Sept. 9, 2009— -- A provocative television ad ready to air next week in Germany suggests that when you have unprotected sex, you could be in bed with the devil himself -- Adolph Hitler.
In a shock and awe campaign that promotes December's World AIDS Day, Saddam Hussein and Josef Stalin are also leading men in a series of highly sexual videos that surfaced on YouTube this week.
The steamy ad opens in a darkened bedroom with a man and woman in bed, climaxing with a look-a-like of the German dictator's face and tag-line, "AIDS is a mass murderer - Protect yourself!"
The initiative came from the German charity, Regenbogen -- or "rainbow," which defends the campaign on its Web site: "Up until now 28 million people have died. And every day there are 5,000 new cases. Which is why AIDS is one of the most effective mass murderers in history."
European charities -- including the National AIDS Trust, which coordinates World AIDS Day in Britain -- have distanced themselves from the commercial, saying it further stigmatizes those who suffer from the disease.
But invoking fear by using a mass murderer as the face of a deadly disease is precisely what would make the ad successful, according to at least one public health specialist.
"It's effective because it raises awareness of the risk factors -- absolutely," said Dr. Amir A. Afkhami, instructor of psychiatry and behavior sciences and Global Health at George Washington University.
"This issue has come up among activists in the U.S. and there have been arguments that there needs to be more shock value," he told ABCNews.com. "The illness has become desensitized and the guards are down."
"There is such a degree of complacency toward HIV/AIDS awareness – but I am afraid the German campaign wins the stage on this issue," said Afkhami.
This controversy comes as the Kaiser Foundation finds that the number of Americans who list AIDS as the "most urgent health problem" is at its lowest level ever -- only 6 percent, compared with 44 percent in 1995.
The April report coincides with one from the Centers for Disease Control and Prevention that found the number of Americans newly infected with HIV/AIDS is 40 percent higher than previously reported -- 56,300.
Afkhami notes that the ad targets heterosexuals, particularly women, who, with African Americans, are one of the fastest growing groups afflicted with HIV/AIDS.
"There has been a lot of soul searching why this is occurring," he said. "The real failure on the part of health care advocates and social advertising has been raising awareness."
Today, with more-effective drugs to treat those infected with HIV/AIDS living, the disease is largely viewed as a treatable, chronic disease.
"It's less of the plague we saw in 1980s and 1990s," he said. "The grim reaper used to characterize AIDS."
The German TV spot, created by the Hamburg-based advertising agency Das Comitee, is accompanied by a series of posters and videos that have been available online. It also plans a radio ad using the voice of Nazi propagandist Joseph Goebbels.
Creative Director Hans Weishäupl told the British newspaper, the Telegraph, that it proposed the Hitler film after being told by the German charity to come up with hard-hitting ideas.
"A lot of people are not aware that AIDS is still murdering many people every day," he said. "They wanted a campaign which told young people that it is still a threat. In Germany, Hitler is the ugliest face you can use to show evil."
But other health professionals believe that the ad is insensitive and confuses the message.
"The woman has obviously seen his face and chosen to be with him," said Jay Winsten, director of the Center for Health Communication at the Harvard School of Public Health. "So it not only stigmatizes her, it blames her. The important message about safe sex is completely lost."
Fear Ads Don't Work, Say Some
Winsten argues that fear appeals "usually don't work because people react by turning away and retreating into denial to escape the fear if it's too intense."
"This particular ad will certainly garner publicity, but will not help the cause of AIDS prevention," he told ABCNews.com. "While I agree that the challenge is to break through young people's complacency, I doubt that this ad will be taken seriously."
But others argue shock tactics have been the bedrock of health advertising for decades with a proven track record.
Anti-smoking ads show cancer victims without voice boxes and charred lungs. One notable anti-drug ad of the 1990s depicted the "your brain on drugs" as an egg frying.
Drunk driving campaigns have used shocking images. And just this week a graphic ad that warns against driving while texting shows gory accident with bloodied teens.
"There is nothing new in the use of shock tactics in trying to elicit change," said Afkhami.
A 2003 study of university students by Darren Dahl that was published in the Journal of Advertising Research found that shock tactics in AIDS ads significantly increase "attention and retention" of the message.
Other studies, including one from Ohio State University, show fear appeals to be "powerful persuasive devices."
But Dr. Peter G. Shields, professor of medicine and oncology at Georgetown University Medical Center, said while the message is "clever," it still offends.
"Hitler and his large supporting cast had made choices to kill," he told ABCNews.com. "The victims were innocent. That is very different than people making their own choices and following risky behaviors."
As for fear-based ads, "More times they have no effect and sometimes they produce an unintended adverse effect," he said. "In this particular case, the issue of AIDS is so well known that this advertisement won't bring new knowledge to the viewer. "
With more than 1 million in the U.S. living with the HIV/AIDS, most prevention programs focus on testing and disclosure. About one quarter of those infected are unaware they have the disease, according to the CDC.
"It's a very disturbing video," said David S. Novak, a senior public health strategist for Online Buddies Inc, who runs Manhunt Cares, a sexual health resources service for the gay dating site, Manhunt.
He advocates non-judgmental "sex positive messaging" that communicates safe sex choices.
"It should encourage conversation about disclosure [of HIV status]," said Novak. "What is terrible is holding a secret and the secret disease inside of them."
But one German native, living in New York City, said she was less concerned about the jarring image of Hitler, which, like the swastika, is highly regulated in her homeland, than the effectiveness of the message.
"I wish that if they are going to bring him out of the closet and dust him off for something, that it actually brings across an important message," said writer Anne Gehris. "This is not the right vehicle."
"I find this more stupid than offensive," she said. "It just doesn't work."