AIDS and its portrayal on television since 1980s - Essay Example

?AIDS and its portrayal on television since the 1980s Acquired Immune Deficiency Syndrome (AIDS) did not come to the attention of general population until the early 1980’s. At first, AIDS was believed to be a disease that only affected gay men and drug users. However, after a couple of years, AIDS was reported among regular women and children as well as hemophiliacs and Haitians in the U.S. (Altman, 1983). Scientists finally identified Human Immunodeficiency Virus (HIV) as the cause of AIDS and had become aware that AIDS was widespread in large parts of Africa. By 1983, 3,000 AIDS cases had been reported in the U.S. At this, the media started play more of a role in reporting AIDS, especially television stations and newspapers. However, many Western scientists and doctors remained ignorant of the growing AIDS epidemic. Meanwhile, in many other countries there was an epidemic of fear and prejudice against HIV affected people. AIDS has been estimated to have affected between 46 and 60 million people. The virus can spread through blood, semen, or vaginal fluids. Every minute five new people are infected with HIV. The virus kills young people who are in their formative years (Weiss, 1993). The disease has killed 25 million people since 1981 and, as of today, 3.3 million people die annually. It has been estimated that 68 million people could die of AIDS between 2000 and 2020. Because of the way Africa has been affected by the AIDS epidemic, some estimates proclaim that Africa has lost 20 percent of its labor power due to AIDS. The average lifespan in Sub-Saharian Africa is now 47 years old; without the AIDS epidemic it would have been around 62. In the developed world, 58 percent of new AIDS cases are drug addicts who share syringes, while and 33 percent of cases occur through unprotected sexual contact. In undeveloped countries, the main causes are through unprotected sex and blood transfusions. Of those affected by HIV, 28 million are found in Africa, half a million in Western Europe, 300,000 in Eastern Europe, 600,000 in Eastern Asia and Oceania, and 2.6 million in the Americas, largely South America (WHO, 2011). There is no vaccine for AIDS; however, a combination of up to four different drugs is the main way of stopping the disease. These particular drugs keep the blood lymphocytes at normal levels, while maintaining the virus’s latency but without lessening its ability to kill. Adults and children receive information about this disease from various sources, but they mostly get it from the media. Thus, it is important to investigate how the media, particularly television coverage, has affecting our understanding of HIV and response to the disease from the 1980’s until now. In early response to the AIDS epidemic, television broadcasted information about the HIV epidemic to the general public, which produced mixed results. In the UK, there was great public concern about the blood supply at hospitals, with references in newspapers to "killer blood" (Vass, 1986). At this time, the media began to take more notice of the AIDS epidemic, with the screening of a television program known as "The Killer in the Village." A number of newspaper articles commented on the subject of the "gay plague." AIDS was the subject of many headlines and caused great alarm among the public. In some newspapers, the prejudice was obvious. Hemophiliacs were seen as the "innocent victims" of the AIDS epidemic, whereas gay men and drug-users were seen as having brought the disease upon themselves (Wellings, 1988). The fear of contracting HIV caused firemen to ban the kiss of life, and it caused holidaymakers to cut their holidays short for fear of contracting AIDS from an HIV positive passenger on the Queen Elizabeth 2 (Vass, 1986). A nine-year old HIV positive hemophiliac was allowed to attend one of the local schools, but some of the pupils where kept home by anxious parents (Pinching, 1990). In the United States, the fear of the AIDS epidemic was just as visible. It was feared that drinking communion wine from a communion cup could transmit AIDS, and Ryan White, a 13-year old hemophiliac with AIDS, was banned from attending school (Levine, 1986). In those early days, public acknowledgment of the HIV/AIDS epidemic often unleashed a flood of fear and confusion. Tabloids carried trumped up stories of HIV-positive sex workers infecting hundreds of men, schools demanded that infected children stop attending classes, and funeral parlors refused services to families of people who had died from AIDS. To prevent panic among the general public, many governments around the world moved quickly to allay their citizens’ fears. By 1987, HIV/AIDS education campaigns had been launched on every continent (Wayling, 1988). In many countries, AIDS campaign materials reflected deep-rooted cultural norms and biases. Like any other