Preventing AIDS, producing mothers: a sociological reading of HIV/AIDS posters aimed at women in the 1980s and 1990s

Abstract

This article offers a sociological analysis of the representational frameworks constructed around women in HIV/AIDS prevention campaigns published in the United States during the 1980s and 1990s. We argue that the recurring use of the category of ‘mother’ progressively supplanted and diluted the broader category of ‘woman’ within these campaigns. The notion of motherhood, as portrayed, was shaped by six intersecting dimensions: (a) advice, (b) autonomy, (c) care, (d) guilt, (e) pleasure, and (f) social support. Drawing on a qualitative analysis of visual campaign materials, we contend that mothers gained visibility in the context of the epidemic primarily through imperatives of care and assistance situated within the domestic sphere. In relation to the six dimensions identified, the data reveal that women were consistently portrayed as universal caregivers, with male partners largely absent from the visual discourse. We conclude with a critical reflection on how women were included and represented in prevention campaigns, with a specific focus on the visual rhetoric of public health posters. Ethical, effective, and inclusive communication—especially concerning sensitive issues such as HIV/AIDS—remains a central concern for contemporary public health. Campaigns that blame or stigmatise women, even subtly, risk alienating their intended audiences and reproducing social inequalities, rather than fostering care and expanding access to healthcare. Preventive efforts are more constructive when they incorporate extended family networks—particularly in the case of Black and low-income women, who often depend on relatives, partners, and public health services. Contributions to the literature.

Text box 1. Contributions to the literature
1. This article provides a sociological analysis of gendered representations in HIV/AIDS prevention campaigns, an area often marginalised in public health scholarship.
2. It critically examines how the category of ‘mother’ supplanted broader representations of ‘woman’, shaping prevention discourse through six intersecting dimensions.
3. The study contributes to debates on stigma, communication ethics, and the social determinants of health, highlighting how campaigns may reinforce inequality.
4. It advances visual sociology methodologies within public health research by combining discourse and narrative analysis.
5. The findings inform more inclusive and culturally sensitive health communication strategies for contemporary public health campaigns.

Introduction

In the 1980 s, the AIDS epidemic emerged as a significant public health challenge, which, in the ensuing decades, required comprehensive responses addressing social inequities, discrimination, and stigma [23]. During the 1980 s and 1990 s, the prevalence and incidence of HIV/AIDS in the United States varied considerably across different population groups, reflecting social inequalities, access to healthcare, and dynamics of stigma and exclusion. By the end of the 1980 s, according to data from the Centers for Disease Control and Prevention (CDC), among the groups most affected by HIV, men who have sex with men (MSM) accounted for approximately 70% of recorded cases, intravenous drug users for around 17–20%, and heterosexual women—particularly African American and Latina women—for roughly 7% (rising to nearly 25% by 1996). Campaigns promoted by national and international organisations played a vital role in addressing preventive strategies and methods, access to information, and the availability of antiretroviral therapies. Throughout the 1980 s and 1990 s, health-related social movements and philanthropic groups linked to HIV/AIDS also formed key alliances for health protection and promotion, expanding both sanitary and social awareness of the disease.

Globally, by the early 2000 s, over 40 million people had been infected with HIV. The impact of the epidemic was particularly exacerbated by racial, economic, and social inequalities. Furthermore, active forms of discrimination and prejudice played a decisive role in shaping societal perceptions of the epidemic, especially in contexts where access to healthcare was limited, or due to a global problem of rights violations and bias linked to race, ethnicity, sexuality, sexual orientation, and gender identity, among other factors. In contrast to the 1990 s, during the 1980 s in the United States, HIV/AIDS campaigns were predominantly accompanied by moral judgements, frequently associating the risk of infection and death with homosexuality [10, 21]. This approach led to a moralisation of public health messaging, permeated by heteronormative and stigmatising views of non-reproductive sexual practices, such as anal sex.

America Responds to AIDS (ARtA) was one of the United States’ principal public initiatives to confront the HIV/AIDS epidemic, launched by the CDC in 1987. This campaign marked a significant turning point in the governmental response to the AIDS crisis, which until then had been widely criticised for its sluggishness and lack of sensitivity. The campaign’s primary objectives were: (i) to inform the public about the modes of HIV transmission; (ii) to promote prevention, particularly the use of condoms and the adoption of safer sexual practices; (iii) to combat the stigma associated with HIV/AIDS; and (iv) to reach diverse audiences, with particular emphasis on young people, women, Black and Latinx communities, and the LGBTQIA + population.

Leaflets, banners, and television and radio commercials conveyed clear, educational messages, grounded in scientific data. The campaign retained a formal and institutional tone, balancing factual information with warnings directed at mainstream communities, and collaborated with celebrities, community-based organisations, and media outlets to expand its reach. The preventive materials encouraged open and direct conversations about behaviours considered risky, such as unprotected sex, intravenous drug use, and multiple sexual partners.

ARtA was based on the idea that “everyone is at risk” and was among the first campaigns to directly address condom use on television and in other media — an approach that was controversial at the time. While ARtA represented a shift in the posture of the US government, which had initially adopted a stance widely perceived as negligent and hostile in the face of the epidemic, and while it served as a means of reducing misinformation about AIDS, certain elements of the campaign carried stigmatising representations that reinforced gender stereotypes.

