Promoting Equal Rates of STI-Testing for LGB Individuals
Natalie Dove
Associate Professor
Eastern Michigan University
Randal D. Brown, MA
Doctoral Student
University of Nevada, Reno
May 30, 2014
Promoting Equal Rates of STI-Testing for LGB Individuals 2
Abstract
Lesbian, gay, and bisexual (LGB) individuals are disproportionately represented within
sexually transmitted infection (STI) prevalence rates, yet marketing campaigns designed to
encourage STI-screening are inordinately targeted toward heterosexual populations. As such,
we sought to examine how marketing campaigns that compared self-, partner-, and
relationship-focused STI-prevention messages would influence LGB individuals’ motivation
and willingness to obtain STI-screenings. We also examined whether these marketing
campaigns would encourage LGB individuals to communicate with their partners about safer
sex and STI-screenings. Results indicated that the partner-focused campaigns motivated more
participants to be willing to obtain an STI-screening, talk to their partners about safer sex
practices, including STI screening, and lastly, have the confidence to initiate conversations
about safer sex practices. Both the benefits of this research and the implications for future
STI-testing related campaigns for LGB individuals are discussed.
Author Information
Natalie Dove is an associate professor in the psychology department at Eastern
Michigan University. Her primary research interests are sexually transmitted infection
prevention and the amelioration of gender bias. Randal Brown is an Eastern Michigan
University graduate and current doctoral student at the University of Nevada, Reno. His
primary research interests are sexual health promotion, communication within romantic
relationships, and LGBTQ issues.
Promoting Equal Rates of STI-Testing for LGB Individuals 3
Promoting Equal Rates of STI-Testing for LGB Individuals
On February 14, 2013, which, ironically, is noted on our calendars as the day for
romance, the CDC released new information about the rates of sexually transmitted infections
(STIs) within the United States. According to these statistics, there are over 20 million new
diagnoses of STIs each year, and over half of these are among 15 to 24 year olds. These
numbers alone are staggering, but previous research has demonstrated that LGB individuals,
and gay males in particular, are overrepresented among those who are infected with any type
of STI.
Because of this increasingly problematic STI pandemic, many researchers within the
areas of psychology, communication, and marketing have focused upon ways to motivate
individuals to not only practice safer sex, but also get tested for STIs on a regular basis.
However, many of these STI-related marketing campaigns have targeted heterosexual
individuals, either explicitly or implicitly, by featuring a heterosexual couple embracing on the
front of a pamphlet or exclusively referencing vaginal intercourse in the text of a campaign,
for example (see Appendix A for examples of these campaigns).
Given the overrepresentations of gay males in STI diagnosis statistics, more empirical
work needs to focus upon how marketing campaigns that encourage STI-testing and safer sex
can reach this population. We cannot assume that the marketing campaigns aimed at
heterosexuals will be equally motivating to LGB individuals without deliberate empirical
testing.
A new STI-related marketing campaign
In 2012, we designed an STI-related marketing campaign entitled “Make the Grade”
that is free of any reference (implicitly or explicitly) to sexual orientation. Though prior STItesting related marketing campaigns have mainly included taglines encouraging a reader to
Promoting Equal Rates of STI-Testing for LGB Individuals 4
“Protect Yourself,” our campaign was unique in that it capitalized upon the notion that sex
occurs within a dyadic interaction. As such, we created three versions of our campaign: one
that encourages readers to protect themselves by obtaining STI-testing (which mirrors many
current campaigns), one that encourages readers to protect their partners by obtaining STItesting, and one that encourages readers to protect their relationships by obtaining STI-testing.
We initially tested the efficacy of these campaigns with a heterosexual sample, and
hypothesized that these participants would rate the campaigns that were partner and
relationship-focused as more effective and motivating. Our hypothesis was supported; our
primarily heterosexual sample rated both the partner and the relationship-focused campaigns
as more effective and motivating. As mentioned earlier, however, we then sought to
empirically test the efficacy of these campaigns using an LGB sample.
LGB Equality Orientation
There are many reasons we wanted to test our previously successful STI-related
marketing campaign with LGB individuals. As previously mentioned, we tried to create a
campaign that was devoid of any reference, either implicitly or explicitly, to the sexual
orientation of the reader, which has been relatively unexamined. In addition, we found it
unacceptable that LGB individuals are largely ignored when STI-testing related marketing
campaigns are constructed, especially given the overabundance of LGB individuals who have
tested positively for STIs. Though we do not know the exact effect that poorly targeted
marketing has had on the increasing STI rates among LGB individuals, the disproportionate
statistics noted earlier suggest that campaigns that primary target heterosexual individuals
are not helping to educate or motivate LGB individuals to obtain STI-testing and practice safer
sex.
