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 segment of people who inject drugs (PWID) is stigmatized, discriminated against, criminalized, and often rejected for their drug use. They may exist outside of formal systems and many live on the fringes of society in fear and isolation with their fellow users. They worry about HIV and their health but those are just a few concerns of the many interconnected challenges that they face, of which their addiction almost always takes priority. These factors combined with depression and a sense of hopelessness, for some, make it very challenging to combat even just one issue.
PWID struggle to stay afloat while bearing the heavy weight of drug addiction.
Problem: The core problem you are trying to address.
PWID long for a brighter and healthier future, but their use of drugs creates a host of challenges that keep many of them in a constant state of struggle.
HIV is one of many issues they face, and for PWID, addressing their risk of HIV and getting support (especially around PrEP) often require extra effort, which is usually at odds with caring for their addiction. Even the time queuing at a clinic can be seen as a “cost.”
HIV prevention just adds more weight to their burden.
Strategic idea: The most powerful idea that can address the problem.
PrEP is one step you can take to start living the life you want and deserve.
Support: Reasons that support the audience’s belief in the strategic idea.
- You get to stay in control. The choice to take it is yours. It fits your life, not the other way around, so you get to go on living life the way you want.
- PrEP is protection you can easily start now and on your schedule.
- PrEP keeps you HIV negative, free of the diagnosis that would make your life more challenging.
- When used correctly and consistently, PrEP is proven to greatly reduce your risk of acquiring HIV so you can stay protected from the adversities that come with contracting HIV.
- 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.
- PrEP does not protect against pregnancy.
Channel Recommendations: Sub-National
- Printed materials: Leaflets, postcards, stickers, and other materials to distribute to health centers, organizations, and communities.
- IPC: Talks and peer outreach programs at churches and hospitals.
Tips for Connecting with Your Audience
- Common interests: Many PWID enjoy listening to music, watching TV and movies, spending time with family and friends, playing football, and going to the beach. 1
- Where they seek care and information: Many PWID visit government hospitals, but when possible will also seek care from NGO hospitals or drop-in centers. 1
Some PWID get sexual and reproductive health information from community talks, church, mobile doctors, friends, peers, radio and TV, and hospitals or health centers. 1
When asked how they think PrEP should be communicated to people like themselves, PWID suggested many of the same channels, and added seminars. 1
Information that is most credible is that which is endorsed by their community. 2 However, research suggests that HIV is rarely discussed openly among PWID. 3
- Consider intersections with other at-risk groups: An individual who injects drugs may also be part of another at-risk population—such as MSM, sex workers, and prisoners. Therefore, providers should be sensitive to co-existing challenges. Programs for PWID should also address the specific needs of female PWID, those who sell sex, and PWID from previously disadvantaged communities. 4
- There is interest—and need—for support: PWID are generally open to health care when they can access it in a safe way. Chris Beyrer, former president of the International AIDS Society said, “…if you reach out to drug users and provide services to them in a safe and nonjudgmental way, they are very eager and willing participants. If they are given access to safe approaches, they will take them and they will use them.” 5
PWID generally need a range of support services related to their health and social welfare. In addition to medical intervention and care, they may need assistance accessing work, housing, and food. 3
- Leverage existing services: ATTC (Addiction Technology Transfer Center) Network centers in South Africa may be key resources when planning for rollout of a PrEP campaign for PWID. 6
- More information on PrEP is necessary: In 2017 market research conducted by OPTIONS in Kenya, many PWID surveyed did not believe there was proof that PrEP worked. Respondents also shared major worries about adherence, including forgetting to take it and not wanting to mix it with alcohol. 1
Successful antiretroviral counseling strategies may be useful in developing PrEP adherence messaging.
These findings show that providing information about PrEP is essential (as it is with any newly rolled-out product). Educating providers and sensitizing all health care workers to PrEP will be important as well.
