Mass media and social marketing campaigns to prevent HIV and other STIs
Mass media and social marketing campaigns to prevent HIV and other sexually transmitted infections (STIs) use media to disseminate information to a large population regarding safe sex and encourage HIV/STI screening, to increase knowledge, improve risk perception, and change behavior. Campaigns can be delivered by traditional media such as television, radio, and print media, or digital media such as websites, social media, QR codes, and internet advertising; digital media may include interactive elements1. Campaigns are usually designed for specific groups, such as young adults or men who have sex with men.
What could this strategy improve?
Expected Benefits
Our evidence rating is based on the likelihood of achieving these outcomes:
Increased STI testing
Increased HIV and STI knowledge
Potential Benefits
Our evidence rating is not based on these outcomes, but these benefits may also be possible:
Reduced risky sexual behavior
What does the research say about effectiveness?
There is some evidence that mass media and social marketing interventions increase frequency of HIV testing in the short-term2, 3, 4 as well as knowledge about HIV and other sexually transmitted infections (STIs)1, 5. Interventions leveraging digital media such as websites and social media can increase testing for other STIs, such as syphilis2, 6. Such interventions may also positively affect risk behaviors such as condom use1, 2, 4, 7, 8 and number of sexual partners in some circumstances4, 9, as well as delay sexual initiation in adolescents1. Additional evidence is needed to confirm effects9.
Research suggests that the most effective mass media interventions define their intended audience, tailor messages to those populations5, 9, 10, coordinate with existing interventions11, and use multiple channels to disseminate messages9. Campaigns that are longer and that incorporate interactive elements may be more effective6, 7. Digital media interventions for condom use may be more effective in women, while those encouraging STI testing may be more effective in young people6. Health campaigns including mass media and either free or discounted health-related products, such as condom distribution, can increase the use of the products provided12.
Digital media interventions have great potential, but the technology does not guarantee campaigns effectiveness13; trends and algorithms change rapidly, which make determining best practices difficult6, 13. Most early studies of digital interventions did not appear to change behavior in men who have sex with men6. However, more recent evidence suggests social marketing campaigns combining traditional and digital mass media may increase STI testing in men who have sex with men in some circumstances14 and may increase awareness of PrEP, a medicine to prevent HIV infection15.
High quality health communication and social marketing campaigns are designed with theory, engage with the intended audience during development, and are segmented to reach specific populations9.
Mass media interventions for HIV prevention appear to be more effective in areas with fewer resources than areas with greater resources; such campaigns also appear less effective in developed countries than in developing countries7.
How could this strategy advance health equity? This strategy is rated potential to decrease disparities: suggested by intervention design.
Mass media and social marketing campaigns to prevent HIV and other STIs have the potential to decrease disparities in HIV and STI incidence if they are appropriately targeted and designed to reach those most at risk of infection, but evidence for these interventions is limited. Available evidence from recent studies suggest social marketing campaigns may increase syphilis testing in men who have sex with men14 and increase awareness of PrEP in Black and Hispanic men who have sex with men and transwomen15. Exposure to risk reduction information on social media is also associated with increased condom use in Black and Hispanic youth18. Evidence from other mass media campaigns suggests targeting can effectively reach specific populations when messages are tailored to the target audience1. How to promote equity in public health communication around HIV remains unclear19, and more research is needed to determine what is most effective in specific populations9.
Inequalities by gender, race, geographical location, and economic status persist in HIV diagnosis and care19. STIs disproportionally affect racial and sexual minority groups. In 2021, almost a third of chlamydia, gonorrhea, and syphilis infections were diagnosed among Black individuals, and men who have sex with men were diagnosed with around a third of gonorrhea cases and almost half of syphilis infections20. In 2019, 29% of new HIV infections were among Hispanic/Latino individuals21 and 26% of new HIV infections were in Black gay and bisexual men22.
What is the relevant historical background?
Sexually transmitted infections (STIs) have carried stigma for centuries, shaped by negative views of poverty, women, and sex23. STIs are associated with promiscuity and deviant behavior for women, while STIs in men are treated merely as a medical condition24. Stigma has continued to shape how STIs are studied, diagnosed, and treated. The racist and unethical Tuskegee Syphilis Study, administered by the federal government, intentionally withheld syphilis treatment from Black men for decades without their knowledge, to study the natural course of the disease, ultimately sowing widespread mistrust of health systems and medical research25.
