User-centred Design and the Graphic Representation of

HIV/AIDS in Public Health Campaigns

Raymond DONOVAN*, L. K. CHAN**

*University of Newcastle School of Social Sciences University Drive Callaghan NSW 2308
AUSTRALIA, raymond.donovan@newcastle.edu.au
** University of New South Wales College of Fine Arts PO Box 259 Paddington NSW 2021
AUSTRALIA, l.chan@unsw.edu.au

Abstract: During the first decade of the HIV/AIDS, graphic designs have been instrumental in providing public
images of the epidemic in response to the need for prevention programmes. Although HIV/AIDS is a medical issue,
the epidemic is also a cultural production since the syndrome has been associated with moral beliefs and social
prejudices about bodies, viral transmission and infection. Graphic responses to HIV/AIDS reflect the perspectives of
government and community groups including legal and moral censure by health authorities, frequently resulting in
sex-negative messages lacking specific information about the syndrome. In contrast, non-government organizations
and grassroots communities adopted sex-positive messages expressed in direct language and imagery and the
promotion of safer sex practices. This paper provides a socio-graphic and comparative analysis of three Australian
graphic responses to HIV/AIDS. Australian graphic responses to HIV/AIDS is not about one but several epidemics
which address the needs of various populations e.g. gay men, women, injecting drug users and HIV-positive men and
women. The aim of Expose The Myth campaigns is to effect behavioral change amongst gay men in inner-city
Sydney, Australia, during 1994, 1995 and 2003. This research addresses the campaign graphics in a user-centred
design model, with particular reference to the socio-cultural production and representation of epidemic knowledges. It
focuses on a textual-visual methodology which analyses and contextualises the graphic designs in relation to the aims
and the outcomes of the campaign, community ownership and participation, official and public censorship, as well as
health policies and strategies. It demonstrates the effectiveness of graphic responses to HIV/AIDS within the context
of the production and consumption of epidemic knowledges particularly in relation to a user-centred model.
Key words: Australian HIV/AIDS campaign, graphic communication

1. Introduction
In Australia, communication on HIV/AIDS awareness began as early as 1985, in Melbourne and Sydney, at grass
roots levels in response to the lack of information for the populations most affected by the virus - male homosexuals,
and men who have sex with men (MSM). The early campaigns consisted of simple printed messages in the form of
flyers and posters, to inform and to allay panic in homosexual men and MSM during a period when information about
the syndrome was sporadic and incremental as medical knowledge about the epidemic developed. It was only when
medical evidence that HIV could affect heterosexuals that the Australian federal government took action and produced a
generic campaign in response to the epidemic at a national level. Although the HIV/AIDS epidemic in Australia is
largely confined to homosexual men and MSM there has been only been one federal campaign, in 1991, which focused
on awareness and intervention directed at these populations. The bulk of the work in HIV/AIDS education programmes
is the responsibility of non-government organizations (NGO) such as the AIDS councils in the states and territories, as

well as community-based organizations (CBO) such as the Bobby Goldsmith Foundation, and the Gay and Lesbian
Counselling Centre in Sydney. NGOs and CBOs are funded from state and federal government sources as well as
community fund-raising activities. Although the arms length funding arrangement of the federal government allows
for some flexibility in the design and implementation of programmes aimed at specific audiences including homosexual
youths, rural men, men who have sex with other men but do not identify as gay, and positive homosexual men and
women, there is a pragmatic awareness and even a measure of self-censorship in the use of images and language in
campaign graphics to avoid offending official and public sensibilities.
The design and implementation of HIV/AIDS awareness and intervention campaigns is a complex process in the
sense it involves various key constituents and affects socio-behavioural changes in diverse populations; as a
consequence the graphics prompt multiple interpretations and meanings. Moreover, as with venereal disease, the subject
of HIV/AIDS raises issues about individual/public responsibilities and rights. Textual and visual analysis of graphic
designs for HIV/AIDS education campaigns must take into consideration the interconnected dynamics of government
policies and strategies, current epidemic and medical knowledges, socio-cultural and medical discourses, and broader
attitudes about gender, morality and sexual identity [1]. Furthermore, research and experience from two decades into the
epidemic have shown that the diverse nature of the affected populations necessitates a specific user-centred rather than
generic approaches in the communication and dissemination of information about HIV/AIDS, and that the
communication process cannot remain static since, of necessity, it needs to change in response to different target
audiences, and over time.
In discussing the nature HIV/AIDS intervention programmes for homosexual men and MSM in Sydney, this paper
provides a comparative analysis of the Expose the Myth campaigns of 1994, 1995 and 2003. The focus is on the textualvisual analysis of the graphics, and emphasises two factors. First, the designer as the conduit in the making and
transmission of meaning by organising visual access to a message. Second, visual syntax and the inference of meaning
in the designs. The Explore the Myths graphics are analysed in relation to the brief and objectives for the campaigns,
the designers response to the brief and the graphic outcomes, and the reported responses from the users or target
audiences.

