Where they hang out: creating a peer-led social media campaign to promote HIV testing in young gay men

HIV Australia | Vol. 11 No. 1 | March 2013

WILLS LOGUE traces the development of a multimedia health promotion campaign developed by and for young same-sex attracted me.

Introduction: the rationale of peer-led health promotion

The use of peers in developing and implementing health promotion activities is a practice used by many community-based organisations, including those in the HIV prevention and youth sectors. Peer-developed HIV and sexually transmissible infections (STIs) campaigns have been shown to be effective in encouraging safer sex behaviour among younger gay men.¹

Over the years, The AIDS Council of South Australia (ACSA) and other AIDS Councils have used traditional health promotion strategies to promote the safe sex message – such as posters, booklets and community-based education workshops – delivered by health professionals and sometimes focus tested by community members.

This article examines why ACSA chose to develop a peer-led campaign targeting young people using social media (YouTube), and how we sought to address the barriers preventing many young gay men from engaging with HIV and STI testing.

We also look at the outcomes for those peers involved in developing the campaign, and lessons learned that might inform future campaign development.

Peer power 2.0

There is a growing body of evidence which supports the incorporation of social media into health promotion,² and social media websites such as Facebook, YouTube, and Twitter are being increasingly utilised by health promoters.

Many young men are ‘hanging out online’ and are increasingly seeking health information via the web – specifically, on various social media platforms. This trend has been recognised in ACSA’s Strategic Plan 2010–2015,³ which notes the importance of integrating digital technologies into the development of new health promotion campaigns.

The Health Promotion team at ACSA remain committed to the principles outlined in the Ottawa Charter for Health Promotion (1986), which calls for ‘strengthening community action, developing personal skills and reorienting health care services toward prevention of illness and health promotion’ .⁴

The South Australian (SA) government’s 2011 Strategic Plan also acknowledges the need for community participation to ensure young people’s wellbeing.

The SA government states that: ‘As active participants in our community, young people are strong advocates. South Australia benefits when their voices are included in decision making within our community’.⁵

It is for these reasons that ACSA’s Health Promotion team engaged in a comprehensive community participation process in developing a campaign to address decreases in HIV and STI testing rates in young same-sex attracted men.

Testing rates: reviewing the evidence

ACSA reviewed data from the 2010 Adelaide Gay Community Periodic Survey that indicated STI and HIV testing rates had declined in Adelaide.

Further, this decline had been part of a decreasing trend in HIV testing amongst homosexually active men (66.3% of men tested for HIV in 12 months prior to the survey).⁶

Similarly, 2011 figures published by Adelaide’s STD Services demonstrate decreases in HIV and STI testing among men who have sex with men, who were also disproportionately represented in HIV, chlamydia, syphilis and gonorrhoea notifications.⁷

The study authors suggest that a significant factor associated with whether an individual tests for HIV is their age, with the likelihood of never being tested being three times higher in young men under the age of 30 compared to older men.⁸

The study authors explain the disparity in the following two ways: firstly, the sexual practices of gay men diversify as they get older, with risky sexual practices prompting increased testing.⁹

Secondly, as gay men age they seek out testing for STIs, and as such the probability that those men will be exposed to health promotion services also increases.¹⁰

An online study examining barriers to testing among young people in New South Wales (NSW) found that younger men who have sex with men ‘were less likely to be tested for HIV/STIs … and reported lower HIV/STI knowledge’.¹¹

This research also found a correlation between low testing rates and the level of exposure to HIV campaigns among younger gay men.¹²

Although sexually active men aged 30 to 45 years have been the main target group of sexual health programs in Australia,¹³ this research suggests the need for more education targeting young men regarding the need for HIV and other STI testing.

According to the Adelaide Gay Periodic Survey, age is a significant factor associated with whether an individual tests for HIV. The likelihood of never being tested is three-times higher in young men under the age of 30 compared to other men.¹⁴

Exploring the findings ACSA recruited 35 gay and bisexual men aged 17–25 from the Adelaide metropolitan area to participate in a community question and answer workshop to explore the findings of the Adelaide Gay Community Periodic Survey, as well as to understand why young men are not testing for STIs and HIV.

The workshop explored potential campaign design and formatting ideas on how to address individual and social factors that may act as barriers to HIV and STI testing among younger gay and bisexual men.

The men who participated in the workshop were asked if they recalled any STI/HIV campaigns; of the 35 men who participated, 30% recalled the Generations Campaign (an ACSA produced and focus tested resource targeting men aged 20–65).

None of the young men identified with the characters, and consequently did not believe the message targeted them.

The men were also asked about recent sexual health screening; 70% of the group had never had an HIV test, and only 50% of the group had undergone an STI health screening in the previous 12 months. This data supports the findings of the Adelaide Gay Periodic Survey, which indicates that younger gay men are not testing for HIV and STIs.¹⁵

This is has been attributed to the focus of social marketing campaigns targeting gay men over the age of 30.¹⁶ The workshop sought clarification from the men as to why they do not test, or do not test frequently; they identified ‘fear’ as the primary reason for not testing.

The following five reasons were frequently mentioned as barriers to HIV/STI testing:

fear of social stigma
fear of being identified at the clinic
fear of the unknown
fear of what is behind the clinic door
fear that having a test will hurt.

A study from the US found that 92% of young people aged 18–29 use the internet, and 71% search for health information online.¹⁷Smart phones were found to be a key way that young Americans accessed health information.¹⁸ This study supports the findings of the ACSA’s workshop.

Echoing this overseas evidence, the young men interviewed by ACSA identified the internet as being their number one source for gaining health information, followed by phoning a sexual health service.

These men stated that they also accessed health information through social media platforms such as Facebook, Tumblr and Twitter, confirming the potential success of a social media based health promotion strategy.

