Does fear work? New York City experience with “hard-hitting” public health advertising campaigns.

“Young gay men glance fearfully (even shamefully) at the camera.  As the sound of a heartbeat quickens,  … the viewer sees … a femur, shown in x-ray, snapping,  … gray matter shrivelling,  … a digitally enhanced internal view of the body fades to a bloody, raw anus, with Frankenstein-like surgery scars, of an African American man”.

This was the “hard-hitting” New York City anti-HIV campaign – “It’s Never Just HIV” – that began December 2010, but seems, as of 2015, to have been shelved in the face of widespread controversy.  Is this kind of thing appropriate?  Does it even work?

Fairchild & Colgrove (F&C) chronicle a decade of “fear-based” public health campaigns in New York City under Mayor Michael Bloomberg, placing the recent HIV campaign in the context of campaigns on tobacco, obesity, and HIV, and focussing on public reactions and the official response to them.  Readers from the UK will be reminded of the famous – or infamous – HIV/AIDS campaigns of 1986-7,  discussed by a number of past contributors to STIs (Nicoll & Catchpole (STIs); Ross & Scott (STIs); Beck & Miller (STIs)).

In NYC, the tobacco campaign, at least, seems to have had some success, being associated with a 35% decline in smoking over the period 2002-2010.  The impact of the obesity and HIV campaigns, launched on the strength of that success, has proved harder to evaluate; but the orthodoxy among health educators of an earlier generation that “fear-arousing messages backfire” seems to have been punctured.  It is noteworthy that the most serious objections to some of the NYC campaigns have concerned not, so much the restriction of individual autonomy, as their stigmatizing affect on socially disadvantaged groups – e.g. black gay men.

The probable impact of the 1986-1987 campaign in the UK is evaluated by Nicoll & Catchpole (STIs) (N&C) in terms of new attendances at GUM clinics requiring diagnosis – which declined by 117/105 in men, and 42/105 in women during the campaign, then plateaued from 1987, only to rise again in the 1990s.  F&C note that the NYC campaign appears to have failed to interrupt the “apparent continuing increase of HIV diagnoses among young men of color having sex with men”.  There is reason to believe that fear can work – “where people believe they have the capacity to act” (see Fairchild & Colgrove, notes 4-9).

 

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