Your Demand Creation Campaign Strategy
Audience: This is the population that you are looking to target, or speak to, with your PrEP communications campaign.
The general public may not be at high risk, but they may contribute to the stigma around HIV and have significant influence over those who are at high risk for HIV. Key audiences and influencers within this group may include sexual partners, clients of sex workers, parents, community leaders, peers and teachers. Whether these individuals identify with the risk of HIV or not, many react to the issue by either denying the existence of HIV altogether or by discriminating against those who are HIV positive (or those whom they believe to be HIV positive based on assumptions and judgments). These attitudes and beliefs effectively hinder the effective prevention of HIV thereby perpetuating the epidemic.
The general public is a critical target audience with regards to cultivating an environment where others can embrace PrEP.
Problem: The core problem you are trying to address.
Views about sex vary based on personal ideologies. Some individuals believe sex should only occur between a man and a woman, while others believe sex should only occur between married couples, or that young people should not be having sex at all. People who hold these beliefs tend to view methods that enable “safe sex” i.e. preventing sexually transmitted diseases or pregnancy as inadvertently encouraging immorality and promiscuity – hence their lack of support for PrEP.
Advocating for PrEP condones the immoral, promiscuous behavior they disapprove of.
Strategic idea: The most powerful idea that can address the problem.
The strongest communities support PrEP.
Support: Reasons that support the audience’s belief in the strategic idea.
- PrEP makes us stronger by combatting the spread of HIV and protecting the lives of our loved ones.
- Using PrEP is a form of practicing “safe sex”; now, in addition to condoms, PrEP provides an added layer of protection. That means it helps keep us healthy and HIV-free so we can stand up to this epidemic and end its stronghold over our current and future generations.
- When used correctly and consistently, PrEP is proven to be highly effective in reducing one’s risk of acquiring HIV.
- Because PrEP doesn’t protect against STI’s, it should be used together with condoms.
- PrEP does not protect against pregnancy.
Channel Recommendations: Community
- Mass media: Posters to put up around community and healthcare centers, hospitals, schools, and social hotspots (such as bars and clubs).
- IPC: Presence of peer educators or representatives at community gatherings and community meetings.
- Online and social media: Facebook, blogs, and Twitter.
Tips for Connecting with Your Audience
- Music is a universal interest: When engaging audiences, music may be a valuable channel because it plays an important role in many people’s lives. In Kenya, for example, gospel music is widespread and underground hip-hop is growing in popularity. 1
- Address everyday stigma: Community members can express and reinforce stigma through everyday interactions including gossiping, laughing, and mocking. The relative absence of supportive community HIV-related discourse also has negative effects. 2 Private support within families and friendships has enabled greater acceptance, but this needs to be translated into everyday advocacy and accepting discourses in public, too. 2
- Avoid unintentional stigma: If using door-to-door IPC tactics, avoid stigma by targeting at-risk neighborhoods, as opposed to individual houses. 1
- Foster conversations: Informal discussion about HIV/AIDS is a mechanism that has been suggested to have significant influence on personal knowledge of people living with HIV/AIDS and may as a result decrease HIV-related stigma. Such discussions may even reduce the practice of risk behaviors related to HIV. 3
HIV prevention efforts and stigma-reduction programs should incorporate novel approaches to foster discussion about HIV/AIDS in informal settings. 4
One study found that negative attitudes and perceived discrimination toward people living with HIV/AIDS were related to a lack of knowledge about treatment, a lack of prior history of HIV testing, and not having discussed HIV/AIDS with anyone. 4 There is a great need for village leaders and clinical staff to be supported—financially and legally, as well as through new social norms—to innovate new ways of generating community discussion and informing policy. 2
- Engage gatekeepers: Community gatekeepers are individuals who are in contact with the community or a certain target population, and have the potential to motivate
and support them. Types of gatekeepers will vary. In rural areas, a High-Risk Women’s study reports that gatekeepers are often chiefs, ward councilors, priests, or traditional healers. In urban areas they can be chiefs or priests, or others like NGO staff, sports coaches, teachers- anyone who provides support or influence. For sex workers, a gatekeeper may be the brothel owner. Its important to understand the community in which you work to understand the gatekeepers that need to be engaged. 1 Gatekeepers can induce community members to have trust and confidence in a product, and they can aid with the recruitment of PrEP educators or champions. 1
- Engage religious leaders, too: Religion and religious leaders often play an important role. In Kenya, for example, an estimated 30,000 faith-inspired organizations implement many kinds of development programs. As community spokespersons, religious leaders can be successful in mobilizing others for positive social change. 5
- Identify high-risk areas or “hotspots”: Community mapping can be a good method of determining where to target outreach activities. Conversations with community members and key stakeholders can help you understand where high-risk target audiences congregate and how to most effectively reach them. 1
- Keep it simple: Keep communications as clear, straightforward, and simple as possible. For example, one of the current health messages in South Africa uses emojis.
