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                  As important as reducing rates
of HIV is, there’s a lot of work done in this country to address that issue,
whereas there is a lack of efforts trying to destigmatize HIV and educate
people to better the lives of HIV+ people. The stigma is a result of people
being misinformed about HIV and holding onto fear from the initial outbreak a
few decades ago.


On September 27th 2017, the CDC stated “people who take ART daily as prescribed and
achieve and maintain an undetectable viral load have effectively no risk of
sexually transmitting the virus to an HIV-negative partner.”
(McCray & Mermin, 2017). Treated HIV+ people can live their life without
worrying about spreading the disease. It should
have meant a shift in how people view HIV and HIV+ people, but it became clear
that would not occur effortlessly. According to UNAIDS “World AIDS Day” 2015
report, “in roughly 35% of countries with data available, more than 50% of women
and men report discriminatory attitudes towards people living with HIV,” (UNAIDS,
2015). Not only does stigma effect people with HIV psychologically, but it also
prevents HIV+ individuals from seeking proper treatment, and prevents people from
getting tested.

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There are still
many who hear HIV and think death sentence, despite studies demonstrating that HIV+
individuals being successfully treated have a completely normal life expectancy
when viewed alongside HIV- individuals (May et. al, 2014). No longer should
there be concern about a treated HIV+ person. The concern should be that 44% of
HIV+ MSM do not know they are infected (Chakravarty et al, 2012). HIV could be
a death sentence for many, because of a lack of awareness and presence of stigma
prevent people from getting tested and prevent HIV+ people receiving/adhering
to treatment.


The group I’ve
chosen to target is gay and bisexual men aged 25-34 in Atlanta, Georgia,
because we’ve seen annual
infection rates increase by 35% among 25-34-year-old gay and bisexual men, and
Georgia has the second highest HIV Diagnoses rate in the U.S. (D.C. is number
one but likely has less severe stigmatization issues). My campaign will focus
on changing the view of HIV from a death sentence to a manageable chronic
condition unless untreated. Studies
show a relationship between stigma and testing. One study observed that people
getting HIV testing would far more frequently list additional non-stigmatized
services as the primary reason for the visit when compared with people who went
in for non-stigmatized services (mammograms or blood pressure tests) (Young, S., &
Zhu, Y., 2012. Additionally, studies have shown
that HIV+ people who feel stronger stigma towards HIV are less likely to adhere
to their medication regimen than those less concerned about stigma (Rintamaki
et. al, 2006).


If people were better informed about HIV treatment and
transmission, they would get tested more frequently because they’d feel less
helpless if they tested positive. People would perceive the severity of HIV and
susceptibility from a treated HIV+ person as lower, which would greatly help
reduce stigma. Additionally, people with HIV would adhere to their medications
more because they’d know they could live a full life and never worry about passing it onto a partner.


                  The theory I’m using in my
campaign is the Extended Parallel Process Model (EPPM). EPPM is based off of
Leventhal’s danger and fear control framework, and it expands upon previous
theoretical approaches of fear appeal (Witte, K., 1994). Danger control is how people cognitively handle a certain
danger or threat through changing of attitudes, intention, or behaviors, while
fear control is how people emotionally handle their fear by lowering how they
perceive the risk/harm of the threat to feel better (Witte, K., 1994).


The EPPM involves two main prongs: threat appraisal and
efficacy appraisal. Threat appraisal is the level of concern a threat is viewed
with by the individual, based on how high the perceived susceptibility (perceived
likelihood of being affected/harmed by the threat) and perceived severity
(perceived extent of harm of the threat). There is simultaneously an efficacy appraisal,
or how much the individual believes they can do the behavior (self-efficacy), and
believe doing that behavior will combat the threat (response-efficacy).


If the threat and efficacy are perceived as high, the
person will likely perform the recommended behavior. This means the individual goes
through the danger control process explained earlier. If threat is perceived as
low but efficacy is perceived as high, then the individual is less likely to do
the danger control behavior. If the threat is felt as high but efficacy feels
low, there will be a fear control as opposed to a danger/threat control. Fear control
is when the individual feels that they cannot successfully take actions to control
the threat, either because of low self-efficacy or low response-efficacy, but
they are still highly afraid of the threat so to relieve the dissonance they
will reduce their fear by lowering perceived susceptibility or severity.

Lastly, when there is low perceived threat and low perceived efficacy, there is
no response.


