Towards more inclusive and empowering healthcare campaigns

The messaging and advertising surrounding HIV/AIDS have undergone significant transformations since the epidemic first came to public awareness in the early 1980s. 

These shifts reflect changes in scientific understanding, public attitudes, and broader societal norms. From fear-based campaigns to inclusive, empowering messages, the evolution of HIV/AIDS communication can be analysed through a psychological lens, examining how different strategies have influenced public perception, behaviour, and stigma.

Early fear-based messaging (1980s-1990s)

When HIV/AIDS first emerged in the early 1980s, limited scientific understanding and widespread fear fuelled panic. The infection immediately acquired a stigma as it affected populations of already stigmatised people (gay men, IVDU, sex workers). 

This stigma became reflected in the early naming of the infection - Gay Related Immune Deficiency (GRID). HIV stigma also influenced public health campaigns during this period as they often relied on fear-based messaging to grab attention and encourage behaviour change. Many conservative politicians and clergy used this opportunity to link infection with punishment from God for immoral and depraved behaviour. For example, the UK's 1987 'Don't Die of Ignorance' campaign featured tombstones and apocalyptic imagery, aiming to shock audiences into awareness and prevention.

From a psychological perspective, these early campaigns reflected the protection-motivation theory, which suggests that individuals are more likely to adopt protective behaviours when they perceive a severe threat and believe that effective responses are available. 

However, while fear can be a powerful motivator (e.g. personal behaviour changes during Covid lockdown), the heavy emphasis on death and disease in early campaigns contributed to the deepening of stigma of individuals living with HIV/AIDS, and further stigmatised vulnerable people and communities. This had negative effects on early identification and engagement in clinical services, and a negative effect on the mental health of stigmatised communities.

Shifting toward empowerment and behavioural strategies (1990s-2000s)

The successful introduction of antiretroviral therapy (ART) in the mid-1990s effectively changed the medical management of HIV. The infection became a manageable long-term condition, but it depended on HIV identification, access to treatment and life-long ART adherence. 

With this shift, public health campaigns moved from emphasising fear to promoting behavioural strategies, such as condom use, regular testing, and harm reduction techniques.

Psychologically, this approach aligns with self-efficacy theory, which suggests that people are more likely to engage in healthy behaviours when they believe they have the ability to do so successfully. Campaigns started providing concrete information on how to reduce risk, rather than solely warning about the dangers of HIV/AIDS.

One prominent example is the 'ABC' strategy (Abstinence, Be faithful, and Condom use), which gained popularity in the late 1990s and early 2000s, especially in sub-Saharan Africa. While it encouraged safer sexual practices, critics argued that the abstinence-first approach reinforced moralistic views that ignored the realities and complexities of sexual behaviour, particularly among young people.

Destigmatisation and inclusive messaging (2010s-present)

In recent years, HIV/AIDS messaging has become more inclusive, focusing on reducing stigma, promoting testing, and encouraging antiretroviral therapy adherence. The advent of Pre- and Post PST Exposure Prophylaxis (PEP and PrEP) as an effective prevention tool has further shifted messaging from fear to empowerment, emphasising that HIV is preventable and manageable.

Social norm theory suggests that people are influenced by their perceptions of what is typical behaviour in their community. By normalising testing, treatment, and conversations around HIV/AIDS, campaigns reduce stigma and encourage positive health behaviours. Research that proved that People Living with HIV (PLHIV) on ART and with an undetectable viral load cannot transmit HIV to others - 'Undetectable = Untransmittable' (U=U) - has been an important milestone for PLHIV in terms of having intimate relationships without the fear of onward transmission.

There has been a stronger emphasis on intersectionality, recognising that different communities experience HIV/AIDS differently, but there are also commonalities based on the negative effects of stigma that affects engagement and trust with healthcare systems. 

Campaigns are now much more carefully designed to address diverse populations, including LGBTQ+ individuals, women, and communities of colour, using culturally relevant messaging that addresses unique challenges and barriers to healthcare.

The role of digital and social media

Another significant shift in HIV/AIDS advertising is the use of digital and social media platforms. Unlike traditional media campaigns, digital outreach allows for personalised and interactive engagement, using behavioural theory to encourage users to take action. Targeted ads on platforms like Facebook, Instagram, and TikTok can reach high-risk populations with tailored messages, providing links to resources and local clinics.

The use of influencers and community advocates has also played a crucial role in destigmatising HIV/AIDS. Seeing trusted figures openly discuss their experiences with HIV helps challenge misinformation and reduces stigma. It also provides role models that emphasise empowerment, personal self-esteem and the importance of seeking and maintaining links with supportive communities.

Conclusion

The evolution of HIV/AIDS messaging reflects broader shifts in public health strategy and psychological understanding. While early campaigns relied on fear and urgency, modern approaches emphasise empowerment, inclusivity, and practical solutions. 

Psychological theories such as protection motivation, self-efficacy, and social norm theory help explain how different messaging strategies have influenced public perception and behaviour over the years. 

As scientific advancements continue to improve HIV prevention and treatment, messaging will also need to evolve to ensure that it remains effective, compassionate and mindful of nuance, but most importantly, based on evidence that is determinedly not prejudiced.

Find out more about the DCP Faculty for HIV and Sexual Health and the resources it offers.