As health agencies look for effective HIV prevention campaigns, fear tactics are an increasingly popular option. Also referred to as negative messaging, fear-based campaigns rely on gruesome images and disturbing stories. These campaigns are controversial, but are often promoted as the only way to shake viewers out of complacency. In several recent studies on public health campaigns, however, results have shown that fear tactics are generally ineffective.
At a recent meeting in New York, community service providers expressed concern that a New York City Department of Health public service announcement would prevent their clients from getting tested for HIV. This 30-second TV spot aimed at gay and bisexual men, titled "It's Never Just HIV" showed images of young black and Latino men suffering from conditions such as osteoporosis, dementia, and anal cancer. An HIV infection, the video explained, puts people at greater risk for these diseases. Indeed, these conditions have been found to be more common in older adults with HIV (but not in younger people). During the debate, some were concerned that the campaign would further stigmatize gay men and people with HIV, while others voiced frustration with what they considered a complacent community. Above all, the most important issue was whether or not fear-based campaigns work.
This was not the first time this question has been raised. A 2002 Yale study found that when fear levels were too high in messaging, fewer viewers processed it, and began displaying denial. A 1989 Yale study showed how attempts to elicit fear from viewers may also cause anger and sadness. Those studied felt they had less ability to practice safer behaviors, but simultaneously felt "more vulnerable to diverse negative health outcomes." Due to a decreased sense of being able to take action, especially when suffering or death were mentioned, they were less likely to adopt risk-reducing practices.
According to a September 2010 Sigma Research brief, threatening messages also lead people to deflect their anxiety onto other groups, and that fear may attract attention but may not necessarily change behavior. In one study, men over 30 insisted that fear-based HIV-prevention posters were meant for younger men, while men under 30 thought they were intended for "scene-oriented, promiscuous gay men." Another study found that a fear-based HIV prevention campaign targeting Scottish teenagers was equally ineffective. Those surveyed said that the campaign would work and that they liked the messaging, but that it wasn't actually meant for them.
Individuals who are targeted may also believe the message to be exaggerated and therefore personally irrelevant. If the negative messages seem too strong, they might rely on personal experience (never having been infected) and grow mistrustful of the message. According to Sigma, the only people who absorb fear-based messages are those already engaged in the desired practices.
The HIV stigma that arises out of fear tactics may also deter those who are positive from disclosing to partners, especially when messages are disempowering. It can also deter those at risk from getting tested. Public health campaigns may wish to remind the public of the dangers of HIV infection given recent successes in treatment, but according to Sigma, "research conducted in the U.K. has concluded there is little or no association between optimism about HIV, given the success of antiretroviral therapy, and high-risk sexual behavior."
Conversely, the positive impact of strengths-based public health campaigns has been widespread. Messages emphasizing what could be gained from using sunscreen were shown in a 1999 American Cancer Society study to have a greater impact in both awareness of health benefits and actions taken. Another study in the same year showed that the likelihood to take preventive measures against breast cancer, as opposed to simply detective measures, significantly increased with positive messaging. Yale University researchers found that the likelihood of someone changing their current behavior is much higher if the change involves gain.
These case studies all show that prevention campaigns are most effective when conducted in positive, affirming ways. In order to change sexual behavior, messages must emphasize the self-efficacy that is needed to reduce one's risk. The targeted communities must also be consulted and actively engaged in framing campaigns. Shocking images may seem like a way to change behavior, but the message that is most effective is the one that reaches out to communities and gives them the confidence and the tools necessary to make a change.