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PSI/VN VCT Communications Strategy

PSI/VN National VCT Communications Strategy

2005/06

DRAFT

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I. Introduction

II. Summary and Conclusions of Research Findings

III. Key Recommendations from Research

IV. VCT Communications Strategy

a. Strategic Goal, Objectives and Key Message Concepts

b. Target Audiences

V. Outline for Initial Communications Campaigns

a. Phase OnePromotional VCT CampaignCreating a Youth Culture: Take Control of Your Serostatus Campaign

b. Phase TwoDemand Creation Among Couples and Adults: Know Our SerostatusCreating a Youth Culture: Know your Serostatus Campaign

VI. Tools and Communications Channels

a. Marketing Tools – The Positioning Statement

b. Marketing Tools – The Logo

c. Generic versus Branded Communications

d. Mass Media and Interpersonal Communications

Appendix: Draft Communications Budget Allocation

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I. Introduction

PSI’s communication campaign will primarily promote VCT services operated under the Life Gap project, a program supported by the U.S. Centers for Disease Control (CDC) and the Vietnam Ministry of Health (MOH). Since the first MOH/LIFE-GAP supported VCT center opened in Hai Phong in 2002, nearly 50 sites have been established in 40 provinces.

There are also other providers of VCT services, including INGOs. FHI has been supporting and managing a flagship VCT center at Hanoi’s Bach Mai Hospital in collaboration with MOH and CDC, since August 2002, and has is operating 3 other sites in HCMC, QN, and HP. Few other non-governmental organizations are involved in the provision of VCT services, though MSF is piloting a mobile VCT clinic in HCMC, and Marie Stopes International has integrated VCT in some reproductive health clinics and funded mobile VCT clinics that serve MARP in hard-to-reach areas.

Much progress has been made in increasing the acceptability of VCT services in Vietnam. In addition to supporting high-quality testing and counseling at VCT sites, the MOH/LIFE-GAP project and other groups have focused on promoting the confidential and supportive nature of this service to MARP. However, decades of “social evils” campaigns to reduce the incidence of intravenous drug use and prostitution ─ together with the tendency to blame PLWHA for their condition ─ have resulted in profound stigma associated with HIV/AIDS infection and related services, including VCT. Stigma, lack of information, and poor access to health care are all factors that may keep at-risk individuals from obtaining information about their HIV status.

USAID recently awarded PSI/Vietnam a one year agreement to develop a pilot social marketing program to increase the demand for VCT services by Most at Risk Populations (MARP) in select sites. The goals of the project will be to increase awareness of and trust in VCT among target populations as well as to increase their demand for VCT services, and to reduce the stigma associated with the use of VCT services.

The intervention implemented by PSI will be based on collaborative work with CDC, MOH/LIFE-GAP project, Provincial Health Departments (PHD), other VCT providers, and nascent civil society groups working with MARP to develop and implement a SM program for VCT.

PSI/Vietnam just finalized formative research addressing motivations and barriers to VCT, and the research report is attached to this brief. The research results provides detailed information on motivations and barriers to use of VCT services among target groups, as well as recommendations for communication campaign development.

Research conducted to create the strategy included:

1. A review of existing, selected VCT data and clinics to understand current VCT client profiles, including a rapid assessment of existing VCT services in Vietnam, focusing on quality control and assurance after a three year rapid scale up of VCT sites by PSI staff.

2. Focus group discussions (FGDs) with SWs, IDUs, and their sexual partners who are non-users to understand motivations, barriers, benefits, and desired characteristics of VCT services; and

3. In-depth interviews with SWs and IDUs that have accessed VCT services to understand the motivations of early adopters.

4. A rapid assessment by PSI VCT specialist

This document describes the strategy for communications related to VCT and makes suggestions for implementation of future communications campaigns.

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II. Summary and Conclusions of Research Findings

Primary data sources used to develop this national VCT communications strategy are the 2004 CDC/Life Gap survey targeting IDUs and SWs, focus group discussions (FGDs) with non-VCT users and in-depth interviews with current VCT users and current/potential referral makers. The summary and conclusions of the FGDs and in-depth interviews are outlined in the individual research reports. The following is a summary of the KAP data:

2004 CDC/Life Gap Survey

IDUs

HIV knowledge and awareness is high amongst both IDUs and SWs.

HIV Test History: over 41% have been tested for HIV, but many of those tested did so because it was required. 40% of those tested questioned did so through a VCT program.

