Abstract

Introduction

Aids representations are generally supported and maintained through different cultural forms, according to the social contexts in which they are built. At the emergence of the epidemic, it was a phenomenon seen by different social actors for the first time. Therefore the media - articulated to scientists - played a unique role in constructing a reality, sometimes clad in the heyday of a “scientific mystery,” sometimes reproducing contradictions exemplified by messages that appealed to both control and solidarity¹1. Herzlich C, Pierret J. The construction on a social phenomenon: aids in French Press. Soc Sci Med. 1989 ; 9(11):235-42..

Media-based representations and state-sponsored prevention campaigns are a crucial aspect of the epidemic and its meanings; among the pioneering analyzes related to this facet, Sontag²2. Sontag S. Illness as metaphor and AIDS and its metaphors. New York: Picador; 1990 ., Treichler³3. Treichler P. AIDS, homophobia and biomedical discourse: an epidemic of signification. Cult Stud. 1987 ; 1(3):263-305., Herzlich and Pierret⁴4. Herzlich C, Pierret J. Uma doença no espaço público: a AIDS em seis jornais franceses. Physis. 2005 ; 15 Suppl:71-101. and Spink et al.⁵5. Spink MJ. A construção da AIDS-notícia. Cad Saude Publica. 2001 ; 17(4):851-62.are noteworthy. Critical research on prevention campaigns should also be highlighted from the perspective of communication⁶6. Mc Manus F, Mercado-Reyes A. Constructing publics, preventing diseases and medicalizing bodies: HIV, AIDS and its visual cultures. Sex Salud Soc (Rio J). 2016 ; (24):69-102..

Part of the national studies on AIDS prevention campaigns include materials produced and disseminated between 1986 and 2010, focusing on the early days of the epidemic. Remarkable controversies were raised by the messages, their counterproductive effects (even if unintentional), in the sense of reforming stigmas or contrary positions by some sectors of society, such as the Catholic Church⁷7. Morais P, Amorim R. Políticas públicas de saúde e campanhas de prevenção à AIDS: resgatando algumas controvérsias enfrentadas nas décadas de 1980 e 1990. Tempo Cienc. 2011; 18:23-6.; as well as the issue of moral panic and the alleged control of sexual practices through information. Generally speaking, the analytical processes focused on language and discourse, pointing to aspects such as campaign discontinuity and the need to involve message-receiving groups in message formulation.

Regarding the axes of analysis, gender and sexuality dimensions have been privileged, reflecting the “feminization” of the epidemic, such as the discussion of the preventive discourse of the campaigns of the 1990s and 2000s, in particular the messages of women’s empowerment⁸8. Arraes GRA. Entre o desejo e a culpa: a transformação do comportamento sexual e as mudanças da noção de risco nas campanhas de prevenção à Aids no Brasil (1981-2013) e Estados Unidos durante a década de 1980 [tese]. Florianópolis, SC: Universidade Federal de Santa Catarina; 2015., as well as an analysis of the campaign focused on elderly women in 2008⁹9. Jardim LN, Perucchi J. Encrencas de gênero nas campanas brasileiras de prevenção ao HIV/Aids para a idade adulta avançada. Ex Aequo. 2012 ; (26):103-17.. Some papers investigate carnival campaigns, problematizing the monogamous ideal as a barrier to condom use¹⁰10. Marinho MB. Entre o funcional e o lúdico: a camisinha nas campanhas de prevenção da aids. Interface (Botucatu). 2000 ; 4(6):103-10. or identifying the target audience with values and positions regarding race, class and sexuality of the characters chosen as protagonists¹¹11. Porto MP. Lutando contra a aids em meninas adolescentes: os efeitos da campanha de carnaval do Ministério da Saúde do Brasil. Cad Saude Publica. 2005 ; 21(4):1234-43..

Paradoxically, the analyses done with regard to the World Aids Day - December 1^st campaign have been less significant when compared to the contributions listed above. Such campaigns have been characterized by their regularity and ability to mobilize discourses from international agencies and national agencies about directions of the response to the epidemic.

