Health Messages Related to HIV Stigma and Discrimination

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Although there is a vast body of research in HIV=AIDS prevention, few studies have questioned how messages that directly target stigma and discrimination may be read and understood by different audiences. Indeed, it has been argued that health messages may have a unique interpretation within each cultural context. This point is especially compelling when we consider that social norms, values, and ideologies often play a vital role in the interpretation of visual texts. Given that the visual materials target a global audience, representing distinct people throughout the world, a more nuanced understanding of these posters necessitates a review of the role that culture plays in the interpretation of health messages. One of our first points of interest is the use of cross-cultural materials in HIV=AIDS prevention. Airhihenbuwa and Obregon point out that many health campaigns employed in the developing world are based on a Western perception of culture. Employing Western models in other cultural frameworks can result in problematic outcomes, particularly since the role of ‘‘the individual’’ varies from one region to the next.

For example, ‘‘Theories based on the individual, which may be effective and meaningful in a Western context, have lesser relevance in selfeffacing cultures of Asia, Africa, Latin America and the Caribbean’’. In these regions, family and community are more central to health and well-being than is the individual. Consequently, campaigns that focus on individual responsibility may promote behaviours that are highly unattainable given the cultural norms of a region. When individuals are unable to meet the expectations that are outlined in health campaigns, it may contribute to a sense of guilt and shame.

Along with issues related to individual and collective notions of health, the literature suggests that HIV=AIDS campaigns do not always speak to the cultural realities that are associated with sexual activity. Pliskin illustrates this notion in a study which concludes that individuals who are about to engage in sexual activity are likely to avoid discussing their sexual past until after intercourse has occurred. Moreover, in many cultures, sexual behaviour precedes sexual knowledge and, consequently, ‘‘The linear model of knowledge leading to attitude and behaviour counterintuitive in the context of relationships and culture’’. This idea is also articulated in the research of Melkote, Muppidi, and Goswami, who note that sexual behaviour is often impulsive rather than rational. Furthermore, Auerback and colleagues show that health messages relating to safety may be ‘‘dismissed in the context of a passionate sexual encounter when competing proximal goals (i.e. sexual gratification) offset well-informed intentions (i.e., to use a condom)’’.

These studies demonstrate that cultural norms and physiological needs may dictate the conditions of sexual activity and, therefore, campaigns may be more effective when they address HIV=AIDS prevention from a (multi)cultural standpoint. In response to various cultural issues confronting HIV=AIDS campaigns, researchers from Pennsylvania State University have developed a communications framework based on five contextual domains that influence behaviours: culture, gender relations, government policy, spirituality, and socioeconomic status. Their recommended communications model is represented as a house whose structure varies according to the conditions of the environment or context. Airhihenbuwa, Makinwa, and Obregon, in explaining this model, claim that a campaign that focuses on the use of condoms in commercial sex work, for example, may position gender relations as the foundation of the house while government policy to mandate 100% availability of condoms represents the roof. Other campaigns will adopt a different structure in order to accommodate the overall goal of a society. Such culturally sensitive approaches to prevention efforts might be augmented through the use of participation-based communications models. As pointed out by Mody, involving the audience of a message in the overall design of that message is an effective means of both targeting the specific needs of a group and also creating messages that respond to problems of a community.

It also helps to overcome the top-down communications structure that treats marginalized groups as objects of humanitarianism. While the literature suggests that HIV=AIDS prevention campaigns may be most effective when they are tailored to the norms, traditions, and specific needs of a society, there appears to be a dearth of information on the role of culture within messages that aim to counteract stigma and discrimination. As previously mentioned, many health campaigns are still derived from communications frameworks that do not speak to the realities of non-Western contexts. With this in mind, one might then question whether dominant Western ideologies pervade the posters, and, if so, what type of impact they may have in the developing world where there exists several cultural and ideological differences. As we shall see, the importance of placing culture at the heart of educational messages is not only pivotal for HIV=AIDS prevention, but it is also an important consideration in addressing HIV=AIDS-related stigma and discrimination.

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