When the AIDS epidemic began, federal response was slow to acknowledge and respond to it, in part because it primarily affected gay men in a time when many states still criminalized homosexuality. While the first case of HIV/AIDS in the U.S. was reported in 198126, 27, major federal funding wasn’t allocated until 198527. HIV criminalization laws were passed in many states criminalizing behavior such as non-disclosure, exposure, and/or transmission of HIV, or increasing sentence length for crimes based on someone’s HIV status28, long before pharmaceuticals were available to treat or prevent transmission29. Today, HIV criminalization unjustly applies criminal law to nonmalicious behavior by people living with HIV and the laws are disproportionately applied to people from groups who have been marginalized30, While 13 states have repealed or modernized their HIV criminalization laws, 34 states still have HIV/STI/communicable disease criminalization laws in place in 2023. Such laws can carry penalties up to life in prison28.
HIV messaging has evolved over time, from initial reporting based on fear in the 1980s to broader awareness efforts in the 1990s. The early 2000s saw campaigns around universal testing paired with greater ability for individuals to be tested, and current communication includes messaging that HIV transmission can be eliminated. Future messaging should incorporate health equity into its design19.
State and federal funding are important to address the rising incidence of STIs, however, historical trends show that funding has stagnated31.
Equity Considerations
- Who needs to be reached by mass media and social marketing campaigns in your community? How can you partner with and incorporate feedback from the populations most affected by HIV and STIs in your area?
- Who can you partner with to create mass media and social marketing campaigns to prevent HIV and other STIs in your community? Who has experience in communication and community outreach?
- How does stigma, and other systematic barriers, prevent people from accessing sexual health care and STI testing services in your community? What additional strategies can be implemented to overcome those barriers?
Implementation Examples
There are a variety of mass media interventions addressing sexual and reproductive health issues in the United States. Some states, such as California, have their own campaigns as well16. In 2023, the STI Awareness Week Toolkit included multiple campaign options, including Prepare Before You’re There, GYT: Get Yourself Tested, and Talk Test Treat17.
Implementation Resources
‡ Resources with a focus on equity.
CA DPH-STD Awareness Campaigns - California Department of Public Health (CA DPH). Sexually Transmitted Diseases Control Branch. STD Awareness campaign resources.
CDC-SAW Toolkit - Centers for Disease Control and Prevention (CDC). Projects & Initiatives: STI Awareness Week toolkit.
Taggart 2021‡ - Taggart T, Ritchwood TD, Nyhan K, Ransome Y. Messaging matters: Achieving equity in the HIV response through public health communication. Lancet HIV. 2021;8(6):e376-e386.
Footnotes
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1 Stead 2019 - Stead M, Angus K, Langley T, et al. Mass media to communicate public health messages in six health topic areas: A systematic review and other reviews of the evidence. Public Health Research. 2019;7(8):1-205.
2 Daher 2017 - Daher J, Vijh R, Linthwaite B, et al. Do digital innovations for HIV and sexually transmitted infections work? Results from a systematic review (1996-2017). BMJ Open. 2017;7:e017604.
3 Cochrane-Wei 2011 - Wei C, Herrick A, Raymond H, et al. Social marketing interventions to increase HIV / STI testing uptake among men who have sex with men and male-to-female transgender women. Cochrane Database of Systematic Reviews. 2011;(9):CD009337.
4 Cochrane-Vidanapathirana 2005 - Vidanapathirana J, Abramson MJ, Forbes A, Fairley C. Mass media interventions for promoting HIV testing. Cochrane Database of Systematic Reviews. 2005;(3):CD004775.
5 Noar 2009a - Noar SM, Palmgreen P, Chabot M, Dobransky N, Zimmerman RS. A 10-year systematic review of HIV/AIDS mass communication campaigns: Have we made progress? Journal of Health Communication. 2009;14(1):15-42.
6 Swanton 2015 - Swanton R, Allom V, Mullan B. A meta-analysis of the effect of new-media interventions on sexual-health behaviours. Sexually Transmitted Infections. 2015;91(1):14-20.
7 LaCroix 2014 - LaCroix JM, Snyder LB, Huedo-Medina TB, Johnson BT. Effectiveness of mass media interventions for HIV prevention, 1986-2013: A meta-analysis. Journal of Acquired Immune Deficiency Syndromes. 2014;66(Suppl 3):S329-40.
