Why sexual health promotion misses its audience: men who have sex with men reading the texts.

PURPOSE: Sexual health promotion aimed at men who have sex with men (MSM) is not achieving its objective of reducing the incidence of new infections of sexually transmitted diseases, notably HIV/AIDS, in the MSM population. The paper aims to raise awareness of possible unintended consequences when using visual culture and advertising techniques in the field of sexual (and other) health promotion and public health messages.

DESIGN/METHODOLOGY/APPROACH: Using critical textual analysis and drawing on visual culture methodology the approach is to critique current practice and suggest alternative ways to approach gay men's sexual health which are not predicated on a "model" gay man.

FINDINGS: Men who have sex with men (MSM) are constructed through sexual health promotion (SHP) literature as young, hedonistic and irrational which may serve to distance the very audience it seeks to attract and address. What may at first appear to be a targeted and helpful initiative to raise awareness may inadvertently have the simultaneous and unanticipated effect of "selling" unsafe sex rather than promoting safe sex. This is because, first, the use of sexual imagery designed to attract attention works in unanticipated ways. Second, MSM are constructed through the images and language used in ways that may be at best unhelpful and potentially quite harmful.

RESEARCH LIMITATIONS/IMPLICATIONS: There are many different approaches and interventions in this field and the criticisms here may not be applicable to many of the other sources of health promotion awareness campaigns. Future research could certainly be conducted in other fields of health promotion and public health issues such as obesity, drug and alcohol abuse and smoking cessation.

PRACTICAL IMPLICATIONS: Health promotion practice should beware of depicting their audience in stereotypical ways. MSM could be constructed far more positively as role models to be followed instead of bad examples to be avoided.

ORIGINALITY/VALUE: The methodology is new to this field and the findings provide an original basis for criticism of advertising techniques which have until now formed the basis of this type of public awareness-raising.