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