research and treatment of sexually-transmitted infections and one of the main reasons for that, in short, is that it avoids all issues of identification. Gay, bi, queer, trans, straight-who-dabbles, you have no fucking idea, you don’t care – if you identify as male and you have sex with other men, you’re in. So already we can see how shit and how homophobic the reporting of this was – reporters skim a document, see ‘men who have sex with men’ and think ‘GAYS!’ because if a guy touches another guy ‘that way’ he’s gay and that’s all there is to it, right? It’s embarrassing.
The second big thing to notice – the recommendation that PrEP is available as part of a ‘comprehensive HIV prevention package’. This isn’t saying to stop everything else. It’s not saying PrEP should replace condoms. In fact, here’s the FIRST guideline:
Pretty categorical, right? There are other guidelines, and whole sections of the report, devoted to HIV education, testing and counselling.
This brings us to the big thing to notice in the guideline: the use of ‘choice‘. To read that guideline and take away from it ‘WHO SAYS ALL GAY MEN MUST TAKE PREP’ is not only wrong, it’s wrong to the point of being deliberately distorting and downright dangerous. It’s sensationalising for the sake of a story and fuck the consequences.
Unfortunately, some of us in the gay community are so wedded to playing the victim that, rather than heading off to the report to find out what was going on, we had instant outrage based on these egregiously incorrect reports. Patrick McAleenan in The Telegraph knocked out a piece complaining that the WHO were ‘perpetuating gay stereotypes’. His piece is a litany of complaints which expose his complete ignorance as to what the WHO actually wrote: why don’t they recommend education instead? Why don’t they recommend condoms? Most appallingly, he complains that “The report will encourage straight people to believe that HIV is simply a gay problem”. Well, not really, since it a) hardly mentions the word ‘gay’ and b) devotes scores of pages to key populations other than msm. In fact, there are other guidelines explictly relating to PrEP:
But it didn’t matter. The outrage was well out of the traps by now:
Basically what the WHO is really saying: “Gay men are gross and spread HIV/AIDS, so they should ALL be medicated regardless of behavior.”— Conner Habib (@ConnerHabib)July 16, 2014
— Leil-Zahra Mortada (@LeilZahra)July 15, 2014
— THE BODY WELL USA (@TheBodyWellUSA)July 12, 2014
As the sensationalist stories make their way around social media and various sites, each day has seen new people jumping on them and complaining about how homophobic the WHO are. Apparently no-one actually bothers to go have a look at the actual guidelines. As a community we kinda have form for not bothering to check stories when there’s a good sense of victimisation to be had.
It’s all so fucking depressing. And what’s most depressing it how inevitable it feels. The WHO report found that “epidemics of HIV in men who have sex with men continue to expand in most countries” and that “in major urban areas HIV prevalence among men who have sex with men is on average 13 times greater than in the general population”. I can see no moral judgement of this fact in the report, and in fact it states:
Discriminatory legislation, stigma (including by health workers) and homophobic violence in many countries pose major barriers to providing HIV services for men who have sex with men and limit their use of what services do exist. Many countries criminalize sex with the same gender (either male–male only or both male–male and female–female). As of December 2011 same-sex practices were criminalized in 38 of 53 countries in Africa (9). In the Americas, Asia, Africa and the Middle East, 83 countries have laws that make sex between men illegal (10). The range of legal sanctions and the extent to which criminal law is enforced differs among countries.
This sounds pretty sympathetic to me. If anything, it’s the responses which have been screeching ‘BUT NOT ALL GAY MEN ARE UNSAFE/PROMISCUOUS’ that are problematic, as they cannot help but imply that the men who do engage in that behaviour almost deserve their fate. The safe ones, though, the ones who don’t sleep around – those nice guys don’t deserve to be treated like this by the nasty WHO! Zero self-reflection, zero sense of agency and responsibility – just instant, facile outrage and a rush to assert victimhood. It’s ironic to say the least that last year several UK HIV charities, including GMFA and the Terrence Higgins Trust, issued a statement supportive of PrEP “so that more gay men are able to reduce their HIV risk.” Presumably they are vile homophobes tooIt’s embarrassing. It helps no-one. It’s downright dangerous. Grow the fuck up.