Question: How To Increase Testing for HIV

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Question How To Increase Testing for HIV?

• Some Answers
• from The Red Ribbon Question Mark Campaign

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Red Ribbon Question MarkHIV Testing
CampaignLaunched on World AIDS Day
1999Developed forThe Maryland AIDS
Administration

• by
• Johns Hopkins University
• Bloomberg School of Public Health
• Center for Communication Programs

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Maryland HIV/AIDS Statistics
14,320 AIDS-Related Deaths 12,042 Residents
Living with AIDS 26,362 Cumulative AIDS
Cases 16,015 Known Cases of HIV 28,057 Marylan
ders Living with HIV or AIDS Source MAA/DHMH
data as of 9/30/03
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The Epidemic Continues to Grow

• At a rate of 2,200 New Cases/Year of HIV
  1,400 New Cases/Year of
  AIDS
• Maryland has 3rd Highest AIDS Case Rate
  in US, over twice the national average.
• Every 4 Hours Someone in Maryland Becomes
  Infected with HIV.

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HIV/AIDS Cases by Jurisdiction as a of All
Cases in Maryland
Source Maryland AIDS Administration, Quarterly
Epidemiology Profile as of 3/31/04
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Baltimore City
5,607 Residents Recorded Living With AIDS
7,395 Residents Recorded Living with HIV 13,002
2.0 Recorded Baltimore HIV/AIDS
Prevalence 4,334 Estimated Undetected
HIV/Infected 17,336
2.7 Potential Baltimore HIV/AIDS
Prevalence (1 out of every 38 residents!)
Sources CDC Formula, MAA/DHMH data as of 9/30/03
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Baltimore - National Ranking for AIDS Cases
Number 3 - Rate for New Number 10 - for
Prevalence Number 1 - Cause of Death Among 15 -
40 Year Olds Source CDC, 2003 Year End Data
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Comparison of Modes of Transmission
Baltimore Baltimore State of 3 Zips
City MD AIDS Natl
AIDS
Mode of Transmission (AIDS)
IDU 60 58 46 27 Hetero 16
15 17 13 MSM 18 21
29 50 Other (incl. Pediatric) 6 6
8 10 100 100
100 100 AIDS Cases Reported Through 9/30/03
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Annual Rate of Increase of New HIV
Infections1994-1999

• State of Maryland 2.3
• Baltimore City 7.4
• Zip Codes 21215-6-7 35.4
• Source MAA Trend Data as of 12/31/99

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Situation Analysis
From 1994-1999, three ZIP codes in NW Baltimore
City were mostly responsible for increases in
HIV/AIDS in Maryland.
Baltimore City
Rest of State
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Combined ZIP Codes21215 21216 21217
1,564 Residents Recorded Living With AIDS
1,919 Residents Recorded Living with HIV 3,483
2.4 Recorded HIV/AIDS Prevalence (Represents
27 of all recorded cases in city)
1,161 Estimated Undetected HIV/Infected
4,644 3.2 Potential HIV/AIDS Prevalence
Source MDHMH data as of 6/30/03
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Baltimore City HIV/AIDS Prevalence Data by Zip
Code
Source MDHMH data as of 6/30/03
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ZIP Code 21217

• Estimated potential prevalence rate of 4.9.
• 50higher than all city average
• 1 out of every 20 residents are HIV
• Source MDHMH data as of 6/30/03

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Demographic Characteristics Zip Codes 21215-6-7
New Cases of HIV/AIDS
Age 30 - 49 ( 67 of HIV/AIDS)
Race African-American (97) Gender Male
(59) Mode of Transmission IDU
(48) Heterosexual (37) MSM (11) Other
(3) Pediatric (1)
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Baltimore City Demographic Characteristics
New New Existing HIV
AIDS HIV/AIDS Gender Male 61 62
62 Female 39 38 38 Race African
American 92 92 89 Age 13-19 2.9
0.7 0.8 20-29 15.0 7.7
6.7 30-39 34.4 31.4 28.6 40-49 34.6 41.5
42.5 50-59 9.6 14.2 16.2 60
2.9 4.5 4.0
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Question How to Reverse the HIV/AIDS Epidemic
in Baltimore, Md.?
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Social Marketing Campaign Strategies

• Concentrate on 3 Problem Zip Codes
• Focus on Testing for HIV
• Simple, Easy Call for Action
• Unifying graphic symbol
• Positive Messages Offering Hope
• Relevant media / spokespersons
• Work collaboratively with community

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Red Ribbon Question MarkCampaign Objectives

• Primary Campaign Objective
• To increase the incidence of HIV testing in the
  City of Baltimore by 10 over the period of the
  Campaign
• Primary Audiences
• Women of child bearing ages 12-44 living in
  Baltimore.
• Men (and women) who engage in risky behaviors,
  ages 12 and older living in zip codes
  21215/6/7,specifically IDUs, MSMs and their
  partners.