media product, HIV/AIDS messages order, categorize, and frame reality. Consciously and unconsciously, campaign creators put a “face” on their subject. They do so not only in superficial characteristics, such as their choice of words, images, sources, and styles, but also in more fundamental ways, such as how they articulate questions of life and death, relationships between men and women, sexuality, friendships, caregiving, and values, such as honesty and openness. Although these representations may change as medical knowledge expands and media coverage shifts, HIV/AIDS education messages, at any given point in time, give snapshot views of the culture in which they are embedded (Johnson, Flora, & Rimal, 1997). Gardner (1966) found that people are more likely to be persuaded by messages they can easily understand and comprehend. The amount of information has been linked comprehensively in an inverted U-shaped relationship, with too much or too little information creating confusion (Keller & Staelin, 1987). Johnson et al. (1997) counted PSA’s (public service announcements) total number of statements, divided them and sorted them into subject categories. Knowing that message explicitness also facilitates comprehension (Bransford & McCarrell, 1974), they examined the bluntness of PSA’s language and how clothed or unclothed its characters were. As for yielding, Bandura’s social cognitive theory (1986) emphasizes the importance of PSA characters performing acts so that viewers can see how they are done and then assess their own capabilities to do so. Of critical importance is viewer affinity with a character: The more viewers perceive a character as similar to themselves, the more likely they are to believe that they can also perform the act. Johnson et al. (1997) again divided PSA characters (or sources) into proximal (similar to viewers) and professional experts. Their genders were also recorded. According to Windhal and Signitzer (1992), the most effective messages define their target population specifically. For each PSA, we examined both the numbers and types of target audiences. Viewers with low involvement tend to remember emotional appeals better, as Flora and Maibach (1990) found, so we examined whether a PSA primarily told a story or gave facts. With PSAs aimed at mass markets, we assumed most viewers would fall at the low end of the involvement spectrum. General information, unrelated information, and nonspecific safe sex information— the least behavior-oriented and least controversial types of information—showed up most frequently. Around 93 percent of the PSAs mentioned something to the effect of “everyone is at risk.” Sixty-three percent offered unrelated facts, while 41 percent talked about safe sex without mentioning condoms or the number of sexual partners a person has. The most frequent behavioral information involved condoms, yet it appeared in only 28 percent of PSAs. Countries with PSAs that gave a high percentage of condom-related facts were Sweden (100 percent), Denmark (83 percent), and India (71 percent). Only 12 percent of PSAs touched on restricting the number of sexual partners someone has. This included 60 percent of Canada’s PSAs and 67 percent of Ghana’s. A little more than four percent of countries brought up HIV tests, with the largest contributors being PSAs from the Ivory Coast (33 percent) and Germany (27 percent). Only 16 percent of PSAs linked HIV risk to drug use (Johnson et al., 1997). Using approximately the same categories, we found that most PSAs handled recommendations gingerly; almost 25 percent avoided them entirely. Thirty-nine percent of PSAs suggested that viewers seek additional information; this recommendation appeared in every PSA from Jamaica, Barbados, Canada, Mexico, Japan, Uganda, and Senegal. General advice, such as “be careful,” was given in 30 percent of the PSAs. Fewer than 20 percent urged condom use. Of the countries producing PSAs that recommended condom use, the United States had the lowest percentage (four percent); the highest were Thailand (100 percent), Switzerland (60 percent), Canada (60 percent), and Spain (50 percent). About 10 percent of PSAs recommended talking to friends and family members about HIV/AIDS; this was carried out more frequently in PSAs from the Philippines (40 percent) and Nepal (50 percent). Just four percent of PSAs told viewers to limit their number of sexual partners; this included half of Nepal’s PSAs and 60 percent of Canada’s (Johnson et al., 1997) These PSAs were produced during the first decade of the pandemic, when governments rushed to quell mounting fear and ignorance. This probably explains why contain over-the-top information. However, their inexplicitness, lack of recommendations, and heterosexual emphasis result in falling far short of what cognitively-oriented theoretical models would deem as effective in motivating attitudinal or behavior changes. The