During an infectious disease outbreak, physicians and public health officials are tasked with providing accurate guidance to the public on how to stay safe and protect themselves and their loved ones. However, sensationalist media coverage can distort the public’s understanding of where new emerging infections come from and how they spread. This can promote fear and stigma, especially among communities that are already distrustful of the health care system.
Racial and sexual stigma surrounding monkeypox prompted the World Health Organization to rename the disease mpox in November 2022. While this is a step in the right direction, I believe more work needs to be done to reduce the stigma surrounding infectious diseases. mpox.
I am an infectious disease researcher studying HIV, COVID-19 and mpox. During the COVID-19 pandemic, I was the principal investigator at the University of Pittsburgh for a national survey of how COVID-19 has affected different communities. Effective public health communication is not easy when conflicting messages may come from multiple sources, including family and friends, other community members, or the Internet. But there are ways that public health officials can make their own messaging more inclusive while reducing stigma.
Creating an inclusive message
Inclusive public health messaging can motivate people to make better decisions about their own health and the health of others. This effort often involves engaging the communities most affected by the disaster. Unfortunately, because these communities are most affected by infection and experience some form of inequality, they are often accused by society of 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 had experienced a COVID-19-related hate event.
Effective public health messaging can focus on the fact that while infections may 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 by race, gender or sexual orientation. Messages that focus on pathogens rather than communities may reduce stigma.
Visually inclusive messages are also likely to engage a larger segment of the community. Examples include ensuring that people represented in posters and flyers, images on TV and websites, and other informational materials are from diverse backgrounds. It sends a more unified message that what affects the individual also affects the larger community.
Avoid guilt and fear
Many media outlets, especially on social media, use fear-based messages to report on infectious diseases. Although it can reinforce some protective behaviors, such as using a condom during sex, it can also increase stress and anxiety. Fear-based messages also worsen stigma, leading to increased discrimination against communities that are already vulnerable and mistrustful of healthcare. Ultimately, this can prevent people from seeking health care and worsen health outcomes.
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 highly stigmatized by society. I have found that some of my patients prefer to avoid being tested and treated for an STI rather than face the shame of having an STI.
Making sexual health and STI testing routine and an integral part of overall wellness and health is an important step in reducing the stigma surrounding them. Similarly, a message that normalizes the challenges faced by people at risk for certain infections can help avoid causing shame.
Tailoring the message
Infections affect different people differently. COVID-19 can be a mild stuffy nose for one person, and it can be months in an intensive care unit attached to a ventilator for another. Messages that focus on the success of medical and public health interventions that resonate with communities are more likely to be successful.
Different groups also have different risk factors. Mpox most affected gay and bisexual men in 2022. One reason had to do with how the virus is transmitted. Earlier research suggested that mpox was largely transmitted through close skin-to-skin contact, but an emerging study questioned whether the 2022 outbreaks were driven more by sexual transmission.
There was controversy over whether public health messaging should highlight sexual encounters as a potential transmission route. This may risk further stigmatizing gay and bisexual men potentially ignoring these key populations at risk. Some advocates argued that spreading the message that mpox is primarily transmitted by close contact prevents resources and interventions from reaching the groups of people most affected by the disease.
One size does not always fit all when it comes to public health messaging. Multiple messages may be needed for different groups of people based on their risk of infection or serious illness. An August 2022 Centers for Disease Control and Prevention survey found that 50% of gay and bisexual men reduced their sexual encounters in response to the mpox outbreak. Since late summer, mpox rates have been dropping rapidly, and many experts think that both behavioral changes and vaccination may have contributed to the declining rates. Studies like these further support the importance of engaging directly with communities to encourage healthy behavior change.
Mistrust is also a barrier to effective messaging. Some communities may be distrustful of medical and health care systems because of prior histories of exploitation, such as the Tuskegee study, where researchers prevented black participants from receiving treatment for syphilis for decades in the mid-20th century, and a persistent fear of abuse.
Identifying trusted community champions and health care providers—especially those from those communities—to deliver the public health message can increase its acceptance. For example, a 2019 study found that black men were more likely to receive vaccinations, accept medical advice, and engage in health care if they had a black health care provider.
Delivering a public health message effectively is a complex and challenging process. But talking and listening to the communities most affected by disasters can make a difference.
Ken Ho, Assistant Professor of Infectious Diseases, University of Pittsburgh Health Sciences