In Repellent and Shameful: The portrayal of AIDS in ‘America Responds to AIDS’, Swanson ([29],, p. 23) noted: “An analysis of the rhetoric and linguistic content of the public service announcements yields no surprises. Men are portrayed as having the power to infect their women, women are at risk of contracting this infection and are virtually powerless to determine their risk, openly admitting their ‘concern’ about being infected by men who are ‘coming out’ or ‘cheating’. Parents are tedious and repetitive; adolescent children are self-absorbed and sarcastic. If we consider that the aim of the announcements was to inform about AIDS and to increase opportunities for behavioural change, such stereotyping serves to dilute rather than enhance the impact of the public service announcements, as it fails to depict individuals in a positive light or as capable of directing their own destinies.”

Health promotion and prevention campaigns may reinforce ideological, cultural, political, and social elements [27, 25, 32]. Ultimately, such campaigns provide a means of understanding how health messages can embed forms of prejudice and stigma, even when their aims are to raise awareness, educate, and de-stigmatise [9].

Within cultural studies, Stuart Hall [13] referred to the concept of representation to emphasise the way in which cultures and identities are constructed and mediated through language, symbols, and images. Hall [13] argued that representation is not merely a direct reflection of reality, but a social and cultural construction that plays an active role in the production of meaning. He proposed that representation is a process whereby signs (words, images, sounds, etc.) are used to convey meaning and construct social reality. According to Hall [13], this construction is not neutral, but is intrinsically linked to relations of power and ideology. For instance, the ways in which different social groups (such as ethnic minorities, women, or workers) are represented in the media and in culture more broadly influence how these groups are perceived by society and how they perceive themselves.

Hall [13] identified two principal types of meaning within representation: (i) denotation – the literal, direct meaning that is commonly shared among speakers of a language or culture; and (ii) connotation – the broader meaning that may carry subjective, ideological, and cultural interpretations. Representation, therefore, is not simply about what is said or shown, but about how power, identity, and social relations are constructed and negotiated through these representations.

Drawing on Hall’s [13] theory, this article critically examines the role of the media and of health messages produced through campaigns disseminated by ARtA and Clement Communications between 1987 and 1996, with particular attention to the portrayal of women and mothers. We argue that such campaigns are not merely mirrors reflecting the reality of a given historical moment and context, but rather play an active role in shaping meanings, social realities, and identities.

Preventive campaigns on women and health messaging: a brief review

In the context of the AIDS epidemic, Johnny and Mitchell [17] examined how health messages played a vital and controversial role in shaping understandings of stigma and discrimination among men and women. Depending on the social and cultural context, health messages disseminated through prevention and health promotion campaigns may take on distinct interpretations [1, 17]. Women have been represented in UNAIDS campaigns—particularly in the early 2000 s—in ways that reinforce femininity, abjection, guilt, or care, whereas men are often depicted as assertive, strong, intimidating, and autonomous. This duality highlights the differential reading of bodies and identities within such campaigns, reinforcing familiar gender stereotypes and contributing to a medical and epidemiological narrative grounded in hegemonic models of masculinity and femininity.

Historically, women have also been featured in HIV/AIDS campaigns with a predominant focus on pregnancy and childcare [12]. This emphasis has often obscured aspects relating to women’s own health by framing awareness of the disease primarily through the lens of maternal care as unidirectional (mother-to-child) and compulsory. A closer analysis of prevention campaigns focused on children and infants reveals the reinforcement of “maternal prudence” and an “inherent risk” associated with women’s exposure to HIV/AIDS, alongside the notable absence of male partners. Additionally, these campaigns have exhibited a kind of sociological truism that, while highlighting the seriousness of the epidemic and the importance of preventive methods, has often overshadowed fear and individual responsibility as central features of the visual narrative.

Health communication studies have shown that focusing on fear as a strategy for awareness and the promotion of safer sexual practices can, conversely, create barriers to effective communication [15, 14, 6, 4, 24].

If we take Hall’s [13] premise as valid—that the connotative meaning of representation varies according to subjective, ideological, and cultural aspects—this becomes particularly compelling when we consider the production of texts and visual elements in health campaigns. In the United States, HIV/AIDS campaigns during the 1980 s and 1990 s were developed by a multiplicity of social and political actors: governmental health institutions, philanthropic aid organisations, medical and pharmaceutical companies, international bodies, civil society groups, and health-related social movements, among others. Likewise, the programmatic interests underlying every health message are marked by specific political and social contours that shape how such messages are received. Many campaigns produced in North America were also reproduced in other geographic contexts without appropriate transcultural adaptation focused on health promotion and disease prevention. In many instances, these campaigns reflected an overly Westernised perception of health and culture, promoting problematic, ambiguous, and stigmatised messages regarding sexual behaviour and care [17].

Given that educational materials and preventive campaigns can produce and reinforce meanings surrounding HIV/AIDS, our aim was to examine the role of stigma and discrimination in the construction of such materials and campaigns. Our aim, therefore, was not limited to a critical reading of these materials/campaigns. Instead, we sought to explore a different kind of framing of campaigns featuring women and mothers, in which motherhood serves as the core of preventive strategies. Alternatively, this approach may provoke and contribute critically to the fields of health and communication studies, as well as inform the testing of communication- and health-based interventions—although the latter was not the primary focus of this work. In sum, such an approach may prove valuable for healthcare teams and professionals involved in the direct production of informational or visual materials in the context of sexually transmitted infections (STIs) among women, or diseases with stigmatised causes, such as HIV, HPV, leprosy, viral hepatitis, tuberculosis, syphilis, and others.

