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Abstract

As of August 12, 2020, there are over 20 million confirmed cases of novel coronavirus disease (COVID-19) worldwide with over 744,000 deaths.[1] Due to existing disparities in health outcomes, the consequences of this pandemic for LGBTQ+ individuals could be magnified in scope and severity.[2] Gay, bisexual, and other men who have sex with men (MSM), particularly those who inhabit multiple minority identities (that is, racial/ethnic minorities, immigrants), are already at greater risk for suicide, HIV, and unemployment, and commonly face systematic, institutional discrimination in the form of criminalization and other human rights violations.[3] Vulnerable subgroups, such as unstably housed or informally employed LGBTQ+ individuals, may struggle to practice social distancing and prescribed sanitation measures. The recommendations presented here are data-driven and informed by a cross-sectional survey implemented by the free gay social networking app, Hornet, from April 16 to May 4, 2020.
8/14/2020 Address Exacerbated Health Disparities and Risks to LGBTQ+ Individuals during COVID-19 – Health and Human Rights Journal
https://www.hhrjournal.org/2020/08/address-exacerbated-health-disparities-and-risks-to-lgbtq-individuals-during-covid-19/ 1/2
8/14/2020 Address Exacerbated Health Disparities and Risks to LGBTQ+ Individuals during COVID-19 – Health and Human Rights Journal
https://www.hhrjournal.org/2020/08/address-exacerbated-health-disparities-and-risks-to-lgbtq-individuals-during-covid-19/ 2/2
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... Minority groups have often been associated with and stigmatized for the spread of infectious diseases (Fischer et al., 2019;Hull et al., 2020), including COVID-19 (Kapiriri & Ross, 2020;Ransing et al., 2020;Wallach et al., 2020) and monkeypox (Bragazzi et al., 2022;Daskalakis et al., 2022). In South Korea, COVID-19 has become associated with unconventional, pseudo-religious groups (i.e., religious cult), sexual minorities, and with defying national interests (Yi & Lee, 2020). ...
... Still, more research is needed to examine how to help stigmatized groups to overcome stigma and engage in public health behaviors. Like other stigmatized minority groups associated with infectious diseases (e.g., HIV/AIDS, Tuberculosis [TB], Severe acute respiratory syndrome [SARS], Ebola virus disease, Zika virus) (Fischer et al., 2019;Hull et al., 2020;Kapiriri & Ross, 2020;Wallach et al., 2020), there were concerns that LGBTQ+ people exposed to COVID-19 in Korea were hesitant to get tested for the coronavirus (Jung et al., 2020;Kang et al., 2020;KCDA, 2020) because of existing stigma and discrimination against LGBTQ+ individuals (Youn, 2018) and COVID-19 stigma. Thus, to examine stigma and risk communication that encouraged COVID testing, this study asks the following research questions: ...
... However, moral stigma associated with sexual minority status has long led dominant groups to blame these minorities, such as LGBTQ+ individuals, for disease transmission (Kapiriri & Ross, 2020;Wallach et al., 2020). Given the layered stigmas that participants faced, it is no wonder LGBTQ+ individuals experience barriers to healthcare access across a host of health conditions (Utamsingh et al., 2015;Wallach et al., 2020). ...
