Mass media and social marketing campaigns to prevent HIV and other STIs

There is some evidence that mass media and social marketing interventions increase frequency of HIV testing in the short-term (Daher 2017, Cochrane-Wei 2011, Cochrane-Vidanapathirana 2005) as well as knowledge about HIV and other sexually transmitted infections (STIs) (Stead 2019, Noar 2009a). Interventions leveraging digital media such as websites and social media can increase testing for other STIs, such as syphilis (Swanton 2015, Daher 2017). Such interventions may also positively affect risk behaviors such as condom use (Stead 2019, Daher 2017, LaCroix 2014, Wakefield 2010, Cochrane-Vidanapathirana 2005) and number of sexual partners in some circumstances (Friedman 2016, Cochrane-Vidanapathirana 2005), as well as delay sexual initiation in adolescents (Stead 2019). Additional evidence is needed to confirm effects (Friedman 2016).

Research suggests that the most effective mass media interventions define their intended audience, tailor messages to those populations (Friedman 2016, Pedrana 2014, Noar 2009a), coordinate with existing interventions (Keller 2002), and use multiple channels to disseminate messages (Friedman 2016). Campaigns that are longer and that incorporate interactive elements may be more effective (Swanton 2015, LaCroix 2014). Digital media interventions for condom use may be more effective in women, while those encouraging STI testing may be more effective in young people (Swanton 2015). Health campaigns including mass media and either free or discounted health-related products, such as condom distribution, can increase the use of the products provided (CG-Health communication).

Digital media interventions have great potential, but the technology does not guarantee campaigns effectiveness (Wadham 2019); trends and algorithms change rapidly, which make determining best practices difficult (Wadham 2019, Swanton 2015). Most early studies of digital interventions did not appear to change behavior in men who have sex with men (Swanton 2015). However, more recent evidence suggests social marketing campaigns combining traditional and digital mass media may increase STI testing in men who have sex with men in some circumstances (Sang 2023) and may increase awareness of PrEP, a medicine to prevent HIV infection (Marshall 2022).

High quality health communication and social marketing campaigns are designed with theory, engage with the intended audience during development, and are segmented to reach specific populations (Friedman 2016).

Mass media interventions for HIV prevention appear to be more effective in areas with fewer resources than areas with greater resources; such campaigns also appear less effective in developed countries than in developing countries (LaCroix 2014).

Mass media and social marketing campaigns to prevent HIV and other STIs have the potential to decrease disparities in HIV and STI incidence if they are appropriately targeted and designed to reach those most at risk of infection, but evidence for these interventions is limited. Available evidence from recent studies suggest social marketing campaigns may increase syphilis testing in men who have sex with men (Sang 2023) and increase awareness of PrEP in Black and Hispanic men who have sex with men and transwomen (Marshall 2022). Exposure to risk reduction information on social media is also associated with increased condom use in Black and Hispanic youth (Stevens 2017b). Evidence from other mass media campaigns suggests targeting can effectively reach specific populations when messages are tailored to the target audience (Stead 2019). How to promote equity in public health communication around HIV remains unclear (Taggart 2021), and more research is needed to determine what is most effective in specific populations (Friedman 2016).

Inequalities by gender, race, geographical location, and economic status persist in HIV diagnosis and care (Taggart 2021). STIs disproportionally affect racial and sexual minority groups. In 2021, almost a third of chlamydia, gonorrhea, and syphilis infections were diagnosed among Black individuals, and men who have sex with men were diagnosed with around a third of gonorrhea cases and almost half of syphilis infections (CDC-STI Surveillance). In 2019, 29% of new HIV infections were among Hispanic/Latino individuals (CDC-Hispanic/Latino HIV Incidence) and 26% of new HIV infections were in Black gay and bisexual men (CDC-African American MSM HIV Incidence).

Sexually transmitted infections (STIs) have carried stigma for centuries, shaped by negative views of poverty, women, and sex (McGough 2005). STIs are associated with promiscuity and deviant behavior for women, while STIs in men are treated merely as a medical condition (East 2012). Stigma has continued to shape how STIs are studied, diagnosed, and treated. The racist and unethical Tuskegee Syphilis Study, administered by the federal government, intentionally withheld syphilis treatment from Black men for decades without their knowledge, to study the natural course of the disease, ultimately sowing widespread mistrust of health systems and medical research (Tobin 2022).