Of those that have not been tested, 52% believed it was unlikely they were infected with HIV; 30% thought they were worried they may already be infected; 21% never thought about having an HIV test, and nearly 20% thought a test would be expensive.

While 52% were tested free of charge, others had to pay from 10,000 to a maximum of 100,000)

Over 65% of those who participated in the study were HIV positive.

CSWs

33% of SWs have injected drugs in the last month.

32% have ever had an HIV test , the reasons for getting tested, 67% of whom tested voluntarily. Of those that have not been tested, 52% felt they were unlikely to be infected, 31% felt they were already infected, 32% were concerned with issues related to confidentiality, and nearly 20% had never considered getting tested.

66% paid from 12,800 to VND 80,000 to get tested.

32.5% of those tested were HIV infected

Qualitative ResearchThe following are the conclusions from the FGDs with VCT non-users and in-depth interviews with current users, potential referral makers and current referral makers:

1. VCT knowledge is low: The overall level of knowledge of VCT facilities and the services they offer is quite low. Very little of the information that potential clients do have comes from mass media or from leaflets or signs associated with specific facilities. Many members of high-risk groups inappropriately transfer ideas drawn from past negative experiences with the health care system to VCT centers and staff.

2. Stigma and shame are major barriers to using VCT services: Social norms are the most significant barriers impeding greater acceptance and utilization of VCT services. Stigma and discrimination foster an environment where even talking about VCT can be a shaming act. A fear of being branded HIV-positive and shunned by loved ones, neighbors, and the community causes many high-risk people to avoid learning their HIV status. The strong stigma attached to

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HIV/AIDS leads to low self-efficacy; people who might be curious, worried, or terrified about their HIV status often remain untested.

3. Lower stigma means more users of VCT services: Those who believe that there is a possibility for beneficial outcomes after testing, and who have less stigmatizing attitudes towards PLWHAs in general, appear to be more likely to seek out VCT services.

4. Confidentiality is key: A second major barrier to increasing acceptance and utilization of VCT services is the related belief that confidentiality can not be promised or, if it is, will not be honored. When the social costs of disclosure are so high, the act of going for an HIV test poses the risk of embarrassment, shame, or, in the case of sex workers, a loss of income. In the health system there appears to be a legacy of not treating patient information with care that contributes to potential VCT clients’ mistrust and fear.

5. Other significant perceived barriers to VCT include a lack of detailed information about locations and services, a lack of trust in the accuracy of test results, fear of being treated rudely and disrespectfully by clinic workers, fatalistic beliefs among IDUs about their HIV status, and worries about the cost of VCT services and follow-up medical care.

6. Personal contact with PLWHA, receiving advice from outreach workers or loved ones, and easing anxiety are major motivators for seeking VCT services: The study also provides insight into the motivations that lead people to use VCT services. The foremost motivating factors users of VCT services identified relate to threat level, subjective norms, and outcome expectation. Personal contact with a person sick with AIDS increases the perceived threat level for participants. Receiving advice to use VCT services from an outreach worker, friend, or co-worker strengthens worried participants’ intention to be tested. A belief that utilizing VCT services will ease the anxiety of not knowing their HIV status is a strong motivator. For many non-users of VCT services, the motivation depended on HIV test outcome: they hoped to prevent transmission of HIV to a loved one if they themselves are HIV-positive and they feared contracting HIV if they proved to be HIV-negative.

7. Future intentions to access VCT services are low: Intention to seek VCT services is low among many participants. Many IDUs are convinced of their HIV-positive status without having been tested and some believe that definitively knowing their HIV status will be profoundly psychologically unsettling. Many CSWs believe that seeking services will make it untenable to continue earning money from sex work. In addition, fears about confidentiality and being seen going for testing led some participants to have difficulty imagining themselves entering a VCT facility in the future.

8. CSWs have a short-term financial incentive to minimize risk perception and avoid VCT: Among CSWs, outcome expectation is low. Despite threat of becoming infected by a client, sex workers emphasize the financial incentive to minimize their risk perception and act as if they are HIV-negative until proven otherwise. The most strongly felt motivations for sex workers to seek VCT services are those that related to thinking about a future in which they imagined themselves finished with commercial sex and in stable spousal relationships that had produced children.

9. Counseling creates affirmative word-of-mouth: The positive feelings generated by VCT counselors are one of the strengths of currently offered VCT services. Praise for the sympathetic manner and informational richness of the counseling experience is viewed by VCT users as a major benefit of getting tested. Good counseling appears to help ameliorate feelings of hopelessness and, possibly, increase users’ willingness to break the code of silence that surrounds HIV testing in Vietnam.