Promoting Equal Rates of STI-Testing for LGB Individuals 5
Lastly, theoretically speaking, our prior research suggests that more partner or
relationally focused campaigns are successful at motivating heterosexual individuals to obtain
STI screenings. What was still unknown was whether LGB individuals would respond in kind
to this type of novel campaign approach. Because LGB individuals are more likely to refer to
their significant others as “partners,” we believed that a partner-oriented screening campaign
might be more motivating to them, but wanted to test this notion empirically.
In sum, the current research sought to examine the effect that an STI-testing related
marketing campaign that is not inclusive could have on the education and motivation of LGB
individuals for obtaining an STI screening. Within the current study, we hypothesized that
participants who viewed the partner-oriented campaign (as compared to the self-or
relationship-oriented campaigns) would be more willing to obtain an STI-screening, discuss
safer sex practices (including STI-screenings) with their partner, and feel more confident
discussing safer sex practices with their partner(s).
Methods
Participants. To date, 49 LGB Eastern Michigan University (EMU) affiliates, with a mean
age of 24.14 (SD = 8.29) have been recruited for the current study. We posted fliers across
EMU’s campus that asked individuals with an “interest in social media” or an “interest in
better health and well-being” to consider participating in our online research. In addition, our
research assistant visited psychology, social work, women and gender studies, and
communication classes and explained the current study.
Procedure. Interested participants were asked to email the primary investigator, and
were then sent a web link to the online study. The surveys provided via this link were
identical with the exception of which marketing campaign was provided. Participants were
asked to view 1 of 3 campaigns: 1) a self-oriented advertisement with the tagline “Protect
Promoting Equal Rates of STI-Testing for LGB Individuals 6
Yourself: Get Tested for Sexually Transmitted Infections,” 2) a partner-oriented advertisement
with the tagline “Protect Your Partner: Get Tested for Sexually Transmitted Infections,” or 3) a
relationship-oriented advertisement; “Protect Your Relationship: Get Tested for Sexually
Transmitted Infections.” In addition to their assigned advertisement, each participant was
asked to rate their perceptions of two additional advertisements, one that targeted drunk
driving with the tagline “Think before you drink. Don’t drink and drive,” and another that
targeted physical well-being with the tagline “Don’t just sit there…Be active!” Participants
were then asked to complete measures of their motivation, intention and willingness to obtain
an STI-screening, their likelihood of communicating with a partner about safer sex and STIscreenings, their confidence in initiating this type of conversation with a partner, and various
demographic items.
Results
The first analysis examined whether marketing campaign type (self-, partner-, or
relationship-focused) influenced how willing and motivated LGB participants were to obtain
an STI-screening. We hypothesized that participants who viewed either the partner or the
relationship-focused campaigns would be more willing to subsequently obtain an STIscreening. Somewhat consistent with our hypothesis, participants who viewed the partnerfocused screening campaign reported being more willing and motivated to obtain an STIscreening than participants who viewed either the self- or relationship-focused campaigns
(see Appendix B).
We then examined whether marketing campaign type would influence participants’
willingness and confidence to communicate with partners about safer sex practices, including
obtaining STI-screenings. As before, we hypothesized that the partner- and relationshipfocused campaigns would most positively influence both willingness and confidence to
Promoting Equal Rates of STI-Testing for LGB Individuals 7
communicate with a partner about these topics. Consistent with the above results, LGB
participants who viewed the partner-focused campaign reported more willingness and
confidence to discuss safer sex practices, including STI-screenings, with partners (see
Appendices C and D).
Discussion
Within the current study, we hypothesized that partner- or relationship-focused
sexually transmitted infection screening campaigns may provide advantages over the current
campaigns that are typically self-focused. As noted above, the current results indicated some
support for our original hypotheses, in that partner-focused campaigns motivated LGB
participants to obtain STI screenings and talk to their partners about the importance of safer
sex practices.
Research Impact
This research contributes substantially to the existing research and marketing
initiatives. First and foremost, this research could facilitate increased emphasis on designing
an actual marketing campaign that could curb the spread of STIs among LGB individuals. As
mentioned previously, designing effective STI screening campaigns offers both practical and
theoretical advancements. In order to implement the results of the current study, this
research should be disseminated within academic outlets, public policy venues, and secondary
and university-level educational curriculum circles. In doing so, we can maximize the impact
that this research has on what matters most to the current researchers: the encouragement of
equal emphasis on STI education and screenings for LGB individuals.
Implications
There are several implications of the current research. Because we have taken initial
steps toward demonstrating that the partner-focused campaign was the most successful at
Promoting Equal Rates of STI-Testing for LGB Individuals 8
motivating LGB individuals to obtain STI screenings, the impetus for pushing these campaigns
into the media is vastly strengthened. In doing so, the goal is for those who find they do not
have an STI to take steps to remain healthy and also protect their partners’ sexual health. We
would also hope that consistent and thorough STI-screening for LGB individuals would allow
those who have an STI diagnosis to be treated as quickly as possible, which would also help
lessen the spread of these infections to others.
