The simple, colourful graphics of the Do It London campaign are based on careful research, as well as lessons from sexual health campaigns in the past. So how does a public health team go about creating an HIV awareness campaign for 2017? We asked Paul Steinberg to explain.
What’s the background to this campaign?
Major changes to the remit for HIV and sexual health happened as a result of the Health and Social Care Act of 2013. Sexual health became the responsibility of local councils, and the leaders of London local authorities gave their backing to the new London HIV Prevention Programme (LHPP) in 2014. The LHPP delivers interventions to prevent HIV where there is rationale for having a multi-borough, pan-London approach, and Do It London is the public campaigning component of that programme.
In some ways, Do It London builds on a long and sometimes controversial history of HIV awareness campaigns, many of which are held by Wellcome Collection.
Can you tell us a little more about these historical campaigns, and what lessons about designing a campaign can be learned from what worked (or didn’t!) in the past?
The history of HIV/AIDS campaigns is fraught with good intentions, bad executions, unintended consequences, controversy and stigma. So wading into that territory is not something to be done lightly! In the early days, many campaigns were focused on one of three themes: fear/death, condom promotion and stigma/discrimination. In many ways, we are still engaged in the promotion of condoms – alongside other, newer methods of preventing transmission of the virus – and there is still a need to correct myths, raise people’s understanding of HIV and to fight stigma.
Having worked in the field of health communications and campaigns for many years, and specifically on HIV in London for almost a decade, I was well aware of how controversial and contested old campaigns have been. One of the challenges with a mass media, general public-focused campaign is the need to provide accurate information whilst also pitching the message at the right level so as not to confuse people who know little about the subject.
In recent years, a number of worldwide campaigns, including some in the UK, had used photographs of people from key at-risk communities (black African men and women, men who have sex with men). Our extensive insight work with those groups found that many people found that representing them alongside the word “HIV” in public space actually added to the stigma. One striking theme of our consumer research was that HIV doesn’t discriminate – that anyone can be at risk of infection – and therefore the message needed to be more broadly focused on Londoners, not specific groups.
That isn’t to suggest that historic campaigns don’t offer valuable lessons. Some of the most effective HIV adverts from the 1980s and 90s still have relevance today, not least in their messaging about making prevention choices, taking responsibility for one’s own sexual health and being empowered to find out more information.
In pictures
![Do It London campaign poster, stating "There are many ways to prevent HIV" with four suggestions in colourful boxes: test, condoms, undetectable, PrEP.](https://images.prismic.io/wellcomecollection%2F07a0cb4d-3a05-4324-b1a7-0bb7badfb991_hiv010_16sh_cr1.jpg?w=1200&auto=compress%2Cformat&rect=&q=100)
Do It London's 2017 campaign features various ways to prevent HIV, including testing, condoms, undetectable status achieved through medication, and PrEP.
![Do It London campaign poster stating that "STIs, including HIV, are on the rise." Illustrated by a zig-zagging arrow going from bottom left to top right, featuring names of STIs.](https://images.prismic.io/wellcomecollection%2F1d2d660f-25bf-47df-883d-a86b0cb86ed5_20161230__16s_poster.jpg?w=1338&auto=compress%2Cformat&rect=&q=100)
The campaign from earlier in 2017 warned about the rapid increase of STIs, including HIV, using a stylised ascending trend line.
![Do It London advertisement placed in the Evening Standard newspaper, which states: ""I do it all over London" You can do it too. Testing for HIV is quick, easy and confidential."](https://images.prismic.io/wellcomecollection%2Fc82d4028-b949-4c13-a9f5-6d63c679adfb_hiv008_eveningstandard_lr+aw1.jpg?w=1306&auto=compress%2Cformat&rect=&q=100)
The "Do It" of the campaign hints at both sex and testing.
![Do It London campaign poster stating "You can do it with a friend. Testing for HIV is quick and easy."](https://images.prismic.io/wellcomecollection%2Fa799a19f-8e4b-4f3f-920b-e199c66d9a69_hiv004_dep_cr2_page_3.jpg?w=1338&auto=compress%2Cformat&rect=&q=100)
In this 2015 poster design, emphasis is placed on the speed and ease of testing for HIV.
![Do It London campaign poster stating "Testing for HIV is an everyday part of living in London. Over 500,000 people do it every year."](https://images.prismic.io/wellcomecollection%2Fe31f8951-b581-4629-9763-8f657dd2b3da_20151015_lhpp_a3size_poster.jpg?w=1338&auto=compress%2Cformat&rect=&q=100)
By presenting figures for London, this poster suggests that HIV testing is an everyday part of being in the community.
How does the Do It campaign differ graphically from previous examples?
We base all our campaigns on evidence and consumer insight. We have two key target groups, men who have sex with men [MSM] and black African men and women, but we are also a campaign for the whole of Greater London. So it’s a big challenge when planning the campaign to get the messaging right for these very distinctive audiences, whilst also making it relevant to several million people!