announcements perceived as the most educationally effective were those that presented hard facts about AIDS in a simple and straight-forward manner. Complex and emotional campaigning techniques drew negative responses. Uses of light humor were positively received by high-risk viewers (e.g., homosexuals). Ironically, three of the five announcements perceived as the most successful were never sanctioned for broadcast use in their respective countries; announcements perceived as the least successful were broadcast in their countries more frequently (Baggaley, 1988). Advertising on television also plays a significant role in AIDS campaigns. It is readily apparent that the 1987 AIDS campaign, with its keynote emphasis on scene (the AIDS environment), sought to build awareness and knowledge of the disease (Bush & Boller, 1991). By portraying AIDS as a deadly environmental threat, the CDC hoped to convince viewing audiences that knowledge of AIDS facts was crucial to their survival. From a traditional hierarchy-of-effects perspective, building awareness is an important first step toward subsequent behavioral changes. If television advertising can be assumed to be the primary source of AIDS and health-related information for individuals in our society, an initial awareness-building strategy would indeed be the best way to do so. Unfortunately, television advertising may not always be the primary source of AIDS and health-related information early in a health crisis. Mass media (publicity) sources may be more important during the early stages of a pandemic. As reported in studies by Gottlieb et al. (1988), special reports or programs in the news media and pamphlet mailings seem to be the other primary forms of mass media. With respect to disseminating critical, health-related information, we may consider relegating this task to mass media sources more specifically designed to perform this task: news media. In this way, advertisements can instead be utilized to direct already informed viewers to various health-related products and/or services, which is the task advertisements are best suited to perform. In 1988, television advertisements changed focus on the AIDS campaign. Instead of building awareness, the campaign built worry and fear. Bush and Boller (1991) suggested that the 1988 AIDS campaign assumed the role of fear-inducer by emphasizing acts (risky behaviors). Viewing audiences were urged to worry about potentially dangerous behaviors in which they or their loved ones engaged. Essentially, advertisements comprising this campaign "served notice" to viewers that behaviors such as extramarital affairs and IV drug use could lead to AIDS. The assumption is that the worry and fear evoked by this campaign would motivate viewers into protecting themselves from the AIDS virus. Although many experts believe that fear often serves as a powerful motivation for behavioral change, much of the research regarding the effectiveness of fear in public service advertising is inconclusive. For example, Robertson (1976) showed that using fear in television campaigns for seatbelt use had little effect on behavioral change. One explanation for the apparent lack of effectiveness is that the anxiety produced by a vivid execution of fear interferes with viewers' comprehension of the message. Hill (1988) extends this explanation in a study concerning AIDS advertising, and argues that viewers experience high levels of anxiety in response to fear because advertisements tend to promote behaviors inconsistent with current behaviors. Unfortunately, the resulting high levels of anxiety left viewers without an appropriate response to the advertisements. Over anxiety can cause some people devastating psychological harm. For example, there were reports of suicides from fear of AIDS during sensational AIDS media campaigns in Finland (Aro, Henriksson, Leinikki, & Lonnqvist, 1995). As such, Hill suggests that health officials find alternatives other than fear when attempting to educate the public on AIDS-related issues. Similar to the 1988 AIDS campaign in the United States, the Australian campaign was distinctive in that there was a particularly heavy emphasis upon the use of shock tactics to arouse public interest and shake people out of a supposed state of apathy about AIDS. The campaign drew upon the Morin Model (Puckett & Bye, 1987) in formulating a plan for changing behaviors in relation to AIDS. A major tenet of that model is that there must be a belief that AIDS is a personal threat if change is to occur. It was decided that the Australian campaign would begin with a strong message by giving an emotional shock to the general community to raise awareness and public concern. The message was to be that all members of the community were at risk of AIDS through sexual and drug-use behaviors, not just homosexual males as previously explained. Having created a demand for knowledge