Prevention in Focus

Fall 2011 

Views from the front lines: Fear-based campaigns

We spoke to four people with different perspectives on fear-based campaigns:

  • Bill Ryan—Activist, author, consultant, psychotherapist, and professor of social work at McGill University
  • Alan Middleton—Assistant Professor of Marketing and Executive Director, Schulich Executive Education Centre (SEEC), Schulich School of Business, York University
  • Brian Finch—Publisher and editor for positivelite.com, regular contributor to Fab magazine; living with HIV for more than 25 years
  • Roseline Carter—AIDS Calgary Awareness Association, Team Leader of Community Strategies

Interviews by Debbie Koenig

Bill Ryan

How did you respond to the “It’s Never Just HIV” campaign when you first saw it?  

I tend to give a campaign a chance by not reacting to the very first images I see because I try to get behind things a bit. When I looked at this campaign a little bit deeper, I thought that it was probably a step backwards in terms of what we want to present around HIV and prevention. I think it’s pretty well been shown that shaming and frightening people are not effective strategies.

The purpose of a social marketing campaign is to target a particular group of people and try to influence a specific behaviour. The “It’s Never Just HIV” campaign targeted young gay men in New York City and told them to “always use a condom.” How successful do you think this campaign would have been at achieving its objective?

I think we have to be more sophisticated in terms of prevention. I think that we turn off [when confronted with this ad], especially younger gay men who don’t want to hear the message and don’t want to see it packaged the way it’s been in the past. I’m concerned that we’re just going back and starting over again with another generation of young men, using methods we didn’t think worked for the older generation. That being said, the idea of always using a condom is a valid one as long as we acknowledge that not everyone is going to all the time and that harm reduction strategies that recognize this are promoted as well.

Fear-based campaigns are extremely controversial. In general, do you think this type of strategy serves to educate and empower or is it potentially disempowering and even harmful?

I’ve been working in this field since 1985. You don’t know how many times I’ve heard arguments for and against fear-based messaging presented at different moments over the course of the last 25 years—people saying that we have to scare the crap out of people to get them to take this seriously.

I look at all my friends who smoke. They don’t look at the images on the cigarette packages, or they cover them up with other things, or they become totally neutralized to them. I think that, in some ways, we’ve got the same reaction to HIV messaging.

In my psychotherapy practice, I meet a lot of younger men who are so terrified that they’re frozen around HIV. For others, for whom prevention messages are just part of the old familiar landscape, they just don’t see them—they just don’t notice them. We’re not reaching young gay men with these kinds of messages. I suspect that people flip through the magazine and avoid the prevention campaign ads. Or, for the ones who are so worried—worried in a way that’s pathological—I don’t think scary campaigns help them at all.

I think back to the Australian campaign of the late 80s, of the Grim Reaper—who represented HIV—walking around with a scythe, chopping people’s heads off. There was another ad where the Grim Reaper is bowling…rolling bowling balls down the alley and knocking people into pieces. An evaluation showed that this campaign didn’t encourage safe behaviours. It actually discouraged them because people felt there was nothing they could do….

[This type of campaign] takes away people’s sense of power and makes them feel like they’re not actors in their own sexual lives and their own health, that they’re victims.

When it comes to HIV prevention, how can messaging speak to people effectively?

I think that the idea that we can change a community’s behaviour with posters or advertisements oversimplifies the issue terribly. I think that we have to use a multi-faceted approach, looking at different subgroups within the community and targeting them with different kinds of messages.

One of the things we need to do (and we haven’t done it very well generally) is talk to gay men about their lives using more than just campaigns. I suspect that if you got groups of gay men talking to each other about the issues that confront them in their lives—about loneliness and isolation, for example—that that would go a lot further towards empowering them in their sexual lives than a campaign that has horror movie music playing in the background and images that frighten or shame people.

[This kind of a multi-faceted approach] makes it much more complicated: It’s easy for governments or funding agencies to say, “Here, we’re going to give you a couple of thousand dollars—now make a campaign that will last a few weeks.” But to actually work on some of the issues that underlie gay men’s lives and aren’t being addressed is more long-term and complex.

