A Campaign Against Fear : The Evolution of the Wording of the New Government Brochure

When the federal government’s newest education brochure starts arriving in mailboxes later this month, it will look pretty much like thousands of other government pamphlets put out each year on topics ranging from aphids in the rose garden to safety tips for working in the barnyard.

But this brochure is different.

Expressly mandated into existence in an act of Congress, it will be mailed to every household in the United States, also handed out in liquor stores, pharmacies and birth control clinics, and written in English, Spanish, Chinese and Braille. It was prepared by the Ogilvy & Mather agency for the Atlanta-based Centers for Disease Control and the U.S. Surgeon General’s office, with input from 288 public health, medical, community and AIDS service organizations.

Sought the Right Tone

Ultimately, the brochure went through 38 different drafts.

The reason, said Jody Powell, president of Ogilvy & Mather Public Affairs, was to ensure that the precise wording of the government brochure on AIDS struck exactly the right tone.

According to Powell, the former White House press secretary during the Carter Administration, “The British over a year ago went out with a nationwide mailing and a TV ad campaign which most people concluded was a mistake in that the tone of the campaign throughout was very much one of fear. Basically it seemed to push people into a fatalistic mode.”

In one sense, said Stephen Heller, the Ogilvy & Mather Advertising vice president who worded the brochure, AIDS “is a very simple disease. There are only a few ways you can get it. But people had heard all kinds of rumors and innuendoes. We wanted to calm people down if they are not in danger of getting AIDS and, if they are, to show them where they can get help and counseling. But the worst thing you can do is make people afraid of AIDS. Most people are probably not at risk anyway.”

Last August, the Centers for Disease Control selected Ogilvy & Mather from 20 competing agencies to find out what the American public wanted and needed to know about AIDS. By October the agency had begun to sample public opinion on AIDS through focus group and shopping mall intercepts in cities all over the country. “People really knew about AIDS,” said Heller. “They had incredible information about it. They just didn’t know what to do with it.”

Beyond the Terms

They wanted to go beyond terms like “casual contact,” “bodily fluids,” and “sexual practices,” said Ogilvy & Mather account supervisor Pamela Adkins.

“People were telling us,” she added, “ ‘Look, what are sexual practices?’ To one person, it might be a kiss, to another it might be anal intercourse. They wanted uniformly and consistently . . . to be given factual, very specific information on how it is transmitted and not transmitted and we heard that over and over again.”

That was why, said Ogilvy & Mather vice president Steven Rabin, the Centers for Disease Control decided that the brochure would make a strong, clear, definite statement on the transmissibility of AIDS: “You will not get AIDS from saliva, sweat, tears, urine or a bowel movement.”

A second problem, said Rabin, was that the public had been given too much contradictory information. “People had sort of been whipsawed by everything from Cosmopolitan saying ‘Heterosexuals don’t have to worry,’ to Masters and Johnson saying, ‘Everyone has to worry.’ . . . There would be one story saying, ‘The AIDS test isn’t any good,’ (then another story saying) ‘The virus has been isolated in sweat.’ ”

“People absorbed almost everything in the news but sometimes glued it together wrong. And that was frightening people,” he added. “They wanted a clear explanation--’I wish someone would say authoritatively, what’s the story here.’ And of all the different sources, the Centers for Disease Control and the Public Health Service were seen as the people who should know.”

To gather the best available information as well as advice on how best to present it, Ogilvy & Mather went to 28 U.S. cities and talked, said Adkins, to leaders of various black, Latino, gay, women, youth, medical and professional organizations. They checked with the national AIDS hot line to put together a list of the most frequently asked questions about AIDS. Heller said many people wanted to know if it was possible to get AIDS from mosquito bites.

These discussions led to the decision to focus on behavior and not risk groups. According to Rabin, “a number of people said, ‘The virus doesn’t discriminate and people need to know that every group can get AIDS but no one group should be stigmatized in a high-risk group. There is only high-risk behavior.’

“We drew that line very clearly on Page 2 (of the mailer): ‘Who you are has nothing to do with whether you’re at risk for getting AIDS. What really matters is what you do.’ ”

It also became clear during the October research blitz, said Rabin, that judgmental words like promiscuous, illegitimate or illicit were counterproductive in that they “tended to allow people to say, ‘Well, I’m not at risk because I’m not a bad person.”’