about AIDS, the plan was to provide factual information through a wide range of alternative sources. Factual information, using “Grim Reaper” visuals and media advertisements, followed the advertising campaign on television for several months. Whilst a person may not be motivated to take the appropriate actions at low levels of fear, when the level of fear is too intense, individuals may behave irrationally or counterproductively. Highly fearful individuals may refuse to expose themselves to additional health information (Levanthal & Watts, 1966) and are thus unable to take effective action (Levanthal & Clearly, 1980). More recently, Sherr (1990) reported on the UK campaign on AIDS, which used targeted fear messages and found that fear messages significantly increased anxiety in low risk individuals and had no impact on those at the high risk end of things. Whether the level of fear induced by the “Grim Reaper” would induce appropriate cognitive, attitudinal, or behavioral changes was unclear. Sherr noted that peoples’ willingness to alter sexual behaviors did not change, nor did drug-using behaviors in those at high risk, in the UK campaign. This data suggests that media campaigns, such as the “Grim Reaper,” do have an effect on peoples’ attitudes, and only convince people that more is known about the transmission of HIV and this makes people less concerned about mixing with HIV infected people. The people who were reportedly influenced by the campaign were those who had a greater fear of diseases and death, suggesting that the fear-related message may have produced concern among those who believed that little was known about AIDS and its spread, and that it was a catastrophic epidemic. Fear may also have given the impression that little was known about the disease. This data suggests that the “Grim Reaper” campaign may have had an adverse effect on peoples’ beliefs about death, or alternatively, may have been noticed more by those with such beliefs (Ross, Rigby, Rosser, Anagnostou, & Brown, 1990). It is equally probable that those who were most concerned before the campaign may have been most affected by it. In contrast to the aforementioned suggestion, La Tour and Pitts (1989) recommend that AIDS officials consider using stronger fear-arousing ads. They base this recommendation upon the results of a study that demonstrated that a college-aged sample favorably evaluated a “Grim Reaper”/slice-of-death AIDS advertisement from Australia (i.e., they perceived the ad to be interesting, of high quality, and unique). Although some segments of society may evaluate AIDS-related fear appeals in terms of aesthetic qualities, Bush and Davies (1989) note that state health officials generally evaluate the use of fear in terms of its effectiveness in helping to prevent the spread of the AIDS virus. Given the controversy surrounding the effects of fear on peoples’ behaviors, we believe that its role in health advertising needs to be reconsidered. It is important to recognize that fear and worry are emotional reactions to threatening situations that individuals feel are beyond their control (Frijda, 1988). More precisely, individuals experience fear when they believe that they lack adequate coping responses to a perceived threat. Advertising campaigns can most effectively induce fear in an audience by failing to provide information regarding the means by which to cope with the threat. But, is this an appropriate role for advertising? Should health-related advertising attempt to "scare" audiences and assume that viewers, of their own volition, will seek appropriate coping responses to the threat? Or, should advertising instead attempt to prevent the experience of fear by providing viewers with a means to cope with the threat? Advertising's role in 1989 provides a coping response to the threat. In the 1988 campaign, viewers were implicitly urged to “just say no” to social and sexual behaviors that may have put them at risk of contracting AIDS (e.g., IV drug use and extramarital affairs). Unfortunately, viewers were never informed about how to behave in a way that the “saying no” technique becomes a viable option. It is important to recognize that sexual activity and drug uses are an exceedingly complex web of interrelated social- psychological behaviors. Public announcements that urge people to "just say no" are more than a waste of time and money; they are exceptionally naive (Bloom & Novelli, 1981). Given the overwhelming number of commercial messages that, implicitly and explicitly, urge viewers to "just say yes," how can we reasonably expect individuals to avoid those behaviors without specific prescriptions regarding the means to avoid them? In general, can we reasonably expect individuals to alter their complex systems of behaviors in a pro-consumption society through the means of simple announcements regarding the potential dangers associated with various