When the AIDS epidemic began, federal response was slow to acknowledge and respond to it, in part because it primarily affected gay men in a time when many states still criminalized homosexuality. While the first case of HIV/AIDS in the U.S. was reported in 1981 (HIV.gov, Bennington-Castro 2020), major federal funding wasn’t allocated until 1985 (Bennington-Castro 2020). HIV criminalization laws were passed in many states criminalizing behavior such as non-disclosure, exposure, and/or transmission of HIV, or increasing sentence length for crimes based on someone’s HIV status (CDC HIV-Exposure), long before pharmaceuticals were available to treat or prevent transmission (CDC HIV-Criminalization). Today, HIV criminalization unjustly applies criminal law to nonmalicious behavior by people living with HIV and the laws are disproportionately applied to people from groups who have been marginalized (Bernard 2022), While 13 states have repealed or modernized their HIV criminalization laws, 34 states still have HIV/STI/communicable disease criminalization laws in place in 2023. Such laws can carry penalties up to life in prison (CDC HIV-Exposure).

HIV messaging has evolved over time, from initial reporting based on fear in the 1980s to broader awareness efforts in the 1990s. The early 2000s saw campaigns around universal testing paired with greater ability for individuals to be tested, and current communication includes messaging that HIV transmission can be eliminated. Future messaging should incorporate health equity into its design (Taggart 2021).

State and federal funding are important to address the rising incidence of STIs, however, historical trends show that funding has stagnated (NCSD-STD Funding).

• Who needs to be reached by mass media and social marketing campaigns in your community? How can you partner with and incorporate feedback from the populations most affected by HIV and STIs in your area?
• Who can you partner with to create mass media and social marketing campaigns to prevent HIV and other STIs in your community? Who has experience in communication and community outreach?
• How does stigma, and other systematic barriers, prevent people from accessing sexual health care and STI testing services in your community? What additional strategies can be implemented to overcome those barriers?

There are a variety of mass media interventions addressing sexual and reproductive health issues in the United States. Some states, such as California, have their own campaigns as well (CA DPH-STD Awareness Campaigns). In 2023, the STI Awareness Week Toolkit included multiple campaign options, including Prepare Before You’re There, GYT: Get Yourself Tested, and Talk Test Treat (CDC-SAW Toolkit).

‡ Resources with a focus on equity.

CA DPH-STD Awareness Campaigns - California Department of Public Health (CA DPH). Sexually Transmitted Diseases Control Branch. STD Awareness campaign resources.

CDC-SAW Toolkit - Centers for Disease Control and Prevention (CDC). Projects & Initiatives: STI Awareness Week toolkit.

Taggart 2021^‡ - Taggart T, Ritchwood TD, Nyhan K, Ransome Y. Messaging matters: Achieving equity in the HIV response through public health communication. Lancet HIV. 2021;8(6):e376-e386.

* Journal subscription may be required for access.

Bennington-Castro 2020 - Bennington-Castro J. How AIDS remained an unspoken—but deadly—epidemic for years. History. 2020.

Bernard 2022 - Bernard, E. J., Symington, A., & Beaumont, S. (2022). Punishing vulnerability through HIV criminalization. American Journal of Public Health, 112(S4), S395–S397.

CA DPH-STD Awareness Campaigns - California Department of Public Health (CA DPH). Sexually Transmitted Diseases Control Branch. STD Awareness campaign resources.

CDC HIV-Criminalization - Centers for Disease Control and Prevention (CDC). (2023). HIV criminalization and ending the HIV epidemic in the U.S. Retrieved April 7, 2026.

CDC HIV-Exposure - Centers for Disease Control and Prevention (CDC). (2023, March 3). HIV and STD criminalization laws. Retrieved April 7, 2026.

CDC-African American MSM HIV Incidence - Centers for Disease Control and Prevention (CDC). HIV: HIV by group. HIV and African American Gay and Bisexual Men: HIV Incidence.

CDC-Hispanic/Latino HIV Incidence - Centers for Disease Control and Prevention (CDC). HIV: HIV by group. HIV and Hispanic/Latino People: HIV Incidence.

CDC-SAW Toolkit - Centers for Disease Control and Prevention (CDC). Projects & Initiatives: STI Awareness Week toolkit.

CDC-STI Surveillance - Centers for Disease Control and Prevention (CDC). Sexually Transmitted Infections Surveillance.

CG-Health communication - The Guide to Community Preventive Services (The Community Guide). Health communication and social marketing: Campaigns that include mass media and health-related product distribution.