The Ministry of Health (MS), through the website of the Portal on AIDS, Sexually Transmitted Infections and Viral Hepatitis, of the Department of Chronic Diseases and Sexually Transmitted Infections (DCCI)^eeNew classification in organizational chart, adopted in May 2019, changing the former Department for Surveillance, Prevention and Control of Sexually Transmitted Diseases, HIV/AIDS and Viral Hepatitis (DIAHV)., makes available the posters of AIDS prevention campaigns in Brazil produced by the agency since 1998. In the realm of the DCCI campaigns, the poster is the media channel that reaches a more even distribution in the regions of Brazil¹¹11. Porto MP. Lutando contra a aids em meninas adolescentes: os efeitos da campanha de carnaval do Ministério da Saúde do Brasil. Cad Saude Publica. 2005 ; 21(4):1234-43.. Campaigns generally aim to a variety of target populations and are based on promoting male condom use. More recently, the 2012 Carnival Campaign aimed mainly at young gay men, and the 2013 campaign aimed to -and made by- prostitutes, highlighting the autonomy and legitimacy of sex work, were the target of censorship.

Against the backdrop of the loss of visibility of gender and sexual orientation issues in global and national prevention policies¹²12. Seffner F, Parker R. Desperdício da experiência e precarização da vida: momento político contemporâneo da resposta brasileira à aids. Interface (Botucatu). 2016 ; 20(57):293-304., the DCCI announced in 2013 the new focus related to AIDS combat: Combination Prevention (CP). This guideline has gradually introduced strategies such as Treatment as Prevention¹³13. Brasil. Ministério da Saúde. Protocolo clínico e diretrizes terapêuticas para manejo da infecção por HIV em adultos. Brasília (DF): Ministério da Saúde; 2015 ., pre-exposure prophylaxis (PrEP)¹⁴14. Brasil. Ministério da Saúde. Protocolo clínico e diretrizes terapêuticas para Profilaxia Pré-Exposição (PrEP) de Risco à Infecção pelo HIV. Brasília (DF): Ministério da Saúde; 2017 . and the reorganization of Testing and Counseling Centers (CTA)¹⁵15. Brasil. Ministério da Saúde. Diretrizes para Organização do CTA no âmbito da Prevenção Combinada e nas Redes de Atenção à Saúde. Brasília (DF): Ministério da Saúde; 2017 .. However, in its original conception, CP proposes alternatives to maximize the protection of individuals and their partners, according to their individual possibilities and needs through biomedical, structural and behavioral actions duly articulated¹⁶16. Hankins CA, Zalduondo BO. Combination prevention: a deeper understanding of effective HIV prevention. AIDS. 2010 ; 24 Suppl 4:70-80..

Considering the possible symbolic effects of this programmatic change, this study aimed to analyze the representations about sexuality and prevention on posters produced by DCCI for the December 1^st - World Aids Day - from 2013 to 2017.

Methods

We examined 19 posters from five campaigns from December 1, 2013 and 2017 using descriptive and documentary content analysis. The documentary study seeks to broaden the understanding of objects whose understanding needs historical and sociocultural context¹⁷17. Sá-Silva JR, Almeida D, Guidani JF. Pesquisa documental: pistas teóricas e metodológicas. Rev Bras Hist Cienc Soc. 2009 ; 1(1):1-15.. The documents are presented in the form of texts, images, sounds, signals, etc., contained in a material support, fixed by special techniques such as printing, engraving, painting, inlays¹⁸18. Chizzotti A. Pesquisa em ciências humanas e sociais. 4a ed. São Paulo: Cortez; 2000 ..