Materials and methods

In this study, we developed a qualitative, cross-sectional, and descriptive approach. We applied theoretical and methodological procedures such as discourse analysis and narrative analysis.

Data extraction

Based on documentary research in the United Kingdom and the United States, we investigated preventive campaigns posters produced from printed materials (folders, booklets, brochures, pamphlets, and reports) about women in the context of the HIV/AIDS epidemic in the 1980 s and 1990 s in the United States. Five historical collections were consulted on-site and online:

• (i)
  Bishopsgate Institute (London, UK).

  • Collections: (a) ACT UP London; (b) Terrence Higgins Trust.
• (ii)
  The Women’s Library, London School of Economics and Political Science (London, UK).

  • Collections: Hall-Carpenter, (a) Simon Watney; (b) Peter Tatchell.
• (iii)
  Wellcome Collection (London, UK).

  • Collections: AIDS in Women.
• (iv)
  Arthur and Elizabeth Schlesinger Library, Harvard University (Cambridge, Massachusetts, USA).

  • Collections: (a) Florence Rush, e (b) Linda Jane Laubenstein.
• (v)
  National Library of Medicine, National Institute of Health (Bethesda, Maryland, USA).

  • Collections: Images from the History of Medicine (IHM).

The selected materials incorporated empirical sources originating from resources produced in the United States. The campaigns were widely publicised nationally and internationally in the context of the 1980 s and 1990 s from state institutions and departments, social health movements, philanthropic agencies and support and assistance groups. These organizations were formed by mixed, charitable and religious institutions, and linked to support services for groups considered exposed, i.e. primarily young women and young adults, pregnant women and intravenous drug users. The selection and inclusion of materials was based on two criteria: (i) preventive campaigns that addressed or mentioned women and the HIV/AIDS epidemic, simultaneously using images and/or texts; and (ii) campaigns broadcast in English (and those correspondingly translated into other languages), produced in the United States.

Data analysis

From the narrative analysis, six subgroups were established in order to understand the sociological meanings and uses of the selected campaigns, following the frameworks of Frith (1998), Emmison and Smith (2000), Johnny and Mitchell [17], and Wileman [31]: (i) Narrative – single or sequential visual images represent and constitute social facts; in this sense, we sought to interpret the images within the campaigns as associated with the socially prevailing images of HIV/AIDS; (ii) Intentional meanings – those meanings intended by the designer/producer in relation to the audience (e.g., in the case of HIV/AIDS campaigns, the meanings may concern safe sex practices, habits, attitudes, and lifestyles); (iii) Ideological meanings – those meanings that express a set of values through images/texts (e.g., such meanings can be decoded when analysing the assumptions and implications embedded within the campaign or advertisement – advertisements for cleaning products in women’s magazines are a well-known example of ideological meaning: by emphasising women in such adverts, there is a reification of social values that frame domestic work as women's work); (iv) Oppositional reading – a means of considering alternative interpretations of meanings in relation to the images/texts in the campaigns (e.g., people interpret advertisements and campaigns based on specific referents that are not always identical or similar, and whose meanings are shaped by education, life experience, political stance, among others. Inferring the different meanings attributed to the same campaign allows us to observe how the meanings of images/texts vary and connect with stigmatised perceptions of health); (v) Clarity – refers to the ease with which a visual message is interpreted (e.g., it is a concept used to assess whether the proposed content is objectively understood by the audience without significant variation across different cultures); (vi) Unity – relates to the compositional value of a visual message (e.g., whether the words used in an advertisement are appropriate to its purpose, whether there is coherence between the text and the highlighted image, which may contribute to the clarity and objectivity of the campaign). The selected campaigns and posters were analysed collectively by the research team. Initially, we engaged in an internal exploratory discussion, gathering diverse perspectives and detailed descriptive accounts for each poster. Subsequently, we posed a common question to ChatGPT regarding all posters that portrayed mothers: “Does this poster blame mothers?”. The combination of our interpretative readings with ChatGPT’s observations helped to generate key analytical insights, allowing for a broader reflection on the campaigns and their respective cultural and historical contexts.

We produced six interdependent dimensions according to the focus/theme of each campaign/material: (a) advice, (b) autonomy, (c) care, (d) guilt, (e) pleasure and (f) social support. The dimensions were developed based on a preliminary reading of the campaigns, which varied in their incorporation of intentional and ideological meanings within the visual messages. These dimensions were also interpreted as analytical categories due to their juxtaposition or alternation. Next, we proceeded to (i) pre-analysis, (ii) exploration of the material, categorisation or coding and (iii) treatment of results, inferences and interpretation.

