How to design an HIV awareness campaign

1 December 2017
 Four tessellating quadrilaterals in green, yellow, blue and red with outline drawings in navy blue of four methods of preventing the transmission of HIV: test (illustrated by a pricked finger), condoms, PrEP and undetectable (both illustrated by pills).

Image of Paul Steinberg
Paul Steinberg

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.

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.

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.

Image of Paul Steinberg
Paul Steinberg

Paul Steinberg is the Public Health Programme, Communications & Campaigns Lead for Do It London.