behaviors within the system? A fundamental difference between the 1988 and 1989 campaigns is that the latter assumed the role of “helper.” With its keynote emphasis on agency, the 1989 campaign provided viewers with one way to cope with the spread of AIDS—open and honest discussions with children. In essence, the advertisements comprising the 1989 campaign amounted to public service "advertisements" for a coping response instead of public service "announcements" about an ominous threat. The messages in the 1989 campaign identified a crucial problem—talking to children about AIDS is a potentially embarrassing and difficult task. The self-relevancy of this problem may have been enhanced through the use of dramatic executions (Boller, 1990). Therefore, these messages offered a solution to the aforementioned problem—a pamphlet that could be obtained by calling 1-800-342-AIDS. Concerned parents were explicitly urged to engage AIDS information and referral services for suggestions regarding talking to their children about the disease. The elegance and potential effectiveness of the 1989 campaign primarily rested on its simplicity. Instead of sweeping attempts to denounce the deadly consequences associated with complex social and sexual behaviors, the 1989 campaign focused on three coping responses: (1) dial 1-800-342-AIDS, (2) request a pamphlet, and (3) discuss AIDS with children. This campaign showed awareness of what commercial marketers have long understood—it is far easier to persuade individuals (over the course of an advertising campaign) to purchase a particular brand of soap than it is to persuade them to change their entire system of behaviors concerning their personal hygiene. Public policy officials and advertising practitioners need to rethink the benefits associated with public service announcements, and contrast them with the potential benefits associated with public service advertisements. If, in the face of a pandemic, medical, testing, referral, and educational services are available, should not our public service advertising be designed to enhance the likelihood that individuals will engage these services? At the very least, should not public service advertising inform viewers about the potential means to cope with a threat? Television can play a far greater role in dealing with AIDS in addition to helping motivate individual preventive behaviors. Several possibilities open up when we move beyond spot announcements and dramatic serials to hour-long specials in news/variety formats, which have an advantage of greater depth and a wide range of flexible program forms. Possible program forms include human interest documentaries, bulletins, person-in-the-street interviews, animated graphics, and on-the-scene coverage of staged and unstaged events. What better way to dispel unfounded fears of transmission by casual contact than through television documentaries that show healthcare workers and family members coming into close daily contact with AIDS patients for a cumulative total of thousands of hours without ever contracting the virus themselves. This, and a shot of the President or Prime Minister holding an HIV-infected infant, may be highly influential in helping to quell the panic that moves people to advocate unnecessary and costly restrictions on the mobility of infected persons. Such programs can help to dispel panic over working with HIV-infected persons, or fears about an impending treatment centers in one's neighborhood (Plamer, 1988). According to Rogers (1973), the strength of mass media revolves around heightening the public’s sensitivity to health issues through transmitting specific information with the use of credible, newsworthy channels. Wouldn’t an influential world figure have a similar effect on people in regards to AIDS issues? As an example, in the mid-1980s, the beloved Princess Diana of Wales’s involvement in charities was frequently shown on television news. She was very much involved in combating serious illnesses and health-related matters, including AIDS, outside the purview of traditional royal involvement (Bureau of Hygiene & Tropical Diseases, 1987). Seeing the late Princess of Wales touching and taking care of HIV-positive patients definitely lessened the fear of contracting the disease from social contacts. Also, it corrects the common misconceptions about AIDS as well as reducing the prejudice against HIV-positive individuals. As a result, the majority of people became more sympathetic towards those unfortunate people who had already contracted the deadly disease. It is not only news and advertisements that provide information regarding AIDS; television shows also play a part in influencing the perspectives of general population on this issue. Lemal and Van den Bulck (2009) found that adolescents who regularly watched semi-explicit sexual television content were less likely to be afraid of AIDS than peers