The dimensions were considered among chromatic categories of the life cycle to highlight the prevalence of each one in the set of selected campaigns. According to the campaign’s emphasis on the aforementioned dimensions, the criteria for colours varied from cold to warm tones in accordance with the life cycle approach (Papalia, Olds, Feldman, 2007), revealing the following palette: (a) blue-pink: prenatal and early childhood; (b) light pink to light yellow: second and third childhood; (c) yellow-orange: adolescence and young adulthood; and (d) mustard-red: middle age and old age (Fig. 1). Despite this, we emphasise that categorisations based on the life cycle or vital cycle, as proposed by Papalia, Olds and Feldman [22], may be inaccurate if understood as objective stages disconnected from cultural and sociological aspects. These, in turn, vary and shape age as a multidimensional referent, and not just ordinal-chronological – that is, guided by an age principle. We used figures to incorporate sociocultural symbols common to the periods analysed, namely, bottle, toy, literacy, school/university socialisation and mature life in society (Fig. 1).

Fig. 1.

Life cycle adapted by the authors according to colour. Source: The authors

We used two types of graphs to represent quantifiable data. The bubble chart was used to compare the prevalent themes according to the life cycle (colour palette according to the scale in Fig. 1) and the number of campaigns per year (random colour palette). In its simplest form, a bubble chart presents the relationship between two quantities, positioned according to their values ​​in a Cartesian coordinate system. Thus, each observation is represented by a point (•), positioned according to the value of two variables. In addition to the horizontal and vertical position, each point also has a size and colour. Secondly, the Nightingale’s Rose chart was employed to explore the six dimensions mentioned previously (advice, autonomy, care, guilt, pleasure, social support), as well as those most prevalent in terms of gender and race-ethnicity, in general (all women) and specifically (White and African American women). Also known as the Polar Area Chart or Coxcomb diagram, the Nightingale’s Rose is a pie chart that combines elements of a radar chart and a column chart. In this graph, proportional areas are plotted in a polar coordinate system, divided into equal segments with the same angle. The differences between categories and groups are visually evident through the filled areas of these segments. The colours of the diagram palettes follow their own scale, so they should not be analysed according to Fig. 1, which is only applied to the bubble chart according to the prevalent themes of the life cycle.

Results

The results initially incorporated a quantitative overview of the campaigns according to the year and the prevalent dimensions identified in the posters. A total of 122 individual posters were selected of which 57 displayed photographs of women and informative texts, with or without engravings/pictures; and 65 contained only informative texts, without pictures. Figure 2 shows the number of posters per year: 1983 (n = 3); 1984 (n = 2); 1985 (n = 4); 1986 (n = 3); 1987 (n = 5); 1988 (n = 7); 1989 (n = 8); 1990 (n = 7); 1991 (n = 12); 1992 (n = 10); 1993 (n = 9); 1994 (n = 10); 1995 (n = 8); 1996 (n = 14); 1997 (n = 15); 1998 (n = 24); 1999 (n = 20); and 2000 (n = 26).

Fig. 2.

Number of campaigns per year, 1981–2000. Source: The authors

Figure 3 illustrates the most prevalent themes in the campaigns from 1981 to 2000. The themes quantified in the campaigns are presented by the colour palette previously defined and shown in Fig. 1. According to the life cycle approach, the related themes of cold and warm intermediate colours (blue-pink-yellow-orange), i.e. prenatal and early childhood, second and third childhood, adolescence and young adulthood, were most prevalent.

Fig. 3.

Number of campaigns according to the life cycle, 1981–2000. See the scale in Fig. 2. Source: The authors

Figures 4 and 5 show the Nightingale’s Rose graphics. In these, we illustrate the six explored dimensions: (a) advice, (b) autonomy, (c) care, (d) guilt, (e) pleasure and (f) social support. Figure 4 shows the relationship/prevalence of dimensions with campaigns aimed at women without racial/ethnic distinction (palette with all colours). We observed a preponderance of materials that emphasised dimensions a, c and d; and to a lesser extent, b, f and e, respectively. Figure 5 shows the relationship/prevalence of dimensions aimed at White women (orange palette) and African-American women (red palette). While campaigns focused on African-American women primarily associated dimensions c and d, those aimed at White women emphasised dimensions a and c.

Fig. 4.

Dimensions explored in campaigns aimed at women in general: (a) advice, (b) autonomy, (c) care, (d) guilt, (e) pleasure, (f) social support. 1981–2000. Source: The authors

Fig. 5.

Dimensions explored in campaigns aimed at white women (orange palette) and African-American women (red palette): (a) advice, (b) autonomy, (c) care, (d) guilt, (e) pleasure, (f) social support. 1981–2000. Source: The authors

Discussion

Between risk and guilt: maternal behaviour

In this section, more specifically, we selected nine posters published between 1985 and 1995 that featured women and/or mothers in preventive campaigns, with the aim of qualitatively exploring the meanings embedded within the narrative dimension. The choice of this particular period was based on the fact that, from the late 1980 s onwards, heterosexual women began to be the focus of preventive campaigns in the United States, supported by the CDC and local philanthropic health institutions. Despite the inclusion of heterosexual women in campaigns, in the context of the AIDS epidemic they assumed an enigmatic role in preventive campaigns. A fundamental distinction in relation to the general campaigns, aimed at heterosexual men, gays and intravenous drug users, for example, has to do with the centrality of three interdependent dimensions, which we observed as advice, care and guilt (Figs. 5 and 6). Women, to some extent, were simultaneously helpers and healers. By contrast, the campaigns reiterated a known type of maternal phenotype: that of the devoted, cautious and care-giving mother. By reinforcing this phenotype, the preventive campaigns left a clear message: Babies and children are in danger due to their mother’s inappropriate behaviour. This framework highlights the pre- and post-natal periods, which are the target of prophylaxis based on safe, reproductive and healthy sex. Demands for pleasure and emotional/sexual well-being comprise a minority of the campaigns analysed.

