Research Update I: HIV Stigma

In 2008, an innovative campaign aimed at gay and bisexual men was launched to stop HIV stigma. This campaign moved beyond more static messages (often the trademark of social marketing campaigns), to spark discussion at the community level about stigma and sexual decision-making -- to ultimately enhance the sexual health of gay and bisexual men.

More recently, a report was published on how the HIV Stigma Campaign was created, rolled out and evaluated. Did this campaign succeed in mobilizing the gay community and in changing people's attitudes and, eventually, behaviours? This campaign model shows significant promise -- take a look at the rationale below for why it worked.

What Was the Campaign?

The HIV Stigma Campaign was developed by Ontario's Gay Men's Sexual Health Alliance, a broad coalition of gay men and their allies from community-based AIDS service organizations, public health, government and research, as well as other community members. This campaign aimed to:

• diminish HIV stigma

• create greater support for HIV-positive men

• make HIV disclosure safer

• discourage reliance on disclosure to prevent HIV transmission

• encourage testing

Unlike other campaigns, which are often based on one key message, this campaign was based on a provocative question: "If you were rejected every time you disclosed, would you?" This question was aimed at encouraging gay men in Ontario to think about, and have conversations with each other about, the effects of HIV stigma. The question was circulated through billboards, in media aimed at gay and ethnoracial communities, in online ads and on standard outreach materials (condom packs, posters, t-shirts and postcards). The point was to lure participants to the hivstigma.com website, the crux of the campaign.

The website included information, a community forum and a listing of relevant organizations in Ontario (including HIV testing sites, AIDS service and other health-related organizations, gay community groups and social groups).

How Did the Website Work?

When someone first visits the website, they are presented with the question: "If you were rejected every time you disclosed, would you?" and an option to click "yes" or "no." They also see a short video that uses casual language and makes a few key points about such things as how stigma discourages disclosure and why disclosure cannot be relied on as an HIV prevention technique.

For five months, eight campaign bloggers -- HIV-negative and HIV-positive gay men -- facilitated lively online discussions on a range of topics, through ongoing postings and videos.

How Was the Campaign Evaluated?

The HIV Stigma Campaign was evaluated by two independent researchers in consultation with the Gay Men's Sexual Health Alliance. By using surveys for gay and bisexual men before and after the campaign was launched, the researchers were able to assess if the campaign had an impact on attitudes about HIV stigma, HIV testing and disclosure in gay and bisexual men who had seen the campaign.

What Did the Evaluators Find?

The evaluators determined that the campaign succeeded in increasing awareness of HIV stigma among gay and bisexual men in Ontario. The men who had seen the campaign were

• more likely to recognize the stigma that HIV-positive men may face (81% compared to 70% of those who had not seen the campaign)

• more able to recognize that poz gay men might be reluctant to disclose their HIV status to sex partners because they don't want to be rejected (73% versus only 65% of the men who had not seen the campaign)

• better able to understand why some HIV-positive men don't disclose their HIV status -- they recognized that there might be a reason for non-disclosure in certain circumstances

The evaluators concluded that these outcomes were the result of using a combination of traditional social marketing (the ads), new social media strategies (the website, videos, blogs) and community outreach activities.

What's the Verdict?

The HIV Stigma Campaign struck a cord with many gay men in Ontario: Over the course of the campaign, a total of 20,844 people visited the website. And 4,000 of those people visited the site more than 10 times. This suggests that many people followed the dialogue on the blogs and that the campaign's impact had not only breadth (reaching many people) but also depth. These findings demonstrate that many gay men will take an interest in such a campaign and that newer social media approaches to awareness-raising can be useful.

While there is no evidence to show that this campaign had an effect on the HIV testing and transmission behaviours of gay and bisexual men, the campaign did prove to be successful in increasing awareness of HIV stigma and its role in HIV transmission, and in generating conversations about how stigma can contribute to situations of vulnerability to HIV transmission. It was a forum that provided men with a collective space to work through perceptions and understandings of HIV risk in their everyday lives.

Social marketing campaigns to address HIV stigma that combine traditional social marketing advertisements, community outreach and a website/blogs can generate dialogue among gay men on important issues related to stigma and HIV transmission. Campaigns that build on strong community-based outreach and use a collaborative approach, as the hivstigma.com campaign did, may have the potential to have a big impact on how men think about HIV stigma and HIV transmission.

Reference

Adam BD, Murray James, Ross Suzanne et al_._ hivstigma.com, an innovative web-supported stigma reduction intervention for gay and bisexual men. Health Education Research. 2011 Jan 17.