Identity-Based Messaging to Equity-Driven Messaging: A Call for Change in Health Communication

In health communication, we’re taught about targeted messaging, a strategy to reach a specific target audience with relevant messaging who are believed to be at higher risk for a health condition or outcome. In public health, one prime example that comes to mind is targeted messaging towards the LGBTQIA+ community with PrEP.

Evidence shows that this community is one of 5 populations most at risk for HIV. PrEP, pre-exposure prophylaxis, is a medication that individuals can taketo greatly reduce their risk of contracting HIV.

How does one contract HIV? The answer: contact with bodily fluids (i.e., semen, blood, anal fluids, vaginal fluids, breast milk). Now, anyone can come into contact with HIV-positive bodily fluids. But there are behaviors that heighten our risk. The most common? Sex.

Our “Sexual” History

A tale as old as time, sex historically has been linked to marriage – and some might still hold this view. Whether it’s pre-marital sex or the ideal that sex is for procreation, not pleasure – this view links a behavior (sex) to an identity (being married). Although out of the scope of health communication, this dialogue amongst society shows how the behavior of sex is subjective and is often tied to identity.

In public health, sex has been funneled through many conversations. Sex is linked to illnesses such as Mpox (Monkeypox), HIV, and other STIs. When we extrapolate on this link, we see how certain communities and identities are mentioned for being more at risk, especially people of color and queer communities. When we communicate about these illnesses, we tend to use identity-based targeting. For example, PrEP ads on Grindr, PrEP messaging for Black Women, national observance days like National Latinx AIDS Awareness Day, or social marketing campaigns like PrEP4Love.

PrEP4Love took place in Chicago in 2017 to increase perceptions and uptake of PrEP. This campaign showed images of queer people of color with messages painted on their bodies, such as: ‘Contract Heat’, ‘Catch Desire’, and ‘Spread Tingle’.  The results from this campaign were a success despite receiving racist and homophobic remarks from viewers of the campaign.

As public health professionals, where do we begin to decide when a campaign needs to have identity-based targeted messaging – particularly when that type of targeting could perpetuate stigma, racism, homophobia, and conspiracy theories and cause people to pay less attention to our health messages? 

Changing Our Behavior

The writing is on the wall: public health challenges stem from behaviors. It’s in our textbooks, from Social Cognitive Theory to the Health Belief Model. Our behavior plays a key role in issues that not only affect us (e.g., risk of HIV) but also in the way we, as public health professionals, handle those challenges that affect the rest of the world. 

So, if not identity-based messaging, then what? Equity-driven messaging. What does that look like? It’s been done before, and it still is being done now. For example, this HIV stigma reduction campaign in Scotland focuses on attitudes and beliefs about HIV and people with HIV. The campaign packs just as heavy a punch as PrEP4Love – but doesn’t target any identity subgroups.

As public health professionals, it’s critical we better understand and consider context and perceptions. Let’s hear our communities and give them a platform, and not just during a month that celebrates them. When making campaigns that do require identity-based messages, those identities should and must be at the table from the start.

So, What Needs to be Done?

We need a widely accepted protocol that could provide insight and considerations for public health professionals to weigh the benefits and unintended consequences of identity-based messaging in public health.

By: David M. Hernández​