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10. More facilities in different settings are desired: Many women want VCT clinics to be anonymously located in large health facilities. IDUs—which in this study were all men—preferred VCT sites to be discreet in both senses of the term; they desire clinics that are separate from large health facilities, which they associate with harsh detoxification treatment, and tucked away off main thoroughfares. All groups of participants agreed that more VCT sites are needed, for reasons of convenience and anonymity.

11. Signs should provide detailed information; signs shouldn’t say “HIV” or “AIDS:” Two views on signage emerged in the study. Many people felt the need for specific information and directions. Opposing this view, others, notably sex workers, want generic signs that do not belie the purpose of the facility. It was widely felt that the words “HIV” and “AIDS” must not appear on any signs.

12. Most commonly Mentioned Motivators: Seeing a family member or friend get sick or die from AIDS while concern over what

will happen to children if both parents are HIV-positive is a dominant worry. A close call that highlights one's own risk—such as a broken condom or STI infection—

accelerated the decision-making process. A new relationship that warrants thinking about one's risk for HIV was a motivator. A

relationship with “love” status is a prompt to know HIV-status in order to protect new partners.

Convenience or being at the hospital or clinic for another reason was, for people who already had the intention to get tested, helpful in the decision-making process. (less commonly mentioned)

13. Most Commonly Mentioned Barriers, in addition to those identified above include: Fear of a positive test result is linked to the fear of death. Most know there is no cure for

AIDS and believe there is no point in knowing their status if nothing can be done about it. Fear of being treated badly by health workers at VCT sites is particularly strong for

stigmatized groups. CSWs, in particular, fear being looked down on and asked invasive questions by health workers. IDUs fears stem from past experience of cruel treatment in medical settings.

Being recognized by friends or acquaintances is a strong fear among CSWs. Fear that results will not be kept confidential—especially if HIV-positive—is a

significant barrier. Past experiences and knowledge of others’ experiences with non-confidential HIV testing at hospitals leads many to suspect that VCT services are not fully confidential.

The fear that hopelessness or depression would result if HIV positive causes many to avoid seeking VCT services. Not being able to psychologically handle being HIV-positive makes not knowing seem like a better choice than VCT.

That there is no cure for HIV/AIDS means that there is no reason to get tested. If medicine were available, or affordable, it might be worth it.

14. Benefits of VCT or Knowing One's HIV Status included: Peace of mind and relief from anxiety and worry. For some, especially CSWs, a

negative test result would be a license to continue risky behaviors and for others, especially IDUs, it would prompt them to want to reform their lives.

Being able to protect partners and family members from infection is a major concern for all who consider there is a chance they are HIV-positive.

Being able to protect oneself from becoming infected is a benefit of knowing one’s status, especially for CSWs, who see continued income-earning as a distinct benefit.

A chance to start again with a brighter future. For IDUs, this means a life without drug addiction and for CSWs different work, a new relationship, and having children

Access to information about HIV/AIDS is commonly understood to be the content of 6


counseling. Knowledge of how HIV is transmitted is viewed as a major benefit of visiting a VCT center.

Access to medical care that might help one live longer was viewed as a benefit. Some non-users hope that they will receive medicine as the result of going to a VCT clinic.

III. Key Recommendations from Research

The following are recommendations for the national VCT communications strategy:

1. Use selected and targeted media to provide correct information on VCT sites and services. The overall level of awareness and understanding of testing facilities and the services they offer is quite low, due to a lack of detailed information about locations and services. Especially where VCT clinics are new, programs should be sure to let potential clients know where and how to access VCT, as well as opening hours and the free price of services. While mass media such as television may not be the most cost efficient method of promoting messages, it would be an effective approach to widely disseminate key characteristics of sites and specific locations. Supplementary media such as outdoor advertising, posters, and brochures would be helpful as well.

2. Emphasize counseling and ‘talking:’ Campaigns should emphasize the value of counseling as a key part of VCT services, encouraging people to come to talk with counselors, work out problems, and learn how they can protect themselves and their families.

3. Messages and campaigns should emphasize confidentiality, friendly and sympathetic staff attitudes, and accurate, timely test results. Campaigns should be affirmative, stressing the supportive atmosphere in VCT centers. Allaying fears and anxiety should be among the main goals of media campaigns.

4. Media messages should highlight the benefits of knowing one’s HIV status: Many members of the target groups do not see much benefit to knowing one’s HIV status and nearly all perceive great costs. Messages should highlight future hopes and plans of MARP, focusing on a “brighter future” or a “new start.” “Peace of mind” and the calming power of certainty should also be stressed. In messages targeting IDUs, “doing the right thing” to protect their families can be emphasized in an effort to counter feelings of alienation.

