When you ask people what sort of HIV prevention campaign is effective, by getting people to test and reducing risk taking behaviours, most people say something shocking is needed – like the falling tombstone used in the UK adverts of the 80s below. But, it this really the best approach, and what are the arguments for and against trying to scare people into having safe sex?
The very fact that most of you reading the blog can recall the tombstone advert seems to demonstrate one advantage of such an approach – done properly it can be extremely memorable, and can attract lots of attention, and really get people talking about HIV. In addition, there is evidence that if someone feels they are equipped to make behavioural changes necessary (whether physically or psychologically) then there is some evidence that this type of approach might have a successful impact. However, the flip side is that such individuals are more likely to already be engaging in safer sex and test frequently anyway, and are (in many ways) not the most useful group to target with HIV prevention messages. In addition, crucially, those that are ‘less well-resourced’ to negotiate safer sex may actually ‘feel even worse when confronted with fear-arousing messaging’ and they might result in feelings of anger or defensiveness which can actually result in unsafe sexual behaviour (see a Sigma report on fear and HIV prevention here for more info).
Other potentially serious consequences of fear based approaches is that they can result in othering of people with HIV and actually increase discrimination as the fear of the virus is transferred to those that have HIV. It can also increase anxiety about HIV which research shows is one of the main barriers preventing people from testing. In addition, there is evidence which shows that fear only translates into behavioural change when people are not fearful, and data from the Gay Men’s Sex Survey shows that most gay men are still HIV and view it as a serious illness. In conclusion, while inducing campaigns can make people more scared of HIV there is little evidence that this would encourage people to make behavioural changes necessary to reduce risk, or increase testing, particularly those that might be seen as most at risk groups.
It is likely that for these reasons HIV prevention campaigns have become less shocking in the last couple of decades. The poster above shows a current campaign by HPE in the UK using the tagline ‘It starts with me’ . Similarly, in New York where HIV prevention campaigns have traditionally been fear-arousing (such as the shocking 2011 NYC department of health advert which included a close-up photo of anal cancer, see here), there has been a move away scare based approaches. For example, the latest HIV prevention campaign by the NYC department of health uses the phrase ‘Be HIV sure’. Dr Daskalakis, who is behind the campaign, claims that its aim is to focus more on health and less on disease. This change in city-wide approach is supported by others working in HIV in New York, such as Terri Wilder of ACT-UP . These ‘softer’ approaches seek to increase knowledge and empower people to make informed decisions through positive terminology, rather than scaring people with explicit imagery and negative wording.
What do you think HIV prevention campaigns should look like? Are dramatic images and shocking phrasing effective, or do you think they are counter-productive?
The views in the article are those of the author and do not necessarily represent those of the GMI Partnership. The GMI Partnership provide rapid HIV testing and outreach work across London. For more information please see their website.