Abstract
Despite significant progress in the prevention and treatment of HIV, disparities in rates of infection remain among key groups in the United States, including blacks and African Americans; Hispanics/Latinos; and men who have sex with men (MSM). The U.S. Department of Health and Human Services’ initiative, Ending the HIV Epidemic: A Plan for America, calls for addressing HIV-related disparities and reducing stigma and discrimination associated with HIV. The goal of this literature review was to identify approaches for effectively communicating about health disparities across the HIV care continuum. We reviewed the literature to investigate strategies used to communicate health disparities and to identify potential unintended adverse effects resulting from this messaging. Messages about health disparities often target subgroups at higher risk and can be framed in a variety of ways (e.g., social comparison, progress, impact, etiological). Studies have examined the effects of message framing on the risk perceptions, emotional reactions, and behaviors of individuals exposed to the messaging. The evidence points to several potential unintended adverse effects of using social comparison framing and individual responsibility framing to communicate about health disparities, and visual images and exemplars to target messages to higher-risk subgroups. There is not yet a clear evidence-based approach for communicating about health disparities and avoiding potential unintended effects. However, we offer recommendations for communicating about HIV-related disparities based on our findings. Because we found limited literature that addressed our research questions in the context of HIV, we propose a research agenda to build an evidence base for developing effective messages about HIV-related disparities.
Highlights
Healthy People 2020 defines a health disparity as “a particular type of health difference between individuals or groups that is unfair because it is caused by social or economic disadvantage” (U.S Department of Health and Human Services, 2008)
We focused the search on studies conducted in the United States; we included two articles from other countries because they examined research questions (RQs) closely aligned with those of interest in this review
We found limited literature addressing the RQs in the context of communicating HIV-related disparities (11 articles focused on HIV and 3 on other sexually transmitted diseases (STDs))
Summary
Ending the HIV Epidemic: A Plan for America is the U.S Department of Health and Human Services’ cross-agency initiative that aims to reduce new HIV infections in the U.S by 90% in 10 years by focusing on communities most impacted by HIV (U.S Department of Health and Human Services, 2020). This initiative highlights the persistence of HIV disparities among racial and ethnic minority groups as well as MSM and the role of stigma in preventing those at risk for HIV or living with HIV from receiving needed health care and services. Social stigma can have serious negative consequences for both psychological and physical wellbeing by decreasing self-esteem and increasing stress responses in stigmatized groups (Major and O’Brien, 2005)
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