A number of years ago, I ran some focus groups for Health Canada around gay men’s health and prevention. We tried to pick men who weren’t involved in the community, who weren’t spokespeople, and the thing that struck me more than anything else—I went to about 12 cities across Canada—was how detached these men were from their communities, how alienated they felt from their community, and how lonely. This issue keeps coming back: solitude, loneliness and the effects of that in people’s lives.

Unless we start reacting to what men tell us are their issues and use those as door-openers into messages about health and taking care of oneself, we’re only going to touch small pockets of people with our messages. I’m not sure that these [fear-based] campaigns help people feel that their lives are worth protecting when their self-esteem is low or they feel this loneliness that so many gay men feel. I believe that the traumatic experiences of having been the target of homophobia, especially as youth, is underestimated in the role that it plays in the adult lives of gay men.

I know that attacking the issue from such a broad perspective is hard to sell because it’s long-term and it’s multi-faceted but I think that we need to get into those sophisticated ways of doing prevention. Otherwise, we’re just going to turn on the hose every once in a while, point it at the fire, then turn it off…and pat ourselves on the back saying, “Well, we did this, we did that…How come they’re not changing their behaviours?”

Alan Middleton, PhD

How did you respond to the “It’s Never Just HIV” campaign when you first saw it?

I must confess I don’t entirely understand the controversy. The problem with any disease is that it gets so much attention, it starts to become wallpaper. Cancer faces that. Heart disease and stroke face that... So everybody looks for ways of re-establishing why it’s serious, why I should pay attention, why there should be behaviour change or why I should give money.

HIV has recently lost a lot of its “star billing.” Elizabeth Taylor died, who was a noticeable supporter. And if you look at things like the Oscars, the appropriate HIV tag is not as evident. So obviously, this advertising was needed because people start sliding back to their old behaviours. This advertising is obviously intended to wake people up again and say “Be careful. It’s not just HIV—even if there are some drugs you can take—it’s more serious than that.”

Bluntly, I think it’s a highly appropriate communication strategy and that it's well executed.

The purpose of a social marketing campaign is to target a particular group of people and try to influence a specific behaviour. The “It’s Never Just HIV” campaign targeted young gay men in New York City and told them to “always use a condom.” How successful do you think this campaign would have been at achieving its objective?

I think it’s a needed re-engagement. I think this ad will be effective. It’s not that people go to sleep about it [the need to use a condom]. It’s just that with everything else happening in people’s lives…there’s a certain impatience to do with sex …you need people to stop and think at a point in time when you tend to be thinking with a different part of your body than the brain. I think this campaign is potentially effective and needed.

There’s a call to action here. It’s not saying stop having sex or damn those people who got HIV. It’s saying: Use a condom!

Fear-based campaigns are extremely controversial. In general, do you think this type of strategy serves to educate and empower or is it potentially disempowering and even harmful?

I would say it’s a good communication strategy. It’s re-engaging and making an issue relevant again. In a curious way, very few advertisers do this kind of communication to prompt the chattering that’s going on around us [as a result of this campaign]. People sometimes assume that “advertisers just want the chattering class chattering” [about their issue]. Very few people do advertising for that reason. But, in this case, I don’t think they’ll be upset about the chatter because it’s getting some play, and therefore potentially getting a broad audience to think about it.

Nice safe messages that we're already familiar with won’t disturb people. You need to disturb. So, what the New York City Health Department has done is disturb people and get them thinking about [practicing safer sex] again, which is the goal.

When it comes to HIV prevention, how can messaging speak to people effectively?

Part of the goal is to establish the relevance to the individual, and to establish relevance not just as knowledge but as an action to be taken.

Depending on your target audience, you certainly can use known personalities—that was the value of the Rock Hudsons and Elizabeth Taylors grabbing onto this in the early days. It still has value today although I think that the strategy of the NYC Health Department has an even greater impact.

Outside of the roles of advertising but definitely within the realm of marketing: you have to make sure that condoms are widely available and make sure that the medical profession is fully aware that these issues are real, so that when they talk to their patients, the need to practice safer sex is not something that’s forgotten and buried, but that it’s something they raise.

