Public health experts are calling for an urgent rethink of the public awareness campaign connected to Australia’s coronavirus vaccine rollout.
Some are looking towards the effectiveness of the country’s infamous HIV/AIDS Grim Reaper campaign from the 1980s.
But not everyone’s convinced. The peak support body for people with HIV said the Grim Reaper campaign marginalised the LGBT community.
A third of Aussies are vaccine-hesitant
Since the country’s COVID-19 rollout began in February, just 13 per cent of the population have rolled up their sleeves.
A recent survey conducted by The Age and The Sydney Morning Herald found that almost a third of Australians were unlikely to get the jab.
And with reports of more than a million doses being left unused dominating news headlines in recent days, there have been calls for a more effective awareness campaign to ensure Australians get their COVID-19 vaccinations.
Bill Bowtell, who spearheaded the public health messages around HIV/AIDS, believes a major advertising campaign to convince Australians reluctant to get the jab is paramount.
He said the Grim Reaper campaign he helped produce from the 80s was highly memorable and impactful.
“It was also one of many campaigns that circulated and were generated at that time to most affected communities, to the general public, that put the case for behavioural change,” Bowtell told the ABC News Breakfast.
He believes it was effective because politicians were nowhere to be seen, which was a deliberate choice.
“Because politicians are not the people we need to sell the message about vaccination now in Australia.
“I wish we had a [vaccine] but we had to promote behavioural change and it was a very tough sell.”
But the campaign also received criticism for provoking fear and hostility towards members of Australia’s LGBT communities and those positive with HIV.
The Grim Reaper advertising campaign ran over a three-week period in 1987 with the line:
At first, only gays and IV drug users were being killed by AIDS.
But now we know every one of us could be devastated by it.
Immunologist Professor Ron Penny, who treated the first case of HIV in Australia, said in hindsight the Grim Reaper ad had unintentionally marginalised gay men, something he later regretted.
“The downside was that the Grim Reaper became identified with gay men rather than as the Reaper. That was what we had unintentionally produced, [the belief] by some that the Reaper was people with HIV infection, rather than the Reaper harvesting the dead.”
A fear appeal communication style
Tom van Laer is an Associate Professor of Narratology at the University of Sydney.
He said the health communication campaigns around HIV/AIDs used something called a “fear appeal” in an attempt to scare the public to practice safe sex.
Dr van Laer said it was only in the early 2000s that academics who study persuasion and communication figured out there were huge mistakes made in those fear appeals.
“It didn’t even tell people, that’s what you need to do.”
He explains if the fear is too high, the public can go into something like a protective mode and deny that they could be affected by the disease.
He believes the only way a fear appeal can work to change people’s behaviour is for the fear to be moderate, not extreme.
“And that’s exactly what happened in the 80s. It’s like, oh, well, that’s just LGBTQIA+ people, that’s the gays … that doesn’t apply to us. It’s a gay disease.”
How did the Grim Reaper ad affect LGBT groups?
David Menadue was among the first in Australia to become HIV-positive in the early 80s.
He believes one of the biggest issues with the ad was that the Grim Reaper’s deathly look replicated some of the most severe experiences of those suffering from the illness.
“A lot of people suffering from HIV looked a bit deathly and a bit cadaverous because they were losing a lot of fat and muscle and facial fat,” he said.
Mr Menadue is firm in his belief the Grim Reaper was a mistake.
“Some people thought it woke people to the reality of HIV, and [they] took it more seriously after that. But my view is, if you’re going to scare the hell out of people, it’s not always a particularly healthy response,” he said.
“You get people, when they act for fear, they sometimes behave irrationally. And that’s what happened with responses to HIV, particularly we feel after ’87.”
Mr Menadue said after the ad, people were scared of people with HIV. He said it changed his life.
He recalls being told to leave a gay bar in the late 80s because he had HIV and the mounting pressure on the gay community due to the Grim Reaper campaign.
“They started resenting us because they thought we’re bringing all this bad reputation onto the gay community,” he said.
“I experienced things at gay bars where people came up to me and asked me to leave.”
“This is in the late 80s when people didn’t know better, and I refused to leave. And I had a group of supportive friends around me, they told the guy off but that’s the sort of stuff that happened to people, horrible things.”
Stigma persists decades on
Aaron Cogle, an executive director of the National Association of People with HIV Australia, believes we have learned a lot since the 1980s that can help us refine campaign messages.
“Marginalised communities often bear the heaviest burden of disease epidemics because of social inequality,” he said.
He believes campaigns that stigmatise particular communities by characterising them as being to blame reinforce social exclusion. Mr Cogle said that stigma makes epidemics harder to respond to.
“We need people to be able to trust their health providers and come forward for testing, vaccination and treatment as appropriate. Stigmatising and blaming communities creates an environment where people can’t do this without fearing for their safety.”
A report from last year found gay and bisexual men are still having to contend with the stigma.
This was despite only 5 per cent of participants of the study being HIV-positive, while over 70 per cent saying they were stigmatised for their assumed risk of HIV.
A community-led public health approach
Mr Menadue believes subsequent HIV/AIDS campaigns from the government were much more successful than the initial Grim Reaper ad.
The federal government at the time worked collaboratively with HIV/AIDS community groups, health professionals and researchers.
The government put in measures like universal and anonymous HIV/AIDS testing, educational campaigns in consultation with the public and high-risk groups, more promotion of condom use and sex safe schemes.
He praised those latter approaches from former federal health minister Neal Blewett and advisor Mr Bowtell.
He believes there was a bigger effort to engage community leaders and affected groups in the public health response.
“The next campaign the government was involved in was a beds campaign,” he said.
“It had possibly 50 beds on the screen. And it had a couple in the bed and it said, now, if you have slept with someone recently, without protection, how do you know where those people have slept before?”
Mr Mendaue said that the campaign highlighted the risk which was unprotected sex, which the Grim Reaper campaign didn’t.
“The problem with it was, it scared everybody but it didn’t follow up with, this is what you need to protect yourself against HIV.”