Fig. 6.

“She has her father’s eyes and her mother’s AIDS.” Before you get pregnant, find out if you need to be tested. Clement Communications, Inc. Concordville, Pa.: Clement Communications, c1988. National Library of Medicine: ID 101438016; A027826. USA

There is a paradox regarding the symbolic structure of the discourse: By including women as target subjects of preventive campaigns, the primary emphasis places babies and children at the centre of health care strategies. Obviously, this is not a mere fact or random accident of campaigns aimed at women, nor can it be evaluated solely on the health context in question, i.e. the AIDS epidemic. In this regard, we developed an approach interested in the macrosociological framework of the late twentieth century, in which mothers gained evidence from moral panics surrounding the use of chemical substances to sexually transmitted infections and their long-term effects on the development of their offspring.

In the 1988 U.S. campaign (Fig. 7) produced by Clement Communications, Inc., the safety awareness poster states: ‘She has her father’s eyes and her mother’s AIDS. Before you get pregnant, find out if you need to be tested’. The image is of a Black female baby, sitting and wearing a striped dress. This campaign evokes a clear message about heredity, suggesting that the baby has inherited her father's eyes and her mother’s pathological condition. Although the primary message is intended to raise awareness about the risk of vertical transmission, the issue of the disease is framed predominantly in relation to the mother and the intrauterine environment during pregnancy. In the final line, the message reinforces a sense of self-surveillance and self-care, emphasising maternal responsibility: ‘before you get pregnant, find out if you need to be tested.’ The problem with the final health message lies in the fact that awareness of the disease is constructed as the sole responsibility of the woman. By distinguishing who has passed AIDS on to the baby, male partners are not even acknowledged as co-responsible or as participants in reproduction and care.

Fig. 7.

“Vivian: her baby comes first.” The girlfriends talking. Newsletters for women. Series 1825.3.13 – History files, Seattle-King County Department of Public Health. Prevention Division/HIV-AIDS Program

‘Vivian: her baby comes first’ was part of The Girlfriends Talking (TGT) campaign, directed at African American women who were disproportionately affected by AIDS, including women who used drugs or were involved in the sex industry (Fig. 7). The title conveys a personal and poignant narrative, highlighting Vivian’s decision to prioritise her child’s health in the face of severe personal challenges. The minimalist visual composition, free from colour distractions, directs full attention to her face and the textual content—a typical feature of campaigns aimed at provoking reflection and empathy. The narrative text outlines Vivian’s life story: a woman in her twenties, pregnant with her fourth child; involved in substance use and prostitution since adolescence; aware of the risks of HIV/AIDS, she gets tested regularly; Vivian is determined to leave drug use and street life behind in order to protect her baby. Her fear serves as a catalyst for change.

The visual message reinforces the seriousness of the risk posed by AIDS and how motherhood becomes a positive and mobilising force in her life. From a social and educational perspective: (i) the poster is directed at other women who may be in similar situations; (ii) it highlights the role of community programmes such as CATCH-On, which offers support for pregnant women in recovery; (iii) and it reinforces the importance of a support network (family, church, healthcare professionals) and the perseverance required in the recovery process. The image in question is a public health poster produced by the Seattle-King County Department of Public Health during the HIV/AIDS epidemic between 1982 and 1996. This poster is part of the online exhibition Responding to AIDS, organised by the King County Archives, which documents the local response to the public health crisis caused by the epidemic in the 1980 s and 1990 s.

Throughout the 1980 s and 1990 s, campaigns about women tended to prioritise babies, representing the fear of AIDS as a disease with deleterious impacts not only for the present, but also in the future. Classical and contemporary approaches interrogated the role of motherhood and hegemonic models of care for women’s bodies of reproductive age. Considering this debate, we next explore the role of motherhood in the course of the AIDS epidemic, problematising how social structures and moral norms regulate and generate reproductive expectations regarding health and illness. We argue that it is only possible to fully understand the role of motherhood if we simultaneously deal with the moral and epidemiological prevailing thought on reproduction at the end of the twentieth century.

Motherhood has historically been displaced by behavioural imperatives that, on the one hand, involve the perception of maternal and natural predisposition to care; and, on the other, the intrinsic risk of failure and the need to medicalise and manage female behaviour. From preventive devices to efficient ways of representing the risk of contracting sexually transmitted infections, some epistemic certainties have crystallised the perception of motherhood as a type of obligation, as shown in Figs. 4, 5, 6 and 7.

In biology and psychology, according to Hrdy [16], the relationships between environment (or social environment) and offspring development culminated in biosocial experiments from the brain of babies to feelings such as insensitivity, introspection, indifference and violent, criminal behaviour or sociopathies in young adult lives. These relationships, however, did not occur as cumulative processes based on evolutionary and Freudian theories [16]. At the end of the twentieth century, and as a component of the social environment, maternal behaviour was considered in regard to its long-term complications in the offspring [26]. As we will briefly see below, the fact that a mother can vertically transmit a viral infection to her offspring, such as HIV, has been less restricted to the epidemiological situation of AIDS. This brought together cultural and social circumstances that involved interests in describing and evaluating the maternal relationship in the development of the offspring.

