Research Humanities and Digital Sciences

Research at the Tilburg School of Humanities and Digital Sciences focuses on transformation processes taking place in contemporary society, related to communication and culture, and analyses the underlying moral and ethical questions.

Conversation-provoking HIV/AIDS campaigns may be counter-productive

Press Release, 12 October 2015 -- Mass media campaigns aimed to make adolescents in South Africa talk about issues related to HIV/AIDS may be counter-productive.

Research by Elizabeth Lubinga (PhD candidate Tilburg University/ University of Groningen, the Netherlands) shows that billboard campaigns that present deliberately puzzling messages about (un)safe sex, intended to spark conversations between people, lead to a lower rather than a higher understanding of the message which could possibly be dangerous.

Over the last two decades the majority of South Africans have been exposed to billboard or poster advertisements produced by the national or provincial governments and/or NGOs with visibility along road networks, in hospitals and clinics, at schools, transport hubs and many other strategic places. Still, with over 6 million people infected and living with HIV (17.9 percent), South Africa has one of the largest shares of the HIV/AIDS pandemic. The Department of Health in South-Africa reports 1,000 new infections daily. Moreover, despite a lot of HIV research and campaigns, the South African Human Sciences Research Council reports problems such as a decline in HIV/AIDS knowledge, a low rate of condom use in monogamous relationships and HIV-related risk behavior.

Puzzling health campaigns

In this dire context, Elizabeth Lubinga set out to study the strategies used in mass media campaigns to make adolescents in South Africa talk about issues related to HIV/AIDS. Lubinga: “A variety of communicative strategies have been devised by organizations in an attempt to come up with the most effective communication tool in the fight against HIV/AIDS.” One of the biggest South African health promotion organizations, loveLife, for years has used a campaign strategy aimed at provoking discussions by using posters with deliberately puzzling messages, both in images and/or verbal metaphors. Lubinga wanted to test whether it is correct to assume that such campaigns will automatically trigger interpersonal discussions, especially since it is a taboo in most South African cultures to talk about sexually related matters.

hiv campagne No discussion

Drawing on earlier empirical studies into the effects of ‘puzzling’ promotional material on conversations and campaign outcomes, Lubinga designed HIV and AIDS prevention posters in which she manipulated puzzling text and/or pictures, and she used these posters to interview participants from the target group. One of the posters was also used to study the conversation behavior of the participants. Lubinga: “Using rhetorical figures proved not to automatically result in adolescents talking about health campaign messages with friends or family. In addition, the results show that when young South Africans do talk about puzzling messages, this led to a lower rather than a higher understanding of the message and resulted in more misunderstandings about HIV/AIDS.”

Campaigners should reconsider their strategiesLubinga’s findings have implications for health campaign designers who advocate for the use of puzzling messages to provoke conversations with the intention of positively Influencing (determinants of) health behavior. “Given the fact that these messages may even create more misunderstanding about the topics they address, using puzzling messages “may even be dangerous”, says Lubinga. “With the current infection rates and the great vulnerability of adolescents, I urge campaign organizations who use these puzzling tactics in South Africa to reconsider their strategies. More research is definitely needed in this field to help designers of mass media health campaigns to create messages that their audience finds interesting enough to discuss, but which do not lead to misunderstanding and undesirable beliefs.”


Elizabeth Lubinga (1969) holds an M.Phil Journalism degree from Stellenbosch University in South Africa. She is a Lecturer at the University of Limpopo. From 2008, Lubinga was a Junior Researcher in a project called HIV/AIDS aimed at Local and Rural Areas (HACALARA) funded by the South Africa-Netherlands Research Program on Alternatives in Development (SANPAD).

Note to the editors

Elizabeth Lubinga will defend her PhD thesis ‘Stop HIV/AIDS. Start talking? - The effects of rhetorical figures in health messages on interpersonal discussions among South African adolescents’ on 16 October 2015 at 10:15am in the Auditorium of Tilburg University, The Netherlands. Supervisors: Prof. Alfons Maes (Tilburg University), Prof. Carel Jansen (University of Groningen).

For a digital copy of her thesis, e-mail: persvoorlichters@tilbuguniversity.edu.

From 12 October to 17 October, Elizabeth Lubinga can be reached in The Netherlands via phone number: +31-(0)6-8283 5471. Her South African phone number is +27 71285 0806.  E-mail: Elizabeth.Lubinga@ul.ac.za.

For further inquiries, contact press officer Ingrid Ramaan: jramaan@tilburguniversity.edu, +31(0)13-(0)6-4419 7002: