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New York City subway riders. Photo by Shiho Fukada/AP.

Over the past few years, the new York City Department of Health has been running ad campaigns decided to shock people out of bad habits like smoking or over-eating. At the beginning of February, it launched a new campaign online and in the subways; it’s aimed at increasing awareness of HIV prevention among gay and bisexual men. But some activist groups want the city to end the campaign.

The video opens like a French film noir, showing portraits of grave-looking men standing against a black-and-white backdrop of menacing New York City streets.

The narrator’s tone is just as somber.

The video warns that the virus causes diseases like dementia and osteoporosis. Towards the end, a graphic picture of an anal cancer growth briefly appears on screen before the narrator delivers the punch line.

New York City subway riders can now see a follow-up poster, which features that same tagline and pictures of men, some of them African-American and Latino.

Kristin Goodwin is the director of New York City Policy and Organizing at Housing Works, an organization that deals with AIDS and homelessness. She says that’s a problem. “Portraying young black and Latino men who are at risk or who are HIV positive as doomed to get horrible illnesses doesn’t necessarily make people want to get HIV tested.”

Goodwin, along with other advocacy groups for people with HIV and for gay and bisexual men, says that fear doesn’t necessarily lead to behavioral change. She says the ad campaign is sending the wrong message. “With the music, the somber faces and the allusions to other illnesses, it certainly adds a layer of stigma of people at risk,” she says.

The Department of Health declined comments. But in a video posted on YouTube, Monica Sweeney, the assistant commissioner for HIV prevention and control, said the ad was effective and necessary. “These ads are hard hitting and sometimes unpleasant but so is HIV and silence isn’t stopping the spread,” Sweeney said.

She also said the ad specifically targeted men who have sex with men because they represent a growing proportion of the 4000 New Yorkers who are newly infected every year. “This increase in new HIV infections 30 years into the epidemic is unacceptable to me, and should be unacceptable to all of us,” she added.

The HIV campaign is the latest in a series of graphic advertising efforts that tackle health issues. The city released ads against smoking, obesity and lead poisoning among children. All of the ad drives use fear to get their messages across.

Kim Witte is a professor of communication at Michigan State University. She says fear works when it comes to health campaigns, but under certain conditions. “In my studies, I’ve scared the bejeepers out of people and as long as they really believe they can do something to avert that threat, the higher the fear, the more motivated they are to act,” she says. “Fear appeals or scare tactics are extremely effective as long as people feel that they’re able to do something to effectively avert a threat.”

Howard Grossman is an HIV specialist who treats mostly lesbian, gay and bisexual patients. He agrees that scare tactics can be effective and thinks a lot of younger gay men today don’t have any first-hand experience with the potentially deadly effects of the virus. “We have this whole group of younger people who never knew anybody with HIV, who never saw anybody die, and they’re not afraid. To them HIV is just another disease that you take one pill for and in fact that’s not HIV disease, but they’re not scared and they’re not having safe sex,” he says.

The Department of Health says its recent anti-smoking campaign has been effective and it thinks the HIV campaign will be too. But activists say the city has taken concrete steps to prevent smoking: it’s distributed Nicotine patches and banned smoking in public spaces. They say there is nothing comparable to prevent HIV once the scare tactics wear off.

Kristin Goodwin of Housing Works says a lot of these problems with the ad campaign could have been avoided had the Department of Health consulted with them and other advocacy groups in the first place. “There was no mention of expanding the ad campaign into the subway and we found out about it the same day that it got posted. I have concerns that the Department of Health is not listening to the concerns of people who are infected and affected and also people that do prevention and outreach in the community.”

Goodwin says there are more positive ways to get the message across. Like the bus campaign released this month by the Washington DC Department of Health, which involves African American gay men. Goodwin says that instead of inducing fear, the campaign encourages people in relationships to reaffirm their desire to be safe for each other.

But not all gay activists think NYC’s campaign is bad. Larry Kramer is a writer and founder of the organization Act Up, and HIV positive himself. He wrote in an email to friends and fellow activists after seeing the spot that he thought it was honest, true and not nearly as scary as HIV itself.