                  Several studies show empirical
results in support of the EPPM, which is very important. The first study looks
at the components of the EPPM (perceived threat and perceived efficacy), and it
found that women who had high self-efficacy scores for the ability to exercise
safely were also more likely to exercise while pregnant (for at least ninety
minutes per week). (Redmond, Dong, & Frazier, 2015). Additionally, pregnant
women who exercised at least ninety minutes a week had higher scores for their
perceived ability to control danger to the baby, and they also felt lower
susceptibility to harm/threat for their babies from prenatal exercise (Redmond,
Dong, & Frazier, 2015). Although this study is not related to HIV, it helps
support the validity of the model.


The EPPM has been used in HIV related studies, but the
studies are typically regarding prevention. Within these EPPM HIV-prevention
studies, there are even instances of using stigma around HIV and HIV+ people as
a way to increase perceived severity of HIV (Bastien, 2011). This same study of fear appeals in messages about
HIV-prevention showed that the people exposed to the messages had a desire for
more information-based messages on ways to protect themselves, and my campaign
focuses heavily on educating the population. (Bastien, 2011).


Currently there are many people (gay and bisexual men in
particular), who perceive a high level of severity and susceptibility to HIV. I
want to shift the perceived severity away from simply HIV as an illness to undiagnosed and/or untreated HIV. Because
rates of untreated HIV are high among MSM, the perceived susceptibility should
be kept high. Far too many people perceive low response-efficacy in terms of
treatment for HIV, which results in lower rates of testing and adherence to medication.

My goal is to maintain the same high
level of perceived threat (but shifted towards untreated HIV instead of HIV in
general), while increasing perceived
efficacy by informing the general public about the completely normal life that
can be lived while HIV+.


My campaign will be narrative based, but I only delve into
the explanation of the EPPM because the narratives are mainly a means to facilitate
the EPPM. For its initial run, my campaign will be a commercial aired in
Atlanta, Georgia on VH1 during episodes of RuPaul’s
Drag Race, because of its large gay and bisexual male fan-base. It will be
split into two ninety-second commercials. My campaign will feature HIV+ gay and
bisexual men telling their personal stories about how they contracted HIV, how
they had reacted when they were diagnosed (because of their preconceived ideas
of HIV), what kind of stigma they feared and/or actually faced, and how their perceptions
of HIV have changed since being diagnosed. The end of the commercial will
provide a website of where to watch and learn more. The website will have more
stories, facts about HIV, places to get tested, and links to support groups for
HIV+ people.


The men would be selected for the campaign based on having
different stories and coming from different backgrounds, so they could relate
to more viewers. The variety of stories and backgrounds will not only help
people identify better with these men, it will also have increased the viewers’
perceived susceptibility. If they see men from all different ethnicities,
variety of occupations, who have different stories, it will be a lot harder for
a gay or bisexual male watching to tell themselves they personally could never
get HIV. Within their personal stories, they can each mention a fact meant to
influence perceived susceptibility, perceived severity, or perceived efficacy. For
further increasing perceived susceptibility, one man who contracted it from
somebody that didn’t know their HIV status can mention the statistic that 44%
of HIV+ MSM don’t know they are HIV+ (Chakravarty et
al, 2012).


                  For the question about how
each man reacted when they found out about their HIV status, we can include in the
narrative of someone who panicked thinking it was going to cut their life short
that they were informed that the lifespan of a treated HIV+ person was no
different than an HIV- person’s life span. Although this runs the risk of lower
perceived severity, it will do a great deal to help inform and destigmatize
people, as well as increased perceived response-efficacy. That one statement
alone tells viewers that the treatment for HIV is so effective that an HIV+
person’s lifespan won’t be shortened by their diagnosis, which will definitely increase
response-efficacy. This increase in response-efficacy is especially important
for increasing adherence to medications for HIV+ individuals, and this same
narrative could include an additional statement like “and to live a full life
all I have to do is take a pill once a day,” to increase perceived self-efficacy.

The CDC release about 0% transmission from treated HIV+ treated to negative
partners would also be mentioned, as it would further increase perceived
response-efficacy and reduce stigma. Lastly, perceived severity would be the mentioning
how short life-spans were for HIV+ people were just over twenty years ago because
of a lack of treatment, to increase perceived severity of HIV if untreated. This increase in perceived
severity of untreated HIV would encourage the viewers to get tested, because
they have learned enough to know their life can be totally fine if they test
positive, while also learning/reaffirming their knowledge of how poorly their
life can go if they have HIV but are untreated.


                  I fully believe my campaign,
using predominantly the EPPM in a narrative structure, would be incredibly
successful in increasing rates of HIV testing, increasing adherence to
treatment for HIV+ individuals, and reduce stigma felt by HIV+ individuals.


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