Croteau and Morgan

TABLE 1

Chart of Risk Reduction Guidelines from Understanding AIDS

Risky Behavior

Sharing drug needles and syringes

Anal sex, with or without a condom

Vaginal or oral sex with someone who shoots drugs or engages in anal sex

Sex with someone you don't know well (a pickup or prostitute) or with someone you know has several sex partners Unprotected sex (without a condom) with an infected person Safe Behavior

Not having sex

Sex with one mutually faithful, uninfected partner Not shooting drugs

Note. From Understanding AIDS, United States Department of Health and Human Services, 1988 (HHS Publication No. (CDC) HHS-888404). Washington, DC: U.S. Government Printing Office, p. 3. "Reproduction of the contents of this brochure is encouraged" printed on the publications.

change in gay men is likely to occur and to give information about such practice.

The guidelines in Understanding AIDS, however, have homophobic effects in ways other than the failure to provide gay men with vital information. The emphasis is on the person with whom one has sexual contact-it should not be someone who "shoots drugs," "engages in anal sex" (read gay/bisexual men?), "who you don't know well," "has several sex partners," or is "infected." You should have sex with "one mutually faithful, uninfected partner." Identifying the characteristics of the other person is misleading medically but also reinforces the source of infection as an "other," not one's own behavior. In other words, these guideline teach fear of other people rather than emphasizing one's own ability to prevent infection through altering one's own behavior.

Educational materials such as the video, pamphlets, and booklets previously discussed are typical. The materials are developed with the best of intention, that is, to get beyond the sense of invulnerability that distances heterosexual college students from looking at their own risky behaviors, to reach students with good and complete information in the context of a Roman Catholic university, or to disseminate information in a widespread fashion through a massive mailing. Despite such good intentions, however, such materials can support and reinforce homophobia.

CONTRADICTING NEGATIVE IMAGES

Several of the available AIDS education resources directly contradict homophobia. Two excellent resources illustrated below explicitly address homophobic attitudes. The American College Health Association (ACHA) Task Force on AIDS (1987) publishes a general pamphlet on AIDS titled AIDS... What Everyone Should Know. A unique part of the pamphlet is a separate, short section highlighted in gray titled "Gay Men and AIDS." It directly contradicts attitudes of blame toward gay men, encourages acceptance and support, and asks people who are "uncomfortable about contact with gay men during this time" to consult the health service for "accurate information and advice." To its further credit, the pamphlet also has separate sections dealing with women and people of color.

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Films can easily be subtly or openly homophobic, as discussed earlier, yet there are excellent examples of films that include antihomophobic content, The film titled Sex, Drugs, and AIDS (O.D.N., 1987) is a good example. The last section of the film is a monologue by the heterosexual male owner of a bicycle shop in Greenwich Village in New York City. He starts by telling of his prejudice toward the gay men who came into his shop and ties that to his own fears of AIDS contagion through casual contact. He continues, however, with his discovery that his well-loved younger brother was gay and had AIDS. He concludes his monologue with an extremely moving account of how he shed homophobic attitudes as he saw his brother and his brother's gay friends deal with illness and death. In the context of this general AIDS education film, the scene promotes a compassionate and antihomophobic response to AIDS.

The overall stance of an organization in relation to the gay and lesbian community can also be important in contradicting homophobia. One example is the Prevention Network, a student membership organization at Ithaca College (van Willigen, 1988). The group undertakes varied programming efforts, such as monthly open meetings, articles in campus newsletters, cosponsorship of AIDS awareness activities, and a speaker's bureau. The Prevention Network (which includes primarily heterosexual female students) maintains a visible association with the gay and lesbian student group by cosponsoring AIDS programs that are gay-oriented, sharing information and announcements about the activities of both groups at the meetings of both groups, and making gay-affirmative statements in their educational programs. Although this public association has made the Prevention Network the target of homophobia at times, this association has also communicated a gay-affirmative message throughout the college community.

We have shown how homophobic messages in AIDS education are frequently communicated and have provided some illustrations that contradict such homophobia. The following suggestions summarize our discussion:

1. Many homophobic messages are not obvious and may come from well-intentioned sources. Careful and focused scrutiny is often required.

2. Direct references to lesbian and gay people will be a new experience for some people and thus carry great weight in the formation of attitudes toward lesbian women and gay men. References should be accurate, caring, and affirmative.

3. A common dualistic notion is that there are two groups of people in relation to AIDS: the guilty, blameful, threatening, and socially marginalized (often gay) people versus the innocent people, threatened not by their own risk behavior but by the other people. This notion inevitably encourages fear and hatred of gay men. All elements of this notion should be avoided and, wherever possible, directly contradicted.

4. Sexuality must be discussed without implying the superiority of heterosexual expression through the discussion of morality or the withholding of information about the full range of choices in homosexual expression.

5. Public alliances between AIDS education groups and the gay community will communicate a general message that contradicts homophobia.