Hrdy [16], in her synthesis of evolutionary and psychological theories in the second half of the twentieth century, recognised that some methods of accommodating animals in vivariums maintained similar characteristics. In laboratory experiments investigating the development of newborn mice, mothers were left in the same nurseries, without the male parent directly participating in the experiments. Typically, nurseries were almost exclusively restricted to the relationship between mother and offspring, with few environmental stimuli concerning territorial enrichment, ​​i.e. toys, vegetation or objects. By overvaluing maternal behaviour, biological and psychological theories have created a long-winded and complex framework for scrutinising reproduction as a naturally maternal entity.1

In the 1970 s and 1980 s, influential studies sought to understand the implications of chemical substance use and foetal formation. The most dramatic example was the race in the United States to identify potential risks posed by mothers to foetuses in so-called ‘crack babies’ [26]. African American communities faced the devastating effects of crack/cocaine, a relatively cheap, highly addictive and lethal drug, in the 1980 s. Images produced by the press, to a large extent, popularised the visual aspects of drug use in babies. Infants were normally represented as undersized and underdeveloped, addicted to crack and with apparent problems since birth. Many women lost their children and faced legal proceedings, although very little was done to offer effective social support, such as access to treatment, dissemination of information, ways to combat violence and sexual exploitation, stigma, racism, sexism and abuse. The legacy of this period was also the production of therapeutic anxieties and moral panic about the reproduction of Black women. Since the lifestyle of Black women was commonly considered deviant, it began to signal intergenerational danger under two main arguments: (i the imminent risk to babies due to the mothers’ use of toxic substances during prenatal care; and (ii permanent social damage caused by high-risk pregnancy, consequently culminating in a kind of ‘transgenerational pathology’ (Richardson, p. 15, [26]. ‘AIDS babies’ date back to this same period. The future of the offspring is the theme of many HIV-AIDS campaigns. AIDS marketing materials show that the expectation of motherhood is a fact that affects both women of reproductive age and female babies and children.

These two images (Fig. 8) are highly impactful public health posters that formed part of a U.S. campaign from the 1980 s–90 s aimed at preventing vertical transmission of HIV/AIDS—that is, from mother to baby—particularly in contexts involving intravenous drug use. In the first image, on the left, titled ‘Most babies with AIDS are born to mothers or fathers who have shot drugs,’ a baby’s pram is shown alongside an intravenous drip stand. This stark contrast between a symbol of infancy and a clinical environment evokes pain, vulnerability, and imminent risk. The secondary message emphasises that babies with AIDS die quickly; if you or your partner use intravenous drugs, you should get tested for AIDS before becoming pregnant; and it encourages condom use and treatment initiation to reduce risk. The tone is direct, alarming, and preventative. The language is deliberately harsh to shock and raise awareness. In the second image, on the right, ‘If you ever shot drugs get tested before you get pregnant. Don’t make them the AIDS Generation,’ four babies of different ethnic backgrounds, wearing nappies, are shown sitting side by side. The image humanises the message and broadens the campaign’s reach across diverse audiences. The accompanying message states that nearly all babies with AIDS have mothers or fathers who used intravenous drugs; many were unknowingly infected due to their parents’ risky behaviours; and it makes a direct appeal to parental responsibility and the need to seek treatment. The tone remains strong, but with a more overt emotional appeal—by showing the faces of real babies, it reinforces the social and human impact. What both posters have in common is a clearly targeted audience: women (particularly of childbearing age), people who use drugs, and those engaged in relationships considered to be high-risk.

Fig. 8.

a “Most babies with AIDS are born to mothers or fathers who have shot drugs.” b “If you ever shot drugs get tested before you get pregnant. Don’t make them the AIDS generation.” National Institute on Drug Abuse. Department of Health and Human Services, DHHS. National Library of Medicine: ID 101438825; A025192. USA

Although the campaigns varied by race and ethnicity, they consistently maintained a gendered approach to parenting. Unsurprisingly, this orientation—or delimited gender bias—also illuminated racial discourses around responsibility for the disease. ‘Just like her mother… HIV positive?’ was one of the more prominent campaigns in the United States between 1985 and 1995, featuring a smiling Black toddler, approximately two years old, alongside the reassuring message: ‘She doesn’t have to be. With tests and treatment, a woman with HIV can have a healthy baby.’ The phrase ‘Just like her mother…’ places the burden of prevention solely on the maternal figure, ignoring structural factors such as: (i) lack of access to healthcare; (ii) gender-based violence; (iii) failures in public policy; (iv) the absence of paternal or familial responsibility. Using the image of a smiling child next to the provocative question ‘HIV positive?’ may prompt the interpretation that the mother is the one ‘responsible’—a rhetorical strategy that, although effective in capturing attention, reinforces stigma rather than fostering empathy or encouraging informed engagement. The poster fails to address the social determinants of health—such as poverty, racism, forced migration, or exclusion from the healthcare system—which have disproportionately affected Black and immigrant women (the target audience implied by both the image and the contact lines featured on the poster) since the beginning of the epidemic.