5. Signs should be published and clearly identify sites as VCT clinics: Signs should not contain words “HIV” and “AIDS” but should be easily recognizable to those wishing to access services. Promotional signs should be visible and clearly identify sites as counseling and testing clinics. One effective method is to employ a ‘brand’ that is promoted in communication programs and serves to link promotional efforts directly to sites. By advertising the branded image, a brand would replace the need to have sites identified as HIV/AIDS centers.

6. Over the long term, decreasing the stigma widely attached to HIV/AIDS should be a target of mass media campaigns: Role models, preferably famous and unlikely ones, could be used in television spots to break the silence and shame that surrounds those who seek testing. One way to indirectly fight the demonization of those who are HIV-positive is to make getting tested widely accepted and normal part of life. As secrecy about testing diminishes, it may be possible to more directly counter people’s ideas about PLWHA.

7. Testing negative is not a license to continue risky behaviors: Although messages to MARP should be upbeat, campaigns should also underscore the importance that testing negative for HIV does not provide a license to continue engaging in risky behavior. Some MARP appear to believe that they can continue taking risks (e.g., having unprotected sex or sharing needles) as long as

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they remain HIV negative. Such misconceptions should be corrected during counseling sessions and other targeted messages.

8. Increase the coverage and effectiveness of outreach efforts by enrolling peers: Personal contact with someone who has been through VCT, is willing to talk about testing and test results, and who is recognizably a behavioral peer (or was recently one) is a powerful motivator for MARP to utilize VCT services. Outreach workers should be able to discuss all of the reasons why MARP currently avoid testing. In addition to increasing the subscription to VCT services, outreach workers should be actively working to remediate anti-HIV/AIDS stigma that is pervasively felt by the target populations. Organize pre-VCT counseling for groups and for individuals. Partners of IDUs will require separate outreach efforts. Local networks of the Women’s Union might be organized to this end.

IV. VCT Communications Strategy

This section outlines PSI/Vietnam’s VCT communications strategy as based on the preceding conclusions and recommendations. The strategy states the goal, objectives and key message concepts that will guide PSI/Vietnam, as well as other VCT stakeholders’ communication campaigns.

Key messages communicate the concept that should take root in the target audience’s mind. Due to the complexity of targeting highly stigmatized and disparate groups such as IDUs, SWs, their sexual partners, and in order to avoid stigmatization of the use of VCT services by other populations, the strategy enumerates key message concepts for each strategic objective. Targeted communications will occur through placement, rather than through specific messaging that may inadvertently stigmatize VCT to the greater populations, or signal to the greater population that VCT is only for high risk groups.

PSI will, in partnership with stakeholders and partner organizations, design a communications campaign and will create and test the actual key messages.

At the end of the campaign, MARP should

(i) be well aware of what VCT is, and that promoted services are a quality and highly confidential service;

(ii) know where such services are located in their community;

(iii) feel confident that they will be welcomed at these VCT sites; and

(iv) feel hopeful that they can improve their quality of life and start living healthier by knowing their HIV status (whether they are positive or negative). They should be ready to begin again after they go through a VCT center and know their HIV status.

Strategic Goal

To decrease HIV incidence in Vietnam via the increase of safer sexual and injecting behaviors. The growth of individual commitment to manage one’s serostatus, either HIV positive or negative, will increase these safer sexual practices through the following strategic objectives and key message concepts:

Strategic Objectives and Key Message ConceptsThe following framework illustrates the relationships between the strategic objectives and the strategic goal:

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Strategic Objective:Create awareness of VCT as a new service:

i. Promote VCT attributes and services that inspire consumer confidence

Knowledge of what VCT is“VCT is a service to help people find out their HIV status, to provide counseling to those people.”

Professional, empathetic counseling on a personal level“With VCT, I can talk to a qualified, friendly, supportive counselor who will discuss my personal issues and help me to deal with them”

Confidential services“VCT services are trustworthy and absolutely confidential – no information goes out of the counseling room without my consent, and not even my community health worker will know that I’ve been tested for HIV”

“I’ve heard about VCT service and the advantages are no name, no ID card, and no registration procedure. They just take your blood and test. I think I may use that service. If the result is positive, no one will discover it and I will also receive a counseling session.”