Cochrane-Vidanapathirana 2005* - Vidanapathirana J, Abramson MJ, Forbes A, Fairley C. Mass media interventions for promoting HIV testing. Cochrane Database of Systematic Reviews. 2005;(3):CD004775.

Cochrane-Wei 2011* - Wei C, Herrick A, Raymond H, et al. Social marketing interventions to increase HIV / STI testing uptake among men who have sex with men and male-to-female transgender women. Cochrane Database of Systematic Reviews. 2011;(9):CD009337.

Daher 2017 - Daher J, Vijh R, Linthwaite B, et al. Do digital innovations for HIV and sexually transmitted infections work? Results from a systematic review (1996-2017). BMJ Open. 2017;7:e017604.

East 2012* - East L, Jackson D, O’Brien L, Peters K. Stigma and stereotypes: Women and sexually transmitted infections. Collegian. 2012;19(1):15-21.

Friedman 2016* - Friedman AL, Kachur RE, Noar SM, McFarlane M. Health communication and social marketing campaigns for sexually transmitted disease prevention and control: What is the evidence of their effectiveness? Sexually Transmitted Diseases. 2016;43(Suppl 1):83-101.

HIV.gov - HIV.gov. HIV and AIDS timeline.

Keller 2002* - Keller SN, Brown JD. Media interventions to promote responsible sexual behavior. Journal of Sex Research. 2002;39(1):67-72.

LaCroix 2014* - LaCroix JM, Snyder LB, Huedo-Medina TB, Johnson BT. Effectiveness of mass media interventions for HIV prevention, 1986-2013: A meta-analysis. Journal of Acquired Immune Deficiency Syndromes. 2014;66(Suppl 3):S329-40.

Marshall 2022* - Marshall B, Salabarría-Peña Y, Johnson W, Moore L. Reaching racial/ethnic and sexual and gender minorities with HIV prevention information via social marketing. Evaluation and Program Planning. 2022;90(101982):1-6.

McGough 2005 - McGough LG. HIV/AIDS stigma: Historical perspectives on sexually transmitted diseases. Virtual Mentor: Ethics Journal of the American Medical Association. 2005;7(10):710-715.

NCSD-STD Funding - National Coalition of STD Directors (NCSD). As STD funding stagnates, rates rise to all-time highs.

Noar 2009a - Noar SM, Palmgreen P, Chabot M, Dobransky N, Zimmerman RS. A 10-year systematic review of HIV/AIDS mass communication campaigns: Have we made progress? Journal of Health Communication. 2009;14(1):15-42.

Pedrana 2014* - Pedrana AE, Hellard ME, Higgs P, et al. No drama: Key elements to the success of an HIV/STI-prevention mass-media campaign. Qualitative Health Research. 2014;24(5):695-705.

Sang 2023* - Sang JM. Examining the impacts of a syphilis awareness campaign among gay, bisexual, and other men who have sex with men (gbMSM) in British Columbia, Canada. Canadian Journal of Public Health. 2023;114:295-307.

Stead 2019 - Stead M, Angus K, Langley T, et al. Mass media to communicate public health messages in six health topic areas: A systematic review and other reviews of the evidence. Public Health Research. 2019;7(8):1-205.

Stevens 2017b - Stevens R, Gilliard-Matthews S, Dunaev J, et al. Social media use and sexual risk reduction behavior among minority youth. Nursing Research. 2017;66(5):368-377.

Swanton 2015 - Swanton R, Allom V, Mullan B. A meta-analysis of the effect of new-media interventions on sexual-health behaviours. Sexually Transmitted Infections. 2015;91(1):14-20.

Taggart 2021 - Taggart T, Ritchwood TD, Nyhan K, Ransome Y. Messaging matters: Achieving equity in the HIV response through public health communication. Lancet HIV. 2021;8(6):e376-e386.

Tobin 2022 - Tobin MJ. Fiftieth anniversary of uncovering the Tuskegee syphilis study: The story and timeless lessons. American Journal of Respiratory and Critical Care Medicine. 2022;205(10):1145-1158.

Wadham 2019 - Wadham E, Green C, Debattista J, Somerset S, Sav A. New digital media interventions for sexual health promotion among young people: A systematic review. Sexual Health. 2019;16(2):101-123.

Wakefield 2010 - Wakefield MA, Loken B, Hornik RC. Use of mass media campaigns to change health behaviour. Lancet. 2010;376(9748):1261-1271.