V&A Dundee

Visual AIDS - a complex history of design and public health

This World AIDS Day, V&A Dundee’s LGBTQIA+ Group considers the role design can play in tackling public health crises, and what those designing campaigns have got right - and wrong - in the past.

Written by: V&A Dundee's LGBTQIA+ Group, with Cat Laird of CHIP Collective

Exactly forty years ago in December 1981 the first cases of a new virus, that had been first reported in the US a few months previously, were identified in the UK. Though no one knew it then, those early cases would be looked back upon as the start of the AIDS crisis, a health emergency that would go on to take more than 30 million lives worldwide.

In Britain, we now know that the first patient to die from HIV/AIDS was John Eaddie from Bournemouth; Eaddie was referenced in the Lancet medical journal simply as a ‘known homosexual’, and his death was attributed to the same ‘mystery illness’ that was sweeping American’s gay community at the time.

While knowledge of the disease was still in its infancy, throughout the early 1980s the messaging about HIV/AIDS conjured prejudice and fear. The medical world, politicians and the media made links between the gay community and the virus, interpreting what information they had largely through the lens of a narrow mindset.

"The same imagery would come up time and time again in poster campaigns, using black and white photography and gut-punching, often insensitive and victim-blaming captions."

While more and more gay men lay in hospital beds, quickly deteriorating and often forcibly separated from their loved ones, the community became victimised as the stigma associated with the disease was pushed to the public. Newspapers began to run headlines proclaiming AIDS the ‘Gay plague’; the ‘guilt of promiscuous homosexuals’ and ‘the wrath of God’, while politicians wrestled with whether to raise public awareness or play it down.

Design became co-opted as a tool to raise awareness, curb infection and save lives – but often also to perpetuate deeply-held prejudices.

Early days - design in the 1980s

Black and white poster with slogan 'AIDS - DON'T DIE OF IGNORANCE'
Campaign graphics from the 1980s often relied on hard-hitting, doom-laden imagery - poster designed by Malcolm Gaskin and David O'Connor-Thompson

In 1986, the UK government launched its ‘Aids: Don’t Die of Ignorance’ campaign; it used grim imagery associated with death, tombstones and lilies in a monochrome palette, with high contrast between light and shadow to emphasise the inevitable end result of death if one were to contract AIDS. The same imagery would come up time and time again in poster campaigns using black and white photography and gut-punching, often insensitive and victim-blaming captions such as 'AIDS: Get the facts. People are dying to know' and 'A bad reputation isn’t all you can get from sleeping around'.

While it’s likely that this blunt approach did achieve its primary aim – of embedding the danger of AIDS in the public consciousness, and changing behaviour – there were also negative consequences for those communities hardest hit.

"When designing any form of media that tackles medical issues it is important to be sensitive about the condition – not just to help prevent it, but to offer support, care and understanding to those already affected and most at risk."

Tracking design’s historic relationship with AIDS

But of course, a global crisis garnered a huge variety of responses from designers across the world.

In its AIDS Education Poster Collection, New York’s University of Rochester has gathered an extensive and often arresting visual history of the relationship between graphic design and the AIDS epidemic. The collection tracks poster and graphic design from 1981 to the present day. From graphic sexual imagery and in-your-face typography, to smiling cartoon condoms and positive messages of affirmation and solidarity, it highlights the many different approaches taken by designers in different countries over the decades.

Photographs of couples kissing with the headline 'KISSING DOESN'T KILL: GREED AND INDIFFERENCE DO' and subheading 'CORPORATE GREED, GOVERNMENT INACTION AND PUBLIC INDIFFERENCE MAKE AIDS A POLITICAL CRISIS'
This poster by Gran Fury for ACT UP highlighted some of the underlying social and political issues exacerbating the AIDS crisis - image credit Gran Fury/Avram Finkelstein

Designing effective campaigns

Public information campaigns are similar in design process to general advertising campaigns. Designers and teams will assess their target market and use their skills of colour, typography, location of the advert, type of media, and sometimes even pop culture references to create graphics that will appeal to them in particular. Successful campaigns can boost sales, spread awareness, and even become infamous among online communities The significant differences between designing advertising for companies versus public information campaigns are the target market and the purpose of the message.

