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Maryland has the fourth highest rate of new cases of HIV/AIDS in the United States.1 The problem is particularly severe in the city of Baltimore, where AIDS is the leading cause of death among those age 15-40.1 How can the issue be addressed?
One answer lies in the Red Ribbon Question Mark Campaign, a multimedia social marketing campaign intended to promote HIV testing in Baltimore, specifically in the three zip codes with the highest HIV seroprevalence in the city. Designed for the Maryland AIDS Administra-tion by the Johns Hopkins University Center for Communication Programs and Eisner Communications, all in Baltimore, the campaign’s intended audience includes women of childbearing age, men and women engaged in risky behaviors, and health care providers.
Since the program’s inception, testing is up 9.6% statewide, and 48% and 30% at sentinel testing sites. The campaign has reached a 76% awareness level and boosted "intent to get tested" by 19 percentage points. Calls to the First Call for Help referral hotline have increased 1,500% after the campaign began, with 62% of callers crediting the campaign as the impetus for their request.2
With new breakthroughs in clinical care, it is important for patients to know their HIV status early enough to take advantage of available treatment, as well as to learn how to protect themselves and others from transmission, says Liza Solomon, DrPH, director of the Maryland AIDS Administration. The Red Ribbon Question Mark campaign addresses these topics through its theme line, "Live Long. Live Strong. Get Tested."
Keep message positive
The key to any successful social marketing program is to know the audience, says Jim Williams, associate director of Johns Hopkins’ Center for Communication Programs. Formative research was conducted through focus groups, with neighborhood community outreach workers targeting such hard-to-reach populations as intravenous drug users.
"One of the things that came through very clearly is that [people] are tired of being threatened with death for HIV; they wanted something that was positive and encouraging, something that would reduce the anxiety level, which is a barrier for people getting tested," observes Williams.
With this information in hand, program officials pretested the theme line, creative concepts, and logo design (the AIDS red ribbon in the shape of a question mark) prior to use in the media campaign.
"We wanted to make sure we weren’t turning our audience off or creating another barrier to testing," Williams explains. "Especially when trying to communicate with hard-to-reach audiences, you don’t want to give any excuse not to get tested."
The comprehensive media campaign includes radio and television advertising, as well as print ads on buses, subway cars, billboards, and clinic posters. Estimated costs total about $450,000, which includes the pre- and post-testing surveys, advertising, and production charges, says Solomon.
The initial campaign, which kicked off in December 1999, used a popular on-air personality at the No. 1 urban-format radio station as the "voice" for the radio spots. This approach lent street credibility with the intended audience, who were already familiar with the disc jockey, says Williams.
Providers also were factored into the program, receiving calendars, notepads, mouse pads, pens, and coffee mugs with the red ribbon question mark logo, as well as posters echoing the images in the print campaign. Lapel pins, worn by providers, were used as "ice-breakers" to help providers raise the subject of testing with patients.
Research showed some providers were uncomfortable in asking about testing, with patients equally hesitant to bring up such a sensitive subject, explains Williams. The buttons, when worn by providers, would prompt patients to ask "What’s that?" so providers could respond, "It’s to ask you if you’ve been tested for HIV. Have you?"
"We know that providers are critical in terms of what a patient will be interested in," says Solomon. "We really wanted to engage the provider in making the first touch."
Provider survey results indicate 40% of respondents felt the campaign helped them speak to patients about HIV testing, says Williams. Two-thirds of respondents noted they were using the campaign material in their practices.
Campaign lives on
The campaign received three awards in a national competition, sponsored by the Marietta, GA-based National Public Health Information Coalition, open to public health departments from all states. The logo design also captured an 1999 Addy Award from the Advertising Association of Baltimore.
The media program was reinitiated in February 2001 with a tie-in to Black History Month. Other programs have inquired about use of the Red Ribbon Question Mark Program, with the Georgia Department of Health scheduled to begin its own version of the campaign as of Contraceptive Technol-ogy Update press time, says Williams.
"We think this is a pretty universal issue for those of us who work in the HIV field," Solomon observes. "If anything we have done can be of use to another public health entity, then we’re thrilled." (See the resource box, above, for contact information. Review the campaign at the following Web page: www.jhuccp.org/hiv_campaign/index.stm.)
1. Johns Hopkins University Center for Communication Programs. Red Ribbon Question Mark Campaign. Baltimore; Web: www.jhuccp.org/hiv_campaign.
2. Johns Hopkins University Center for Communication Programs. The Red Ribbon Question Mark Campaign Wins Three National Awards. Baltimore; Nov. 13, 2000. n
For more information on the Red Ribbon Question Mark Campaign, contact:
• Liza Solomon, DrPH, Maryland AIDS Admini-stration, 500 N. Calvert St., Baltimore, MD 21202. Telephone: (410) 767-5013.
• Jim Williams, Johns Hopkins University Center for Communication Programs. Telephone: (410) 659-6273. E-mail: firstname.lastname@example.org.