Mpox, AIDS and COVID-19 show the challenges of targeting public health messages to specific groups without causing stigma

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(THE CONVERSATION) During infectious disease outbreaks, clinicians and public health officials are responsible for providing specific advice to the public on how to stay safe and how to protect themselves and their loved ones. However, sensationalist media coverage can distort public perceptions of newly emerging infections, including their origin and mode of spread. This can foster fear and stigma, especially towards communities that are already distrustful of the health system.

The racial and gender stigma surrounding monkeypox is what prompted the World Health Organization to rename the disease mpox in November 2022. While this is a step in the right direction, I believe there is still work to be done to do to reduce the stigma surrounding infectious diseases like mpox.

I am an infectious disease researcher studying HIV, COVID-19 and mpox. During the COVID-19 pandemic, I was the lead investigator at the University of Pittsburgh for a nationwide investigation examining how COVID-19 affected different communities. Effective public health communication is not easy when mixed messages can come from many sources, including family and friends, other community members, or the internet. But there are ways public health officials can make their own messages more inclusive while reducing stigma.

Create an inclusive message

Inclusive public health messages can motivate the public to make better decisions about their personal health and the health of others. This effort often involves engaging the communities most affected by an outbreak. Unfortunately, because these communities are heavily impacted by infection and tend to experience some form of inequity, they are often blamed by society for spreading the disease.

COVID-19 has led to an increase in pandemic-related hate crimes against Chinese and other Asian communities in the United States. A 2022 UCLA survey found that 8% of Asian American and Pacific Islander adults in California have experienced a hate incident related to COVID-19.

Effective public health messages can focus on the fact that while infections may first affect certain groups of people, they often spread to other groups and eventually encompass entire communities. Infections are caused by bacteria, viruses and fungi. They do not discriminate based on race, gender or sexual orientation. Messaging that focuses on pathogens rather than communities can reduce stigma.

Inclusive visual messages are also likely to engage a larger portion of the community. For example, make sure that people depicted in posters and flyers, images on television and websites, and other informational materials come from a variety of backgrounds. This sends a more unified message that what affects one individual also affects the community as a whole.

Avoid blame and fear

Many media outlets, especially on social media, use fear-based messages to report on infectious diseases. While this can reinforce certain protective behaviors, such as using condoms during sex, it can also increase stress and anxiety. Fear-based messages also compound stigma, leading to further discrimination against communities that are already vulnerable and distrustful of health care. Ultimately, this leads people to avoid seeking health care and can make health problems worse.

Public health officials have often used fear-based messages in response to sexually transmitted infections, or STIs, such as HIV, chlamydia and gonorrhea. Sex itself is heavily stigmatized by society. I have found that some of my patients would rather avoid being tested and treated for an STI than live with the shame of having an STI.

Making sexual health and STI testing routine and integral to overall wellness and health is an important step in reducing the stigma around them. Likewise, messaging that normalizes the challenges faced by those at risk for certain infections could help avoid causing shame.

Tailor the message

Infections affect different people differently. COVID-19 can be a mild stuffy nose for one person, and it can take months in a ventilator-attached intensive care unit for another. Messages that emphasize the successes of medical and public health interventions that resonate with communities are the most likely to succeed.

Different groups also have different exposure risks. Mpox strongly affected gay and bisexual men in 2022. One of the reasons was related to the way the virus is transmitted. Previous research suggested that mpox was widely transmitted through close skin-to-skin contact, but emerging studies have raised the question of whether the 2022 outbreaks were driven more by sexual transmission.

There was controversy over whether public health messages should highlight sexual encounters as a potential route of transmission. This may risk further stigmatizing gay and bisexual men rather than potentially neglecting these key at-risk populations. Some advocates have argued that promoting the message that mpox is primarily transmitted through close contact would prevent resources and interventions from reaching the groups of people most affected by the disease.

One size doesn’t always fit all when it comes to public health messaging. Multiple messages may be needed for different groups of people depending on their risk of infection or serious illness. An August 2022 survey from the Centers for Disease Control and Infection found that 50% of gay and bisexual men were reducing their sexual encounters in response to the mpox outbreak. Since late summer, mpox rates have fallen rapidly, and many experts believe behavior change and vaccination may have contributed to lower rates. Studies like these confirm the importance of engaging directly with communities to encourage healthy behavior change.

Trusted messengers

Mistrust is also a barrier to effective messaging. Some communities may be wary of medical and health care systems due to a history of exploitation, such as the Tuskegee study, where researchers barred black participants from receiving syphilis treatment for decades in the mid-20th century. century, and the lingering fear of abuse.

Identifying trusted community champions and healthcare providers – especially those from that community – to deliver a public health message can increase its acceptance. A 2019 study, for example, found that black men were more likely to accept vaccines, medical advice, and use health services if they had a black health care provider.

Effectively disseminating public health messages is a complicated and demanding process. But talking and listening to the communities most affected by an outbreak can make a difference.

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