PSI & VCT:PSI & VCT:Social Marketing Approaches Social Marketing Approaches
to Voluntary Counseling to Voluntary Counseling and Testingand Testing
Hang Trinh, MD, MPH
Senior Program Manager
PSI/Vietnam - August 2005
Strategic Objectives of PSI VietnamStrategic Objectives of PSI Vietnam
Increase knowledge of and demand for VCT services by select target groups
Increased capacity of partners to implement social marketing interventions
Addressing issues related to decreased stigma of HIV-positive persons and the use of VCT services in high-prevalence communities
Target populationsTarget populations
Injecting Drug UsersSex Workers (Direct (street based)
and Indirect (karaoke, massage)Sexual partners of most at risk
populationsShort, Most at Risk Populations
(MARP)
Increased knowledge of and Increased knowledge of and demand for VCTdemand for VCT
Simply: Get more vulnerable groups to access VCT services
HOW? Development of an integrated marketing and communications campaign
A Social Marketing StrategyA Social Marketing Strategy
Formative Research– Identify the barriers of MARPs to accessing
VCT– Develop messages to break down those
barriersSegmentation and focused targetingDevelop the marketing strategyDevelop the communications campaignMonitoring and evaluation
SUMMARY OF PSI/VN’S SUMMARY OF PSI/VN’S QUALITATIVE RESEARCH QUALITATIVE RESEARCH
ON VCTON VCT
What we wanted to knowWhat we wanted to know
How do MARP perceive VCT:Understand motivational triggers, perceived
barriers and benefits to accessing VCT
Users‘ of VCT past experiences: Obtain insight into the benefits and
advantages of knowing HIV status
Why?Why?
To develop a focused communications campaign to increase informed demand for VCT
Simply put, convince vulnerable populations to access VCT
MethodologyMethodology14 In-depth interviews w/prior users of
VCT16 Focus Group Discussions w/target
group (generally non users):Study Groups
IDUs SWs (Direct and Indirect) Sexual Partners of IDUs
Target Sites: Hanoi and Hai Phong
Many misconceptions of VCT Many misconceptions of VCT dominate, especially w/SWs:dominate, especially w/SWs:
Few non-users know where VCT sites are located
Knowledge of services is vague, and VCT is not well differentiated from hospital testing
Past negative experiences with health care system shape feelings about VCT
Barriers to Access Barriers to Access (Linked to Stigma and Fear)(Linked to Stigma and Fear)
Stigma/discrimination against PLWHA, as well as behavioral related stigma (IDU and SW)
“I’m sure that 100 drug addicts all have the same thought. They’re afraid of being isolated, kept away, and losing the chance to go back to their family.” (Hanoi IDU)
Being recognized by friends or acquaintances Issues related to Confidentiality Fear of positive result, and with no cure for HIV/AIDS,
there is no reason to get tested—hopeless and depression that would accompany.
Barriers to Access Barriers to Access (More surprising)(More surprising)
Among sex workers the fear that testing will result in loss of income
“We accept the fact that we might contract the disease, however we don’t dare to go for a medical examination because people might start rumors about our problem and keep away from us. Consequently, we will find it difficult to continue our jobs, to earn money, to feed our children. This is a reality”. (Hai Phong street-based sex worker)
Fear of being treated badly by health workers
Motivational triggers for Motivational triggers for accessing VCTaccessing VCT
A family member, friend demonstrating symptoms of AIDS
Outreach workers can be crucial“Now there is a peer group. They came to my house and invited us to join the group activities. We joined for one meeting and last Sunday went for the 2nd time. Then I noticed my husband got sick, so my husband and I planned to go [for VCT].” (Hanoi partner of IDU)
Motivational triggers for Motivational triggers for accessing VCTaccessing VCT
A close call To make a ‘New Start’ (relationship,
getting clean)
“There is a girl who loves me. I will go for the test in order to protect her. I really love her and will make a new start if I’m not infected.” (Hanoi IDU)
Perceived Benefits of Perceived Benefits of accessing VCTaccessing VCT
Opportunity to protect partners and family members from infection
“The test result is positive. I use drugs and I have to accept that. I’m okay, but knowing that I am positive, I’m thinking of my wife. She is my hope.” (Hai Phong IDU)
Perceived Benefits of accessing VCTPerceived Benefits of accessing VCT
Peace of mind and relief from anxiety and worry:Relief is the converse of the fear of
hopelessness if found positive. Opportunity to protect oneself from
becoming infected (especially for CSWs)A chance to start again with a brighter
future. Access to medical care
Key Desired Characteristics of VCT Key Desired Characteristics of VCT services: services: What do people want?What do people want?
