“Do you want to die? If not, wear a condom,” is one of the messages the DP’s Mike Ellis (Sunday World, 5 September) feels should be broadcast to South Africans to wake them up to “the threat AIDS poses to all citizens”. He could not have chosen a formulation more at odds with current international approaches to condom-promotion.
Studies have shown that fear tactics do not encourage people to change their behaviour. On the contrary, fear usually encourages denial and fatalism. Thus, many South Africans respond to the threat of HIV/AIDS by either denying its seriousness, or by adopting the fatalistic attitude that they will die when their time comes.
Fear also contributes towards discriminatory attitudes and practices. When there is widespread public fear, tolerance becomes fragile. This can have tragic consequences for people living with HIV, such as Gugu Dhlamini, who was murdered when she disclosed her HIV status.
Behind the call for “scare-tactics” also lies an assumption that people have the freedom to act in accordance with their own best interests. But many people, mostly women, cannot say “no” to sex or take ownership of their bodies without risking rejection and violence. These people do not need health education nearly as much as they need social and economic reform.
Knowledge alone does not change behaviour. Most South Africans are now acutely aware of the threat AIDS poses yet they do not practice safer sex. Numerous studies show that information is only successful when it is reinforced by adequate community services, social support and an environment that creates opportunities for constructive action.
This means that advertising can play only a limited role in changing people’s behaviour. However, advertisements can do a lot better than to pump out death-threats. They can feature soccer heroes Lucas Radebe or Benni McCarthy on national TV, saying that they use condoms. And they can link people to organisations such as Lifeline, the toll-free counselling service that people can contact to get answers to their specific concerns. (“Condoms make me lose my erection”; “Where can I get free condoms?”; “What if a condom bursts inside me?”)
Another example of an excellent mass-media intervention is the popular SABC TV drama, Soul City, that aims to change basic social norms around gender inequality. According to Shereen Usdin, Soul City project manager, Soul City’s decision to tackle gender inequality is based on the understanding that condoms will never be used unless there is negotiation around sex, and partners can talk about the sexual act.
Rather than preach about the dangers of HIV, condom-promotion should show that when people are comfortable with, and in control of, their sexuality, condoms do not result in unsatisfactory sex.
At the same time, messages around condom-use need to be authentic. We have been led to believe that only those who “sleep around” need to use a condom. Otherwise, magic words like “relationship”, “marriage” and “love” are seen to be protection enough. Condom promotion must show that condoms do not undermine the assumption of mutual trust which is the basis of human relationships. As Gordon Isaacs, a psychotherapist specializing in HIV/AIDS, points out, when people are confronted by condoms they do not see plastic but images in their heads that date back to their grandparents. In other words, images of promiscuity and sinfulness.
Promoting condoms should not instill and reinforce fear of AIDS and, by implication, of people living with HIV/AIDS. Rather, the aim of condom promotion is to change the way people think and feel about condoms. Advertising needs to take this into account. Otherwise, advertisements are no more than a highly visible yet meaningless contribution to the counter-productive quick-fix solutions that we are trying to avoid.
* Jo Stein was a researcher for Health-e News.