In addition, you’ve got to be working with social media now. You’ve also got to get in the high schools. You can do it the formal way—through teachers, clinics, somebody known by the school sending the message around. The problem with teenagers is that they think they’re invulnerable, they’re never going to die, they’re never going to have anything wrong with them…Threats often don’t get through but [the “It’s Never Just HIV” ad] is sufficiently well done that it could get people to pay attention.

You’ve got to do something like this every so often because no health issue will permanently remain front of our minds. Whether it’s after a year or two years that you’ll need this kind of push again, it will be needed. You can’t just assume having done it once and there’s a broad awareness of HIV and what it can do, that that awareness will remain. That’s not how our minds work. [If you see the same messaging for too long], it becomes part of the background and it’s no longer effective.

Brian Finch

How did you respond to the “It’s Never Just HIV” campaign when you first saw it?

So, my first reaction was “hmmm”…and now I hate it. I think it is extremely aggressive and in-your-face, like the ads on cigarette packaging. I know that they were basing this campaign on strategies like that, but it’s shocking to have it thrown in your face like this.

Some people, even some people with HIV think, “We have to let them know how terrible it is.” I don’t think that strategy helps.

If I had just found out that I was HIV-positive and saw this ad, it would scare the hell out of me. If I was concerned about my HIV, it would scare the hell out of me too.

The purpose of a social marketing campaign is to target a particular group of people and try to influence a specific behaviour. The “It’s Never Just HIV” campaign targeted young gay men in New York City and told them to “always use a condom.” How successful do you think this campaign would have been at achieving its objective?

I suspect that some people might be so scared that they may just not deal with it because it’s easier to push it under the rug and not think about it, especially when it’s presented as, “You’re going to be eaten up by cancer, your bones are breaking…” It’s true that those things can and may happen for some people living with HIV, but that doesn’t constitute what the average experience is in North America.

Fear-based campaigns are extremely controversial. In general, do you think this type of strategy serves to educate and empower or is it potentially disempowering and even harmful?

I don’t think you can scare people into behavioural change when there’s short-term gratification involved. Like with smoking, for example, people know [about the risks] … and could be dying of cancer even, yet some continue to smoke. There’s a short-term need that demands to be met and I don’t think you can scare people to change that. There need to be other approaches to engage people in the conversation.

When it comes to HIV prevention, how can messaging speak to people effectively? 

I think that we need to take whole new approaches to HIV prevention. I’m making generalizations and I don’t have research to back it up, but I’m tired of social marketing campaigns. Back in the 80s—even before I knew I was positive—I was tuning stuff out because I thought, “OK, enough already.” I think we’ve been besieged with all these campaigns. If the times are changing and the contexts are changing, then I think that the approach needs to change as well. We need to make use of new technologies and new ways of engaging people in these discussions.

My personal view is that social marketing campaigns are not all that effective these days. Social marketing in the form of an ad and poster is just too passive. It just becomes part of the background noise. Think about the 80s and how much messaging we were getting then and compare it with now. Twitter, Facebook, TV…we’re bombarded with information all the time. So how do we cut through that? And how do we balance the message that HIV is something that you don’t want to get (life would be a lot easier without it) yet without portraying people with HIV as scary people, with such horrible lives…as victims or lepers. It’s a balancing act.

When I went public with my HIV status, it was just me and Oprah talking about things publicly (and others, but we were few and far between)…Now it’s become the norm: we live in an era where people are putting their stuff out there all the time. Engaging with the new social-media environments means putting the human and financial resources into it. There are all these ways to engage people in ways other than throwing up a poster or making a video, which can still happen, but we need to expand our tools. There’s a new culture now: people want to feel connected. Young people are using—through phones and all those different avenues—the social media a lot.

Roseline Carter

How did you respond to the “It’s Never Just HIV” campaign when you first saw it?

A friend sent it to me and said, “check this out and tell me what you think.” So I watched it. On my very first watch, I was pretty horrified by it. I thought it was way too in-your-face and aggressive, and I worried about the impact it would have on people’s perceptions of the gay community and HIV in general.