who were exposed to such programs on a less frequent basis. One may consider that semi-explicit sexual television content desensitizes adolescents about important sexual health issues. Sexual risks, such as AIDS, seem to become less salient issues in their sexual scripts or schemata. In the case of semi-explicit sexual television messages, content analysis has found that television mainly portrays sexual activity without emphasizing responsibility or the negative consequences of not taking precautions. Nevertheless, television can be great means of safe-sex education. For instance, most participants who watched Queer as Folk, a television drama, raved about how great it was that this television program consistently and explicitly showed its characters using condoms during sex. Here, one of the group members gave the show credit for promoting safe sex by including multiple scenes in which characters chose not to have sex without a condom (Farrell, 2006). Another study suggested that children who were encouraged to watch the program viewed the show more often, talked more about sexual issues within their families, and were more knowledgeable about AIDS than the control group. However, parents of children identified as at risk for HIV infection had more difficulty discussing AIDS with their children than parents whose children were not at risk. The use of the media can be effective in presenting material as a matter-of-fact manner, and decreasing the negative valence on the topics of sex and HIV transmission. The surveys investigated high school students’ knowledge and awareness of AIDS, and the results indicated that adolescents have very limited knowledge of AIDS, are often misinformed about AIDS, and possess low levels of concern about the virus (Crawford et al., 1990). Teenagers may be at lower risk of contracting HIV if they are encouraged to discuss safe sex with their families by being exposed to repeated television presentations of families discussing these topics openly and being provided with behavioral strategies aimed at increasing competence in approaching sensitive subjects, such as sexual behavior and drug use (Crawford et al., 1990). Even though knowledge about HIV and its transmission, including its prevention, is widely known by a majority of people in developed countries, people in developing countries still have misconceptions about the disease—this maintains bias and prejudice against people who are HIV positive. Of the respondents in Porter’s study (Porter, 1993) who had heard of the disease, 95 percent knew that AIDS was transmitted by sexual intercourse; less than half, however, also knew that AIDS could not be acquired through kissing, insect bites, or by using public toilets. In general, respondents in India had little specific knowledge regarding the symptoms of AIDS, and 29 percent of Indians were unaware that infected persons could be asymptomatic and appear healthy. More than one-third of respondents would not have dinner with or continue to work with an AIDS patient, and 50 percent believed that every AIDS patient should be quarantined. Lau, Tsui, and Phil (2003) suggested that misconceptions about HIV transmission routes were strong predictors of discriminatory attitudes. Around one-third of the respondents clearly indicated their unwillingness to make contact with a friend who was infected with HIV. Though some improvement has been observed, the level of discriminatory attitudes remains high. Sustained education to remove misconceptions about HIV infection is required. In another study by Tebourski and Najem (2005), a population of school-going adolescents of both sexes, aged 16 to 20, was sampled in 1997 and once again in 2002. They found that once HIV/AIDS and other sexually transmitted diseases became better known, there was more tolerance expressed for people living with AIDS, and the use of condoms was more positively judged. Fewer misconceptions surrounding the condition were also noted. However, many results recorded during the 1997 survey remained unchanged (e.g., television as a primary source of information). Approximately 24 percent of adolescents continued to believe that HIV infection could occur through saliva, insect bites, or public baths. In conclusion, attitudes towards AIDS patients are improving globally. There is a trend for positive attitudes if contact with an HIV-positive person is indirect (e.g., a working relationship, 72.2 percent). However, even less agreed to “eat with an HIV-positive person” (40.3 percent) and even fewer to “kiss him or her” (25.7 percent) (Tebourski & Najem, 2005). As long as program producers adopt a strategy that portrays protective sex in a positive light when showing explicit sex scenes, or a show where children discuss AIDS and safe sex with their families, there will be fewer people contracting HIV each year. 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