Predictably, most of the comments on the YouTube site are of the “This stigmatises gay men, especially those with HIV” ilk. More nuanced views over at Towleroad, one of the most consistently rational and informative gay blogs.

Can you protect your nation from HIV by testing immigrants for the virus? Even the United States now thinks that’s a daft idea; it finally dropped its HIV testing requirements for immigrants earlier this year. Now South Korea has followed suit, sort of. The country will drop HIV testing for some, though it has announced different rules for teachers and entertainment industry workers.

Should the International Union of Sex Workers start girding their loins to fight for equal rights for hookers? No. Seoul has decided that people applying for entertainment industry visas do not need to be tested for HIV. People wanting to teach English do. An official of the Ministry of Education, Science and Technology explained the decision thus: “Education is considered a very intimate relationship. According to an unofficial survey by the Prime Minister’s Office, the majority of parents wanted solid evidence of their children’s teachers’ HIV status.”

The implication — that English teachers from Wisconsin are more intimate with their clients that hookers from Vladivostock are with theirs — is clearly absurd, and the Korean authorities are squirming a bit about the silliness. But it reminds me of a piece of ancient history in the HIV industry’s cooking up of Stigma Soup.

Many years ago, we were trying to come up with ways of measuring HIV-related stigma in international surveys. We suggested three questions: Should HIV infected nurses be allowed to treat patients in hospital? Should HIV infected teachers be allowed to teach? Would you buy cooked food from someone with HIV? To everyone’s surprise, a lot of respondents in African surveys replied no, no, yes. So was HIV stigmatised, yes or no? A bit of qualitative work shed more light. HIV-infected nurses shouldn’t be allowed to treat patients because they had compromised immune systems and it was better for them not to be around sick people. Not all that stigmatising, then. Food sellers? What? Everyone knows you can’t pass on HIV in a pot of stew! No stigma there, either. But teachers, what about teachers? Well they’re always having affairs with the pupils; we don’t want our daughters to get anywhere near a positive teacher. It strikes me that’s stigmatising of teachers, though not necessarily of HIV.

While we’re on the subject of HIV and immigration, I do think it remains the great untouched subject of the UK HIV epidemic. A first glance at figures provided by the soon-to-be late and very much lamented Health Protection Agency shows us a great wave of heterosexual infections in the UK.

If you take away the infections that are diagnosed in people who were born in a sub-Saharan or Caribbean country with high HIV prevalence, the picture looks very different indeed:

The difference is assumed to be the infections that are “imported”. In fact, there may well be quite a bit of transmission within communties of African-born people in the UK. But there’s virtually no effective targeted prevention programmes for that group, because we’re all so scared of two things. [Note comment on this point] Firstly, the Daily Mail getting hold of the issue and beating up support for a “test the immigrants” campaign. Secondly, the idea that targeted prevention would be stigmatising. Imagine, it might engender a backlash from all those Pentacostal Churches in East London. And then we’d be in the same situation that so many African countries are in: community leaders choosing to deny a problem rather than help their people by dealing with it.

Malawi is suspending its payments to HIV-infected civil servants because so many uninfected people are trying to cash in, according to AFP (via Cryton Chikoko). A third of Malawi’s 120,000 civil servants have registered as HIV positive. That puts HIV prevalence among government workers at twice the national rate of 14 percent.

Infected civil servants top up their salaries by US$ 35 a month –that’s a 50% slab on top of their average earnings — enough to make many of us change our behaviour. Obviously enough to overcome the stigma that is so often said to stand in the way of any effective HIV programming. It reminds me of stories that surfaced in China when the government started providing free schooling for the kids of people with HIV. China being China, it wasn’t long before there was a secondary market in HIV-infected blood.

Stigma exists because we allow it to, because we reinforce it by tiptoeing around it. The bulldozer of personal incentives can break through stigma in exactly the same way as it can break through corruption, poor productivity and other areas of human endeavour. If we have to bribe our way into greater openness about HIV, why not?

Well, maybe because peverse incentives are a dangerous thing. We want to make it worth people’s while to be more open about their HIV status, without making it worth their while to be infected with HIV. And we don’t want to do anything to reduce the motivation that uninfected people have to protect themselves (which, judging from high rates of new infections in many populations, it already pretty slim). This came up in an interesting discussion I had with the Oxford Global Health group recently. One person mentioned that people in South Africa who get disability payments linked to their TB infection are reluctant to be fully cured, because they don’t want to lose the payments. I’m all for using bribery to change attitudes and behaviour. But one does have to remember that the sword of incentives can have many edges.

It takes me back to the time we were trying to explain the results of a study of HIV and syphilis to transgender sex workers in Jakarta. Stats — even terrifying ones like “23% HIV positive” don’t necessarily mean much to people who dropped out of primary school, so we drew 100 waria on a graph and coloured 23 of them in red, and 17 in green, with quite a few in red and green stripes. The red ones have HIV, we said. The green ones have active syphillis. And it immediately opened up the discussion: who’s a red one? How can we tell? Only by getting your test results.

An HIV prevention organisation targeting gay men in Britain did much the same thing. They put 10 men on a poster with a who-will-you-go-home-with-tonight message: one of these men has HIV. The poster did not show faces, but a more focused part of the anatomy. I’m afraid I can’t post it on a family website like this one… Much less give many details of the same organisation’s wonderful campaign to get guys to recognise the symptoms of syphilis, and go for tests and treatment. Suffice it to say that the information came as an insert with a fabulous CD called Sex Pigs: 60 minutes of music to fuck by.

More politely, while I’m on syphils, check this delightful essay by Marlene Zuk. It discusses whether or not it is in syphilis’s own interest to leave ugly, suppurating boils on the genitals. But it’s delightful, really.