2. Background to Expose the Myth

The rationale of the Expose The Myth campaigns arose from extensive research conducted by the AIDS Council of
New South Wales in early 1994 which reported that homosexual men, and men who have sex with men (MSM) in inner
city Sydney were increasingly practising unsafe sex without condoms, and that there was common misinformation
about the ways HIV could or could not be transmitted in relation to specific sexual behaviours [2]. The campaigns
sought to articulate and invalidate common myths about HIV/AIDS transmission and the sexual practices of
homosexual men and MSM, by providing practical information in the gay press and at gay venues. The central elements
of the campaign graphics cartoon figures and short taglines were replicated in posters, print advertisements, and
drink coasters. Although no formal evaluation of the campaigns was conducted, the response of the target audience was
positive, and focus testing of the graphics provided feedback for the fine-tuning of the cartoons and texts.
A second series of poster graphics was released in 1995 with the intention to build upon the success of the first stage
of the campaign in the previous year. Unfortunately, no evaluation for this stage of the campaign was conducted. The
third series of the Expose The Myth campaign in 2003 was planned and developed in the second half of 2002 in
response to reported incidences of increases in unsafe sex practices particularly among young homosexual men in innercity Sydney, as well as the perceived need to re-emphasise and repeat the message of safer sex practice for homosexual
men, and MSM [3]. The first stage of the 2003 campaign included three designs developed in response to an extensive

marketing survey; the graphics appeared as posters, print advertisements and condom packs. The evaluation of user
responses to stage one of the 2003 campaign is currently under way, and will culminate with the release of stage two of
the present series later in the year.

3. Doing graphic interpretations

Meaning-making in the graphic communication of messages is a dynamic process characterised by the interconnected relationship of three factors: the graphics, the designer, and the user. The designer is briefed by the
client on the intention, the codas and the meanings to be embedded in the graphics; yet the intended meaning
remains inarticulated, let alone realised, until the graphics are interpreted by the user [4]. This notion of design as
a trigger to the accessibility of random meanings acknowledges and recognises the significance of the user in the
communication process. It recognises the importance of the doing of socio-cultural interpretations and
translations, rather than merely focusing on the aesthetics and formal qualities which privilege the designer as the
principal agent in the process of the communication of pre-ordained messages [5]. It also calls into question the
often-assumed passive role of the designer in the structuring of the elements of graphic design, and the
consequential and unintended multiple meanings subsequently perceived by the user.
3.1 Cartoons - 1994
The objectives of the 1994 Expose the Myth campaign were two-fold.
First, to underscore the need for homosexual men, and men who have sex with
men (MSM) in inner-city Sydney to continue with safer sex and/or safe
injecting practices. Second, a recognition of the visibility of the latter and,
irrespective of what they actually do, the importance of self-care with the
promotion of health maintenance of HIV-positive men in the gay community.
At the outset, the campaign design focused on a series of graphics and
messages encompassing similar layouts for print advertisements in the gay
press, and posters distributed at gay venues. The original brief called for the
commissioning of three artists to each contribute four graphics addressing
twelve commonly held myths about HIV/AIDS and homosexual men each
graphic to challenge a specific myth about the epidemic. The myths were
collected by a working group from the AIDS Council of New South Wales;
they related to issues such as health maintenance, safer sex and safe injecting.
Known for his designs for the Sydney Gay and Lesbian Mardi Gras, Ian
Barbour was chosen to devise the graphics for the 1994 Expose the Myth
campaign. Initially, he considered a surreal theme but decided the idea was
unsuitable for the budget and print specifications. Content to be given the