In symbolic terms, the interposition of photographs of Black female babies requires a more complex analysis of the framing [28]. Historically, Black women have been most associated with high fertility rates and early pregnancy [7, 8]. This established a characteristic collage effect of the campaigns that, in representational terms, captivated reproductive expectations with hyperbolic cultural elements of gender and race/ethnicity. By highlighting Black women in the marketing, the common message produced by the campaigns also revealed which bodies were more susceptible to the disease and, consequently, demanded control and management. In the summary of the campaigns (Fig. 5), we observed that Black and/or African American women were more associated with the dimensions of guilt, care and pleasure, compared to materials that openly represented White women. The pleasure dimension is interpreted less as an equitable category that could be mistakenly read as related to expectations of desire and the recognition of the affective sphere of Black women, than as part of a stigmatising cultural understanding that Black women are fonder of uncontrolled, recreational, non-monogamous and non-reproductive sex [5, 7, 20, 26].

‘You can get AIDS by being born to an infected mother’ (Fig. 9). In short, AIDS and pregnancy combined fears that, on the one hand, affected young and adult women indiscriminately regarding race/ethnicity; on the other hand, they also produced different preventive expectations and terms depending on the generational and/or racial-ethnic profile. In preventive campaigns aimed at non-pregnant women, the focus tended to be mainly on AIDS and recreational sex common in youth, even though questions about the reproductive future were raised. Responsibility for offspring and health was generally delegated to women, who were urged to protect themselves in heterosexual relationships with supposedly infected men: ‘My boyfriend gave me AIDS. I was only worried about getting pregnant. AIDS is a killer. Protect yourself’ (Fig. 10). Male partners were rarely mentioned in preventive campaigns, unless it was to highlight women’s recklessness in relation to unsafe sex and conscious and deliberate exposure to risk. In Fig. 10, although there is mention of sex with male partners infected with HIV, the issue of vertical transmission remains framed primarily as a women’s issue. This interpretation invites reflection on how preventive and reproductive discourses have consistently chosen maternal behaviour in the visual messages produced for health campaigns. Figure 10, on the other hand, makes it clear that the woman was infected by her partner, highlighting risky behaviours adopted by male partners as well. Alternatively, pregnancy is mobilised as a prior concern, suggesting that sexual activity occurred without the use of condoms. Although the focus does not fall primarily on pregnancy or maternal blame, the secondary message may reveal a form of moral panic surrounding reproduction and youth. The central image of a white woman, in her twenties, with a visibly worried expression, underscores the broader issue of infections among women of reproductive age who are sexually active.

Fig. 9.

“Stop worrying about how you won’t get AIDS. And worry about how you can.” National Institute on Drug Abuse. Department of Health and Human Services, DHHS. National Library of Medicine: ID 101438825; A025192. USA

Fig. 10.

“My boyfriend gave me AIDS. I was only worried about getting pregnant.” National Institute on Drug Abuse. Department of Health and Human Services, DHHS. National Library of Medicine: ID 101438825; A025192. USA

From the perspective of care and social support, visual messages primarily reinforced maternal responsibility for self-education and counselling regarding risk behaviours and pregnancy, while simultaneously downplaying the need to target women and mothers with the same awareness and educational strategies. As an alternative to posters aimed at young mothers in the prenatal period, materials aimed at adult, middle-aged and older mothers inverted the ‘risk (of the offspring) of the mother’s unprotected sex’ with the ‘risk (of the children) of absence mother’s care’ (Figs. 7, 8, 9).

In Fig. 11, ‘It might take more than motherwit to tell my children what to do about AIDS,’ the poster starts from the premise that talking to one’s children about AIDS is difficult—and acknowledges that not even ‘motherwit’ (an African American colloquialism referring to mothers’ practical wisdom) may be enough. The photograph features a Black mother with two children (a girl and a boy), all with serious expressions, directly facing the camera. The central phrase does not accuse or pass judgement—it acknowledges the limitations that any mother may face when dealing with a new and sensitive issue at home. Although the tone of the text is supportive, the poster still reinforces the mother’s exclusive role as a sexual health educator and career. This can be interpreted as: (i) the invisibilisation of fathers or other family figures; (ii) an overburdening expectation placed on women, particularly Black mothers; (iii) the reinforcement of an implicit idea that ‘if children are not well-informed, it is the mother’s fault.’ This subtle form of responsibility—even when well-intentioned—may be read as moralising, especially in public health campaigns that often require women to ‘make up for’ structural failings (such as medical racism, poverty, unequal access to information, and so forth).

Fig. 11.

“It might take more than motherwit to tell my children what to do about AIDS.” Department of Health and Human Services, DHHS, USA. Wellcome Collection: ID 667250i. London, UK

A woman, in this regard, assumes the role of the nurturing mother, who gives up her own interests and can offer advice and information for a healthy life for her children. While motherhood is celebrated as an effective route to counselling, services conclude that this may not be enough, as Fig. 7 suggests. As mothers get older, their partners, who had appeared incipiently in campaigns, progressively disappeared. Although this is an explicit and important sign that many mothers and women care for children and relatives alone and without the support of their spouses, campaigns reiterated these same expectations of care.

In Fig. 12, ‘I didn’t know I had AIDS… not until my baby was born with it’, a Black woman looks directly into the camera, her expression serious and apprehensive. She stands beside a crib with infant furniture — a symbol of motherhood and innocence that starkly contrasts with the harshness of the message. The body of the text is a personal narrative. The woman recounts that her partner died of AIDS and that she knew nothing about the disease at the time. Some time later, she discovered that both she and her baby were infected. She recalls that her partner used intravenous drugs and shared needles, expressing regret for not insisting on condom use, and ends with a plea: ‘Please don’t let this happen to you.’