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Campaign Tactics

• Generate awareness and urgency for HIV testing
  through mass media (radio,TV, transit and
  outdoor).
• Unite other HIV testing / communication
  programs with a common, adaptable symbol
  and urge to action.
• Support local testing outreach programs with
  campaign promotional materials(balloons,
  giveaways, media, etc.)
• Promote a referral hotline (can track
  effectiveness.)
• Use premium items and direct mail to remind
  audiences (including pre-natal caregivers) to
  encourage HIV testing.

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Campaign Symbol / Slogan
Live Long. Live Strong. Get Tested. Get
Treatment.
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Audience Women of Child Bearing Age (Ages 12-44
Living in Baltimore City)
Key Issue Lack of knowledge why HIV testing is
important Key Message Perinatal transmission
can be significantly reduced with proper
treatment Key Media Radio, TV, Transit,
Outdoor, Posters Premiums Calendars, shopping
bags, pens, mugs, buttons, kitchen magnets, neck
totes, etc.
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Audience Prenatal Caregivers
Key Issue Missed opportunities
to suggest HIV testing. Key
Message Dont forget to discuss HIV testing
with EVERY pregnant woman. Key Media Direct
mail, mass media campaign Premiums Lapel pins,
calendars, mouse pads, coffee mugs, post-it cube
pads, pens.
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Over 450,000 Premium Items Distributed To Service
Providers Clients and Targeted Population
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Audience At-Risk Individuals(especially those
living in zip codes 21215/6/7)
Key Issue Negativity, fear, skepticism, anxiety
Key Message Be positive. There is hope.You can
live a long, healthy life with early detection
and sustained treatment. Key Media Radio, TV,
Transit, Posters Premiums Individual testing
site promotions, incentives, outreach
activities, etc.
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Red Ribbon Question Mark Campaign Results
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The Red Ribbon Question Mark Campaign A
Coordinated Comprehensive Effort which
included Multi-Mass Media Community
Mobilization with CBOs FBOs Expanded and
Improved Service Delivery City Health Department
Mobile Needle Exchange Vans
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HIV Testing Results
Original Objective 10 Increase Per
Year Actually Achieved Baltimore
City Three Zip Area Source MAA CTS Site
Statistics for 2000 - 2001
61 Increase
68 Increase
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The Rate of New Cases of HIV Has Declined By
24 In The Three Focus Zip Codes
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New HIV Cases per 100,000 Population (Three focus
zip codes)
300
250
Average annual increase in new HIV infections
35
200
Cases per 100,000
150
100
50
0
1994
1995
1996
1997
1998
1999
2000
2001
2002
Year
Actual Cases per 100,000 population
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New HIV Cases per 100,000 Population (Three focus
zip codes)
300
250
200
24 Decline
Cases per 100,000
150
Red Ribbon Question Mark Campaign
Launched On 12/1/99
100
50
0
1994
1995
1996
1997
1998
1999
2000
2001
2002
Year
Actual Cases per 100,000 population
50
New HIV Cases per 100,000 Population Cases
Averted Since 1999 (Three focus zip codes)
300
250
619 HIV Cases Averted
200
Cases per 100,000
150
100
50
0
1994
1995
1996
1997
1998
1999
2000
2001
2002
Year
Projected
Actual Cases per 100,000 population
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New HIV Cases per 100,000 Population Potential
Impact of Cases Averted Since 1999 (Three focus
zip codes)
Key Point Working together can help save lives!
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Summary of Case Rate Data 1994-2002
HIV incidence in 3 zips increased from
1994-1999 (at a rate of 35 per annum) and then
decreased from 1999-2002 (by -24). HIV
incidence in Rest of City was virtually unchanged
from 1994-2002. HIV incidence in Rest of State
was unchanged from 1994-2002. Rates in 3 ZIPs
remain higher than Rest of City and Rest of
State.
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Correlating Factors As Evidence of Mass Media
Impact
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Red Ribbon Question MarkCampaign Results

• Advertising Awareness at 76
• Intent-to-Get-Tested up 19 Percentage Points
  to 46
• Calls to Telephone Referral Hotline up 1500
• (65 of callers cited the Red-Ribbon
  Question Mark Campaign as the impetus for their
  call.)
• Direct correlation between telephone response
  and media activity.