The choice of posters as a unit of analysis was done due to the fact that we consider that the contents available are defined according to what they want to transmit as well as to the recipient they are aimed. Posters are “elements of culture” that try to influence the receivers’ way of thinking and acting on a particular subject or problem¹⁹19. Moles A. O cartaz. São Paulo: Perspectiva; 1974 .. The idea is that posters are elements not isolated from a wider context: on the contrary, the construction of these campaigns and the design of the technologies they disseminate are engaged in a co-construction system that already anticipates the users’ profile of the target audience²⁰20. Oudshoorn N. Clinical trials as a cultural niche in which to configure the gender identities of users: the case of male contraceptive development. In: Oudshoorn N, Pinch T, organizadores. How users matter: the co-construction of users and technology. Cambridge, Massachusetts: MIT; 2003 . p. 209-28.. Therefore, there is a trove of meanings that require a sophisticated process of decoding and interpreting the representations of these materials²¹21. Kellner D. Lendo imagens criticamente: em direção a uma pedagogia pós-moderna. In: Silva TT, organizador. Alienígenas na sala de aula: uma introdução aos estudos culturais na educação. Petrópolis: Vozes; 1995 . p. 104-31..

The research procedures were developed in three stages. In the first one, the research identified those epidemiological bulletins available on the DCCI website during the period from 2001 to 2017, in order to verify to what extent the campaigns from December 1^st are based on these documents.

In the second stage, a survey analyzed the posters available on the same website^ffWebsite DCCI: http://www.aids.gov.br/pt-br/centrais-de-conteudo/campanhas . The images analyzed in this article are under public domain, disseminated by the DCCI own website. accessing the Content Centers section, and then the Campaigns section. We only selected those posters created for the December 1^st campaigns produced between 2013-2017, considering that in 2013 the agency launched the CP strategy.

In the third stage, we submitted the material to a pre-analysis aimed to verify the relationship between epidemiological trends and the campaigns of December 1^st. Following the proposal of Thiago, Russo and Camargo-Junior²²22. Thiago C, Russo J, Camargo Junior K. Hormônios, sexualidade e envelhecimento masculino: um estudo de imagens em websites. Interface (Botucatu). 2016 ; 20(56):37-50., the material was submitted to a content analysis to identify the main themes regarding the representations about subjects, sexualities and prevention methods.

Results and discussion

Relationship between epidemiological trends and December 1st campaigns: historical series

DCCI made available on its website for the first time a December 1^st campaign in 1998. These campaigns followed UNAIDS recommendations between 1998 and 2000, prioritizing children and adolescents (1998 and 1999) and men (2000). The AIDS Epidemiological Bulletins began to be published on the Internet from 2001 on. These documents are produced annually by the MS through data provided by the National Disease Surveillance System (SINAN) and always published on dates around December 1^st. The main data contained in the Epidemiological Bulletins from 2001 to 2017 are shown in table 1, an overview of the AIDS epidemic in Brazil in this century and the strategies to combat it.

In part of the campaigns (2004, 2005, 2007, 2008, 2011 and 2013), the information released in the Epidemiological Bulletins guided the actions of the World AIDS Day. The 2004 focus is on women; 2005 highlights the relationship between poverty and AIDS, especially among black people. The 2007 and 2008 campaigns address young people (14-24 years old) and mature heterosexual adults (over 50 years old) respectively. In 2011, youth is again targeted in the campaigns, and especially gays aged 15-24. In all of them, there is a clear direction towards any of the groups in which there was an increase in reported cases.

The fight against racism, prejudice and discrimination marks the period under study permeating explicit campaign intentions. However, the titles chosen in the last five years (2013-2017), with focus on diagnostic technologies and prevention of new cases, seem to reveal less attention to subjects who have already the infection as well as towards the mobilization of attitudes/emotions of solidarity/social commitment to the epidemic. The 2012 epidemiological bulletin is not available on the DCCI website, but the December 1^st campaign of that year highlights the importance of testing as a prevention method; the slogan of the 2000 Testing Campaigns (Get to Know) is expressed by the words “Don’t be in doubt, get to know”. We may assume this to be the kick-off for what would be the next focus of campaigns the following year: the CP. In 2013, the campaign seeks to reach different groups, including sex workers and young people, putting an emphasis on testing. On the following year (2014) it is the time for treatment through the so-called “With treatment you are stronger than AIDS”. Finally, in 2017, we see the crystallization of the guideline in force through the invitation: “Shall we combine?” This is a play on words, due to the fact that in Brazilian Portuguese, it may mean “Shall we agree?” using at the same time the verb to combine, as in Combination Prevention. Considering that CP has guided almost all December 1^st campaigns in recent years, we will then focus on the representations about the subjects, sexualities and prevention methods at stake in the research corpus.