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Members of stigmatized groups, including lesbian, gay, bisexual, transgender, or queer-identifying (LGBTQ+) individuals, face greater vulnerability to infectious diseases, such as HIV/AIDS, coronavirus disease (COVID-19), and monkeypox, than non-stigmatized groups. Stigma can impact LGBTQ+ people’s access to health resources and can lead to discrimination. Risk communication messages for LGBTQ+ communities can also activate stereotypes and de-incentivize positive health behaviors. This vulnerability became clear for already heavily stigmatized LGBTQ+ people living in South Korea during the COVID-19 pandemic. As governments and media outlets communicated the sites of COVID-19 outbreaks, they shared details about transmission in LGBTQ+ spaces (e.g., gay nightclubs, bathhouses) that activated stereotypes about health, risk, and identity. LGBTQ+ individuals in South Korea subsequently experienced intersectional stigma related to gender, sexuality, and COVID-19. Since little research has examined intersectional stigma with COVID 19, the current study used in-depth interviews (N = 21) to examine the intersectional stigma and discrimination that LGBTQ+ communities experienced before and after the COVID-19 outbreak in Korea. Also, this study investigated risk communication that can help reduce and overcome stigmatization and thus encourage LGBTQ+ individuals to get tested, traced, and treated. Results revealed that reducing stigma is critical to encourage stigmatized groups to engage in infectious disease testing and treatment. Implications for public health are discussed. Highlights •LGBTQ+ people in South Korea experienced intersectional stigma with COVID-19•Anonymized testing procedures can reduce stigmatization and encourage testing•Health authorities can partner, consult, and collaborate with stigmatized groups•Health authorities can use trusted in-group messengers and messages with compassion•Governments should proactively develop anti-discrimination policies
... This population has already experienced the social impasses of the HIV pandemic, which to the present day reflects negatively on this group in comparison to the general population (Emlet et al., 2019). Although the characteristics of this pandemic are different from the HIV pandemic, discriminatory impacts and the lack of public commitment in the search for equality favor the vulnerability of the LGBT+ population in the face of COVID-19 (Santos et al., 2020;Wallach et al., 2020). ...
... Furthermore, considering the complexity of the impacts of a major pandemic on the LGBT population, there is a need to understand the seriousness of the repercussions of the COVID-19 pandemic on this population, since sexual and gender minorities have suffered and still suffer impacts which are different than those experienced by the general population in other epidemics around the world (Gausman & Langer, 2020;Santos et al., 2020;Wallach et al., 2020). Thus, this study aims at assessing the effects on the social life and mental health of Brazilian sexual and gender minorities during the COVID-19 pandemic. ...
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The COVID-19 pandemic exerted major impacts on the entire population, but some groups such as sexual and gender minorities have been disproportionately affected. Therefore, we aim at assessing the impacts on the social life and mental health of Brazilian sexual and gender minorities during the COVID-19 pandemic. This is a cross-sectional nationwide study conducted between September and October 2020. Participants were recruited through convenience sampling (snowball), being invited to answer an online questionnaire. The participants were invited to participate by social networks and websites directed to the LGBT+ population over 18 years old. This study included 659 sexual and gender minorities from all five Brazilian regions. The main impacts caused by the COVID-19 pandemic reported by the participants were anxiety (73.5%), stress (71%), loneliness (59.6%), sleep pattern changes (69%) and income reduction (36.9%). Participants with low educational level presented higher income reduction than participants with high educational level (0.61, 95% CI 0.48-0.77) and high income (0.46, 95% CI 0.34-0.62). Low income (1.14, 95% CI 1.03-1.26) and being lesbian (1.13, 95% CI 1.01-1.26) are related to changes in sleep patterns. Totally isolated participants presented high stress rates. The LGBT+ population presented high economic and emotional impacts during COVID-19 pandemic. The results of this study highlight the need for heath public policies directed for sexual and gender minorities.
... A community study in Indonesia among men who have sex with men (MSM) and transgender individuals in July-September 2020 found that nearly 70% of participants reported worse psychological distress during the COVID-19 pandemic than pre-pandemic [11]. One of the reasons was discrimination faced by LGBTIQ people, which has existed long before the pandemic [12,13]. In other studies, vulnerable and marginalized communities (e.g. ...
... However, this finding was statistically non-significant that might be due to the low representation in the overall participants (0.8%). Despite the non-significant ratio, the current finding reinforced previous studies that highlighted the very limited access to mental health services for LGBTIQ and people living with HIV worldwide, particularly in LMICs, which has worsened during the pandemic [13,14]. ...