Personal decision to take a safe, accurate HIV test“HIV testing is my personal decision when I go to a VCT center”

“If I decide to get an HIV test, I know that the results are mine”

Linkages to support services“My counselor will link me to the services I need”

ii. Promote VCT accessibility and affordability

Accessible and affordable services9

Awareness of VCTAttributes that inspire consumer confidenceAccessibility and affordability

Reinforced Ideal BehaviorsKnow serostatusManage serostatus

Self EfficacySkills related to

knowing HIV status

Skills related to managing serostatus Active

Serostatus ManagementMaintaining a

negative status

Living positively with HIV/AIDS

Personal Conviction in Benefits of Managing SerostatusCommitment to know

serostatusDecreased fear to

know serostatus

Societal Factors that Enable/ Reinforce Objectives


“I know where to go for VCT and that it is free”

“Even though I’m busy, some VCT centers are open at convenient hours for me”

Strategic Objective:Increase self-efficacy related to knowing and managing one’s serostatus

Self-efficacy is the belief that people have in themselves that they can do or perform a specific behavior. Self-efficacy key messages are specific to the target audience, particular behavior and context. The following are some examples of such key messages:

Overcoming related stigma to accessing VCT services“I’m afraid that people will think that I’m HIV positive if I go to a VCT center or that they will think that I’m ‘not normal’ but I know I can get over this by… (entering the site in a private manner, knowing that the service is anonymous, etc.)

Fear of taking an HIV test“Even though I am scared of getting an HIV test, I know that a VCT counselor can help me overcome this fear and help me through the process”

Serostatus management skills“Even though I don’t know much about protecting myself against HIV/AIDS, I know I can get the skills I need by talking to a VCT counselor”

“I know I can live positively with HIV with the support of my VCT counselor”

Strategic ObjectiveIncrease personal conviction in the benefits of managing one’s serostatus:

Staying HIV negative Living positively with HIV/AIDS

i. Increase individual commitment to know one’s serostatus

“I want to make a new start, quit the drugs and stop making trouble for my wife and children.”

“There is a girl who loves me. I will go for the test in order to protect her. I really love her and will make a new start if I’m not infected.”

“I think I should go for test because I will not work as a sex worker for my whole life. I will stop in the future and get married. I’m worried about transmission from mother to baby and want to know my status.”

“I’ve used drugs for years, but now I want to protect my family and myself by knowing my HIV status”

“Sometimes I had to share a needle so I’m very worried about HIV. So I want to have a blood test to see if I’m infected and then I can take some measures to prevent giving it to others.”

ii. Decrease fears related to knowing one’s serostatus 10


“I’m going to make a fresh start in life and knowing my HIV status opens the door”

“Whatever HIV results I get, infected or not infected, a counselor is really there for me”

Strategic Objective:Build societal elements that encourage knowing and managing one’s serostatus

i. Maximize the use of resources that enable or reinforce serostatus management, knowing one’s serostatus and VCT use.

Resources that encourage VCT use depend on the target audience and context. The following are examples of such resources and potential outcomes:

Community opinion leaders – create awareness of VCT and the need to know and manage one’s serostatus

People living with HIV/AIDS – increase societal understanding of the need to know and manage one’s serostatus

VCT service providers – increase client confidence in VCT services

Referral makers – increase linkages between potential clients and VCT services

ii. Decrease specific societal barrier towards VCT as feasible

One of the largest societal barriers towards VCT is stigma associated with HIV/AIDS and PLWAs. A corollary campaign should address the roots of related stigma and discrimination by addressing such issues as the fear of accidentally acquiring HIV from a positive person and the widespread belief that isolation and discrimination of PLWAs is justifiable.

Any campaign that addresses stigma should also address behavioral stigmatization amongst the community and health system. Years of social evils campaigns against sex workers and injecting drug users have made it very difficult for these most vulnerable populations to access health and social services.

b. Target Audiences

Primary Target groups

The project will focus on sex workers (SWs) and their clients; injecting Drug Users (IDUs) and their sexual partners. Priority sites will initially be in Hanoi, Hai Phong, and Quang Ninh but will likely expand throughout the project. Elements of the campaign may also be picked up by provinces that wish to promote sites and funded by Life Gap.

Justification: The HIV/AIDS epidemic in Viet Nam is still in the “concentrated epidemic” stage. The disease has spread rapidly in specific subpopulations, particularly among IDU and SWs, while unprotected sex with regular and irregular partners in both groups is high.

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Secondary Target Groups

People who currently or have the potential to influence the target audiences’ decision to know and manage their serostatus VCT, and those can contribute to a supportive, non stigmatizing environment.

