Condom Sense Comes to Italy...Finalmente!

I have over my desk a poster that I consider to be one of the best pieces of social marketing I have ever seen.

The poster, from the Lega Italiana per la Lotta contro l’AIDS (The Italian Anti-AIDS League), features a photograph of two items, set against a blood-red background. On the left appears a cornicello, the ancient horn-shaped amulet worn to protect against the malocchio (evil eye); on the right, an unrolled condom. Under the cornicello is the word “irrazionale”; under the condom, “razionale.”

The Lila poster notes that the “profilatico,” when used correctly, “is an effective means of preventing HIV and sexually transmitted diseases.”  Unlike the cornicello, it actually does protect its wearer from grave misfortune. Men who use condoms are making a rational choice to protect their health and those of their partners.

But until very recently, irrationality trumped reasonableness when it came to condom advertising on Italian TV.  Since the AIDS epidemic began in
Italy during the 1980s, the Italian government has run public information campaigns about the disease. But the words “profilatico” or “preservativo” were never used, mainly to avoid the ire of the
Vatican, which perversely deems a piece of protective latex a greater danger to Italian society than a deadly virus.

That will all change in January 2008, with the airing of a series of taboo-breaking HIV awareness ads that mention condoms by name. The ads, by film director Francesca Archibugi and paid for by the Ministry of Health, are designed to help Italians, and especially young people, overcome their embarrassment in asking for condoms in pharmacies and other outlets.

One ad, shot in a pharmacy at
Rome’s Fiumicino airport, shows a young man trying to get up the nerve to ask for condoms. His impatient girlfriend charges up to the counter and asks for them. An older heterosexual couple follows her example. Suddenly the pharmacist is overwhelmed by customers demanding condoms.

Francesca Archibugi, known for films such as “Shooting the Moon,” emphasizes the urgency of pro-condom advertising in
Italy, where some 4,000 new cases of HIV infection are diagnosed each year.

“The true dangers are never talked about – there’s a moralistic facade which, when uncovered, reveals great ignorance,” she told the Reuters news agency.

The Lega Italiana per la Lotta contro l’AIDS supports Archibugi’s point. Based on calls to the organization’s telephone information lines, Lila says that knowledge about HIV transmission in
Italy is “often extremely confused” and “often linked to emotional elements that have nothing to do with the actual possibility of infection, or with prevention.” In the latter instance, Lila is referring to the irrational fear of catching HIV from things like toilet seats or mosquitoes.

The long overdue condom ads are part of a larger government anti-AIDS campaign that Lila has urged health minister Livia Turco to support. In a June 2006 letter to Turco, Lila’s national president Filippo Manassero noted that she had the opportunity to reverse the neglect that characterized the Berlusconi administration’s handling of the epidemic. Manassero criticized the previous government for its “progressive disinvestment” in HIV/AIDS and a general “lowering of the guard in respect to the issues of prevention.”

He noted that the government had registered more alarm over avian flu and SAARS, even though “there has not been a single case [of those diseases] recorded in our country” while 40,000 Italians have died from AIDS.     

In his letter Manassero called for a “serious HIV prevention campaign aimed at the general population, with clear and explicit messages specific to gender, with clear messages about condom use.” In addition to messages for the general population, he called for a focus on specific groups at higher risk for catching or spreading HIV, including adolescents and young adults, gay men, drug users, sex workers, foreigners, and HIV-positive people.

The first ads produced by the Health Ministry for the new anti-HIV campaign feature heterosexuals, which makes sense given the epidemiology of AIDS in
Italy. The most recent statistics (from 2006) show a cumulative total of 57,375 AIDS cases. In the early years of the epidemic, most cases were caused by drug users sharing infected syringes and needles. But now, most are due to unprotected heterosexual contact.

The World Health Organization (WHO) reports that in 2006, about 42 percent of new AIDS cases in
Italy were among heterosexuals, 29 percent among injecting drug users, and 21 percent among gay men. Rome and Milan have the highest annual incidence rates, followed by Genoa and
Bologna. During 2006, 1,126 new AIDS cases and 254 AIDS deaths were reported. But these reported cases most likely do not reflect the full extent of the epidemic in Italy because HIV reporting occurs in only 10 regions/provinces of the country's 20 regions: Bolzano, Friuli Venezia-Giulia, Lazio, Liguria, Modena, Piemonte, Rimini, Sassari, Trento, and
Veneto.

If Italy does not have the worst AIDS epidemic in
Europe, the numbers of new HIV infections and actual AIDS cases are high enough to warrant the campaign Lila advocates and that the health ministry appears to fully support. And with most HIV infections being transmitted by unprotected sex, condom promotion needs to be at the heart of any prevention campaign.

It’s amazing that it took so long for condom advertising to come to Italian television. Sexual innuendo and explicit sexual content is common on both government-owned and private TV channels, and in advertising. And not only TV advertising. A few years ago while on vacation in Sicily I was surprised to see huge billboard ads in
Catania that likened a brand of mozzarella to a woman’s breasts. In
Rome last summer, I saw ads for a health club that featured both naked men and women, with only their genitalia obscured.

Italians are hardly a prudish people. So why the squeamishness about frank condom advertisements?  When Francesca Archibugi describes her new ads as a “triumph over taboo,” she’s speaking about the Catholic Church’s longstanding assertion that condom use fosters “immoral” and “hedonistic” lifestyles. Although Catholicism is no longer the official state religion of
Italy, the Church looms large in Italian public life, insisting that Catholic values must be those of society in general. Some criticize Islamic societies for not recognizing a secular sphere where religion should not intrude. But the
Vatican hardly is a fan of Church-State separation, either.

The
Vatican, under both John Paul II and Benedict XVI, has dogmatically and often hysterically denounced any form of sex that is not of the heterosexual reproductive variety, reserving special venom and cruelty for homosexuals. 

The Church continues to insist that the only surefire protection from AIDS is monogamous, heterosexual marriage. Needless to say, this is of no use to all those human beings, Italian and otherwise, Catholic and not, who don’t live their lives in accordance with this intransigent, unrealistic, and yes, inhumane dogma. Pope Benedict XVI even has urged Catholic pharmacists to refuse to sell condoms and other contraceptives, arguing that “conscientious objection” by chemists “must be recognized as a right by the pharmaceutical profession.”

The new TV condom ads are sure to put Italy’s fragile center-left government – which overall is not even particularly progressive on matters of sexuality -- on a collision course with the
Vatican. But so far Livia Turco is standing her ground.  She has stated that although the Pope had the right to “urge young people to be sexually responsible,” he had “no business telling professionals such as pharmacists what to do.”

Italy’s new condom promotion campaign, though a step forward doesn’t go far enough. Educating the public about the importance of protected sex should be paired with widespread distribution of free condoms. New York City and
Washington, D.C. both have established massive condom giveaways in response to high rates of HIV and other sexually transmitted diseases.

The Italian Young Socialists (Federazione Giovani Socialisti) on World AIDS Day, December 1, 2007, kicked off a campaign to do away with the value-added tax on condoms and to promote free condom distribution. Marco Alberio of the FGS said, “In our country the price of condoms is high and that means that young people don't buy them and that can be bad news for their health.”  It’s fine to encourage people to buy condoms in pharmacies, or even from the condom vending machines found in Italian cities. But when it comes to the public health and HIV, the best price of a condom is free.

Condom advertising and other forms of sexual health promotion, coupled with wide availability of condoms, are critical to HIV prevention. For
Italy to do otherwise would be to permit many needless and preventable HIV infections and AIDS cases. It would mean choosing “irrazionale” over “razionale.”