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Background It is estimated that 77.0% of suicide cases occurred in low-and-middle-income countries (LMICs), which would increase because of the COVID-19 pandemic and socioeconomic inequity. However, there is lack of reports on this topic from LMICs, especially during the pandemic. Therefore, this nationwide study aimed to explore self-harm and suicide ideation and its predictive variables during the pandemic in Indonesia as a MIC with the highest COVID-19 fatality rate in Asia. Methods Non-random sampling online survey was conducted nationwide between 25 May and 16 June 2021. The collected data were demographic variables (i.e. age group), loneliness from social isolation using The UCLA Loneliness Scale Six Items (ULS-6), and self-harm and suicide ideation using item 9 of The Patient Health Questionnaire-9 (PHQ-9). Predictive model was analyzed using hierarchical logistic regression. Results A total of 5211 participants from all 34 provinces in Indonesia completed the survey. Among 39.3% of them reported self-harm and suicide ideation during the pandemic, which significantly correlated with loneliness. The predictive variables associated with the likelihood of self-harm and suicide ideation were age, residence, job, religion, sex-gender, sexual orientation, HIV status, disability status, and loneliness. The predictive model showed a significant goodness-of-fit to the observed data ( x ² [ (15)] = 1803.46, p < .001), R N ² = .40. Conclusion Four out of 10 Indonesians experienced self-harm and suicide ideation during the COVID-19 pandemic, particularly people within the age range of 18–24, living in the Java Island, unemployed/student/retired and freelancer, women, members of minority and marginalized communities, and experience of loneliness during the pandemic.
... [9][10][11] Reports also indicate the unique concerns and challenges experienced by members of the LGBTQ+ community resulting from antigay backlash and community crackdown under false pretexts. [12][13][14] Moreover, many members of the LGBTQ+ community are at increased Strengths and limitations of this study ► Large, global sample of lesbian, gay, bisexual, transgender and queer (LGBTQ+) persons regarding the impact of COVID-19 -likely one of, if not the first of, its kind. ► Considers the immediate and secondary effects of COVID-19 on the LGBTQ+ community. ...
... 72 73 For countries with less favourable views, it will require recognition of this community, eliminating criminalising policies on same-sex behaviour and sex work, extending the right to marry for same-sex couples and establishing laws that bestow legal protection to members of this marginalised community throughout society. 13 74 75 Notably, there are some limitations of this study. Individuals must be users of Hornet in order to participate in the survey, and thus must have internet and smartphone access, limiting generalisability of the findings to a target population of interest. ...
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Introduction Emerging evidence indicates that the COVID-19 pandemic, and the responses it has generated, have had disproportionate impacts on lesbian, gay, bisexual, transgender and queer (LGBTQ+) communities. This study seeks to build on existing information and provide regional insight. Methods In response, a cross-sectional survey was administered to a global sample of LGBTQ+ individuals (n=13 358) between 16 April and 20 May 2020 via the social networking application Hornet. The survey contained questions that characterise the impact of COVID-19 and associated mitigation strategies on economics, employment, mental health and access to healthcare. Results 5191 (43.9%) individuals indicated they were somewhat, slightly or unable to meet basic needs with their current income, while 2827 (24.1%) and 4710 (40.1%) felt physically or emotionally unsafe in their living environment, respectively. 2202 individuals (24.7%) stated they are at risk for losing health insurance coverage. 2685 (22.7%) persons reported having skipped or cut meals as there was not enough money. Conclusion Many LGBTQ+persons who responded reported adverse consequences to mental health, economics, interruptions to care and lack of support from their government. This data is part of ongoing analyses but accentuates the unique needs of LGBTQ+ communities that will require targeted, ameliorative approaches.
... Not only does it put these communities at additional risk, and it is a direct violation of international humanitarian and human rights law. [22][23][24][25][26] As outlined in Article 7 of the Universal Declaration of Human Rights, 'all are entitled to equal protection against any discrimination in violation of this Declaration'. 27 The rights to protection from discrimination and violence based on sexual orientation and gender identity are further detailed in the International Covenant on Civil and Political Rights. ...