Fig 1. Expose the Myth. Marching

into the sea of ignorance. Print
advertisment AIDS Council of
New South Wales, Sydney, 1994.

creative development for the Expose The Myth campaign, he was conscious of criticisms that the proposed campaign
focussed yet again on inner-city homosexual men who already knew what they needed to know about HIV/AIDS.
Aware it was easy to focus on images of beautiful bodies rather than on the message, Ian Barbour regarded HIV/AIDS
education as a delicate issue, where the graphic messages needed to be repeated in fresh and interesting ways so as
to appeal to all target groups. Realising he did not have the luxury of character development within the short period and
limited duration the campaign would run, he decided on the use of cartoons for the campaign graphics. Ian Barbour
created cartoon characters with deliberate twists in the captions and expressions, with underlying humour. He believed

in the universal appeal of cartoon characters, although he was aware it could take time for engagement and familiarity
with new cartoon characters to develop [6].

Although responses to the campaign graphics were positive, not everyone related warmly to the print
advertisements; the in-your-face graphic style was offensive to some. When questioned about the reaction, Ian
Barbour conceded that the reality of HIV/AIDS is threatening to some people and provokes adverse reactions, but
he rationalised this to be a good sign: the audiences reacted to the cartoons, and connected them with the
messages. He said: The Sea of Ignorance image is not anti-love. Its about waking up to reality. That is why some
people have strong reactions to it, reality can be threatening. A good ad is an ad that is remembered. It should
provoke reaction, it should hit home, it should stick [6] (Figure 1).
3.1 Post-photography - 1995
The 1995 variation of the Expose The Myth campaign built upon the
success of the 1994 cartoon campaign. For this, the AIDS Council of New
South Wales commissioned the artist Andrew Clark as the designer for the
poster graphics, which drew upon the artists personal life and experiences.
The myths he addressed were the issues of being young and feeling
invulnerable to HIV; being in a relationship and feeling protected from
HIV; being HIV positive and healthy, and not considering early treatments;
and believing that only junkies get HIV [7]. The posters and postcards
were designed for distribution in gay bars and clubs, and community
groups and community health services.
While Ian Barbour worked within the constraints of the design brief,
Andrew Clarke incorporated in his graphics a spectrum of his personal
beliefs, and creative expressions and responses, which he described as
post-photography: a composite of digital image technology and mediated
techniques including collage, painting, photography and so on in the

Fig 2. Love is wonderful, sweetie

but it wont stop you from getting
AIDS. Expose the Myth. Poster
AIDS Council of New South Wales,
Sydney, 1995.

construction of multi-layered images with associated (random) meanings

[8]. He speaks of building layer-upon-layer in the devising of complex composite graphics which encompass:
HIV status and discrimination; symbolism of dark/light, and life/death; Australian icons; the politics of Australian
HIV/AIDS; sexual identities; the plight of rural homosexual youth in urban Sydney; the politics of injecting drug
use; denial in the homosexual community; camp identity and homosexuality; the church and discrimination;
monogamy; multiculturalism and the celebration of difference; and community spirit [7].
The narratives which accompany Ian Barbours graphics are illustrated with cartoon characters and speech
bubbles which, together, connect with and draw upon and reflect the wider message: the text concerning the
specific myths, and the facts about safer-sex practices. The layered meanings embodied in Andrew Clarkes
graphics are lost in an esoteric confusion of camp icons, images and symbolisms and, in the event, illegible
computer-manipulated typography. Although there are no visible clues necessary to make connections with the
disparate graphic elements, he presumes the user, the viewer, has prior knowledge of the layered pictorial
elements, the abstract symbolisms and the narrative in reading the meanings of the techno-graphics. In his
description of the poster, Love is wonderful, sweetie but it wont stop you getting HIV, Andrew Clark explained
the graphic as representing the strong denial, represented by the serpent as a symbol of denial coiling around the