- Generating product legitimacy: Using multiple kinds of media, especially TV and radio, adds legitimacy to a product. In addition, using a Ministry of Health logo and/or endorsement may help build trust.
Community events may also be helpful in building trust toward the product by enabling conversation. However, it may be difficult to maintain confidentiality in such settings. Creating a connected but online forum for conversation and Q&A may be the solution in this case. 1
- Create “buzz”: Word of mouth is effective at reaching at-risk populations. However, it’s important that the correct messages are spread, as word of mouth can work both ways: to spread a campaign message or misinformation. 1
- Educate on HIV risk and PrEP: There are a number of broad misperceptions and misunderstandings about HIV risk and transmission, as well as about PrEP. Informing the general population in these areas may help decrease stigma and aid community-wide acceptance. In addition to information, it may be necessary to address and dispel common myths, thus making it easier for at-risk populations to uptake. 1
- Normalize at-risk populations: Through persistent and omnipresent messaging, communications may normalize conversations about HIV risk and prevention, as well as the presence of at-risk populations. Even if messages are not targeted at the general population, the repeated presence of HIV prevention messages and talk about at-risk populations may help to instill recognition throughout society that HIV is a public health issue relevant to everyone, and that health access is a universal right.
- Cultivate contacts: To further normalize conversations about HIV, it may be beneficial to create opportunities for the general population to informally interact with HIV negative-but-at-risk people and HIV positive people.
- Who delivers the message: Include both HIV-positive and -negative individuals as message-bearers. By placing both visibly as recognizable members of the community, such communications may help decrease the stigma associated with those who may have HIV or may be at risk.
- Co-create solutions: Engage with community members and community leaders, who should be informed of and involved in the implementation planning for the new prevention program and/or the design and implementation of the PrEP demonstration project. This will promote acceptance and ownership of the program by communities. It requires giving appropriate and clear information about PrEP to communities at information sessions, seeking feedback on attitudes and perceptions, and through mass public education and sensitization using mass media.
According to the qualitative analysis memos from the Reaching High Risk Women for PrEP: Learning from ARV-based HIV prevention trials study, provided by K Stankevitz, MSc, in May 2018.
Bonnington O, Wamoyi J, Ddaaki W, et al. Changing forms of HIV-related stigma along the HIV care and treatment continuum in sub-Saharan Africa: a temporal analysis. Sex Transm Infect. 2017;93(suppl 3):e052975. doi:10.1136/sextrans-2016-052975.
Eribake A. True believers or gospel fakes? This Is Africa. June 27, 2014. Source. Accessed January 3, 2018.
Stoneburner R, Low-Beer D. Population-level HIV declines and behavioral risk avoidance in Uganda. Science. 2004;304(5671):714-718. doi: 10.1126/science.1093166.
Tsai A. Socioeconomic gradients in internalized stigma among 4,314 persons with HIV in sub-Saharan Africa. AIDS Behav. 2015;19(2):270-282. doi:10.1007/s10461-014-0993-7.