Representations about subjects, sexualities and prevention methods on posters from 2013 to 2017

In the first year of our time frame, DCCI opted for using posters that address different target populations: pregnant women, homosexual men, health practitioners, sex workers, and transvestites. The focus of the campaign is to encourage testing of HIV, syphilis and hepatitis B and C. There is also the image of a woman in a white coat, remembering that health professionals should prescribe those tests to SUS (Brazil’s Unified Health System) users who have “active sex life”. All these images were compiled in Figure 1.

Photo backdrops may vary depending on the subjects. Only the pregnant woman is in a domestic environment; a lighter set of shades appears in the photo, similar to the poster with the health practitioner in the workplace. The others are set in public spaces, with different degrees of urbanity: a clear allusion to the big cities in the “transvestite” poster; a square or park in the “sex worker”; and an urban aesthetic in the case of the poster that alludes to young MSM (men who have sex with men).

In Figure 1, both in the “pregnant AIDS poster” and in the “homosexual AIDS poster” we observe the statements “Some things we should know a.s.a.p.; Regarding AIDS this is also the case. Do the test”. These two posters showing subjects in interaction, propose as main theme the responsibility of the transmission of the virus when contacting another person, through vertical transmission, in the case of the pregnant woman, or sexual, in the case of homosexual partners. It is noteworthy that representations of ‘heterosexual’ couples are absent in this campaign.

These interactions lead us to the idea of self-surveillance, a displacement of the state as responsible for health procedures on the individual and the community for self-management of health²³23. Ortega F, Zorzanelli R. Corpo em evidência: a ciência e a redefinição do humano. Rio de Janeiro: Civilização Brasileira; 2010 .. The statement and the picture seem to naturalize and foster the idea that an HIV-infected body can be “dangerous,” and in consequence, “Some things we should know a.s.a.p.; Regarding AIDS this is also the case”. At the same time, the message implies as an important requirement for establishing an affective-sexual relationship to know the serological status of the partners. In both interpretations, testing gains the space of an indispensable element of prevention.

The subjects evoked in the “Professional Aids Sex Poster” and “Transvestite Aids Poster”, are supposed to be even more “dangerous”, carrying the statement “Do not be late for your health. Take the AIDS test.” The change only in the vocative sex or transvestite in the main call naturalizes the representation that both this gender identity and sex workers are potential vectors of the virus.

On the posters of homosexual men, sex workers and transvestites, the text highlights how “AIDS is a serious disease that still has no cure, but it’s treatment is guaranteed by the SUS”. In some way, the posters reinforce old stereotypes and moralisms about the subjects who do not fit the parameters of heteronormativity or monogamous life, linking them to potential illness and death. In the pregnant woman’s image, there is no mention of the severity of the disease or the impossibility of curing the HIV virus. As Pelúcio and Miskolci²⁴24. Pelúcio L, Miskolci R. A prevenção do desvio: o dispositivo da aids e a repatologização das sexualidades dissidentes. Sex Salud Soc (Rio J). 2009 ; 1:125-57. propose, public health laid the foundations of the AIDS device that has effects to the present day through the prejudiced way that initially intervened with the AIDS epidemic. This device operates through public HIV prevention policies and results in control and normalization of affective and sexual relationships based on heteronormative patterns.

The State is represented as responsible for prevention in the poster that thematizes the “health professional”. The image and content convey the idea that the professional has the prerogative to prescribe the test, and it is up to the SUS user to decide to do it, which brings us back to the theme of responsibility and self-surveillance of “knowing” the condition of carrier or non-carrier of the virus, especially among those who have a sexually active life.