These opinion leaders will be of particular importance for community-based, interpersonal communications campaigns. Although specific opinion leaders are not enumerated in this document, the following are suggestions as per the VCT formative research:

Already counseled advocates and peers Husbands and wives, sexual partners Health care providers Mass organizations: Women’s and youth

unions People living with HIV/AIDS Religious leaders

It is important to note that, although the primary target for the communications are MARP as defined as IDU, SWs, and their sexual partners, this campaign will and should in no way future stigmatize an already marginalized population. That is, should a university student, a working class individual, or a mother or father see this campaign, they may very well identify with the message and may be persuaded to test themselves. It is expected that much of the work on targeting will occur during placement of the campaign in areas most likely to be seen, viewed, or experienced, by those most at risk.

V. Outline for Initial Communications Campaigns

The following is an outline for the initial communications campaigns to be developed from the VCT strategy. These are the first steps only. Communications by nature is a creative, iterative process, and experiences from the field, changes in context and advances in our communications objectives will require the VCT community to periodically update the communications strategy.

The use of a logo or brand to identify Life Gap VCT centers will be explored during Phase One.

The communications campaign will be broken down into two phases. Phase one will increase client knowledge of what VCT is. This will be accomplished by focusing on VCT service attributes, that is voluntary, completely confidential, is a place where counseling is offered and HIV status can be known. Addresses and locations of clinics will be promoted in each spot.

Phase One: Campaign to Promote and increase knowledge of VCT services Programmatic context: To date, several VCT centers are functioning within selected geographic regions in Vietnam. CDC/Life Gap sites now number 53 in 40 provinces, FHI will be operating 5 multi purpose sites (integrated into hospitals or drop in centers) by the end of the year, and the Global Fund is supporting a number of sites (that do not currently have funds for testing).

Most sites are underutilized and currently seeing well under their maximum capacity, and staff at sites appear to have little to do at times. The most established site in the network in Hai Phong sees only 250 clients per month. Supporting data from Life Gap suggests that underutilization is common to all if not most sites in the network

Campaign description: Phase One communications activities will focus on creating general awareness of VCT as a new service available in Vietnam by promoting existing VCT centers. This will be a typical marketing campaign focusing on the consumers’ “What? Where? Why? and How much? “(Free)”. This promotional campaign may be branded as rapid assessments determined that LifeGap sites are of sufficient quality.

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The campaign will address the following strategic objective, which includes the ultimate goal of increasing client flow for VCT centers at select sites by:

Increasing awareness of the VCT center locations and where they are in the community.

Communicating the significance of friendly counseling aspect of VCT services in order to encourage people to come in and discuss their HIV/ AIDS related concerns. The campaign should emphasize the value of counseling as a key part of VCT services, encouraging people to come to talk w/counselors and work out problems and issues.

Communicating the confidentiality of services offered

*red signifies a primary objective to be address in the campaign

Target Audience: MARPs as defined above

The following execution/creative elements will be taken into consideration with this campaign:

The development of a ‘generic’ VCT brand and / or slogan used to unite different campaign pieces of the VCT communications strategy will be explored. The brand may or not be employed by CDC / Life Gap supported sites.

Due to limited resources, Television will not utilized although it is generally listed as a favored method of receiving information (49% of IDUs feel the most useful information they have received is from TV). Instead, PSI will rely on ‘mid media’ focusing on a print campaign, including outdoor. The benefits of a print and particular outdoor and poster campaign is that it is the most efficient method of targeting MARPs, without stigmatizing VCT services by other populations. Targeting will occur by placing promotional materials at vulnerable areas. For example, billboards will be placed in the vicinity of known ‘shooting areas’ while posters will be placed at designated hot zones.

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Awareness of VCT*Attributes that inspire consumer confidenceAccessibility and affordabilityConfidentiality

C

Reinforced Ideal BehaviorsKnow serostatusManage serostatus

Self EfficacySkills related to

knowing HIV status

Skills related to managing serostatus Active

Serostatus Management

Maintaining a negative status


Personal Conviction in Benefits of Managing SerostatusCommitment to know


know serostatus

Societal Factors that Enable/ Reinforce Objective


IPC activities will support and further disseminate the VCT promotional campaign. The following channels/resources will be considered, and will build on existing CDC/LG outreach, as well as other outreach, as much as feasible:

Peer educators: there is currently an extensive network of peer educators supported by CDC/Life Gap, DFID/WHO, and others that can communicate the VCT strategic objectives to a highly targeted audience. Peer educators are particularly effective in skill building activities. Peer Educators were also repeatedly cited as being a major motivator in accessing VCT, and some participants suggested that PEs, after repeated exposure, finally convinced them accessing VCT was a positive and beneficial thing.

