How can social marketing help control the alarming spread of HIV/AIDS?

Question: We’re junior public administration students. Some three years ago, we attended your social marketing seminar. In one portion, you narrated your experience in the 1980s with the social marketing of condoms for the Population Commission (Popcom).

Last school year, we came to know of three confirmed cases of students with HIV. We suspect there may be more. Quietly, our school doctor advised us, section by section, that the use of condoms can help control or prevent the spread of infection. Wasn’t that what your Popcom campaign was all about?

We’ve met informally with our student association officers who are just as concerned. We want to organize and quietly launch a simple and inexpensive word-of-mouth IEC (information, education, communication) campaign. It’s just for student awareness and information about where to go for testing and counseling. Please give us some tips.

How can social marketing help stop the alarming spread of HIV?

Answer: I agree with you that there is a real cause for alarm. That “cause” resides in the known facts of the case.

According to DOH’s National Epidemiology Center, just in the month of November 2014, there were 492 new HIV cases. Of this total, 134 were aged 15 to 24 years old. The 492 new cases represented a 28-percent increase from the 384 new cases recorded in November 2013. So HIV infection is on the rise. The three known student cases in your school are a part of those total reported new cases. Thailand used to have the most alarming rate. The Philippines has now replaced Thailand. It’s a sad record and nothing to be proud of.

Can a social marketing based IEC about the use of condoms help stem the spread? Let me start with some quick clarification about that condom usage campaign of the late 1970s. So it wasn’t a campaign of the 1980s.

The program was for a different purpose. It was to persuade couples. particularly those in the Class D and Class E segments. to use condoms to prevent unwanted pregnancies or for birth spacing. The campaign you wish to get into is a persuasion program that’s trying to convince the sexually active students to use condoms as protection against HIV infection.

But there are strategic similarities. Both campaigns are about condom usage.   And that usage is about wearing a condom during sexual contact, without exception. It’s critical that there be no exception, Otherwise, the user is open to the risk of accidental pregnancy (in the case of the partner for family planning usage) or the risk of infection (in the case of HIV protection).

The compliance rule of no-exception-in-condom-usage for protection against HIV infection contains the true core of the problem. Interrupted patient compliance is common. This is true in TB therapy, drug addiction rehab, smoking cessation and even physical fitness programs. Uninterrupted and no-exception usage behavior is not even an exception. We have no recorded experience of a campaign that has been successful in this kind of behavior changing intervention.

In the latter half of the 1980s, when the WHO sounded the alarm on the HIV/AIDS pandemic, most NGOs and health organizations talked of their engagements for diffusing condom usage for protection in terms of the “condom sales” metric.

In 1991, I spoke at the Usaid-sponsored Second Annual AIDS Prevention Conference in Washington, D.C. I talked about “how to contain the rise of AIDS prevalence and condom usage.”

I rejected the reported condom sales as a valid metric for gauging the success of HIV/AIDS prevention programs in the African countries with the highest rates of recorded HIV/AIDS incidence. I insisted on a no-exception condom usage, even for married couples. This was the valid though difficult-to-monitor success metric. In your own school campaign, avoid this error of “sales-as-success” metric.

In its actual effective execution, what did that no-exception to condom usage program look like? Eventually, health organizations in the African countries accepted the reality that condom sales were a poor and misleading metric of condom usage. Then, the HIV protection program became a condom usage behavior changing program. For couples, for example, the program was a coaching module.

In several sessions, a trained male mentor coached a husband on how to “negotiate” with his wife about his using condom in each and every sexual contact. “Negotiation” was key to disarming a suspecting wife about her husband’s fidelity. Similarly with the wife whose husband, for example, refuses to use condom. A trained female mentor coached the wife how to persuasively “negotiate” with the suspecting husband to wear a condom during every sexual contact. It was long and tedious, but in the end it proved to be the effective process of finally containing the epidemic.

For the commercial sexual workers (CSWs) or prostitutes, a very at-high-risk population segment, another kind of coaching program was put in place. For example, in Bangkok, a professionally trained Ministry of Health female coach mentored a CSW on how to orally put on a condom on a customer’s penis. This was necessary because almost all customers refused to wear condoms.

All the preceding was just the first round although it was the critical and crucial round. What came after were IEC activities like condom usage reminders, support group sessions, and other “habituating” initiatives. To the same extent that we require of at-risk persons a religious and unfailing condom usage behavior, we have to require of ourselves as social marketers a similar religious and unfailing informing, educating and communicating (IED) behavior toward our intended beneficiaries.

And please note that every step in the process was a team effort. The social marketer cannot work alone. She must have her own support team consisting of social workers, doctors, nurses, and midwives, counsellors, trainers, and several others. The critical role of this team approach has its details explained with real-life case illustrations in my 2012 book, How to Change the World: a Manual for Social Marketers.

So that’s how you should organize and launch in your school a social marketing based “simple and inexpensive word-of-mouth IEC campaign” for condom usage by the sexually active student segment.

Keep your questions coming. Send them to me at [email protected].