The second benefit is a more abstract, broad one, and that is the advancement of
equality for LGB individuals. As previously mentioned, STI prevention campaigns that are
relevant and applicable to individuals of varying sexual orientations have been largely nonexistent. It is possible that heterosexist campaigns in this domain have further ostracized LGB
individuals in ways we do not typically conceptualize or even realize. In other words, we
typically discuss prejudice and discrimination against LGB individuals in other formats;
however, the authors of the current study argue that within the area of STIs, disparities exist
between LGB and heterosexual individuals. Ignoring these disparities via our STI-related
marketing campaigns can be framed as a less typical, yet critically important, form of
discrimination against LGB individuals.
Lastly, as also mentioned elsewhere, this research has contributed to our theoretical
understanding of how individuals of varying sexual orientations respond to STI testingrelated marketing campaigns. Based upon our past research, we believe that the inclusion of a
partner-focused emphasis within the STI-related campaigns is widely beneficial and
motivating to viewers. This may also inform how health care providers discuss and encourage
STI screenings for LGB individuals. If health care providers include a partner-focused
discussion when talking with patients, STI testing rates may increase.
Limitations and Future Research
Promoting Equal Rates of STI-Testing for LGB Individuals 9
There are some limitations to the current study that should be noted. First, though we
found that intentions and willingness to obtain and discuss STI screenings were higher after
exposure to a partner-focused campaign, we still do not know whether the partner-focused
marketing campaign increases actual behavioral responses. In other words, will individuals
who view a partner-focused campaign actually obtain a timely STI screening or discuss these
issues with their partners? Future research will address this issue more longitudinally to
examine whether the increase in the willingness and intentions of participants actually
translates into behavioral responses.
An additional limitation stems from the relative, but not absolute, effects of the tested
marketing campaigns. More specifically, the effects reported in this paper were such that the
partner-focused campaigns were the most effective at motivating participants to obtain an STI
screening and discuss safer sex practices with their partners. However, the absolute levels of
intention to complete these critically important behaviors are still not as high as we would
hope. Ideally, we would like to see that overall levels of intention and willingness to obtain or
discuss an STI screening would be much higher. As such, though it appears that the partnerfocused campaign was successful, future research will examine what variables can be coupled
with a partner-focused marketing approach to boost levels of intentionality and willingness to
even higher absolute rates of compliance.
Conclusion
In sum, we have demonstrated that a partner-focused STI-screening campaign may be
more effective in promoting STI testing for LGB individuals. It is imperative that we continue
this line of research in order to increase the efficacy of STI-preventative marketing campaigns.
It is our hope that, over time, we will see a decrease in LGB STI prevalence due to stronger,
empirically supported prevention initiatives.
Promoting Equal Rates of STI-Testing for LGB Individuals 10
References
Brown, R. D. (2012). Make the grade: An investigation of STI-related marketing campaigns
(Senior honors thesis). Eastern Michigan University, Ypsilanti, MI.
Centers for Disease Control and Prevention. (2013, February 13). Incidence, prevalence, and
cost of sexually transmitted infections in the United States. Retrieved from
http://www.cdc.gov/std/stats/STI-Estimates-Fact-Sheet-Feb-2013.pdf.
Promoting Equal Rates of STI-Testing for LGB Individuals 11
Appendix A
Figure 1. Examples of STI-screening campaigns targeted at heterosexual individuals.
Promoting Equal Rates of STI-Testing for LGB Individuals 12
Appendix B
Figure 2. Intention to obtain an STI-screening among LGB individuals as a function of
campaign type.
5
4
3
2
1
Self Ad
Partner Ad
Relationship Ad
Note. Intention to obtain an STI-screening was assessed on a 1-5 scale, where 1 = not at all
true of me and 5 = extremely true of me. Higher scores indicate increased intention to
obtain an STI-screening.
Promoting Equal Rates of STI-Testing for LGB Individuals 13
Appendix C
Figure 3. Intention to communicate about safer sex practices among LGB individuals as a
function of campaign type.
4
3
2
1
Self Ad
Partner Ad
Relationship Ad
Note. Intention to communicate was assessed on a 1-4 scale, where 1 = never confident and
4 = a lot. Higher scores indicate increased intention to discuss safer sex practices with a
partner.
Promoting Equal Rates of STI-Testing for LGB Individuals 14
Appendix D
Figure 4. Confidence in communication regarding safer sex practices among LGB individuals
as a function of campaign type.
40
35
30
25
20
15
10
Self Ad
Partner Ad
Relationship Ad
Note. Communication confidence was assessed on a 1-4 scale, where 1 = not at all confident
and 4 = extremely confident. Scores for all items were then summed to create a total score.
Higher scores indicate increased confidence to discuss safer sex practices with a partner.