Your Demand Creation Campaign Strategy

Audience: This is the population that you are looking to target, or speak to, with your PrEP communications campaign.

This audience segment—men who have sex with men (MSM)—includes those who engage in same-sex sexual practices regardless of whether they self-identify as MSM and/or also have sex with women.

Many MSM are married but do not disclose their same-sex sexual practices, generating feelings of fear and guilt. They face criminalization* and experience persistent stigma and abuse from all corners of society; some are even shunned by their own families. Some have a hard time trusting others and may even view associating with their MSM peers as a risk due to the possibility of being outted. Protective of their identity and often afraid for their safety, some turn to a life in hiding, drawing as little attention to themselves as possible to protect themselves from discrimination and life-threatening situations.

MSM live life under the radar—out of fear, shame, or necessity.

* not the case in all sub-Saharan African countries

Problem: The core problem you are trying to address.

PrEP access and information may be hard to come by for MSM, and much of the information and focus around sexual health caters to heterosexual sex, leaving many MSM out of the picture.

In need of support but afraid of being subject to further discrimination by healthcare workers or to being outed, some MSM keep up their disguise when seeking medical care or avoid health services altogether. For some, HIV prevention or treatment has become synonymous with risk—of being outed or becoming the target of more abuse.

HIV prevention poses a risk to his confidentiality.

Strategic idea: The most powerful idea that can address the problem.

Protection that fits discreetly into your life.

Support: Reasons that support the audience’s belief in the strategic idea.

• By using PrEP you are practicing a form of safe sex that only you need to know about. Taken orally and on your own schedule, taking PrEP is protection that is your own personal business and no one else’s.
• No matter the situation you find yourself in, whether you can insist on condom use or not, you can rest assured that you have an added layer of protection.
• PrEP helps build your confidence by knowing that you are safe and healthy, protected from HIV.

Considerations:

• PrEP can be taken by anyone that is HIV-free, no matter your relationship status or the sexual
  practices you engage in.
• 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 STIs, it should be used together with condoms.

Channel Recommendations: Subnational

• Printed materials: Leaflets, posters, bookmarks, postcards, stickers, and other innovative materials to post or hand out at nightclubs and bars frequented by MSM. 1
• Mass media: Local radio, TV, magazines.
• IPC: Peer-driven communication and outreach programs, targeting locations frequented by MSM, and events and services conducted by community based organizations.
• Mobile and SMS/text: Mobile technologies may be good tools for engaging and disseminating information to MSM. In the 2017 OPTIONS research in Kenya, 90 percent of MSM interviewed had access to a cellphone. Of those, 77 percent had access to a smartphone. 2
• Online and social media: Social media (including Facebook) can be used to communicate with MSM, broadcast information and advice, identify potential clients, and/or build and maintain an online community of MSM.
  Research in Kenya found that some MSM may now be meeting one another online on dating and cruising sites, indicating that the internet may be an increasingly familiar medium for some and could be a good way to reach MSM where they already are. 1
• Mobile, tablets, social media, and online content: Apps and web-based material (such as information, podcasts, and video content) especially pushed out via online platforms that are popular with MSM.
• Journalist/media outlets: Engage local media outlets and journalists to cover campaigns and intervention launches.
• National celebrations: e.g., Pride, World AIDS Day events.

Tips for Connecting with Your Audience 

• Common interests: Many MSM enjoy listening to music, watching TV, watching movies, socializing with friends, being on social media, traveling locally, and taking photos. 2
• Where they go for care and information: MSM often visit NGO hospitals or drop-in centers for health care and testing, likely because of the hostile treatment they may receive at traditional healthcare centers. 2 MSM primarily access sexual health information through social media, peer educators, newspapers, health centers and hospitals, radio and TV, and doctors. 2
  The many MSM that reported awareness of PrEP had most commonly heard of it through word of mouth or from medical professionals, seminars, or a specific NGO (according to one study in Kenya). 2 When asked how they think PrEP should be communicated to people like themselves, MSM recommended a range of channels: peer educators, community-based organizations (CBOs), guidance counseling groups, seminars, mass media, instant messenger apps, and leaflets. 2
• Prioritize discretion: Because confidentiality is very important to MSM, finding ways to stay discreet and build trust over time may help you engage MSM. Consider using mobile technology to facilitate this type of interaction.
  One study in South Africa found that sending periodic text messages to MSM encouraged them to test for HIV. 3 Some MSM may be concerned about disclosing the fact that they take PrEP. Therefore, it may be helpful to talk through how to take the pills with discretion.
• Peer engagement: Peer educators (and other MSM) are critical to engaging this audience and gaining their trust. Studies have shown that HIV services targeted at and run by MSM have seen the greatest response and uptake, because they are viewed as more credible and accessible. 4
  One organization in Zimbabwe, Gays and Lesbians Zimbabwe (GALZ), reports that older MSM deal with different issues compared to younger MSM. Older MSM may be coping with loneliness; aging and HIV; coming out to their children; hiding their sexuality and relationships from family; and divorce. GALZ has developed a separate network of “community leaders,” members of similar age who can better reach and engage these older MSM. 5
• Decrease stigma: Because social pressure and discrimination play an influential role in MSM’s health care, it can be important to engage religious leaders, other healthcare organizations, community leaders, and the media in public, non-homophobic conversations to help alleviate stigma.
• Communicate in relatable terms: Some MSM may not identify with the term “MSM” as much as “gay man.” Communications materials should include references to different races and religions—MSM are a diverse and multifaceted group.

Recommended Tactics

• Keep it simple: For mass communications materials such as leaflets and posters, keep the message simple. The easier the message is to understand, the easier it will be to translate and use to engage audiences.
• Deliver through peers: Organize a group of “PrEP champions” to be the face of communications and help with outreach. Train MSM peers to educate others, provide services, and link people to MSM-friendly services. 6
• Highlight community ties: To build credibility and trust, clinics and community organizations should emphasize their roots within the MSM community, as well as their MSM leadership. 5
• Partner with others: When possible, identify and partner with existing credible sources of sexual health care and information for MSM. This could include clinics with a good reputation among MSM, peer or self-organized support groups, or any other MSM organizations or associations.
• Explore the full potential of mobile: Mobile technology may be an effective way to engage MSM and disseminate information. Secret passwords can be used to enable MSM to access specialist services in mobile clinics without fear of discovery. 1  Given the rise in accessibility and use of mobile phone technologies, consider using them to deliver intervention content. Short videos or podcasts can either be downloaded independently by MSM or used by outreach workers to illustrate or describe prevention information. 5
  Some CBOs have been experimenting with existing technologies popular with MSM, such as Facebook and WhatsApp, to engage a wider constituency of men. 5 Facebook groups may be targeted and maintained to reach wider and new groups of men. 5
• Use needs to engage: Offering condoms, sexual lubricants, health information, a safe space, social services, security training, well-being services, and support are opportunities to reach and engage MSM. 7
• Create safe, social spaces: Social events and parties can be used to establish a physical space where MSM can congregate and be engaged for interventions, education, or training.
• Include and sensitize community influencers and leaders: Because of the stigma inflicted upon this population, it may be important to approach and include community leaders, tribal elders or chiefs, and religious leaders to join the conversation and the intervention. 5