- Mass media may be limited: Mass media may have a limited appeal because it may not be accessible for the majority of PWID. It may also be difficult to target this relatively small population. While some may watch TV or listen to the radio, PWID may frequently perceive media as unfriendly. However, mass media should still be considered to educate and sensitize the general public, including family and community members, on how to treat PWID, and to encourage support for PWID in recovery—and in using PrEP. 7
- Keep it simple: For communications materials used in outreach efforts, such as posters or leaflets, keep the message simple. The easier the message is to grasp, the easier it will be to translate and engage audiences. 7
- Train providers on sensitivity and confidentiality: Discrimination by and hostility from healthcare workers are huge barriers that inhibit PWID from seeking and receiving care. 8 Providers at all levels should be adequately trained in engaging with PWID with sensitivity and confidentiality, and without judgment. Training methods include courses, mentorship programs, continuous medical education, study tours, and exchange learning visits.
- Deliver through peers: Peer distribution of needles and syringes can increase access, especially for the most marginalized people (women and young users). This can also help ensure a constant supply of needed equipment throughout the week. 7
- Educate and inform on PrEP: Due to low awareness and understanding of PrEP, PWID need comprehensive education about what PrEP is, how it works, how it is effective, and how to take it. 9
- Foster awareness of risk: PWID may not accurately perceive their own activities as high-risk. It may be helpful to review safe injecting practices and safe sex practices. 1
- Make it convenient and accessible: The opportunity cost of seeking health care for PWID may be top of mind; therefore, clinics should think of ways to remove barriers related to time or money. For example, some clinics have implemented a policy giving priority for PWID within queues when accompanied by an outreach worker. As another example, some clinics or clinic partners also organize transportation assistance. 7
- Emphasize community ties: To build credibility and trust, clinics should seek to emphasize their roots within the PWID community and among their peers, and by delivering messages and care through peers.
- Partnerships: Identify and connect with other organizations and programs that are already engaging PWID, such as peer educator programs, medically-assisted therapy programs, harm-reduction programs, support networks, and community-based organizations.
- Combine prevention and harm reduction: In addition to PrEP and condoms, combination prevention approaches have included needle and syringe programs, opioid substitution therapy, HIV testing and counseling, and antiretroviral therapy; these have been found to have the greatest and most cost-effective impact on the HIV epidemic among PWID. 3
- Offer other services that PWID need: Consider also offering access to things that PWID may need or want, such as sterile injecting equipment, mental health services, sexual and reproductive health care, and condoms.
- Target PWID hotspots: One study in Nairobi indicated that PWID typically congregate at outdoor public areas where drug dealers sell drugs. Hotspots like these could serve as useful touchpoints for engaging PWID. 8
OPTIONS. OPTIONS Market Intelligence Report: Kenya. Source. Published November 9, 2018. Accessed January 11, 2019.
Informational interviews conducted by Transcend Media Group, Kenya. 2017.
Guise A, Rhodes T, Ndimbii J, Ayon S, Nnaji O. Access to HIV treatment and care for people who inject drugs in Kenya: a short report. AIDS Care. 2016;28(12):1595-1599. doi:10.1080/09540121.2016.1191606.
Southern Africa HIV Clinician Society/Wits RHI. Working with Different Groups: Module 3(f), People who Inject Drugs. Powerpoint presentation. Published February 2, 2017.
Green A. How Africa’s addicts are being helped to stay HIV-free. Bhekisisa Centre for Health Journalism. Source. Published April 20, 2016. Accessed January 3, 2018.
NGO staff interviews conducted for strategic concept testing in South Africa, Uganda and Zimbabwe.
National AIDS and STI Control Programme (NASCOP). National Key Populations Communication Strategy 2014–2017. Source. Published September 2014. Accessed December 22, 2018.
Tun W, Sheehy M, Broz D, et al. HIV and STI prevalence and injection behaviors among people who inject drugs in Nairobi: results from a 2011 bio-behavioral study using respondent-driven sampling. AIDS Behav. 2015;19(suppl 1):S24-35. doi:10.1007/s10461-014-0936-3.
Hyde L. Achievements and challenges in introducing a harm reduction programme in Kenya. Source. Published April 2016. Accessed December 22, 2018.