As noted earlier, while in pre-2012 campaigns there was an -albeit not an entirely close one- relationship between epidemiological trends and campaign motto, from 2013 the new prevention guidelines appear to act as a sort of “compass” - the incentive testing goes throughout all the posters of this period. Figure 1 suggests the incorporation of the Provider-Initiated HIV Counseling and Testing (PICT) strategy into the official preventive discourse, which consists of routine testing in health services, where the physician requests the examination, subject to user consent²⁵25. World Health Organization. Guidance on provider-initiated HIV testing and counselling in health facilities. Geneva: WHO/UNAIDS; 2007 .. This strategy should be differentiated from Voluntary Counseling and Testing (VCT), which materialized in Brazil through CTAs, where the spontaneous demand of users for testing predominates.

In 2014, the Ministry of Health highlights the 30 years of the fight against AIDS and reinforces the idea of prevention, not only through condoms, but also through testing and treatment in SUS. In spite of the various visual materials made for such a campaign, banners, magazine and Facebook ads, we only were able to locate one poster (Figure 2).

The figure has as its central element a montage composed of people, male condoms, medicines and images of the HIV virus. Among the subjects portrayed are Cazuza and Renato Russo, famous musicians who died as a result of the infection.

Unlike in the previous year, sexual identities and practices are not at play in images. There are no explicit interactions, although there is action and movement. All the pictured individuals are young, possibly unborn at the time of the outbreak. The expert figures are also present the scientist being more prominent than the health practitioner. The text on the poster addresses the three preventive methods, condoms, testing and medication, emphasizing testing with the slogan/hashtag “#partiuteste”. In it, we were able to identify for the first time in the material analyzed an image that synthesizes the three biomedical resources hitherto available within the scope of the CP, located in the lower left corner of the image. We are proposing to call this significant image the tripod of prevention. Our analysis points to a biomedicalization²⁶26. Clarke A, Shim J, Mamo L, Fosket J, Fishman J. Biomedicalization: technoscientific transformations of health, illness, and US biomedicine. Am Sociol Rev. 2003 ; 68:161-94. of the epidemic, noticeable through the emphasis on images that refer to health and joy, but also to the scientific and technological nature of biomedicine, under the argument that condoms, testing and treatment, can protect the person with the virus and their partners if the examination is positive.

According to the MS, the objective of this campaign is to prioritize the strategic focus on priority spaces and populations to accelerate the expansion of treatment. The campaign follows the UNAIDS/WHO²⁷27. UNAIDS. Ambitious Treatment Targets: writing the final chapter of the AIDS epidemic. Geneva: UNAIDS; 2014 . targets known as 90/90/90, i.e. to increase to 90% the proportion of people living with HIV to know their diagnosis; of this total, have 90% receiving antiretroviral treatment; and within this number in treatment as prevention, to have 90% with undetectable viral load.

In 2015, five posters were made available, three of them picturing the faces of “young people on treatment living with HIV”, with the message “living with AIDS is not easy. But I can handle it.” The fourth poster highlights a “young female activist for the fight against HIV / AIDS”, with the statement “my fear cannot overcome my desire to win” (Figure 3). Already, the fifth poster (Figure 4) shows a man with a pill on his tongue.

The 2015 campaign is clearly aimed at people living with HIV and AIDS, encouraging them to seek early treatment as it is “simpler and with fewer side effects”. Thus, the recommendation of Treatment as Prevention (TcP) is materialized, especially in the slogan of Figure 4: “With treatment, you are stronger than AIDS.” Such messages lead to the bio-medicalization of the AIDS epidemic anchored in the false promise of HIV / AIDS end of the disease by signaling the absence of “magic bullets” and the profusion of “misleading slogans”²⁸28. Aggleton P, Parker R. Moving beyond biomedicalization in the HIV response: implications for community involvement and community leadership among men who have sex with men and transgender people. Am J Public Health. 2015 ; 105(8):1552-8.. Another feature of this process would be the resumption of the leading role of medical and behavioral knowledge that prevailed in the early days of the epidemic.

