Ineffective HIV fear-based ads may help someday in New York City

While evidence of their effectiveness remains uncertain, fear-based public health campaigns in New York City could be a useful tool to help prevent HIV in the future, researchers suggest.

“Relying on fear is risky business. The decision about whether to use a fear-based campaign and how far to go is not simply a technical, evidence-based determination,” Amy L. Fairchild, PhD, assistant professor at Columbia University’s Mailman School of Public Health, and colleagues wrote in Health Affairs. “Decisions are almost always political, reflecting a calculation of how to balance issues of effectiveness, uncertainty, stigma, marginalization, emotional burdens, justice, community participation, and scientific credibility.”

The researchers wrote that HIV prevention efforts that “equated sex with death” in the 1980s were heavily criticized by activists, who claimed such campaigns served to stigmatize and marginalize those vulnerable to HIV, rather than change behaviors. Fear-based campaigns were largely out of favor until New York Mayor Michael Bloomberg brought them back in separate campaigns against HIV, smoking and obesity from 2005 to 2013, according to Fairchild and colleagues.

“The controversy over ‘Pouring on the Pounds’ was nothing compared to the pitched battle that would erupt when the New York City Department of Health determined that longstanding efforts using humor or affirmation — known as ‘sex-positive’ approaches — had failed to reduce HIV incidence among young men who had sex with men, especially among blacks and Latinos,” they wrote.

According to Monica Sweeney, the city’s former assistant commissioner for HIV/AIDS prevention and control, the 2010 “It’s Never Just HIV” campaign was based in part on feedback from focus groups with black and Latino men who said recent HIV campaigns needed to more closely mirror a fear-based smoking campaign, the researchers wrote.

“But the politics of fear in the realm of HIV differed from those in tobacco control, where nonsmokers’ rights groups and national organizations such as the American Cancer Society, not smokers themselves, helped define the agenda early on,” according to Fairchild and colleagues. “In the case of AIDS, community-based organizations had already successfully challenged the use of fear-based appeals.”

The campaign, which featured 30-second TV ads and subway posters, included graphic images of the consequences of osteoporosis, dementia and anal cancer. The researchers noted that activists had mixed views.

“It really paints this picture of gay men as these sort of disease-ridden vessels,” Francisco Roque, of the Gay Men’s Health Crisis, said.

However, long-time AIDS activist Larry Kramer said: “This ad is honest and true and scary, all of which it should be. All attempts to curtail it via lily-livered nicey-nicey ‘prevention’ tactics have failed.”

The New York City Department of Health continues to use fear-based campaigns to combat obesity and smoking — the city’s smoking rate declined from 22% in 2002 to 14% in 2010 — but appears to have shelved these types of HIV campaigns for now, according to the researchers.

“There is now empirical evidence that when carefully designed, fear-based appeals can work,” Fairchild and colleagues wrote. “Decisions regarding fear-based messages will need to be made in a context where it is no longer possible to assert that fear-based efforts can never serve the interests of public health.” – by David Jwanier

Disclosure: The researchers report no relevant financial disclosures.