Community-level media: there are a variety of community level media that can be harnessed to communicate the VCT strategic objectives. These media include the communal level health systems, but also include public announcement systems.

IEC materials and direct distribution ‘referral cards’. IEC materials will be employed through peer education and outreach workers to convince MARP to access VCT while promoting safe behaviors (injecting or sexual).

Secondary Activities, to be carried out given limited resources and/or expanded programming

“Post-test” educators: Experience in other countries suggest that Vietnamese will be encouraged to access VCT by learning and being encouraged by someone who already accessed services. VCT centers should consider incorporating “post-test” advocacy or peer education into their program.

Advocacy: community, regional and national level advocacy is an important tool for creating a supportive society. Well planned and targeted advocacy can be highly effective in creating enabling or reinforcing environments as well as in breaking down societal barriers. For instance, advocacy can help wives accept couple counseling. With the proper training and support, people living with HIV/AIDS (PWLAs) can be motivational community advocates.

Post-test clubs: post test clubs are an important VCT support service that encourage individuals to go to a VCT center and take an HIV test. In addition, clubs provide a forum in which individuals can learn and practice serostatus management skills. Clubs will be supported as resources permit.

Results: The campaign will result in an increased general awareness of VCT. It will also assist the current centers in reaching their daily client capacity by addressing the latent demand for VCT.

Specifically, at the end of the campaign, MARP should

(i) be well aware of what VCT is, and that promoted services are a quality and highly confidential service;

(ii) know where such services are located in their community;

(iii) feel confident that they will be welcomed at these VCT sites; and

(iv) feel hopeful that they can improve their quality of life and start living healthier by knowing their HIV status (whether they are positive or negative). They should be ready to begin again after they go through a VCT center and know their HIV status.

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Phase Two: Campaign to Promote the benefits of knowing serostatus Although there is no defined time line for the launch of Phase Two, this phase will emphasize benefits of knowing sero status, used identified motivators from the research. As with phase one, the use of a logo or brand to identify VCT centers will be explored during Phase Two as feasible.

Programmatic context: Research did identify motivators and benefits of accessing VCT, which will be promoted. building personal conviction in the perceived benefits of learning one’s status via VCT, whether one is HIV positive or negative. Prioritized benefits identified in research, and not included in any particular order, include:

o to protect loved ones from possible infection; o to plan for a brighter future- including marriage or children, new work;o if you are negative, learn ways of staying negative; o peace of mind and relief from worry; o if you are positive – access to medical care;

Campaign description: A demand creation campaign targeted to IDU and SWs, and their sexual partners, will center on increasing personal conviction in the benefits of managing one’s serostatus, and in particular within the concepts of a brighter future. This will be achieved by increasing the desire to know one’s serostatus and by decreasing the fear associated with taking an HIV test. In addition, the campaign will increase self-efficacy related to taking an HIV test and managing the associated fear. The campaign will continue to create awareness of VCT as a new service.

The campaign will address the following strategic objectives:

*red signifies a primary objective to be address in the campaign; yellow a secondary objective

The same execution/creative elements will be applied with the second phase of the campaign, and indeed aspects of phase 2 may be included in phase one of the program.

Results: The campaign will result in an increased demand for VCT among adults and couples via an increase in the conviction to know one’s serostatus, enhanced related skills, and a decrease in the fear of knowing one’s HIV status.

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Awareness of VCT*Attributes that inspire consumer confidenceAccessibility and affordability

Reinforced Ideal Behaviors*Know serostatusManage serostatus

Self Efficacy*Skills related to

knowing HIV status

Skills related to managing fear Active

Serostatus ManagementMaintaining a

negative status


Personal Conviction in Benefits of Managing Serostatus*Commitment to know


know serostatus

Societal Factors*BlockEnableReinforce


VI. Tools and Communications Channels

This section presents suggestions for campaign development and dissemination related to PSI/VN’s VCT communications strategy. It is intended to give strategic guidance to organizations involved in promoting VCT via interpersonal or mass media communications.

a. Marketing Tools – The Positioning Statement

Social marketing uses a variety of tools in order to convey its goals and objective. One of the key tools of a marketing strategy is the positioning statement. A “position” is what the service stands for in the minds of the client. The positioning statement provides a concise means of communicating the service’s communication strategy.