In preparing the brochure, said Heller, there was no outside pressure from any agency, group or person to soft-pedal any of the hard realities of AIDS. “I never felt that anyone was making changes for no good reason. I was actually quite impressed by the attitude of some of the higher-ups. They took the position that this was too important to be messed up by government gobbledygook.”

Still, said one source close to the project who doesn’t want to be identified, in attempting to be sensitive to the gay community, there were times when it was necessary to tread a middle road. “There is one interesting issue where the gay community is split . . . Page 3 (of the mailer) says anal intercourse is risky behavior, (but) then on the next page, it says condoms are the most effective if you are going to continue to have sex. . . . (The reasoning was) if you are going to reject the advice on Page 3, there is still a way of catching you on Page 4.”

To ensure the accuracy of the document, said Adkins, Ogilvy & Mather discussed it “one-on-one” with medical professionals as well as more than 40 government scientists, epidemiologists and health officials. Then in January with a draft of the document in hand, Ogilvy & Mather went back to the AIDS groups, the medical and scientific Establishments, and a new round of focus group testing in cities ranging from Raleigh, N.C., to San Juan, Puerto Rico. These focus groups, said Adkins, included teen-agers, single and married people, parents with children or married persons without children, from blue-collar to white-collar backgrounds.

Positive Response

Generally, added Rabin, the response was very positive. “People liked the fact that the information was broken up into boxes. They liked that they could find different things that they were interested in without having to read it from beginning to end. . . . We had one woman from Denver in a focus group who said, ‘This is just what I need. I’m going to tack this over my teen-age son’s bed.’ ”

At the same time, said Rabin, they also took exception to certain assumptions in the prototype. “They wanted the dating section to acknowledge that you can date and not have sex.” The prototype had sort of jumped into that--’When you’re dating, you can’t tell if the person you’re having sex with is affected or not.’

“As one parent said, ‘I don’t know what my daughter is doing. (But) I’d like this mailing to give her a pat on the back if she is not having sex and the information to make it through this thing if she is.”’

Even though some of the information in the brochure will undoubtedly be controversial to some people, said Adkins, it has been reviewed by people representing enough religions, backgrounds and interest groups that in effect it has “already been endorsed” by the American people.

Not Universally Admired

Which is not to say that everyone universally admires it. Some critics have already charged that the mailer unduly alarms the public by exaggerating the spread of AIDS to the heterosexual community and especially to women, only 1,350 of whom have contracted the disease though sexual intercourse in eight years. In addition, said critics, it ignores the role of “promiscuity” in spreading the disease.

As for the likelihood of AIDS spreading to the heterosexual community, Heller agreed that “percentage-wise it’s not.” In fact, he said, AIDS is “harder to get than most people think. Not only can’t you get it from mosquitoes, you can’t get it from sex if you take a few simple precautions.” The point the brochure was trying to make, he said, is “that just because you are not homosexual doesn’t mean you are totally incapable of contracting the disease.”

On the subject of the risk of AIDS to women, Heller said that the problem was that “so much of the American population doesn’t know anyone who has AIDS. They may have an uncle who knows someone who lives in San Francisco who has AIDS but that’s as close as it gets to them.”

As a result, talking to them about AIDS is like saying “that the Martians have landed in Cleveland”--it just doesn’t seem real. That’s why, said Heller, the booklet contains a picture of a woman who had AIDS: “It’s a way of personalizing it.”

As to why there were no statistics in the brochure on such matters as the likelihood of catching AIDS, Heller explained that at one time an earlier draft of the brochure did have information about how many people had been affected and were expected to be infected. What was discovered, said Rabin, was that people were either confused by statistics or used them as a “form of denial, and from a public health point of view, there is a real effort to discourage people from walking around with little calculators trying to decide if they are going to engage in risky behavior or not.” Asked why the government didn’t just come right out and say that promiscuity is dangerous to your health, Heller pointed out that the brochure says it is risky to have sex with “someone you don’t know well.”

Besides, he said, “the government didn’t want to come across as too moralistic.” One of the main things learned from the focus groups was that people “laugh at you if you tell them ‘Just say no to sex.’ ”