August 16, 2006—Take the face of a young, handsome African-American man. Put it squarely in the crosshairs of a sniper’s rifle. Slap that image on a poster, with the tagline “HIV: Have You Been Hit?” Then plaster the ad on public buses, trolleys, and trains—and in clinics and print and broadcast ads—across Philadelphia. And what do you get? Depending upon whom you ask in the City of Brotherly Love, you have either a vital recipe for HIV prevention among gay and bisexual men of color—or yet another incendiary stereotype suggesting that guns and violence are the only language African-American men can understand.

The $236,000 campaign, which the Philadelphia Department of Public Health launched in May, responds to alarming data that the Centers for Disease Control (CDC) released last year. The report found that in five American cities (Philadelphia wasn’t included), 46% of African-American men who have sex with men (MSM) were HIV positive; two-thirds of those had told pretest interviewers that they believed they were negative.

What’s more, the CDC notes, African Americans are ten times more likely than Caucasians to be diagnosed with full-blown AIDS when they first test positive for HIV, due partly to low testing rates.  So the city interviewed several advertising firms, then tapped the local, black-owned Zigzag agency to craft a strategy. “This was an entire social marketing campaign,” says Mark Norris, 45, Zigzag’s president. “This campaign is about saving lives.”

And indeed, many in its target demographic embraced it. Carlos Harkum, a 25-year-old HIV positive gay man who lives in gun-ravaged North Philadelphia, told, “I liked the ads. I thought they were catchy, and people need to get tested here. It’s like, ‘Have you been hit?’ ”

However, the campaign itself was hit—when it crossed hairs with another Philadelphia health emergency. As of August 16, a wave of record-breaking gun violence had claimed 244 murder victims in the city since January 1, 2006—most of them African-American. (Another 1,200 Philadelphians have been injured.) The perceived threat is so severe that in July, Philadelphia Mayor John Street made a rare public television address, urging citizens to “take a deep breath before resorting to the use of guns to settle minor conflicts.”  

Not-so-minor conflicts arose over Zigzag’s poster—as gay, African-American and AIDS activists assailed the city and the agency, citing what they called an insensitive and self-reinforcing affirmation of violence. Hassan Gibbs, 49, an HIV positive treatment educator at Philadelphia’s largest AIDS service organization (ASO), Philadelphia Fight, says he didn’t mind the ads at first but soon changed his mind when activists sent him e-mails. Gibbs, who is gay, says, “Every day here is like Iraq; every day we count down [the murders] on the news. The [Zigzag] ads are culturally inappropriate. Young men here glorify shooting each other, and [the firm] should have left the guns out of the ad.”  Diagnosed in 1985, Gibbs says he is living proof that, as he puts it, “HIV is not a death sentence” and that contrary to the ads’ implication, “once you’ve been hit, you’re not necessarily dead.”

Among the ads’ more vocal opponents is Lee Carson, 33, chair of the city’s Black Gay Men’s Leadership Council. “We need to be culturally sensitive,” he says. “ Not only are black men usually victims of gun violence, but these ads further perpetuate the existing stereotypes that we are gun-toting hoodlums.” In a letter to the interim director of the Philadelphia Health Department, Carmen Paris, Carson wrote, “Given the violence perpetuated against gay men, it is not far-fetched to see how this campaign fosters violence.”

Zigzag’s Norris says he still doesn’t understand the activists’ objections. “We don’t agree that these images have anything to do with violence,” he says, adding that the campaign was endorsed by two focus groups from gay and African-American organizations. “I did not choose it,” he adds, to which Carson responds, “This image should never have made it to the focus groups at all.”

Such fear tactics—images of guns, lesions, scorpions and skeletons, plus spooky, threatening ultimatums—are hardly new in HIV prevention, and their use perennially sparks controversy in the AIDS community. Although Norris says Zigzag “rarely uses fear campaigns,” he adds that “MSMs or men on the ‘down low’ are so hard to reach that fear is the most effective way. Do you pussyfoot around and spend government tax dollars on a campaign that you know won’t work?” Norris says the campaign has been extremely successful, claiming that calls to the Philadelphia Department of Public Health’s HIV/AIDS hot line have increased by 150%. (Department spokespeople did not respond to’s numerous requests for comment on this story.)

David Malebranche, MD, 37, an assistant professor of medicine at Atlanta’s Emory University who has extensively studied the African-American MSM community, doesn’t dispute Norris’ numbers. But he does question what he considers the agency’s sensationalistic approach in achieving them. “When government dollars are involved, [prevention contractors] only want to show good numbers up-front,” he says. “I think using fear as a last [desperate] resort is garbage. Everything fear-based comes down from our president who uses fear to launch every agenda.”

Adds Carson, “Phone calls do not translate into testing. We need campaigns that are going to change behaviors over the long haul. We also need to address the underpinnings of HIV—heterosexism, stigma and homophobia.” Malebranche suggests, “What young MSMs need are more strategies that focus on how we can become more empowered and negotiate our mental health without the fear.”

During the week of August 7, local and national media, including the Associated Press, reported that the Department of Public Health pulled the campaign in, well, self-defense. “Not so,” Norris says. “The health department never pulled the ads; they were being phased out on schedule, and this part of the campaign ran its course.” He pauses. “Now, we are ready for Phase 2.” Norris didn’t specify what that phase would involve but did offer these clues: “We will work with any and all groups to make sure that everyone’s opinion is considered. But that will not preclude us from creating sometimes controversial campaigns to get the results our clients are after. We’re not gonna go and get tamed.”