homosexual couple (Figure 2). He also dismissed cynicism in the inclusion of the church stained glass windows,
and rationalised that they referred to monogamy and the churchs decree against sexual activity outside of
marriage. One of the figures sported a question mark on his forehead, and the other the acronym HIV. He
explained that the symbols represented social discrimination and the segregation of people living with HIV/AIDS,
and the need to deconstruct the social barriers which created the false sense of security between Us and Them
[9].
The 1995 version of the Expose the Myth campaign is overly layered and a complex graphic design which, in
effect, subverts the intended safer-sex message. The graphics are an echo of an ambiguous and complex narrative.
This version of the campaign was devised on the assumption that HIV/AIDS is an everyday experience; but at the
expense of direct and practical safer-sex information. No data is available for the evaluation of the campaign
graphics. Andrew Clarke completed four graphics in the series intended for reproduction in poster and postcard
formats. The fourth design, Being young and feeling invulnerable to HIV, was not produced; the male model
who had HIV superimposed on his forehead declined to sign the release form authorising the use of the image.
3.3 Illustrations - 2003
The concept for the first of the 2003 Expose The Myth campaigns was
initiated and developed by graphic designer Sasha Dobies. Drawing upon
the technique of using a central image for the graphic focus, she drew upon
analogies from traditional fairytales to provide the narrative about the
dangers and misconceptions concerning HIV/AIDS, and safer sex
practices. The AIDS Council of New South Wales identified the myths
which phrased colloquially - included Snow Dwyte and the Seven
Dwarfs (serial monogamy); Insy Winsy Spider (viral load); Jack and Bill
(injecting drug use); Three Blind Mice (sexually transmitted infections);
Aladdin (post-exposure prophylaxis); and Goldijocks and the Three Bears
(withdrawal). The first stage of the 2003 campaign involved the design and
development of graphics featuring three myths for application to posters
placed in gay clubs and venues, print advertisements in the gay press, and
condom packs. The three designs featured coloured illustrations of male
couples in various stages of sexual activity and excitement, with speech

Fig 3. Little red riding Expose

the Myth. Poster AIDS Council of
New South Wales, Sydney, 2003.

bubbles which contextualised the safer-sex message in a straightforward narrative style. A novel graphic element
in each of the poster designs are subtle references to the fairytale in question, for example, the boy with the red
cap in Little Red Riding , which, in this instance, is a whimsical graphic allusion to anal sex and condoms
(Figure 3).
Extensive focus testing of the preliminary designs allowed for the feedback to be incorporated in the refining
stages of the design process. An ACON report states: Overall most gay men did not like the Gothic lettering of
the first letter of the text. It was also pointed out that the Myths should be the main focus, not the nursery rhyme
the Myths have been linked to. The round speech bubbles were preferred over the elongated thought rectangles.
[] One man during the focus test pointed out that if you only look at the picture and read the speech bubbles,
this poster gives the message that it is OK to have unprotected sex. The speech bubbles need to clearly indicate
the message intended for those people who would not read any further [3]. Spatial display of the graphics is