As I mentioned above, we have repeatedly heard from our target audiences – particularly those within black African communities – that they do not like seeing images of people from their communities in campaigns about HIV as it can add to the stigma that’s all too often associated with HIV and how it affects minority groups. So in 2015, alongside our creative specialists, we took the bold decision to avoid photography and to adopt a bold and colourful text-based approach. This developed further in 2017 with the addition of graphic design artwork alongside striking text and colour. Our January campaign starkly represented the rise in Sexually Transmitted Infections (STIs), using a graph which had some simple but somewhat abstract, subliminal artwork. Most recently, our bold graphic design campaign on combination prevention for 2017 represents each form of HIV prevention as a simple icon which is able to translate across all our media, from our website to digital and social.
And how is the content also designed to target a modern audience?
There is lots of evidence that fear-based campaigns don’t change people’s behaviour when it comes to HIV, but that doesn’t mean we shy away from giving difficult messages, such as our 2017 STI campaign. This was almost like a news headline, revealing the steep rise in infections which occurred during the period 2007-2015. It’s a difficult balance between urging people to take action, and seeming to hector or lecture.
I think this latest campaign – the second one in 2017 - gets the balance right: we offer simple information about combination prevention in as clear and comprehensive way possible in one advert, suggesting that people make their choice – or “do it your way” as the tagline says. And, most crucially, we then seek to guide people to find out more about their prevention options. This campaign is also the first official government campaign to advertise Pre-Exposure Prophylaxis (PrEP) and “Undetectable” HIV status as part of the promotion of what is known as “combination prevention”. I’m very proud of that, in the sense that we’ve retained our long-standing focus on testing and condoms, but by adding in these other proven methods of prevention we have shown that we aren’t afraid of stepping into previously controversial – but scientifically proven – territory.
More importantly in some ways, this latest campaign puts HIV-positive people, who have often been cut out of the prevention equation, right at the centre of the message. For the general public, the concept of “undetectable” status is a new one, so this campaign builds on the authority and reach we have built up over the last couple of years to tell Londoners that an HIV-positive partner who is undetectable cannot pass the virus on to their partners. Some people thought that I was being quite daring; in my mind, I was just doing my job of telling people the scientific truth about HIV - and how to prevent it.
In pictures
![A man in shorts and t-shirt bearing label 'Hounslow Leisure' sitting on a seat in a swimming pool; an advertisement for safe sex by the Hounslow Council's Corporate AIDS/HIV Unit. Colour lithograph, October 1996.](https://images.prismic.io/wellcomecollection%2F4abb2553-f887-4bf6-b466-4e53608d7f01_zv6wbk49.jpg?w=1338&auto=compress%2Cformat&rect=&q=100)
This poster is part of a London council's HIV awareness campaign from the early 1990s.
![Graffiti about AIDS representing an advertisment for the HIV/AIDS program by the New Hampshire Division of Public Health Services. Lithograph, printed in black and white with yellow lettering, 1989.](https://images.prismic.io/wellcomecollection%2F6c20ed80-b8a2-4efb-99d5-577ee9397e87_rcmtnz8u.jpg?w=1338&auto=compress%2Cformat&rect=&q=100)
Youth culture is hinted at via graffiti and slogans like "bad to the bone" and "killer" in this 1980s American poster, which hints at the literal danger presented by AIDS via a cross with RIP.
![Two hands wrap around each other to form the shape of the AIDS red ribbon against a grainy backdrop of the world within a circle inscribed with the slogan 'Shared rights. Shared responsibility'; an advertisement by the Kenya National AIDS/STD Control Programme, part of the Kenya Ministry of Health. Colour lithograph, 1997.](https://images.prismic.io/wellcomecollection%2Fe24848a5-297b-4506-af4e-eee1617c3223_x5euv4u7.jpg?w=1338&auto=compress%2Cformat&rect=&q=100)
This Kenyan poster shows the red ribbon, one of the most recognisable symbols relating to HIV and AIDS.
![A black couple lie on a bed together smiling; advertisement for the new female condom by the Black HIV/AIDS Network. Brown lithograph, published in the 1990s.](https://images.prismic.io/wellcomecollection%2F3da32343-9b86-4ec4-bb40-a4059fa73bdd_jtudx64m.jpg?w=1338&auto=compress%2Cformat&rect=&q=100)
This poster, created by the Black HIV/AIDS Network, appeals to women to use new female condoms for safer sex.
![A large personified condom stands triumphantly on personified versions of the HIV virus who cry out for 'help'; with rays of sunshine in the background; a safe-sex advertisement by the AIDS Unit Department of Health, Government of Hong Kong. Colour lithograph, 1995.](https://images.prismic.io/wellcomecollection%2F1b4d6a4b-0115-467d-a6c7-327baedb1a53_mqbvv2jd.jpg?w=1338&auto=compress%2Cformat&rect=&q=100)
The HIV virus is actually represented in cartoon form in this Hong Kong poster encouraging condom use. Personified condoms are a common theme in sexual health campaign posters, but depiction of microscopic images of viruses is unusual.