The purpose of a social marketing campaign is to target a particular group of people and try to influence a specific behaviour. The “It’s Never Just HIV” campaign targeted young gay men in New York City and told them to “always use a condom.” How successful do you think this campaign would have been at achieving its objective?

I really don’t know but from all the research I did in planning for my blog, the ad seemed to receive mixed reviews. From the reviews of the impact it had on the young gay population, I’m not sure it’s going to achieve what it’s hoping to achieve. I think that [the intended audience] have just kind of tuned out and found that it didn’t appeal to them. I think it certainly got people talking—which is a good thing—but I’m not sure young gay men are going to respond to it in the way [the marketers] would have hoped.

I think that young gay men respond to conversations about their sexuality that are open and honest, and don’t stigmatize anal sex. I feel like this ad had too much of a doomsday-type of feeling, where the intended audience is going to think, “Here’s another thing telling us that we’re doing something wrong by being gay or engaging in anal sex, and I don’t want to hear about it.” That’s certainly a lot of the feedback I heard about it. So I feel like it’s that age-old issue: If someone tells you not to do something and they’re really aggressive about telling you, you’re just not going to listen to them.

Fear-based campaigns are extremely controversial. In general, do you think this type of strategy serves to educate and empower or is it potentially disempowering and even harmful?

Personally, I’m not the biggest fan of fear-based campaigns. In certain areas, they might be helpful but I’m not sure with HIV—a disease that is stigmatized, that already segregates certain populations who are already highly marginalized—I don’t think that fear-based messaging is the right way to go. I feel like there are enough uphill battles to fight when dealing with these issues. We’ve been trying to tell people for a very long time that HIV has changed, trying to gain support and compassion for people living with HIV. I’m not sure that putting out messages that are frightening is going to be effective.

This messaging might make people less likely to go for HIV testing. They might think, “What’s the point anyway? If I find out I have HIV and go on these medications and then I’m going to get anal cancer, osteoporosis and all these things anyway.” Some people might stop taking their medications, thinking “What’s the point, if I’m going to have all of these impacts anyway?” So, I think there are larger issues that might come into play other than people just not listening to the message.

Also, if someone not living with HIV watches that video, it puts this idea in their head of what living with HIV is like and although I think that the issues brought up in that ad are absolutely real for some people with HIV, for others this is not the case. I think it’s unfair to paint a whole group with the same brush.

When it comes to HIV prevention, how can messaging speak to people effectively?

I’m not sure we’ve figured out the right way to do that yet. If we had, we’d probably see a decline in HIV rates. But my initial thought is that telling people to use condoms—we know that message is getting old. People often tell us that they have condom message fatigue and that HIV prevention messaging has got to go beyond that. So we need to look at why people aren’t using condoms.

I think we’ve seen a shift towards positive social norms marketing—looking at what people do really well and reinforcing that—as opposed to continuously telling people what they’re doing wrong. A couple of positive social norms campaigns came out recently…[including] one in Alberta about safer sex. They polled a bunch of people and then used the messaging to tell people what they were doing well. For example:

  • X% of people said that they’ve been tested for HIV. Are you one of them?
  • Y% of people told us that they used condoms with their last partner. Did you?

This makes it a normal thing to talk about these issues. I do think we need to make messages more about what people are doing well…and about the actual challenges to why people are not using condoms.

Like I’ve said, I’m not sure we’ve found the perfect way to deliver these messages, but if they can be peer-delivered…also, I think that we need to move beyond population-specific approaches and not just target specific individuals because a lot of the issues are similar [for different groups]. I think that since the beginning of this, gay men have gotten the short end of the stick—they’re the ones who are constantly put in the campaign messages and constantly told that they’re the ones who are disease-ridden and the ones fueling this epidemic. When we start to make our messages more broad—look at other people who are infected with HIV and other people who are at risk of HIV—that might also help reduce some of that stigma.

Related article

For more detailed information on fear-based campaigns, see Fear-based campaigns: The way forward or backward?