8 Wakefield 2010 - Wakefield MA, Loken B, Hornik RC. Use of mass media campaigns to change health behaviour. Lancet. 2010;376(9748):1261-1271.
9 Friedman 2016 - Friedman AL, Kachur RE, Noar SM, McFarlane M. Health communication and social marketing campaigns for sexually transmitted disease prevention and control: What is the evidence of their effectiveness? Sexually Transmitted Diseases. 2016;43(Suppl 1):83-101.
10 Pedrana 2014 - Pedrana AE, Hellard ME, Higgs P, et al. No drama: Key elements to the success of an HIV/STI-prevention mass-media campaign. Qualitative Health Research. 2014;24(5):695-705.
11 Keller 2002 - Keller SN, Brown JD. Media interventions to promote responsible sexual behavior. Journal of Sex Research. 2002;39(1):67-72.
12 CG-Health communication - The Guide to Community Preventive Services (The Community Guide). Health communication and social marketing: Campaigns that include mass media and health-related product distribution.
13 Wadham 2019 - Wadham E, Green C, Debattista J, Somerset S, Sav A. New digital media interventions for sexual health promotion among young people: A systematic review. Sexual Health. 2019;16(2):101-123.
14 Sang 2023 - Sang JM. Examining the impacts of a syphilis awareness campaign among gay, bisexual, and other men who have sex with men (gbMSM) in British Columbia, Canada. Canadian Journal of Public Health. 2023;114:295-307.
15 Marshall 2022 - Marshall B, Salabarría-Peña Y, Johnson W, Moore L. Reaching racial/ethnic and sexual and gender minorities with HIV prevention information via social marketing. Evaluation and Program Planning. 2022;90(101982):1-6.
16 CA DPH-STD Awareness Campaigns - California Department of Public Health (CA DPH). Sexually Transmitted Diseases Control Branch. STD Awareness campaign resources.
17 CDC-SAW Toolkit - Centers for Disease Control and Prevention (CDC). Projects & Initiatives: STI Awareness Week toolkit.
18 Stevens 2017b - Stevens R, Gilliard-Matthews S, Dunaev J, et al. Social media use and sexual risk reduction behavior among minority youth. Nursing Research. 2017;66(5):368-377.
19 Taggart 2021 - Taggart T, Ritchwood TD, Nyhan K, Ransome Y. Messaging matters: Achieving equity in the HIV response through public health communication. Lancet HIV. 2021;8(6):e376-e386.
20 CDC-STI Surveillance - Centers for Disease Control and Prevention (CDC). Sexually Transmitted Infections Surveillance.
21 CDC-Hispanic/Latino HIV Incidence - Centers for Disease Control and Prevention (CDC). HIV: HIV by group. HIV and Hispanic/Latino People: HIV Incidence.
22 CDC-African American MSM HIV Incidence - Centers for Disease Control and Prevention (CDC). HIV: HIV by group. HIV and African American Gay and Bisexual Men: HIV Incidence.
23 McGough 2005 - McGough LG. HIV/AIDS stigma: Historical perspectives on sexually transmitted diseases. Virtual Mentor: Ethics Journal of the American Medical Association. 2005;7(10):710-715.
24 East 2012 - East L, Jackson D, O’Brien L, Peters K. Stigma and stereotypes: Women and sexually transmitted infections. Collegian. 2012;19(1):15-21.
25 Tobin 2022 - Tobin MJ. Fiftieth anniversary of uncovering the Tuskegee syphilis study: The story and timeless lessons. American Journal of Respiratory and Critical Care Medicine. 2022;205(10):1145-1158.
26 HIV.gov - HIV.gov. HIV and AIDS timeline.
27 Bennington-Castro 2020 - Bennington-Castro J. How AIDS remained an unspoken—but deadly—epidemic for years. History. 2020.
28 CDC HIV-Exposure - Centers for Disease Control and Prevention (CDC). (2023, December 19). HIV and STD criminalization laws. Retrieved October 17, 2024.
29 CDC HIV-Criminalization - Centers for Disease Control and Prevention (CDC). (2023, December 18). HIV criminalization and ending the HIV epidemic. Retrieved September 18, 2024.
30 Bernard 2022 - Bernard, E. J., Symington, A., & Beaumont, S. (2022). Punishing vulnerability through HIV criminalization. American Journal of Public Health, 112(S4), S395–S397.
31 NCSD-STD Funding - National Coalition of STD Directors (NCSD). As STD funding stagnates, rates rise to all-time highs.
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