A new Alberta syphilis-awareness campaign that parodies online dating websites – and the people who use them – has been slammed by critics as stigmatizing people with sexually transmitted infections (STI) and unlikely to promote behaviour change.
Alberta has the nation’s highest rates of syphilis, which is relatively easy to treat effectively in places where there is adequate testing, treatment and education. The number of Albertan infections has climbed steadily every year since 2002.
A previous education campaign in 2008 was cancelled by Alberta Health Minister Ron Liepert, who told a government committee the problem was caused by people with “careless attitudes” as well as an increase in the number of sex workers.
The Plenty of Syph website features mock sex ads from people with syphilis making statements such as “What’s a dick sore here or there if you’re still getting laid?” Conceived and executed by ad agency Calder Bateman as part of a $2-million program by Alberta Health Services (AHS) and Alberta Health and Wellness (AHW), the campaign also includes mass-media advertising, posters in bars across the province and online promotion on Twitter (@PlentyOfSyph).
“We needed to take a totally different approach to reach internet-savvy 16- to 24-year-olds, who are at high risk for STIs,” says AHW’s Micky Elabdi. But youth exposed to the campaign – which consists of profiles of people with syphilis chancres on their faces and bodies who reject condoms and don’t care if they infect others – may not get the right message prevention experts say.
“Branding those infected with syphilis as ‘different’ only further supports myths about who can and can’t become infected, while simultaneously promoting stigma towards individuals who have been diagnosed with an STI,” says researcher Joshua Rosenberger, who studies sexual behaviour in youth.
The website leaves the user with “more questions than answers with regard to syphilis, the website itself and the goals of this campaign,” says Rosenberger. “Adolescents continue to be disproportionately burdened by STIs,” he notes, but he says they “expect, and deserve, to be provided information about STIs in a manner that is honest and straightforward.”
The satire muddies the message, says Adam Bourne of Sigma Research, the author of multiple studies about what does and doesn’t work in STI prevention. “If taken in the wrong light, I think the campaign gives the impression that individuals carrying STIs such as syphilis and HIV are not taking their infection status seriously and are not behaving in a socially responsible manner.”
“The website provides knowledge of syphilis – although this is somewhat buried amongst the spoof aspects of the site – but I'm not sure how it empowers people to change their behaviour,” says Bourne.
David S Novak, the former national syphilis elimination coordinator for the US Centers for Disease Control, agrees. Now a senior health strategist with Online Buddies, the company that runs Manhunt, he recently rejected an opportunity to promote Plenty of Syph. Novak is concerned the compaign will have a negative impact on men who have sex with men.
“We’ve learned so much from HIV educational campaigns and have spent years perfecting campaigns that avoid stigmatizing those who test for or are living with a sexually transmitted infection,” he says. The ad agency “clearly missed an opportunity to collaboratively design and promote an effective syphilis education campaign,” he says.
“Stigmatizing the disease could reduce testing rates. Those who experience more stigma associated are likely to engage in more risky behaviour,” says Lynn Miller, a communications expert who has studied online risk reduction strategies. She suggests that a successful campaign would focus less on “generating buzz” and more on concrete health tips.
“There is no magic bullet” when it comes to education and prevention messages, says André Corriveau, the province’s chief medical officer of health. He says the ad agency that proposed the campaign did so based on market research, including the perspectives of men who have sex with men. According to Corriveau, the new campaign harkens back to innovative and successful approaches used to approach HIV transmission in the '80s and '90s.
Plenty of Syph does not specifically address any of the Albertan populations most affected by syphilis, which include black men and aboriginal women, or pregnant women with the disease, but Corriveau says they will be reached through other “culturally appropriate outreach efforts” in another phase of the campaign.
AHW’s Micky Elabdi points out that STI testing rates have jumped in the province since the Plenty of Syph campaign launched, noting that some clinics have occasionally had trouble meeting the need.
But poorly targeted campaigns “risk mobilizing the ‘worried well,’” says Bourne of Sigma Research, meaning that people who are not at risk can clog the system when they rush to get tested. “It is crucial,” says Bourne, “that precious sexual health promotion resources are utilized effectively.”