‘TESTING, Too Easy!’ Developing the campaign

The ACSA workshop participants said they thought the most effective method of communicating a health message was through social media and developing a peer-based campaign that took on a ‘real’ or relevant message, as opposed to the traditional campaign formula of top-down health education by professionals.

Consequently, ACSA sought both community (ten men from the workshop) and sector participation in developing a peer-led social media campaign targeting same-sex attracted men aged 17–25 years.

ACSA invited Sexual Health Information Networking and Education (SHine) SA and The Second Story Youth Services, (South Australia’s two lead sexual health providers targeting young same sex attracted men), to assist in developing and delivering the campaign.

The working committee made recommendations based on evidence, and asked the young men to ensure the key findings were included in the campaign messages.

The primary aim of the campaign was to address some of the ‘fears’ around testing, as identified by the young men at the workshop.

The use of social media, and engaging peers from the developmental stage through to implementation had a dual purpose.

Through community participation, the campaign took on a more ‘real’ or relevant message which helped ensure that it was promoted within the men’s social networks.

The community members involved in developing the campaign were also able to take real ownership, which in turn ensured the message of the campaign was promoted to the targeted demographic through social networks.

Based on the outcomes of the workshop, the men involved were engaged by ACSA to develop a short video and named it ‘TESTING, Too Easy!’.

The group met weekly at ACSA for three hours per week, working with a professional filmmaker and health professionals to create and deliver a seven-minute video, developing the characters and then the script. View long version on YouTube

All participants received an incentive payment to compensate for travel and time. The video was shot at various locations across Adelaide, in a marathon 14-hour day.

ACSA paid for the services of a professional cameraperson, a make-up artist, an editor, and a director who all contributed to the final product.

ACSA would like to acknowledge Youth Empowerment Against HIV (YEAH) and SHine SA for promoting the ‘TESTING, Too Easy!’ video on their websites.

Since the video launch, Google analytics statistics reveal 730+ viewings of the 40-second trailer and the full-length 7-minute video. The total minutes viewed exceed 645 minutes; the demographic indicators show 50% of those viewing the video are aged 16–30 years. Google analytics indicates that 70% of viewings are through a mobile phone.

The target viewing number is 1,000 by 30 June 2013.

ACSA is currently undertaking an impact evaluation on the effectiveness of the campaign, to determine if the campaign has directly influenced the number of younger men testing for STIs and HIV.

The evaluation results will provide some insight around the success of peer-based social media campaigns as an effective way of engaging with young gay men in the community.

Conclusion

Health promotion has evolved rapidly over the past ten years. Gay men of all ages are accessing more health information online, and with the use of Facebook, Twitter, YouTube and other social media platforms on the rise, the mode of online communication is changing.

There are examples from across the globe of successful social media campaigns being implemented: young people in Africa are creating rap songs about HIV and uploading them onto YouTube; The Victorian AIDS Council has embraced the two-way communication of web 2.0 in ‘Down and Dirty’ (www.downandirty.org), allowing community members to post videos and encouraging online engagement to access information, knowledge, perspectives, resources and community participation.

How gay men access health information has undergone a ‘revolution’, and it is important that HIV health professionals engage with gay men ‘where they hang out’. This will ensure we are reaching our communities.

References

1 Kegeles, S., Hays, R., Coates, T. (1996). The Empowerment Project: A community level HIV Prevention Intervention for Young Gay Men. American Journal of Public Health 86(8), 1129.

2 Park, H., Rodgers, S., Stemmie, J. (2011). Health Organisations Use of Facebook for Health Advertising and Promotion. Journal of Interactive Advertising, 12(1), 1–16. Retrieved from: jiad.org/article153

3 AIDS Council of South Australia (ACSA). (2010). Strategic Plan 2010–2015. ACSA, South Australia.

4 World Health Organization (WHO). (1986). The Ottawa Charter for Health Promotion. First International Conference on Health Promotion, Ottawa, 21 November 1986. Retrieved from: www.who.int

5 Government of South Australia. (2011). South Australia’s Strategic Plan website (Category: Young People). Retrieved from: http://saplan.org.au

6 Hull, P., Holt, M., Mao, L., Skene, H., Dinnison, S., Mortimer, E., et al.(2011). Gay Community Periodic Survey: Adelaide 2010. National Centre in HIV Social Research (NCHSR),The University of New South Wales, Sydney. Retrieved from: http://nchsr.arts.unsw.edu.au/

7 The Kirby Institute. (2011). HIV, Viral Hepatitis and Sexually Transmissible Infections in Australia, Annual Surveillance Report 2011. The Kirby Institute, The University of New South Wales, Sydney. Retrieved from: www.med.unsw.edu.au

8 Lee, E., Holt, M., Mao, L., Wanganeen, K., Dinnison, S.,Williams, S., et.al. (2012), Gay Community Periodic Survey: Adelaide 2011. NCHSR, The University of New South Wales, Sydney. Retrieved from: http://nchsr.arts.unsw.edu.au

9 ibid.

10 ibid.

11 de Wit, J., Holt, M., Treloar, C. (Eds.) (2012). HIV/AIDS, hepatitis and sexually transmissible infections in Australia: Annual report of trends in behaviour 2012 (Monograph 6/2012). National Centre in HIV Social Research, The University of New South Wales, Sydney. Retrieved from: http://nchsr.arts.unsw.edu.au

12 ibid.

13 ibid.

14 Lee, E., et al., op. cit.

15 ibid.

16 de Wit, J., et al., op. cit

17 Fox, S. (2011, 12 May). The Social Life of Health Information, 2011. Pew Internet. Retrieved from: http://pewinternet.org

18 ibid.

Wills Logue is Health Promotions Officer, Gay Men’s Health at The AIDS Council of South Australia.