Friendly Fire: Stigma & Social Marketing Redux

A few weeks ago, I wrote about a community forum (“Selling Us to Ourselves: Is Social Marketing Effective HIV Prevention?) in New York that would be discussing recent HIV/AIDS prevention social marketing campaigns that have been criticized by the gay community for using stigmatizing messages and images. CHAMP, which was one of the sponsors, has now posted a report from the forum that summarizes the speaker presentations.

And last week, another forum was held in Los Angeles to discuss a new campaign by the LA Gay and Lesbian Center that states “HIV is a gay disease. Own it. End it.” Richard Kearns of attended the forum and posted his notes and reactions, along with a powerful poem about the use of stigma in these recent social marketing campaigns. He calls the effects of this approach “friendly fire,” which I thought was a quite apt description. While trying to shoot down the “enemy” — AIDS — these social marketing campaigns also cause some collateral damage by either reinforcing negative stereotypes or creating an environment that makes people not want to acknowledge that they are at risk.

By saying that HIV is a “gay disease” (75% of people with HIV in LA are gay), the campaign undoes decades of hard work to get the point across that anyone can become infected if they engage in risky behaviors. While I understand that the point is to get the gay community to re-engage and take ownership of the solution for ending AIDS, this statement in one fell swoop both implies that all gays have HIV and that everyone with HIV is gay. If this campaign were only visible to the gay community (maybe using gaydar vision?), then perhaps it would be justifiable if it were shown to be effective, to get people talking and empowered to take action. But they cannot ignore the effects of the campaign on the general population, who may form negative opinions about gays or people with HIV as a result.

Steve Simon, the LA City AIDS coordinator, spoke on the panel and said that he had received phone calls 20 to 1 complaining about the ad. He felt that “this is undermining messages we’ve been putting out for a long time.” He was contemplating creating a series of ads to balance out the “HIV is a gay disease” theme, with messages like “HIV is a Latino disease,” “… a black disease,” “…a woman’s disease,” etc.

Les Pappas, whose company Better World Advertising created the campaigns, spoke at both forums. At the New York forum, he said this about the approach they took with the HIV (not fabulous) campaign:

Change can come in different ways. It can come from attracting people (getting them on the bandwagon), but it also comes through disturbing them or causing them discomfort (so they’re challenged in some way to move to make a change). We like it when it makes us “feel good” but we don’t like it when it confronts our reality, shocks us, airs our dirty laundry, or makes us think too much. But why do we think that we have to like or approve or agree with social marketing? Ultimately, what is the role of controversy? We need to leverage the scarce resources we have, and we need to get people’s attention. The first hurdle is getting people’s attention; then, you can gauge people and deal with other hurdles…

…Now what about campaigns that people don’t like so much? What about campaigns that make people feel bad? For example, we launched the HIV (not fabulous) campaign. We had a gentleman with facial wasting, we had a gentleman in a diaper because of chronic diarrhea, and we had a gentleman with a bloated belly. People thought it was stigmatizing people with HIV, but what I can speak for is the e-mails that we received about the ads. We had a lot of people complaining, but we also had a lot of people who had no idea that HIV was so bad. Young gay men in Los Angeles woke up with this campaign—it gave them a reality check and changed their behavior in terms of protecting themselves.

Contrast this confrontational in-your-face approach with other more positive and empowering campaigns like Better World’s HIV Stops with Me and We Are Part of You or Oakland’s new I Am Worth It campaign (though I’m not crazy about Kenneth Cole’s anti-stigma We All Have AIDS campaign — it’s too wishy-washy). Unfortunately, there is not much data to show whether the controversial approach has been effective.

So what do you think? Is it worth creating controversy and potentially stigmatizing some of the members of your target audience in order to attract attention to the issue? Is some collateral damage acceptable when dealing with life and death issues? Or should you stay away from those methods even if you find it works to bring about change?

I think an effective social marketing campaign needs to involve members of the target audience in the message development and pretesting to find out whether the approach will shock and awe or completely backfire. If you make people angry with your message, they will dismiss you and the campaign without paying attention to what else you might be saying. Getting their attention is good, but you also need to get them on your side.

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