Other posters focus on the idea that it is possible to face HIV, and it is necessary to “overcome” fear. Thus, the collective invitation to combat prejudice, evidenced in previous campaigns, is replaced by an appeal for individual control of emotions associated with seropositivity. This type of message, propping-up “willpower”, seems to reveal the rescue of the behavioral perspective of AIDS, mainly counterbalanced by the formulation of the concept of vulnerability²⁹29. Mann J, Tarantola D. Aids in the world II: global dimensions, social roots and responses. New York: Oxford University Press; 1996 ..

The narrative about “overcoming AIDS” by “confronting it” through testing and treatment hides the difficulty many people have in accessing antiretrovirals; it also hides a second dimension: those who get medicines sometimes use only those that do not impact quality of life; and finally hides the crisis of AIDS responses in Brazil and around the world.

Without experts or interactions, the focus of the 2015 campaign is on the identities of individualized subjects facing the epidemic, by their HIV-positive condition, gender, race / color, generation.

When we look at 2016, there is a total erasure of individuals, their sexual identities. On the poster, a text invites prevention, testing and treatment (Figure 5). The goal of the campaign is “We can build a future without AIDS”. In this respect, the “invitation” to the end of AIDS makes invisible the crisis in the response to AIDS in Brazil, where there is an increase of new infections, especially among the ‘key populations’, added to the hardening of conservatism, the lack of political will on the part of government as well as the weakening of SUS and NGOs / AIDS³⁰30. Seffner F, Parker R. A neoliberalização da prevenção do hiv e a resposta brasileira à Aids. In: Associação Brasileira Interdisciplinar de Aids, organizador. Mito vs realidade: sobre a resposta brasileira à epidemia de HIV e AIDS em 2016. Rio de Janeiro: ABIA; 2016..

In a year of singular political instability in the country, there was no campaign from the MS for World AIDS Day, but an articulation with the Catholic Church, through the National Conference of Bishops of Brazil (CNBB) and the Pastoral for AIDS.

The CNBB AIDS campaigns from previous years may be found on the DCCI website. An “unprecedented and historic action” by the MS and the Catholic Church aimed in 2009 to “make the faithful aware of the importance of testing for AIDS in the general population and for syphilis among pregnant women”. In 2014, MS technically supported the testing incentive campaign promoted by the CNBB and the Pastoral for AIDS. Two aspects are highlighted in these initiatives: on the one hand, the promotion of testing as a sponsored strategy through this articulation and –as expected- the omission of condoms; on the other hand, despite the campaigns resulting from the partnership with the Catholic Church both in 2009 and 2014, the MS launched its own campaign on December 1^st .

In 2017, the MS resumed the promotion of its own campaign, whose name and posters use the language of biomedical prevention alternatives, contemplated in the national guideline of the CP, launched that same year. The statements express the idea of inviting the population to know “all forms of prevention” through a website designed specifically for this campaign, with the general theme “#VamosCombinar”.

The invisibility of the subjects was almost total. It possible to clearly understand which group is in focus only through the image of the heterosexual couple with the title “Pregnant”. In other images, the identification of the diversity of sexuality and gender expressions is only possible by the titles given to each poster on the DCCI website: “Gay” (purple background); “Manager” (gray background); “Hetero” (red background); “Physicians” (blue background); “Trans” (yellow background). There is still a third red background image titled “Numbers” that reports data on the epidemic. All these images are in figure 6.

The original conception of CP not only emphasizes the biomedical approach, but also contemplates the cultural, social and structural dimensions of the epidemic¹⁶16. Hankins CA, Zalduondo BO. Combination prevention: a deeper understanding of effective HIV prevention. AIDS. 2010 ; 24 Suppl 4:70-80.. However, it seems that CP’s government discourse has stagnated on medicines, as if it had discovered the “magic bullet”. In 2017 posters, it is possible to highlight symbols, whose distribution resembles a constellation that evokes the image of the test, the pill and the strategies, the diagnosis and a male condom. Without further explanation of what these acronyms mean, and with the exception of the “manager” posters and the heterosexual couple with the pregnant woman, the words PEP and PrEP are highlighted for the first time.

