The different prevention needs of people with HIV

People with HIV have fundamentally the same need for interventions that can help them attain and maintain better sexual health as people without HIV.

However, the motives for maintaining safer sex, and therefore the kind of psychological reinforcement that best supports it, may be very different. In November 2000, a CHAPS campaign, ‘In Two Minds’, depicted the rationalisations gay men may make to give themselves ‘permission’ to have unprotected sex. In the advert, a head is depicted giving the reason for safer sex, with a  groin giving the rationalisation against it. This obviously struck a chord with gay men: Sigma Research found that this had the highest recognition score for any CHAPS campaign in the previous two years.¹

All but one picture showed models depicting HIV-negative men. Terrence Higgins Trust, who produced the campaign, wanted to include an HIV-positive man, but ran into difficulties deciding what it should depict him thinking. The problem they had was that the HIV-negative men had a clear and identical motive for avoiding HIV, namely fear of infection. But what was the HIV-positive man’s motive?

Serodiscordant partners are united by their sexual identity and by personal bonds. But the motives for maintaining sexual safety are often different.

If one looks at HIV prevention from the theoretical viewpoint of the Health Belief Model,² the activity is about reinforcing and reminding people that unpleasant emotions are a consequence of HIV transmission. In this case, HIV-negative people are motivated by an emotion (fear) that is caused by contemplating an existential and unvarying physical phenomenon (death and disease). In contrast, HIV-positive people are motivated by an emotion (shame) that is caused by contemplating a contingent and variable social phenomenon (stigma and isolation).

Campaigns and prevention interventions may run into problems, such as a reinforcement of stigma, if they try to reinforce this emotion in the same way.

The findings from the Albarracin meta-analysis cited above³ – that ‘threat’ messages were not as counterproductive when used to frame prevention messages for people with HIV, as they were for people without – and Jean Richardson’s finding that ‘loss framed’ messages work better for people with HIV,⁴ gives some credence to this idea.