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Objectives To characterise the extent to which the levels of violence and discrimination against lesbian, gay, bisexual, transgender and queer (LGBTQ+) people have changed amid COVID-19. Design Cross-sectional, secondary analysis. Setting 79 countries. Participants All adults (aged ≥18 years) who used the Hornet social networking application and provided consent to participate. Main outcome measure The main outcome was whether individuals have experienced less, or the same or more levels of discrimination and violence from specific groups (eg, police and/or military, government representatives, healthcare providers). Results 7758 LGBTQ+ individuals provided responses regarding levels of discrimination and violence. A majority identified as gay (78.95%) and cisgender (94.8%). Identifying as gay or queer was associated with increased odds of experiencing the same or more discrimination from government representatives (OR=1.89, 95% CI 1.04 to 3.45, p=0.045) and healthcare providers (OR=2.51, 95% CI 0.86 to 7.36, p=0.002) due to COVID-19. Being a member of an ethnic minority was associated with increased odds of discrimination and violence from police and/or military (OR=1.32, 95% CI 1.13 to 1.54, p=0.0) and government representatives (OR=1.47, 95% CI 1.29 to 1.69, p=0.0) since COVID-19. Having a disability was significantly associated with increased odds of violence and discrimination from police and/or military (OR=1.38, 95% CI 1.15 to 1.71, p=0.0) and healthcare providers (OR=1.35, 95% CI 1.07 to 1.71, p=0.009). Conclusions Our results suggest that despite the upending nature of the COVID-19 pandemic, around the world, government representatives, policymakers and healthcare providers continue to perpetuate systemic discrimination and fail to prevent violence against members of the LGBTQ+ community.
... In addition, LGBTQ + persons have difficulty finding non-stigmatizing and nondiscriminatory cancer care [44,45]. These multiple forces may have impeded LGBTQ + survivors from using necessary medication, showing nearly fourfold increases in changing medication use relative to cis-heterosexual persons in this study [46,47]. ...
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Purpose We examined whether financial burdens occurring during the COVID-19 pandemic impacted healthcare utilization among survivors of adolescent and young adult cancers. Methods We surveyed survivors enrolled in a patient navigation program to obtain self-reports of delayed/skipped cancer care or other care, changes to medication obtainment, and changes to medication use since the COVID-19 pandemic began. Reported financial burdens were defined as financial toxicity in the past 4 weeks (COmprehensive Score for financial Toxicity [COST] ≤ median 21) and material hardships (range = 4–11) since March 2020. Adjusted logistic regression models calculated associations and effect modification by gender. Results Survivors (n = 341) were mostly female (61.3%) and non-Hispanic White (83.3%). Nearly 20% delayed/skipped cancer care, 35.2% delayed/skipped other care, 19.1% changed medication obtainment, and 12.6% changed medication use. Greater material hardships were associated with delayed/skipped cancer care (odds ratio (OR) = 3.13, 95% CI = 1.44–6.81) and other care (OR = 2.17, 95% CI = 1.18–3.98), and changed medication obtainment (OR = 2.72, 95% CI = 1.43–5.18) or use (OR = 4.49, 95% CI = 2.05–9.80). Financial toxicity was associated with delayed/skipped other care (OR = 2.53, 95% CI = 1.31–4.89) and changed medication obtainment (OR = 1.96, 95% CI = 1.01–3.83) and medication use (OR = 3.73, 95% CI = 1.59–8.73). The association of material hardships and any changes in healthcare utilization was greater among female compared to male survivors. Conclusion Financial burdens experienced during the pandemic impeded survivors’ ability to utilize necessary healthcare, with worse impacts among female survivors. Implications for Cancer Survivors Delayed or skipped healthcare may lead to an increased cancer mortality or severity of therapy-related conditions. Providing resources that enable survivors experiencing financial burdens to continue critical cancer and preventive care during the COVID-19 pandemic is a priority.
... Transgender older adults experience higher rates of sexual assault, violence, family rejection, and social isolation than any other group within the LGBTQ community. 21 In addition, for some older adult LGBTQ people, the COVID-19 pandemic is reminiscent of the earlier days of the human immunodeficiency virus (HIV) epidemic when death and despair were pervasive, and the initial HIV response ignored the nuanced impact it had on communities with intersectional identifies. 22 The elevated health threats to LGBTQ persons, including youth and adults, coupled with the COVID-19 pandemic result in alarming increases in vulnerabilities. ...
Article
The violence and victimization brought by colonization and slavery and justified for over a century by race-based science have resulted in enduring inequities for black, Indigenous and people of color (BIPOC) across the United States. This is particularly true if BIPOC individuals have other intersecting devalued identities. We highlight how such longstanding inequities paved the way for the disproportionate burdens of coronavirus disease 2019 (COVID-19) among the BIPOC populations across the country and provide recommendations on how to improve COVID-19 mitigation strategies with the goal of eliminating disparities.