restricted to gay venues and publication in the gay press so the explicit depiction of genitalia in one of the designs
did not become a public issue. Early indications show a positive response to the three poster graphics after the
launch in February in 2003. Posters for stage two of the campaign will be issued later in 2003, when an evaluation
of user response to the designs will be conducted.
4. Reading graphic strategies
Just as the designer requires a logical system for the construction of
meaning in the communication process, the user is also in need of a
corresponding system for the reconstruction of meaning the design or
trigger which provides the interface by which the user reads or makes
meaning. The designers strategy is to purposefully effect a systematic
arrangement of pictures, typography, rules and points to guide the user in
meaning-making and the provision of visual cues necessary for the
comprehension of the graphic message. When visual guidelines are absent,
the user may confuse or mistake the graphic message for another intention
altogether, which is likely to arise when a design is embedded with multicomplex meanings (refer Figure 2).
Two significant methods of visualisation strategies can be employed in
assisting the user in making-meaning. First, graphics like pictures and
diagrams are objects for communication and cognition, and therefore are
subject to the Gestalt laws of visual perception. Second, the rationale of
visual syntax or formal relations guides the reading of a graphic. Thus in
the case of Ian Barbours graphics for the 1994 Expose The Myth

Fig 4. Expose the Myth. Ignorance

ties them in knots. Print
advertisment AIDS Council of
New South Wales, Sydney, 1994.

campaign, the hierarchical structure of the pictorial and textural elements in

the design layout helps to guide the user to read and make meaning in a
logical manner (Figure 4). The repeat of the banner for Expose The Myth in
all the graphics provides familiar recognition of the graphics as part of a
series; the speech bubble is related to the pictorial image of the figures for
the narrative; the tag line ignorance ties them in knots is framed and
located above the script which provides detail information to counter the
myth; and the logotype of the AIDS Council of New South Wales is
positioned at the same location in each of the graphic to provide
consistency in the series. The distinguishable picture plane emphasises the
figures and adds to accessible reading of the figures among other pictorial
and textual elements. Initial focus testing of the 1994 campaign graphics
also highlighted language problems in the users meaning-making,
particularly the link between the speech bubble and the script; complex and
contradictory messages; and the use of pejorative language such as
substance abuse instead of substance use.
Similar visual strategies were employed in the 2003 campaign graphics

Fig 5. Little Jack Horny. Expose

the Myth. Poster AIDS Council
of New South Wales, Sydney, 2003.

to facilitate reading and meaning-making by the user. Although in this series colour has been introduced, the use
of tonal variations allowed the figures to appear in the foreground while the panel of script recedes slightly into
the background. The concept of layering and translucency is also used for textual elements to screen over portions
of the figures without obscuring the reading of the type. The use of a consistent format in the arrangement of
textual panel, tag line panel, and speech bubbles provides the logical access to different levels of information in
the construction of the meaning of the narrative (Figure 5).
5. Conclusion
The reading of the 1995 campaign graphics is marred by the juxta-positioning and multiple layering of pictorial and
typographical elements without defined logical tropes for clear comprehension in the process of meaning-making. There
is an absence of visual clues linking the different elements, and the scale of the
pictorial elements does not provide for familiarity in the establishing of
connections. The use of computer-generated effects of wavy structures and
distorted figures contribute to a disconcerting visual experience, and the special
effects accorded to the typography does not assist with the reading and
meaning-making of the graphics. The overall effect is one of total confusion and
difficulty in understanding the intended meaning of the message(s). As
described by the artist, Andrew Clark, this graphic image was meant to
symbolise a state of denial and drunk behaviour of celebratory Sydney (Figure
6).
Designing graphics for HIV/AIDS awareness and prevention campaigns is a
complex activity. The process has to address an interwoven network of issues
including gender, sexuality and morality with reference to socio-cultural,
economic, political, medical and historical contexts. Textual-visual analysis of
HIV/AIDS graphics need to go beyond the formal critique of the aesthetics of
the design; it should address the relationship of the designer, the design and the

Fig 6. Dont wait until youre sick.

Expose the Myth. Poster AIDS
Council of New South Wales,
Sydney, 1995.

user in the tripartite relationship which influences the construction and

reconstruction of meanings of epidemic knowledges. By defining the designer as the conduit in the making and
transmission of meaning through the organization of visual access to a message, the role of the user is thus redefined as
the one who receives and makes meaning out of the designs in the very activity of the communicative process.

References
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