Later this spring the health department's most famous mascot for STD testing is coming out of retirement.
In May the Healthy Penis will be popping back up in San Francisco as officials address spiking rates of various sexually transmitted diseases and aim for further reductions in the number of new HIV cases among gay men.
"We want to resurrect the Healthy Penis campaign," said Joseph Imbriani, a health educator with the Department of Public Health's HIV Prevention Section.
When it debuted in 2002 the campaign, initially begun by the health department's STD Prevention and Control Section, featured cartoon advertisements starring penis characters and was solely focused on combating rising rates of syphilis. It ended after a five-year run but never fully went away; it has returned in some form over the ensuing years.
This time the character is coming back as stress relief squeeze toys stamped with the message that sexually active gay and bisexual men should get tested for HIV every six months (and every three months for chlamydia, gonorrhea, and syphilis). They will be part of safer sex packets given to clients at the city's HIV testing sites over the course of the new initiative.
The expansion of the Healthy Penis' testing message to include HIV is just the latest example of the collaboration the health department's various sections have embarked on in recent months, explained Dr. Susan Philip, director of the STD section.
"We see that as a furthering of the message and the Healthy Penis is helping get that message across and helping them extend the use of that tool," said Philip, adding that, "the Healthy Penis does not just belong to us."
Anyone who tests for HIV or an STD between May and the last week of October at one of the city's testing sites will receive a safer sex packet, which will also include a coupon redeemable at nearly two dozen Castro businesses. The coupon will resemble dollar bills, but with the face of the penis character known as Byron H Penis replacing that of President George Washington.
Posters listing participating businesses, which will also feature the cartoon phallus, will be hung at the various testing sites. Imbriani is hoping to recruit at least 30 stores to participate and pitched the new campaign during the April meeting of the Merchants of Upper Market and Castro.
"It is the STD section's brainchild, which was absolutely incredible, and we are just going to make some good use of it in a slightly different way and have businesses involved," Imbriani told the Bay Area Reporter this week.
It is believed to be the first time the HIV prevention section has recruited business owners in the gayborhood as partners in one of its campaigns, said Imbriani. It is modeled partly on a community effort that he led eight years ago that saw volunteers approach people in the Castro and say hello as a way to foster community and bolster gay men's health.
"I haven't seen a huge community effort in terms of health and well-being for a long time," Imbriani said during the MUMC meeting in explaining the genesis for the new initiative.
He credited Ken White, the manager of the Books Inc. Castro location, with the idea for the coupons. The store discounts are meant to be minimal, as the real push behind them is to show that the community supports seeing gay and bisexual men remain healthy.
"The business involvement is mostly symbolic. It is saying this business cares about our community's health and well-being," explained Imbriani. "I think it is nice to walk into a business and know it just doesn't want my money but cares about me."
White told the B.A.R. this week that the upper Market Street bookstore has yet to finalize what sort of discount to offer for the coupons. Describing the Healthy Penis characters as "cute," he saw the new campaign as fitting into the company's desire to have an active role in the neighborhoods where it has stores.
"Every Books Inc. store is meant to be a part of the community where it lives. This is a community effort and it is a way for us to contribute to the well-being of the neighborhood," said White.
Mike Holland, the owner of Worn Out West 2nd Generation on Market Street, also agreed to take part. He expects to offer a 15 percent discount in exchange for the coupons.
"Anything we can do to help in the community, we want to help do that," said Holland, who added, "this issue certainly is worth the effort."
Ensuring that men who have sex with men get tested for HIV and know their status is a proven tactic in reducing new infections. Health officials hope the reintroduction of the Healthy Penis and community backing of the new campaign will bring them closer to their goal of ending transmission of the virus.
Penis characters had an impact
Since their inception the Healthy Penis characters have proved to be effective ambassadors to educate gay and bi men about the need to test frequently for STDs. The cohort of multi-racial phalluses includes Pedro, who is Latino, and Clark, who is African American. There is also their nemesis Phil the syphilis sore.
Over the initial four years of the campaign, cases of syphilis in San Francisco declined, posting a 20 percent decrease in one two-year period. Then in 2008, two years after the Healthy Penis advertising had ended, syphilis rates reversed and began increasing.
As part of their response to combat the upward trend in cases, health officials brought back the Healthy Penis in 2009. Syphilis rates then flat-lined, but a year later, the STD section changed focus and stopped featuring the cartoon penis characters in its advertising.
Despite various new approaches and messages health officials have rolled out, rates of syphilis, gonorrhea, and chlamydia have annually increased. Based on preliminary figures for 2012, male rectal chlamydia rose nearly 13 percent last year, while rectal gonorrhea in men rose 26 percent. Early syphilis cases grew by 31.5 percent.
In the first two months of 2013, initial STD reports show cases of both chlamydia and syphilis outpacing the cases from the same period in 2012. Gonorrhea cases, however, are slightly less so far in 2013 than was seen during January and February of 2012.
As for HIV rates, however, the data shows there have been steady decreases in the number of new infections in San Francisco. In 2007 there were 533 new infections, while last year initial reports had the total at 377.
The reasons behind the disparate trends in HIV and STDs are myriad, say health officials, who point to gay and bi men's sexual practices based on their partners' HIV status, adherence to the testing guidelines and health officials' adoption of a test and treat model as contributing factors.
"I would hesitate to say that a certain campaign is the answer or not the answer," said Philip. "We know it is a very complex issue, people are very complex and sexual behavior is very complex."
Steps that work for preventing the transmission of HIV can inadvertently lead to acquiring STDs, making the need for cooperation between the HIV and STD prevention sections critical, said Philip. Thus, she sees having the Healthy Penis be an ambassador for both as a logical step.
"We have to look at it holistically," she said. "We have to have a discussion with the community about what sexual health looks like in San Francisco and what we should be aiming for."