“Are You Iffy?”: A Social Marketing Campaign to Address Uncertainty in HIV Status Communication Among Men Who Have Sex With Men

Abstract

To The Editor: Recent data show that 44% of HIV- positive men who have sex with men (MSM) in the United States were unaware of their infection.1 Having inaccurate information about one's HIV status along with increasing practice of serosorting may increase risk of HIV infection among MSM.2,3 Yet, the continued use of the language “HIV-negative” to describe one's HIV status, regardless of recent sexual risk and HIV testing history, suggests that new language is needed for self assessment and communication of HIV status. We launched a social marketing campaign “Are You Iffy?” to encourage MSM in San Francisco to reassess their HIV-negative status. Focus groups and community field-testing were conducted to design the campaign, introducing the concept of being “iffy” about one's HIV status (Fig. 1). Between May and July 2008, 10,000 palm cards, 140 posters, 7 large billboards, and 10 newspaper advertisements were distributed at various locations, including bars/clubs, bathrooms, subway and bus terminals, and newspaper kiosks, in neighborhoods where MSM are known to congregate. A post-test evaluation was conducted between July and October 2008 to assess the effects of the campaign as a part of the National HIV Behavioral Surveillance survey. Details of National HIV Behavioral Surveillance sampling and recruitment procedures have been described elsewhere.4,5 Participants were asked how sure they were about their HIV status on a scale of 1 (not sure at all) to 5 (very sure), and if they had rethought how certain they were about their HIV status after they saw the campaign. The study was approved by the Centers for Disease Control and Prevention Institutional Review Board and the Committee for Human Research of the University of California, San Francisco.Figure 1.: “Are You Iffy?” campaign palm card.Study population: N = 316; 53% white, 24% Latino, 7% Asian, and 7% black; mean age = 37.6 (standard deviation = 11.3); 54% with a bachelor degree or higher, 33% completed some college, and 13% with a high school degree. In all, 61 (19%) participants self reported being HIV positive and were thus not asked the evaluation questions. Of the remaining 255 MSM, 114 (45%) reported having seen the campaign. About 73 (64%) correctly identified the campaign as being about reassessing one's HIV status. Overall, of those who saw the campaign, 41 (36%) indicated that they rethought their own HIV status after seeing/reading the messages in the campaign (Table 1). It is noteworthy that 31% of those who were “Very sure” of their HIV status at the time of the survey also reported to have reconsidered their status, suggesting that the campaign concepts and messages resonated with men across varying levels of certainty around their HIV status.TABLE 1: Effects of the “Are You Iffy?” Campaign in San Francisco: Proportions of MSM Participants Who Have Reconsidered Their HIV Status Due to Exposure to the CampaignThe campaign was moderately successful in reaching non-HIV-positive MSM, and encouraging them to reassess their HIV status. This effort suggests that such campaigns may help reinforce MSM who are unsure of their HIV status to think critically about how confident to be in their HIV-negative status. Future campaigns built on this one can explicitly focus on how to appropriately communicate uncertainty around HIV status to one's partners and how to overcome barriers to HIV testing so that MSM will be better aware of their HIV status. Jennifer Hecht, MPH Jason Riggs, BA Hunter Hargraves, BA STOPAIDS Project San Francisco, CA Chongyi Wei, DrPH Behavioral and Community Health Sciences Graduate School of Public Health University of Pittsburgh Pittsburgh, PA H. Fisher Raymond, MPH San Francisco Department of Public Health San Francisco, CA hfisher.[email protected]