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This summary research report briefly presents the main findings of my desk and field (personal interviews with relevant stakeholders, experts etc. including representatives of Greek LGBTQI+ organizations) survey conducted in Greece for the purposes of the Project "PARADISO" (funded by the General Secretariat for Research and Innovation, K/E 81012) during February and March 2022 regarding LGBTQI+ people and health sector in Greece before and during the Covid-19 pandemic.
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Στην Έκθεση αυτή του έργου "Συμμετοχική Προσέγγιση για την Ευαισθητοποίηση και Καταπολέμηση των Διακρίσεων βάσει του Σεξουαλικού Προσανατολισμού και της Ταυτότητας Φύλου στον τομέα της υγείας - PARADISO" (με χρηματοδότηση της Γ.Γ. Έρευνας & Καινοτομίας, Κ/Ε 81012), επιχειρώ - μέσω ποιοτικής κοινωνιολογικής έρευνας πεδίου - να αναδείξω τις πιθανές προκλήσεις και τα εμπόδια που αντιμετώπισαν και αντιμετωπίζουν τα ΛΟΑΤΚΙ+ άτομα στην Ελλάδα όσον αφορά την πρόσβασή τους στο εθνικό σύστημα υγείας και τη λήψη των υπηρεσιών υγείας κατά την περίοδο της πανδημίας του κορωνοϊού Covid-19, καθώς και η ανάπτυξη ολοκληρωμένων προτάσεων πολιτικής προς τους αρμόδιους θεσμικούς φορείς για τη διασφάλιση της ισότιμης και απρόσκοπτης πρόσβασης τους σε ποιοτικές υπηρεσίες υγείας. Ειδικότερα, στόχοι της έρευνας είναι, πρωτίστως μέσα από την διεξαγωγή ποιοτικής κοινωνιολογικής έρευνας και, δευτερευόντως, μέσω βιβλιογραφικής επισκόπησης: - η διερεύνηση των αναγκών υγείας των ΛΟΑΤΚΙ+ ανθρώπων σε συνάρτηση με τον σεξουαλικό προσανατολισμό, την ταυτότητα ή τα χαρακτηριστικά φύλου τους και της πιθανής αλλαγής /μεταβολής αυτών κατά την διάρκεια της πανδημίας - η διερεύνηση της πρόσβασης των ΛΟΑΤΚΙ+ ανθρώπων στο εθνικό σύστημα υγείας και στη χρήση των υπηρεσιών του πριν και κατά τη διάρκεια της πανδημίας, ο εντοπισμός πιθανών διαφορών στην προπανδημική και στην πανδημική περίοδο, καθώς και των πιθανών κενών και προκλήσεων στην πρόσβαση των ΛΟΑΤΚΙ+ ανθρώπων σε υπηρεσίες υγείας κατά την πανδημική περίοδο - η διερεύνηση της ανταπόκρισης του ελληνικού κράτους (αλλά και φορέων της κοινωνίας των πολιτών και του ιδιωτικού τομέα υγείας) στην κρίση δημόσιας υγείας, εστιάζοντας στην κάλυψη των αναγκών υγείας των ΛΟΑΤΚΙ+ ατόμων και η συλλογή βέλτιστων πρακτικών, θετικών μέτρων ή πρωτοβουλιών (αν υπάρχουν) - τόσο από το κράτος όσο και από φορείς της κοινωνίας των πολιτών και τον ιδιωτικό τομέα – αναφορικά με την παροχή υπηρεσιών υγείας σε ΛΟΑΤΚΙ+ άτομα κατά τη διάρκεια της πανδημίας στην Ελλάδα - η ανάπτυξη στοχευμένων προτάσεων πολιτικής με βάση τα ευρήματα της έρευνας πεδίου, για την διασφάλιση της απρόσκοπτής και ισότιμης πρόσβασης και μεταχείρισης των ΛΟΑΤΚΙ+ ανθρώπων στο εθνικό σύστημα υγείας - και, ευρύτερα, σε υπηρεσίες υγείας - τόσο κατά την περίοδο της πανδημίας όσο και όταν αυτή θα έχει πλέον τελειώσει.