Confidential and Anonymous Testing. Friendly, sympathetic, and respectful staff Staff they don’t already know Convenient (times & locations) Counseling with accurate information to prevent
transmission. Accurate test results Free or low cost service Quick results with short waiting time Routine testing or making it "normal" was proposed as
a way to ameliorate the anxiety surrounding testing. If everybody does it, it won’t be so embarrassing or frightening.
Started off in Beginning with a Real Started off in Beginning with a Real Social MarketingSocial Marketing ChallengeChallenge
Creating demand for a service: With high latent need
(but very low perceived need) With possibilities of being highly stigmatized Capable of making frightening revelations Whose benefits are neither tangible nor clear That initially promised no curative or medical back
up . . And the preventive benefits were not really widely understood
Media Messages: Phase 1 (2005)Media Messages: Phase 1 (2005)
Increased general awareness of VCT as a new service available in Vietnam through promotion of specific VCT centers. The goal is for populations to: be well aware of what VCT is; and that promoted services are a quality and highly
confidential service; know exactly where such services are located in their
community; feel confident that they will be welcomed at these
VCT sites;
Provide Correct Site Information Locations Clarification of Services offered Operating hours
Media Messages: Phase I (2005)Media Messages: Phase I (2005)
Define Quality of Service
Confidentiality
Friendly, sympathetic staff attitude
Accurate, timely results
Media Messages: Phase I (2005)Media Messages: Phase I (2005)
Emphasizing Counseling and Talking
Calm anxieties
Opportunity to “Work out problems”
“Protect yourself and your family”
Media Messages: Phase I (2005)Media Messages: Phase I (2005)
Sample of Concept DesignSample of Concept Design
Emphasize benefits of knowing serostatusBuilding personal conviction in the
perceived benefits of learning one’s status via VCT, including: to protect loved ones from possible infection; to plan for a brighter future- including marriage or
children, new work; if you are negative, learn ways of staying negative; peace of mind and relief from worry;
if you are positive – access to medical care;
Media Messages: Phase II (2006)Media Messages: Phase II (2006)
Signs should: avoid using “HIV” or “AIDS”
Branding Sites will increase awareness and acceptability of sites, and serve to link advertising campaigns with sites
Promotional materials should: Clearly identify sites as VCT clinics
Give detailed directions and hours
SignageSignage
Brand Name & LogoBrand Name & Logo
Brand name: Implying a new beginning in life
Logo: Depicting “Hope” through rising sun and vibrant colors
Product description: “Counseling and Testing Centre” (Not “HIV/AIDS center”)
Includes desired action right in slogan itself: “A New Horizon!”
Lowering Stigma is essential
Use role models to break the silence
Make testing a part of normal life
Behavioral stigmatization needs to be
addressed
Long Term (and not easy)Long Term (and not easy)
ConclusionsConclusionsSocial marketing can be successfully used to
increase demand for VCT services Research is key to prioritizing messagingTwo phases will be utilized, emphasizing
– Knowledge of VCT, service attributes, and locations
– Benefits of accessing VCTStigma against PLWHA and discrimination of
specific groups (IDU/SW) is very high and should be addressed concurrently with VCT promotion activities for maximum benefit