Fig. 12.

“I didn’t know I had AIDS… not until my baby was born with it.” Department of Health and Human Services, DHHS, USA. Wellcome Collection: ID 667250i. London, UK

The choice of a personal and confessional narrative serves to humanise the woman’s experience, rather than directly assigning blame. The final line (‘Please don’t let this happen to you’) functions as an appeal to solidarity, not as a moral judgement. Although the voice is that of the woman herself, the poster presents: an image of suffering linked to motherhood; a direct association between the mother’s failure to prevent infection and the baby’s suffering. This composition may be interpreted in two ways—both as an attempt to mobilise women through guilt or fear, and as a reinforcement of the archetype of the regretful mother who ‘should have known better’. Similarly, the health message omits reference to the healthcare system, the lack of access to testing, or the widespread social misinformation. Instead, it highlights individual decisions (such as not insisting on condom use or remaining with the partner) as central causes of infection. This implies that the issue lies in personal failure, rather than in collective or systemic shortcomings—potentially placing moral responsibility on the woman.

Sociologically, women appear as the bridge or vector of the disease to babies through the campaigns analysed. The moral panic of the baby and child under threat placed pregnancy at the forefront of prophylactic strategies in the first two decades of the epidemic when the ‘woman category’ was mobilised and represented in HIV-AIDS campaigns.

Final considerations

If in the 1980 s and 1990 s concerns about pregnancy and maternal-foetal effects emerged with a focus on epidemiological surveillance and as the motto of prevention campaigns, today the focus falls on the many forms of exposure to risk [2, 3, 19, 26, 30]. As Richardson [26] observed, since the advent of epigenetics, maternal behaviour has gained centrality as an axis of control, administration and biomedicalisation, in which mothers are obliged, even after the birth of their babies, to reflect retrospectively on the causality of health problems of their children. In the case of HIV-AIDS, the sociological effort is also to understand how these ideas were translated into advice for women, data that informed public policies and clinical practice, in addition to investments in the education of children at home, to a large extent. Similarly, preventive recommendations created a sense of self-monitoring, and the definition of risk colonised the future with fears and fatalistic assumptions that women aspired to motherhood and should be held responsible for the healthy development of offspring [11, 18, 19].

Ethical, effective, and inclusive communication—particularly on sensitive topics such as HIV/AIDS—is a crucial issue for contemporary public health. Campaigns that blame or stigmatise women, even subtly, tend to alienate their target audience and reproduce inequalities, rather than promote care and access to healthcare. Preventive campaigns can be more constructive when they include the extended family, particularly in the case of Black and low-income women, who often rely on relatives, partners, and public health services. Shifting the focus from blame to care should be guided by three key principles: (i) treating women as active agents of care, rather than as ‘bearers of risk’; (ii) presenting prevention as a right, not a moral obligation; (iii) highlighting the possibility of living well with HIV and protecting one’s family with appropriate support.

From a social perspective, constructive and effective campaigns should demonstrate that prevention involves support networks, access to healthcare, safe and caring relationships, and shared decision-making. They must also consider factors such as race, class, gender, migration, and violence, all of which influence access to testing and treatment. Pathways to more just and effective preventive campaigns include: Empathy (focusing on dignity and care, not guilt); Diversity (featuring multiple and positive representations of women); Context (acknowledging the structural factors that influence prevention); and Positive action (showcasing solutions, care, inclusion, and rights). Finally, we developed an example of a poster incorporating the elements of ethical, effective, and inclusive communication outlined above (Fig. 13).

Fig. 13.

“With care, a woman with HIV can have a healthy baby.” OpenAI. (2025). Public health poster [Image generated by artificial intelligence]. ChatGPT

Authors’ contributions

JPG carried out the conceptualisation, methodology, data collection, data curation, data analysis, writing (drafting, review, and editing), and funding acquisition. LBS participated in the conceptualisation, methodology, supervision, data analysis, visualisation, writing (review and editing), and funding acquisition. All authors read and approved the final manuscript.

JPG carried out the conceptualisation, methodology, data collection, data curation, data analysis, writing (drafting, review, and editing), and funding acquisition. LBS participated in the conceptualisation, methodology, supervision, data analysis, visualisation, writing (review and editing), and funding acquisition. All authors read and approved the final manuscript.

Funding

This research was supported by the São Paulo Research Foundation (FAPESP; grants 21/07737–5, 19/10677–4, 17/23665–9, and 23/02752–1). The funder had no involvement in the study design, data collection and analysis, manuscript preparation, or the decision to submit for publication.

Data availability

The materials analysed came from advertising campaigns and historical sources available in public repositories for academic and non-commercial research. The authors confirm that all data generated or analysed during this study are included in this article.

Declarations

Ethics approval and consent to participate

The materials analysed came from advertising campaigns and historical sources available in public repositories for academic and non-commercial research.

Consent for publication

We confirm that we have consent to publish the data related to public health campaigns presented in this article. All materials originate from public repositories, and the sources are duly identified with each referenced poster.

Competing interests

The authors declare no competing interests.