Grant Tudor

NexThought Monday: Beyond Slogans – Relevant Communications to Fight HIV

Sometimes, slogans work wonders. IBM is building a Smarter Planet – and expanding its market potential by upwards of 40 percent globally, thanks to the campaign. Just Do It stole a quarter of the U.S. sports-shoe category for Nike in its first decade.

But sometimes, slogans are really, really dangerous. While on a field visit to Guatemala, a former colleague of mine was startled to discover that at the behest of a local USAID official, an HIV intervention for sex workers was propagating ’abstinence’ and ’be faithful’ messages. The irony might be comical if it weren’t for the seriousness of the epidemic.

As plainly stated by the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), it is still official government policy to include “all three elements of the ’ABCs’ [abstinence, be faithful, correct and consistent condom use] in every country program.” That includes the growing body of organizations tackling HIV at the BoP who receive federal funding. What started as a catchy slogan in the 1990s has morphed into a marketing straightjacket for public health practitioners across the developing world.

The evidence supporting the ubiquitous use of the ABCs is, charitably speaking, weak (see here, here or here). But the debated efficacy of abstinence promotion in general isn’t the heart of the problem. Instead, the ABCs have fallen victim to the worst of marketing blunders: they’ve limited relevant messaging. If your goal is to halt the transmission of HIV, preaching abstinence to sex workers probably won’t get you very far.

A recent study highlights how abandoning the limitations of the ABCs opens the door to more relevant, results-oriented messaging. In sub-Saharan Africa, HIV prevalence is three times higher among teenage girls than boys, in large part due to cross-generational sex. That’s because older men (“sugar daddies”) – who are more likely than younger boys to be infected with HIV – have unprotected sex with younger girls on a large scale.

In a randomized control trial, researchers in Kenya evaluated 163 schools teaching the ABC curriculum, the national standard policy. They then studied 71 schools that opted instead for a more tailored message: through a ten minute informational video and thirty minute discussion, they told girls that older men are more likely to be HIV positive than younger ones. While the ABC group had “no impact on the incidence of childbearing” (a proxy for unprotected sex), the latter led to a 28 percent decrease.

In other words, telling young Kenyan girls that sex is dangerous with the help of bland slogans didn’t work. But understanding and messaging directly to their particular situation – one in which cross-generational sex is the true risk factor – resonated loud and clear. Nowhere were messages of abstinence, faithfulness, or even condom use offered. Instead, communications did what they’re supposed to do: responded to realities in the most relevant way possible.

The ABCs have their place. Abstinence discussions can help to delay sexual debut for pre-teens. ’Be faithful’ conversations can minimize concurrent sexual partnerships. And condom use promotion is, of course, in many contexts critical. But the fight against HIV doesn’t stop there: sex workers and injecting drug users and men who have sex with men – just to name a few high-risk groups – all call for relevant communications that differ markedly from context to context.

The private sector doesn’t succeed with a one-size-fits-all marketing framework; nor will public health. As a community that employs business acumen (including skilled communications) to tackle pressing social issues, and as one that aims to measurably improve the lives of the poor, we have a roll to play in calling for smarter policy.

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