CDC and UGA recently partnered on a project to develop "personal PSAs" (PPSAs) for National Testing Day. Sounds kind of old-school, right? Think again. The 32 PPSAs were developed by Atlanta college students in the course of a single day using cell phones. The videos, which were disseminated through YouTube, other websites, and cell phones, paired field teams of college students with professional producers, who helped them edit their footage - a fact that the program team believes was critical to both the quality of the PPSAs and the success of the campaign. UGA and CDC provided the students with basic training on HIV/AIDS, as well as key messages, but left the rest of the creative process to the teams, allowing for truly participatory (if not actually user generated) media. Some PPSAs were found to have been circulated within social networks as far away as Tanzania and Botswana - not bad given that they were only promoted in eleven American cities. An evaluation of the campaign is currently in the works. Check out the PPSAs on the UGA website. Kind of makes you want to buy an I-Phone, doesn't it?
On Tuesday, Tiffiany Aholou, Tanisha Grimes, and Su-I Hou of UGA presented a qualitative study exploring strategies for reducing stigma and promoting HIV testing proposed by PLWHA in rural Georgia. Some of the themes that emerged from the participants' suggestions included:
Based on these suggestions, the authors recommend that stigma reduction programming in the rural South include mass media campaigns that empower those across the socio-economic (and HIV-experiential) spectrum with dual messages of disease prevention and disease management. Specific recommendations include expansion of current BCC programming on cable stations to major networks and a possible revival of comprehensive household mailing strategies used to communicate health information during the 1980s. To me, what's really striking about this research are the parallels between the respondents' recommendations and the best practices that were discussed at the panel on global evidence-based stigma programming at the IAC (described in "A Viral Disease, Not a Moral One," below). Further evidence of just how universal the problem really is?
At PSI, we like to bundle things - condoms and lube; male circumcision consumables; basic care products for PLWHA - so I was excited to check out some new research on message bundling. For those of you not in the know (like me, five hours ago), "message bundling" is just a fancy way of describing what BCC implementers everywhere are prone to doing - fitting lots of messages into one material. Is this a bad thing, in a field where we're constantly reminded that "focus demands sacrifice?" How many messages is too many?
A recent study of preconception health messages conducted by Karen King indicated that one could bundle up to four messages in a single print material without significantly impacting message recall, regardless of whether or not the messages were clearly related in terms of "category" or theme. What's not clear based on the study is the upper limit of bundling - subjects demonstrated significantly less recall for materials that contained sixteen messages, but no reduction for materials containing four. It would be helpful to know at what point between those two numbers the critical transition from memorable to forgettable occurs (maybe this brings us back to George Miller's Magical Number Seven, noted in this morning's plenary?). Also significant: the fact that the study only examined message recall for brochures. One would think that bundling would be more feasible using longer or more interactive formats. Ready for your next study, Dr. King?
I'm posting this week from the second National Conference on Health Communication, Media, and Marketing in Atlanta. The conference, which is sponsored by the CDC, revolves this year around the theme "Engage and Deliver" and brings together nearly 1000 BCC and social marketing implementers, academics, and researchers.
Due perhaps to the current focus on social drivers of the HIV epidemic, stigma - against those infected and affected by HIV, TB patients, MSM, and CSW - was much discussed in Mexico City. So why aren't we doing a better job addressing it? In an inspiring presentation on Wednesday, Edwin Cameron of South Africa's High Court observed that, while we know a good deal about the external manifestations of stigma, we are less well informed about the internal dimension of the problem - how stigma works in the mind of a person who has or fears s/he has HIV. Cameron also posited that we may be further stigmatizing HIV by "making exceptions" around counseling and testing rather than routinizing it in the way we have diagnostics for other health conditions. Both of these points, should one subscribe to them, have important implications for communication around stigma, which has tended to be broadly targeted, proscriptive, and solidly focused on "external" stigma.
In practical terms, we could stand to better adhere to best practices in stigma reduction programming, which are now well established. These include involving gatekeepers early; cultivating multiple change agents; using a range of intervention approaches and communication channels; addressing multiple "layers" of stigma (stigma around HIV, homophobia, stigma around TB, etc); and perhaps most importantly, giving PLWHA both a central role and a safe space to address internal stigma before acting as advocates.
