What Sexual Health Awareness Campaigns Can Learn From Art

Her head’s thrown back; her lips open at the imperative of a moan. Her white dress is hiked up, her legs spread to receive her lover — a human-sized tarantula, its palpi resting on its human lover’s lap, its mandibles deep between her legs. The violently disturbing image is one of many created between 2004 and 2005 by the media firm TBWA to raise awareness about AIDS in France.

For decades, governments and groups have worked to inform the public about sexually transmitted infection, often resorting to similarly terrifying imagery. In 1987, the Australian National Advisory Committee on AIDS ran a television spot in which the Grim Reaper bowled down groups of men, women and children. During the 1940s, the United States spent a significant amount of propaganda turning venereal disease into a matter of patriotism and natural security.

These, like many other campaigns, illustrated the danger of infection clearly, but at a price. The TBWA ads turned people living with HIV or AIDS into horrific arachnids. In Australia, the Grim Reaper was soon identified with HIV-positive people, specifically gay men. The WWII posters warning servicemen about the dangers of syphilis and gonorrhea effectively turned “good time girls” into a lipstick-wearing, cigarette-smoking, juke joint brigade of first-class saboteurs.

The ads might have brought people’s vulnerability into the forefront of their minds, but they dehumanized and reinforced stigma against people living with sexually transmitted infections (STIs). Research since has identified the problem with this approach: it turns out that stigma is one of the greatest barriers to successfully battling the spread of STIs.

In their 1997 paper focusing on factors that contribute to the spread of STIs, Thomas R. Eng and William T. Butler noted that stigma around infection leads to a higher incidence of people ignoring symptoms, delaying treatment, and refusing to seek medical care at all. These findings have been reinforced by subsequent research.

In 2008, another paper – this one looking into attitudes toward pubic lice, chlamydia, gonorrhea, syphilis, human papillomavirus (HPV), herpes, and HIV and AIDS – illustrated this stigma. Researchers noted that although HIV and AIDS were the most stigmatized conditions, all STIs were stigmatized regardless of their seriousness.

“The data suggest that rather than being viewed in terms of a hierarchy of stigma (i.e., from least to most stigmatized), STIs should be perceived as a class of infections with the global power to stigmatize,” conclude authors Bronwen Lichtenstein, Tess M. Neal and Stanley L. Brodsky. “The finding that STIs were so perceived regardless of their curability, variability (there are many types of infection), or prevalence in U.S. society is further evidence of the power of stigma to create global fear about STIs as a basis for social exclusion. […] On the one hand, respondents were moderately biased against infected people and somewhat likely to avoid seeking treatment or notifying partners. On the other hand, they were very concerned about the morbidity of STIs and about feeling dirty, embarrassed, ashamed, secretive, and shunned in the event of a positive diagnosis.”

When Buffalo photographer Andrea Brough decided to do a photo series narrating the story of a couple grappling with a positive test result, she wasn’t thinking about the history of sexual health ads. She only knew one thing: she didn’t want to be preachy.

“Over the years I’ve had several friends and myself deal with the effects of sexually transmitted diseases (STDs) and what really struck me was the staggering numbers,” she told me when we spoke over the phone. “One in six sexually active individuals has herpes. It’s staggering. You get six friends in a room and at least one has been exposed to some sort of STD in their life, either they have already been treated or they have it.”

In February, the United States’ Centers for Disease Control and Prevention (CDC) reported 110 million cases of sexually transmitted infections (STIs), such as chlamydia, gonorrhea, hepatitis B, herpes, human papillomavirus (HPV), trichomoniasis, and human immunodeficiency virus (HIV). They estimate some 20 million new infections in the U.S. per year, with half of these affecting people between the ages of 15 and 24. While four of the STIs analyzed by the CDC are treatable – chlamydia, gonorrhea, syphilis, and trichomoniasis – many of these infections go untreated because they often have no symptoms.

“STDs in general tend to be invisible,” Brough added. “A lot of us are walking around without knowing that we have them. That was the point: to visualize an invisible thing and really push the emotional idea of how these diseases affect people.”

Brough used a Calumet 45NXII view camera made available to her by the University of New York at Buffalo to capture her subjects. Most people would know a view camera in an instant if they saw an image of the old-school device with its accordion body so common to cartoons of our youth. To many photographers interested in high quality prints, the view camera isn’t a device of the past, but a tool of large-format photography. With its four by five to eight by ten negatives, view cameras can achieve a level of detail that leaves even some digital cameras in the dust. But working with a view camera isn’t as simple as shooting with digital cameras can be.

“The original idea behind the view camera — the mechanics — still works and they’re great, even though some people consider them an obsolete technology,” said Brough. “It does take a lot of work and time to set up each shot. You need to set up the tripod, you need to get the focus right, the composition correct — and the exposures can be longer. For some of the shots you have to sit there still for fifteen seconds, waiting for the film to be exposed. There was a lot of work that went into this series.”

The result of her labors, which she presented as her thesis in 2009, is Perilous Transmission, a painstaking work of humanity that transcends the easy message of most sexual health awareness campaigns. The series shows a couple as they work out their emotions following infection, as well as a cast of other characters going about their daily lives, showing the viewer that there is life after a positive test result.

To visually illustrate what is so often invisible, Brough used her models’ skins as a canvas. She thought a long time about how she was going to show positive status, conscious of the possible stigma that easy solutions — such as the biohazard symbol — would convey.

“I was trying to think of some kind of symbol that would help people see what was going on but also question what was going on,” she told me. “The markings ultimately were made with a rubber stamp that I found at a craft store. The stamp is actually supposed to be an image of a water ring – you know how you put your glass of water down on a coffee table and it leaves a mark? That’s what it is.”

The water ring gives the impression of a cell – but it’s a neutral image. While some of the shots inspire very emotional reactions in viewers, the imagery used to portray the models’ status retains its neutrality, making all the images depicting life with STIs all the more poignant. Without the stigma, a viewer is capable of seeing beyond disease to the people themselves – the young woman putting on makeup, the couple cuddling, the woman playing pool.

“It can be very shocking that humans are so vulnerable,” Brough said about her series. “We go about our lives and never think any of these scary things that can happen to us. I hope to make people stop and think and maybe even learn.”

Perilous Transmission hasn’t been viewed as a series very often, but it’s available for purchase as a book on the self-publishing platform Blurb, starting at $16.82. Individual prints are available for purchase on Sexcusemoi as 11 by 14-inch chromogenic photographic prints.