Sexual and gender diversity is once again “visible,” but it becomes dangerous if it is not performed according to “combined prescriptions.” It is of note also the return of the experts. Now they are named as “doctor” and “manager”, thus including not only health professionals working at the frontline of the SUS, but also those working in public policy management.

The central design of these posters is the interlocking of people’s hands, which resemble typically youthful (tattoos, bracelets) or gendered (e.g. arms of official actors wear men’s and formal clothes). This image evokes a new alliance or combination: between couples (and their distinct arrangements), and between subjects and experts. Historically, on the December 1^st campaign posters, the maximum symbol is the red bow, absent only in 2008 and 2016. In 2017, the images of the crossed hands and arms refer precisely to the iconic red ribbon, which symbolized the struggle for the availability of the antiretroviral therapy in the 1980s. The loop refers to the expression “cut the red tape”.

Given the complexity of the symbols that make up this latest campaign, it should be considered whether or how much the recent messages about CP are really intelligible to the public. Or, to put it another way, part of the information conveyed in these images is interpreted only by a public “initiated” in the CP, as seems to be the case with the acronyms PEP and PrEP.

Conclusion

The analysis of AIDS from the perspective of the human and social sciences has been focused on its symbolic dimensions, such as the experience of the disease, the forms of social mobilization, the sexual morals, among other issues¹²12. Seffner F, Parker R. Desperdício da experiência e precarização da vida: momento político contemporâneo da resposta brasileira à aids. Interface (Botucatu). 2016 ; 20(57):293-304.,³¹31. Parker R. Unintended consequences: evaluating the impact of HIV and AIDS on sexuality research and policy debates. Cad Saude Publica. 2009 ; 25 Supl 2:251-8.. Aligned with this thematic scope, the study made a quest for some keys to interpret the representations of sexuality and AIDS prevention in the December 1^st campaigns in Brazil.

The messages of the analyzed material attribute responsibility and self-surveillance of sexuality, especially through testing, as an essential element of AIDS prevention. Although this type of message is not a novelty in itself, it must be stressed how its meaning seems to have shifted. If pre-CP campaigns appealed for condoms and the management of affects and erotic interactions - particularly in those relationships regarded as stable⁸8. Arraes GRA. Entre o desejo e a culpa: a transformação do comportamento sexual e as mudanças da noção de risco nas campanhas de prevenção à Aids no Brasil (1981-2013) e Estados Unidos durante a década de 1980 [tese]. Florianópolis, SC: Universidade Federal de Santa Catarina; 2015. - now the motto for accountability is directed to ‘self-awareness’. This would be one of the effects of the growing incentive to incorporate testing into the subjects’ daily lives, as illustrated by an analysis of the international literature on test uptake strategies among the so-called MSM³²32. Mora C, Brigeiro M, Monteiro S. HIV testing among “MSM”: prevention technologies, sexual moralities and serologic self-surveillance. Physis. 2018 ; 28(2):e280204..

In the preventive discourses recreated in the posters, there is also a shift in emphasis on social commitment or goals that can be understood as structural, such as the fight against discrimination. The attention of those subjects living with HIV and AIDS is directed towards emotions such as “courage” and “willpower” to bet on a life with dignity. These representations are in line with recent initiatives such as the 90/90/90 goal and its optimistic messages, which advocate for the normalization and chronification of AIDS at the biological and social levels.