Public information campaigns also have to appeal to the most amount of people – hence why many different announcements are made on the same topic for different audiences. Trying to grab the attention of everyone at the same time with one image is almost impossible. The purpose of the message is to inform, spread understanding and promote the wellbeing of the viewer and those around them. So when an epidemic like AIDS arrives – and the public need to know about it urgently – public information campaigns are needed fast, and they need to work effectively to avoid unnecessary loss of life.

Taking care with design

In an ideal world these campaigns would be free of any political alignment, bias, and have all the information about the subject to hand for designers to create effective and considerate pieces. But, as the famous 1980s campaigns show, tactics like scaremongering (effective but not necessarily productive) often win out.

When designing any form of media that tackles medical issues it is important to be sensitive about the condition – not just to help prevent it, but to offer support, care and understanding to those already affected and most at risk.

"[Comics are] an effective way to not only simplify topics and make for easy reading, but to provide a level of separation from, and access to, tougher subject matter."

However in the early days of the AIDS crisis, by not offering appropriate support to one of the groups most affected by the disease, governing bodies left the LGBTQIA+ community (already suffering from losing their friends and found families) in dire straits; viewed even more as a public enemy, with old homophobic attitudes finding a new narrative – that this was divine punishment for “sexual deviancy”.

Poster featuring yellow characters on a red and blue background, with the slogan 'IGNORANCE = FEAR, SILENCE = DEATH', screenprinted
A 1989 screenprint by Keith Haring for US campaign group ACT UP

Design as a tool for public health

What does it look like when campaigns are designed well? Some of the best examples of design as a tool to promote public health are showcased in Sarah Shrauwen’s 2017 book Can Graphic Design Save Your Life? – which also came to life as a public exhibition at the Wellcome Trust.

"By telling stories compassionately we can improve quality of life of those affected, allowing them to speak for themselves, and reach out to others affected across the globe."

More recently people have become aware of the existence of public health campaigns due to the COVID-19 pandemic. There are notices all around us in every form imaginable advising the public on ways to minimise their risk of getting sick. Ideally each has been designed to convey accurate information as simply as possible, so that even when it’s difficult to comprehend how the virus works, we can understand the actions we need to take to combat it. The development of this field of design has come along leaps and bounds, although still not perfect by any means.

Visual storytelling

A page from the comic Paco, showing a young man talking to his doctor about his fears of HIV/AIDS
The title character in Carlo Quispe's Paco is nervous about getting tested for HIV

The introduction of graphic medicine – the use of comics and other forms of visual storytelling – has been another significant milestone in helping more people understand the intricacies of their own health. It’s an area explored by Dundee-based comic creators CHIP Collective. Using visuals combined with text, comics can tell an entire experience from start to finish. It is an effective way to not only simplify topics and make for easy reading, but to provide a level of separation from, and access to, tougher subject matter – something that the photographic approach of the 80s (triggering for some) struggled to achieve.

Visual AIDS, an art organisation committed to raising AIDS awareness and promoting artists with HIV/AIDS, is one of many organisations working to tackling stigmas and preserve the legacies of affected artists. In 2020 they released a series of comics under the series title of Strip AIDS 2020 including Paco by Carlo Quispe, a comic about a gay man going through the testing process for HIV and discussing his fear with his community and his doctor.

The future for public health and design

Our understanding of HIV/AIDS has broadened through scientific research, reducing misinformation and making it something to be less fearful of and easier to comprehend how to protect yourself against. In many countries, treatments have taken away its title of being a death sentence and, by encouraging people to have empathy for those affected and telling stories compassionately we can improve quality of life of those affected, allowing them to speak for themselves and reach out to others affected across the globe.

Public health campaigns have the ability to spread worldwide now thanks to the internet and translation services but there is still much more needed to be done to reach communities that simply don’t have access to the wealth of information (and healthcare) that we often take for granted. In 2020, 680,000 people died from HIV-related causes, with African nations and parts of Asia hardest hit.

Here in the UK, while medical advancements continue to improve and allow those with HIV to live a full life, for many the stigma remains and so the challenges for LGBTQIA+ community remain also; to educate, raise awareness, and remember those lost from the community who were, in the early years, publicly blamed yet deliberately forgotten – people like John Eaddie. Design can be a tool to help us achieve this.

Main image credit - Carlo Quispe for Strip AIDS 2020