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Introduction Despite the development of safe and highly efficacious COVID-19 vaccines, extensive barriers to vaccine deployment and uptake threaten the effectiveness of vaccines in controlling the pandemic. Notably, marginalization produces structural and social inequalities that render certain populations disproportionately vulnerable to COVID-19 incidence, morbidity, and mortality, and less likely to be vaccinated. The purpose of this scoping review is to provide a comprehensive overview of definitions/conceptualizations, elements, and determinants of COVID-19 vaccine hesitancy among marginalized populations in the U.S. and Canada. Materials and methods The proposed scoping review follows the framework outlined by Arksey and O’Malley, and further developed by the Joanna Briggs Institute. It will comply with reporting guidelines from the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). The overall research question is: What are the definitions/conceptualizations and factors associated with vaccine hesitancy in the context of COVID-19 vaccines among adults from marginalized populations in the U.S. and Canada. Search strategies will be developed using controlled vocabulary and selected keywords, and customized for relevant databases, in collaboration with a research librarian. The results will be analyzed and synthesized quantitatively (i.e., frequencies) and qualitatively (i.e., thematic analysis) in relation to the research questions, guided by a revised WHO Vaccine Hesitancy Matrix. Discussion This scoping review will contribute to honing and advancing the conceptualization of COVID-19 vaccine hesitancy and broader elements and determinants of underutilization of COVID-19 vaccination among marginalized populations, identify evidence gaps, and support recommendations for research and practice moving forward.
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There is an urgent need to measure the impacts of COVID-19 among gay men and other men who have sex with men (MSM). We conducted a cross-sectional survey with a global sample of gay men and other MSM (n = 2732) from April 16, 2020 to May 4, 2020, through a social networking app. We characterized the economic, mental health, HIV prevention and HIV treatment impacts of COVID-19 and the COVID-19 response, and examined whether sub-groups of our study population are disproportionately impacted by COVID-19. Many gay men and other MSM not only reported economic and mental health consequences, but also interruptions to HIV prevention and testing, and HIV care and treatment services. These consequences were significantly greater among people living with HIV, racial/ethnic minorities, immigrants, sex workers, and socio-economically disadvantaged groups. These findings highlight the urgent need to mitigate the negative impacts of COVID-19 among gay men and other MSM.
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Health inequities have long defined health and the healthcare system in the USA. The clinical and research capacity across the USA is unparalleled, yet compared to other high and even some middle-income countries, the average health indicators of the population remain suboptimal in 2020, a finding at least in part explained by inequity in healthcare access. In this context, COVID-19 has rapidly emerged as a major threat to the public’s health. While it was initially thought that severe acute respiratory syndrome coronavirus 2 would be the great equaliser as it would not discriminate, it is clear that COVID-19 incidence and mortality have rapidly reinforced health disparities drawn by historical and contemporary inequities. Here, we synthesise the data highlighting specific risks among particular marginalised and under-resourced communities including those in jails, prisons and detention centers, immigrants and the undocumented, people with disabilities and people experiencing homelessness across the USA. The drivers of these disparities are pervasive structural risks including limited access to preventive services, inability to comply with physical distancing recommendations, underlying health disparities and intersecting stigmas particularly affecting racial and ethnic minorities across the country, including African Americans, Latinx Americans and Native Americans. Advancing the COVID-19 response, saving lives and restarting the economy necessitate rapidly addressing these inequities rather than ignoring and even reinforcing them.
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Fear is now commonly used in public health campaigns, yet for years ethical and efficacy-centered concerns provided a challenge to using fear in such efforts. From the 1950s through the 1970s, the field of public health believed that using fear to influence individual behavior would virtually always backfire. Yet faced with the limited effectiveness of informational approaches to cessation, antitobacco campaigns featured fear in the 1960s. These provoked little protest outside the tobacco industry. At the outset of the AIDS epidemic, fear was also employed. However, activists denounced these messages as stigmatizing, halting use of fear for HIV/AIDS until the 21st century. Opposition began to fracture with growing concerns about complacency and the risks of HIV transmission, particularly among gay men. With AIDS, fear overcame opposition only when it was framed as fair warning with the potential to correct misperceptions. © 2018 American Public Health Association Inc. All rights reserved.