Purposely or not, in the analyzed period, biomedical alternatives have been gradually occupying a prominent place, focusing on specific groups. Previous campaigns were a call to society, with less emphasis on behavioral change and even messages to disrupt the representation saying that women cannot talk about sex or propose condom use⁸8. Arraes GRA. Entre o desejo e a culpa: a transformação do comportamento sexual e as mudanças da noção de risco nas campanhas de prevenção à Aids no Brasil (1981-2013) e Estados Unidos durante a década de 1980 [tese]. Florianópolis, SC: Universidade Federal de Santa Catarina; 2015.. However we have recently witnessed a turning tide to new tones, objectives and means, which end up erasing or eclipsing social and symbolic aspects that are so dear in confronting the epidemic. It seems that recent campaigns aim at spreading CP strategies in themselves, and that the meaning of the subjects in the images is that they are only concerned by their acceptance. Despite the diversity of portrayed characters (e.g. transvestites, youth, pregnant women), reflections on sexual practices and gender relations are not at stake in the images or even related to condom use. Also noteworthy is the appearance of characters -sometimes masculinized- representing medical knowledge in the scope of the campaigns in the material analyzed.

Earlier observations converge with the process described as the biomedicalization of AIDS, which consists of focusing the AIDS response on biomedical interventions as well as “... a moment of greatest drama, marked by a heavy moral panic in the politics of sexuality.”³³33. Ferrari F. Biomedicalização da resposta ao HIV/Aids e o caso da emergência da PrEP: um ensaio acerca de temporalidades entrecruzadas. Equatorial. 2017 ; 4(7):131-60. (p. 131). Far beyond the daily use of medication, this logic imposes an individualizing regime, which does not require dialogue with collective subjects or social movements¹²12. Seffner F, Parker R. Desperdício da experiência e precarização da vida: momento político contemporâneo da resposta brasileira à aids. Interface (Botucatu). 2016 ; 20(57):293-304.. Additionally, we suggest that the issue of biomedicalization needs to be studied further, using methodologies that directly address the social actors involved.

The analysis of the study corpus timeline also revealed that the design of the campaigns in recent years has scarce continuity regarding formats and mottos adopted, while before 2013 the posters tended to align with information from epidemiological bulletins. Therefore, we identified a game of visibility/invisibility in the approaches, sometimes collective, sometimes individualizing, as well as certain subjects and identities. The trellis of this game, shows a conjunction of symbols from previous campaigns - “Get to Know”, “No shame, Girl!”, “Dress up” - as well as new symbols, highlighting the prevention tripod. The construction of these representations, which hybridize multiple initiatives and guidelines, is a mark of a process of changing preventive discourses in Brazil. In this change of discourse, those initiatives focused on prostitutes and trans (as subjects considered non-heteronormative), whose scope once recognized rights and citizenship, currently reinforces old moralisms, linking them to potential illness and suggesting their need to be disciplined. In this process, which involves thorough examination of the body, HIV testing occupies a significant place³²32. Mora C, Brigeiro M, Monteiro S. HIV testing among “MSM”: prevention technologies, sexual moralities and serologic self-surveillance. Physis. 2018 ; 28(2):e280204..

In the analyzed period, the language used in the posters sometimes highlights certain subjects and their gender expressions, possibly obeying the “logic of the essentialist concept of vulnerability”¹²12. Seffner F, Parker R. Desperdício da experiência e precarização da vida: momento político contemporâneo da resposta brasileira à aids. Interface (Botucatu). 2016 ; 20(57):293-304., whose effect in political and social terms results in the widening of the distance between ‘us’ and the ‘others’. In the 2016 campaign, we identified an exception, which concerns the resumption of the alliance between the state and the church, in which the imagetic terms differ from the tendency to show subjects’ faces as a way of coping with AIDS.

Finally, the language of the posters, based on acronyms and norms about the self-surveillance of the serological status and its possible familiarity among those who master minimal information to interpret it, provokes a reflection on an issue raised by Herzlich and Pierret⁴4. Herzlich C, Pierret J. Uma doença no espaço público: a AIDS em seis jornais franceses. Physis. 2005 ; 15 Suppl:71-101. and that still holds true: what future is reserved to those who do not know how to survive the infection?

References

Publication Dates

History