RENDERING LESBIAN WOMEN

AND GAY MEN INVISIBLE

In examining AIDS education, we must also look at another form of homophobia. Shilts (1987) and Bayer (1985) have documented the dramatic increase in attention to AIDS as a result of

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evidence that mainstream heterosexual people could be at risk for AIDS. Now many programs, in the positive attempt to make people aware that AIDS prevention is crucial in all people's lives, have stressed that "AIDS is not a gay disease." This truth, however, can allow programs to place their focus primarily or exclusively on heterosexual students or community members. The action of excluding lesbian and gay people is discussed by D'Eramo (1988) using the term, the de-homosexualization of AIDS. Association with lesbian and gay people can detract from public approval and financial support for AIDS education. The result is an attempt to "make AIDS a 'decent' disease" by not recognizing the enormous contribution of lesbian women and gay men in AIDS services and education and by excluding them from educational materials that are being "targeted to the average person" (p. 23). The de-homosexualization of AIDS education may be the most common form of homophobia in AIDS education and one that is particularly hurtful to those lesbian women and gay men who have both suffered so much and worked so hard in this epidemic.

In one early campus program on AIDS, two speakers associated with a regional AIDS program addressed a large college audience. The audience included many lesbian women and gay men. The basic message of the speakers was that not just gay and bisexual men needed AIDS-prevention information, but, you, the members of the audience, also need such information. They continued throughout their presentation to address the audience as if we were all heterosexual. So much of AIDS education has taken that tone.

Many materials make no attempt at all to be inclusive of lesbian, gay, and bisexual people. Most school curricula are like the New York State curriculum (University of the State of New York, 1987), which mandates AIDS education but never mentions the word homosexual or gay and emphasizes delaying intercourse until marriage. De-homosexualization may well be most prevalent in informational materials for young people. Martin (1988) states that AIDS education for children and

Guidelines

Implicit inclusion

Homophobia in AIDS adolescents "virtually never mentions gay and lesbian youth" (p. 380).

The danger in programs or materials that ignore gay and lesbian people is that the message can be actively homophobic even if the educators did not intend it that way. The underlying message in these materials is that concern is only for the heterosexual population. Heterosexuals walk away feeling that same-sex relations are the "other," separate from their normal world and less deserving of attention. Perhaps even worse, people with same-sex attraction who have not yet found a positive identity may walk away with many of these same feelings about themselves. Such exclusion can contribute to the already difficult process of dealing with their identity. Even individuals with strong, prideful lesbian or gay identities feel the effects of such exclusion through a sense that the educators do not care about their lives. This contributes to the alienation many gay and lesbian people feel from helping professionals of all types.

COMBATING INVISIBILITY

Materials and programs that directly address homophobia will, of course, render gay men and lesbian women more visible. But there are other important ways of being inclusive of gay and lesbian people. Just as content needs to be nonsexist (i.e., APA, 1983), content also needs to be nonheterosexist or lesbian and gay inclusive. Table 2 describes some practical guidelines and illustrations for inclusive language in AIDS education.

Two current pamphlets on risk reduction make some attempt to be more inclusive (ACHA, 1987; Channing L. Bete Co., 1987). Both pamphlets carefully follow the first two suggestions in Table 2 concerning "implicit inclusion." The text discusses partners without references to opposite or same sex, and at no point in the written text does it assume heterosexuality. The illustrations, however, are exclusively heterosexual-the photographs in the ACHA pamphlet and the few cartoon

TABLE 2

Some Guidelines for Lesbian/Gay Inclusive Content in AIDS Education Examples and Explanations

1. Use referents that do not identify sexual orientation, especially when referring to "everyone."

2. Use language that indicates not everyone is heterosexual.

Explicit inclusion

3. Make direct references to lesbian women and gay men that are evaluation-free or affirmative.

4. Use examples or illustrations of same-sex partners.

"One's partner should hold the base of the penis while it is withdrawn." (Use gender referents like "one's partner" and do not specify the gender of the hand or orifice.)

In addressing a woman or group of women, "Talk about safer sex with the women or men with whom you are sexual." (Don't use pronouns or words indicating sexual partners are of the opposite sex.)

"This particular discussion is limited to heterosexual risk reduction."

"If you are heterosexual. . . . (The italic words indicate heterosexuality is not the only or best alternative.)

"AIDS can affect us all: heterosexual, bisexual, and lesbian/gay." "Whether you're a straight or gay couple...." (Simple use of the words lesbian or gay is very effective.) "Many gay men are now practicing safer sex. . . ."or "Lesbian women have taken the lead in providing AIDS services. ..." (Gay men and lesbian women can serve as models for positive responses to AIDS.)

Use same-sex pairs occasionally in role plays discussing safer sex. Use same-sex illustrations in printed materials (i.e., CARN, 1986). Include gay-oriented resources in AIDS resource lists.

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