Why is this so important now, for those of us in the world of communication? Stigma continues to undermine the success of interventions in all domains of HIV/AIDS programming, from service promotion, to prevention, to treatment uptake and adherence. Addressing stigma should be, as one speaker on Wednesday's panel pointed out, the complement to all other HIV/AIDS interventions - enhancing their efficacy by providing a solid social foundation for individual behavior change.
With the Olympics, China has been in the news a lot lately. However, PSI's own Clare Ye Sheng was interviewed about PSI's HIV prevention work in Kunming, China. She talks about PSI's programs and the challenges faced in raising awareness of HIV and changing behavior and social norms. Check out the article here.
Amidst all the fevered talk of scaling up medical circumcision at this year’s International AIDS Conference, there were quieter rumblings about the surgical procedure’s oft-maligned older brother, traditional circumcision. Fred Sawe of the Kenya Medical Research Institute presented on an intervention in Kenya’s Rift Valley, in which community IPC agents were trained to promote SRH among young men during the annual circumcision season. Mogomotsi “Supreme” Mfalapitsa of EngenderHealth South Africa argued the need for SRH “curricula” for initiation “schools,” and participants at MC sessions proposed programmatic approaches ranging from training of clinicians moonlighting as traditional circumcisers to the establishment of charters for initiation schools. Participants in several MC sessions I attended also expressed broad support for the idea of national and sub-national consultation with local stakeholders (including both men and women), as well as increased focus on CT services for men.
Recent dialogue around circumcision (in both its traditional and medical forms) provides a valuable opportunity to get serious about improving men’s SRH. How to address traditional circumcision in the context of MC programs remains a difficult question - but maybe we should also be asking ourselves how we can leverage traditional coming of age rites to improve access to services and SRH information among young men. Too often, we see MC and traditional circumcision framed in opposition – an either/or of male well-being. Shouldn’t we be grateful that male SRH and service use are on the global agenda, and take any opportunity we can to improve them?
I went to a fantastic session on Wednesday on using sensuality to promote safer sex among MSM. The workshop, which was facilitated by Anupam Hazri of the SAATHI project, included a series of participatory activities on sensuality and safety, as well as presentations of work being done by the Pleasure Project and Australia's Victoria AIDS Commission. All of these organizations are putting pleasure front and center in their HIV prevention programming - through sex-positive IPC, safer-sex porn, and multi-media campaigns that play on desire rather than fear.
What would sexier programming mean to us at PSI? First and foremost, framing safer sex in the context of pleasure rather than safety. Would this be appropriate in all settings, or with all audiences? Probably not - but considering it as an option seems like an important first step. Central to this approach is the recognition that safer sex doesn't have to just mean using a condom. At SAATHI, staff talk to male masseuses about using a "ladder process" when negotiating safer sex with a client - first discouraging penetrative sex; then (if the client refuses or wishes to continue) alternatives to penetrative sex (such as intercrural or "thigh sex"); then penetrative sex with a condom; and finally, as a last result, refusal or "extreme excuses." This reflects both a pragmatic approach to condom negotiation and an appreciation of the fact that the universe of sexual opportunities is broad and varied.
The idea that people have multiple identities and "gender performances" that play into the different aspects of their lives and influence their decision-making is also key. We spend a lot of time segmenting our audiences according to their behaviors and demographic characteristics, but we don't always take the next step and think about the "whole" person, including those parts of them that may be less obvious or less directly linked to the behavior we seek to change. Developing comprehensive audience profiles - something we emphasize at PSI - helps with this, but we need to be especially conscious of the many facets of gender and sexuality.
Finally, promoting safer sex with a greater focus on sensuality has implications for our work with couples, providing an opportunity to address sexual equity and communication in a way that is fun and empowering.
For more information on erotic promotion of safer sex and case studies of some of the organizations that are doing it well, see the Pleasure Project's new Global Mapping of Pleasure report at: https://www.thepleasureproject.org/content
If the offerings at the International AIDS Conference are any indication, the days of stickers, baseball caps, and trifold brochures may be behind us. Here are some of the many creative gadgets and audience take-aways I spotted around the conference today: sweatbands; accordion-style pocket medication calendars; dog tags; scratch cards; printed cloth wristbands (these seem to be overtaking LiveStrong-style rubber bracelets as the hot campaign accessory du jour); pens with roll-out brochures in the cartridge; tea towels; condom "wallets" on lanyards; printed matchbook-style condom envelopes; brochures in shapes - high heels, condoms, lungs, etc; and pocket comics. Nice!