![A group of men, women and children representing the difficulty in spotting who carries the HIV virus, with text: "Est-ce que vois pouvez trouver la personne qui est atteinte du SIDA?". Colour lithograph created by UNICEF Uganda, the Uganda Ministry of Education & Uganda Ministry of Health, 1995.](https://images.prismic.io/wellcomecollection%2F83522ca2-68ae-4913-ad52-2e0daebb4d0c_wvr4wuw3.jpg?w=1338&auto=compress%2Cformat&rect=&q=100)
Viewers of this Ugandan poster are informed that it's impossible to tell who has AIDS by sight and warned that people who carry HIV may feel and look healthy but can pass it to others.
![Message in numerous languages of the Pacific Islands that AIDS and HIV does not respect tradition culture or religion; advertisement by the Pacific Islands AIDS and STD Prevention Programme. Lithograph, printed in green and brown, 1995. middle-aged man in a shirt and tie aims a syringe at another man against a backdrop of a building bearing a flag representing a message about HIV by the AIDS Council of New South Wales. Colour lithograph, published in the 1990s.](https://images.prismic.io/wellcomecollection%2F6851ac40-0fc8-4527-8de3-0fc9dbebd602_zg8ah52z.jpg?w=1338&auto=compress%2Cformat&rect=&q=100)
The message in numerous languages of the Pacific Islands on this poster warns that AIDS and HIV does not respect tradition, culture, or religion.
![A middle-aged man in a shirt and tie aims a syringe at another man against a backdrop of a building bearing a flag representing a message about HIV by the AIDS Council of New South Wales. Colour lithograph, published in the 1990s.](https://images.prismic.io/wellcomecollection%2Fb4264cad-e9e4-4748-a723-79588333ba24_jmq3d6wy.jpg?w=1338&auto=compress%2Cformat&rect=&q=100)
In this Australian poster, an older white man assumes that he is safe from HIV despite sharing needles whilst taking drugs. The poster warns that behaviour, rather than identity, is important.
![Lithograph, printed in burgundy, pink and black on white, stating: "You cannot catch the HIV virus by: working with someone who has HIV; living with someone who has HIV; looking after someone who has HIV." New Zealand, published in or before 1995.](https://images.prismic.io/wellcomecollection%2Faf8c706a-c2e9-48eb-a1d1-e2c2006e2b26_pp4mnub4.jpg?w=1338&auto=compress%2Cformat&rect=&q=100)
Educating people about how the HIV virus cannot be caught (to allay fears of contracting the virus through everyday social activity) is the purpose of this poster from New Zealand.
Can a campaign like this really have an effect on people’s behaviour? Can graphic design save people’s lives?
For every phase of the campaign, we commission independent research and evaluation which, to date, has found that the campaigns have been very positively received and have changed people’s behaviour in line with our objectives around increased testing and awareness of safer sex methods. In statistical terms, one study showed that two-thirds Londoners felt the campaign had positively influenced their practice of safer sex and 68 per cent reported that it had strongly influence their behaviour towards HIV testing.
In terms of our overall strategic goal – to reduce new HIV infections and prevent late diagnosis – it was confirmed last week that, for the first time in 35 years of the epidemic, HIV diagnoses fell in London by 40 per cent during 2015 and 2016 – directly aligning with the lifetime of the LHPP. That decline appears to have continued during 2017, though data out early next year will confirm that as an ongoing trend. A similar steep decline was not witnessed in the rest of the UK.
Detailed evidence, compiled by Public Health England (PHE), confirmed that this was a consequence of markedly increased testing rates in key groups, alongside the prompt provision, at diagnosis, of anti-HIV medication by our world-class sexual health and HIV clinics.
Further analysis of Do It London, by University College London, found a statistically significant increase in HIV testing during the exact period of the first Do It London campaigns in 2015, among both MSM and black Africans. Statistically adjusted analysis of this clinic data found that HIV testing rates remained significantly higher for local black African men and black African women after Do It London began, compared to before the campaign launched.
Furthermore, PHE data published in September revealed that, for the first time in a decade, Sexually Transmitted Infection (STI) rates in London dropped by five per cent in 2016, with a 19 per cent drop in gonorrhoea rates overall (an impressive 25 per cent reduction in MSM, which reflects the focus of Do It London in upweighting our reach to that audience for that particular advertising burst). In their official report, PHE London explicitly cited the impact of Do It London in promoting condom use and regular screening, in helping to drive this record reduction.
What happens next?
We have just been shortlisted for "Campaign of the Year" by the Local Government Chronicle Awards, which is a real boost to end a hugely busy, but productive and rewarding year.
In a practical sense, the LHPP is funded until at least March 2019, but our budget was reduced this year by 13 per cent, so it’s a battle to keep the momentum going and to build on the achievements we’ve clearly made to date whilst protecting the front line as much as possible from financial cuts.
Meanwhile, the current campaign is still live and we are already working on plans for 2018. We have some more surprises in store for next year!
Do It London is the multimedia public health campaign element of the London HIV Prevention Programme (LHPP). So far, it has delivered five separate campaigns under the “Do It” theme to date, focusing on various elements of HIV prevention and the prevention of other sexually transmitted infections.
About the author
Paul Steinberg
Paul Steinberg is the Public Health Programme, Communications and Campaigns Lead for Do It London.