Commentary from Mark Gibson and Nur Ferrante Morales

I developed an interest in health promotion via the PIL user testing work that I was engaged in during the 2000s. I spent time in Jamaica, which is where we get our hummingbird logo from, the colibri being Jamaica’s national bird, that a Jamaican designer did for us. Jamaica is where GRC was conceived and born. I took an interest in how health issues were communicated by the Ministry of Health and Wellness, particularly how they use songs to educate about issues, such as prevention of dengue, zika, malaria, chikungunya, and so on. An example of this is We Nuh Want Zik V, using a dancehall-sounding ditty to educate about mosquito prevention.

This kind of approach to public health messaging can be found all over the world: Africa, Pacific Islands, the Caribbean and Latin America. The best ones are grassroots, bottom-up, conceived and executed by people from the communities in question. The worst ones are top-down, one-size-fits-all information from outsiders, like NGOs, which often have only tokenistic community engagement and sometimes have more than a whiff of that specific brand of Saviour complex.

On this note, I want to ‘big up’ Jamaica. I recommend that you take a tour around the Jamaican Ministry of Health and Wellness YouTube channel and see how proper health communicating is done. This is the template. Learn it.

An earlier route into health promotion came from a different source, many years earlier, when I lived in Spain in the 1980s. While other countries were ramping up HIV/AIDS campaigns with fear-based messaging, such as the now infamous tombstones of the British campaign or the Grim Reaper of a hard-hitting Australian campaign, Spain deliberately turned away from this. The Spanish Ministry of Health rolled out the now-legendary “Sí da / no da” campaign, focusing on calm myth-busting, but in a very engaging way.

This was at a time when the HIV/AIDS epidemic was still poorly understood by the public, rumours and misinformation were widespread. Could you catch HIV from a toilet seat? A hug? Sharing a drink? While other countries leaned into alarmism, Spain chose a very minimalist way of addressing these uncertainties.

The message was simple, binary and memorable: two cartoon figures discussing different scenarios: unprotected sex, sharing needles, receiving contaminated blood transfusions: “Sí da” (yes, it transmits), while “No da” (no, it doesn’t transmit) applied to casual contact, hugging, using public toilets, sharing utensils.

The binary structure had several advantages. It was:

·       Easy to remember: the phrase could be repeated, even joked about and referenced as a catchphrase, but without undermining its clarity.

·       Directly responsive: it tackled misinformation head-on by breaking it into digestible facts.

·       Non-stigmatising: it specified the routes of transmission and how these could be avoided, reducing the “fear of people with AIDS” that was sweeping the world at that time.

·       It was a clever play on words: “Sí da” / “SIDA”, being the Spanish acronym for AIDS.

“Si da / No da” countered fear with pragmatism. It was a calm and rational campaign. It was light-hearted but neither sensationalised nor downplayed the severity of HIV. It was an attempt to restore social cohesion. People living with HIV were being ostracised in workplaces, schools and social spaces due to public paranoia. The campaign openly addressed what does and what does not transmit the virus. It reassured the Spanish population at large and helped to de-escalate stigma.

“Sí da / No da” became more than just a public health slogan, it entered the vernacular. As a phrase, it was adapted humorously in unrelated contexts:

·       ¿Ir a la playa? (Go to the beach?) – Sí da

·       ¿Trabajar en domingo? (Work on a Sunday?) - No da.

In a way, it came close to flirting with the irony trap, but the HIV-specific message remained intact. People know and acknowledge that the serious origins of the message and playful adaptations did not erase its educational power.

Some campaigns give way to ironic slang, such as ‘nuigrave’ in French for cigarettes, which directly mocked the health promotion warning, However, Sí da / No da remained respected even when joked about casually.

A different public health model

Spain’s strategy showed that calm myth-busting campaigns can be highly effective, even without shock value:

·       It trusted the audience’s intelligence.

·       It addressed misinformation directly.

·       It prioritised social inclusion over fear

·       It sought to eliminate stigma and prejudice.

Therefore, fear-based messaging is not the only path to behaviour change. In many ways, “Sí da / No da” was ahead of its time, anticipating best practices in public health communication that became textbook standards. If only all subsequent health promotion campaigns followed the same instinct.

Legacy

Outside of the Spanish-speaking world, “Sí da / No da” escapes much of the world’s attention, unlike the Grim Reaper and Tombstones of other countries. However, “Sí da / No da” has aged very well. It is an example of how clear, factual communication can stick in collective memory without triggering a backlash.

In this era of false information, this type of simple, respectful messaging is more relevant today than it was when it appeared on Spanish TV screens 40 years ago.

In the Spanish TV program Informe Semanal, an episode called “Aislada por el miedo” (Isolated by fear) was released in 1990. It told the story of a six-year-old child from Málaga who had been born in 1985 and when she was one year old, she lived in jail when her mother, a heroin user with AIDS, was imprisoned. Her mother died and she was adopted by her aunt Carmen Martínez. Her name was Montse Sierra Martínez, and she had HIV antibodies.

In 1989, her adopted mother decided to take her to preschool but felt that it was her responsibility to inform the school board about the child’s health status. Montse was left alone and isolated. The parents of the other children had decided not to take them to school until she was expelled, thus being the only student in the entire building for many days. The fear and pressure from the parents’ association caused Montse’s adoptive mother to agree to sign a voluntary dismissal agreement. One of the parents even said, “If the child is sick, give her an overdose so that she may die”. The case was taken to court, and the declaration of AIDS specialized doctors provided a positive result, thus allowing Montserrat to return to school.

Despite all the information provided to the parents regarding how AIDS could be transmitted and the risks involved (including the Sí da / No da campaign), the fear increased to the point of a boycott. This dramatic situation helped raise the concern of the medical establishment and the Spanish Ministry of Health which considered that they were failing at educating the population on AIDS transmission and other aspects of how patients survive with the condition. Sexual education was minimal and needed also to be urgently addressed. Montse suffered the stigma from early childhood and was one of the most important sources of awareness and impulse for change at the time. One of the parents took the chance away from fear and following her heart made the first step by taking her child to school and Montse had her first classmate, others would eventually follow until the music of laughter resonated everywhere in the classroom.

From that moment on, educational videos and other materials were provided at schools, hospitals, healthcare centers, television and radio. The Sí da / No da campaign was a first step into transforming fear into knowledge (despite great resistance from the Catholic Church and other conservative collectives) followed by Monse’s innocence and her adoptive mother’s unconditional love who opened the door to allow true compassion and inclusion to have a space in a highly prejudiced and fearful society.

https://www.rtve.es/play/videos/informe-semanal/sida-aislada-miedo-informe-semanal-1990/1118998/

Thank you for reading,

Mark Gibson and Nur Ferrante Morales, April 2025