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Telephone Referral Calls Regarding HIV
Testing for Total Area and Focus Zip Codes May
1999 - July 2001
Source United Way First Call For Help Hotline
Data Reports
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Identification of Campaign Advertisements by
Name and Description
Source Peoples Expo Intercept Survey -
Preliminary Data
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Discussions with Family or Friends and Health
Care Provider About Some Element of the RR?
Campaign
Source Peoples Expo Intercept Survey -
Preliminary Data
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HIV/AIDS Discussions with Health Care Providers
and Testing Behavior
Source Peoples Expo Intercept Survey-
Preliminary Data
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Self Reported Effect of the RR? Campaign
Advertisements
Source Peoples Expo Intercept Survey -
Preliminary Data
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Frequency of Exposure to RR? Advertisements
Source Peoples Expo Intercept Survey -
Preliminary Data
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Direct Effect of Communication Exposure on
Actually Get Tested for HIV (n95)
57
53
44
41
36
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Percent Tested
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Number of Different Communication Channels
Source Peoples Expo Intercept Survey
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Provider Survey Results

• Half of Respondents Reported Seeing at Least One
  Red Ribbon Campaign Advertisement
• Two-thirds of Respondents Were Using Red Ribbon
  Campaign Materials
• Forty Percent of Respondents Felt that the Red
  Ribbon Campaign Helped Them Speak to Their
  Clients About HIV Testing

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Key Lessons Learned
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Key Lessons Learned

• The Value of Unifying Symbol / Slogan
• Importance of a Specific, Simple Call-To-Action
• Benefit of a Sustained, Joint, Comprehensive
  Program
• Combination of Mass Media and Community
  Mobilization Multiplies Success

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Key Lessons Learned
Networking is Necessary for Success
- Create Mutual Ownership - Parlay
Opportunities - Build Momentum - Support of
CBOs/FBOs is Critical
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Key Lessons Learned
Service Delivery is Essential to
Success - Anticipate Success - Be
Prepared! - Support Local Activities with Mass
Media Promotion - Support with
Giveaways/Incentives (450,000 items
disseminated to 150 organizations to date)
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Key Lessons Learned
Early Evaluation Pays Off - Builds Enthusiasm
and Momentum - Provides Opportunity for
Mid-course Corrections - Marketing Tool to Raise
Additional Funds - Continue to Monitor Results
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Solicit / Nurture Political Support
- US Congressman, from the 7th District
(Chair of Congressional Black Caucus) - Lt..
Governor Endorsement - City Health
Commissioner - Local State Representatives/Cou
ncilmen - Keep CDC Informed and On-board
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Work The Media

• Be Prepared To Tell The Story
• Press Releases, Hand Outs, Power Point
  Slide Show, Web Site,
• Copies of Ads, Fact Sheets, etc.
• Maintain Good Press Relations
• Meet with Editorial Board of Newspapers,
  Write Op-Ed Piece,
• Letters to the Editors, etc.
• Seek Broadcast Opportunities
• Interviews on MPT, BET Network News,
  Gospel Radio, 92Q

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Work The Media

• Radio Station Co-operative Support
• Remote Broadcasts / Mobil Vans Appearances
  at Community Events
• Promotional Tie-Ins with Station Events (92Q
  Peoples Expo, Stone Soul Picnic, Jingle Jam,
  African American Heritage Festival, etc.)
• On-Air Personalities Endorsement / Involvement
• (Konan Became Unofficial Spokesperson)

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Red Ribbon Question MarkCampaign Recognition

• Best Public Information Campaign 2000
• Gold Award by National Public Health
  Information Coalition
• Best Poster Best Internet Home Page
• Bronze Awards by NPHIC 2000
• ADDY Awards as Best in Baltimore
• 1999 Campaign Logo and Print Campaign

• Campaign Refunded for the Forth Year