Positioning Statement PSI supported VCT

To Vietnamese IDU, SW, and their sexual partners who want to plan their lives or obtain greater control of their lives, a VCT experience is the diagnostic and counseling health service that enables clients to know and manage their HIV serostatus through high quality and supportive VCT services.

b. Marketing Tools – the Logo

The use of a logo with or without a slogan is a key marketing tool used to convey strategic goals and the positioning statement. In Vietnam, PSI will license the use of a logo only to those sites that have a minimum standard of quality, initially determined by CDC and LifeGap, but later with PSI concurrence. Logos are useful:

To communicate a point of difference between different products or services. In the case of VCT, there are no other comparable services. However, HIV testing services do exist as does HIV counseling (Global fund in particular offers counseling w/out the testing). Considering the negative experiences many MARP have had with the health system, it is important to differentiate quality VCT from mandatory, non confidential testing. Therefore, potential clients could confuse VCT with testing services that have a health care provider present to administer the test, resulting in a client not easily drawing the distinction between VCT client oriented interpersonal counseling and a health care provider answering questions. The potential risk associated with a lack of a logo in this situation is undermined consumer confidence in VCT.

To provide a visual link between the client and VCT center. Once the point of difference is established, then the client can easily identify centers that provide VCT from those that provide testing only.

To link messages and sites to the client. Logos convey messages about their particular type of service or product. However, it is critical that proper monitoring be in place to ensure that the service is delivering exactly what is promised. In the case of VCT, a “soft” logo might mean “VCT is here” and serves to provide a visual link between the VCT and the client. A “strong” logo can convey the message “quality counseling and safe accurate testing provided here with a counselor who cares about your needs”. Obviously, the latter tells a more attractive story to the client than the former and requires quality monitoring.

To endorse approval by an institution that is credible to the client. This institution is usually responsible for licensing and managing the logo.

The following are advantages and disadvantages of the use of a logo versus generic approach for VCT promotion in Vietnam:

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Advantages:Logo Logos communicate to the client a clear point of difference between mandatory testing, other

services or clarify potentially confusing aspects of new services. Logos provide a long-term visual link between the client and the service that remains even if

promotional activities have stopped. A logo’s message can be built up over time. For instance, a logo can be launched telling a

“soft” message then built up as the context changes. A logo tied to standardization and quality control provides motivation to service providers.

They will feel that they are part of a supportive network and feel more obligated to provide high quality service. Since they will feel more part of a team they would be less likely to view monitoring and evaluation as a burden or intrusion but part of an internal quality improvement mechanism.

A logo tied to standardization and quality connotes a “seal of approval” to the client.Generic If the context cannot support a logo, a generic approach can communicate many of the same

key messages. There is little risk of VCT centers being associated with each other if key factors, such as

quality control, are not standardized and proactively managed.

Disadvantages: Logo A group of services must uphold the value of the message of the logo. If not, then there is a

risk that consumer confidence will erode on all the centers carrying the logo. This risk increases with the strength of the message conveyed (for instance “VCT here” versus a strong quality service message)

Once a logo looses equity, it is difficult to rebuild. Generic There is little linkage between the client and VCT center, visual or otherwise. Promotional

activities that state the specific VCT centers must run continually since recall of the names of the center is considerably shorter than that of a logo.

Client might confuse VCT services with services that offer diagnostic testing since there is no clear point of differentiation.

c. Mass Media and Interpersonal Communications

In order to obtain the strategic goal and objectives in an effective and efficient manner, a mix of mass, and ‘mid’ media and interpersonal communications channels should be used to convey the key messages.

The following is an overview of mass media in Vietnam, and recommendations for use. Source: latest media survey. In brief:

TV is scewed in popularity slightly toward younger, more educated, higher income urban areas, although it appears to be evenly watched across groups.

Print is slightly more popular with males readership, younger (15-44), highly skewed toward upper educated (high school and above) aid higher income urban.

Radio: slightly more popular with males, older, rural or semi rural groups. Internet: is highly dominated by male, young (15-25) well educated high income urbanites.

Effectiveness of preferred advertising sources can be extrapolated from those that reported viewing/reading/listening “With Interest”-- rates included 28% for TV, 20% for print, 11% for radio, 11% for print adds in supplemenat, and 9% for video.

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Television

According to a 2004 comprehensive survey over 95% of households in selected provinces had access to a television (93% color), and 90% reported watching TV the day before. Television is very popular and is a common fixture in cafes, bars, and tea shops..

Although cabal television is widely available and relatively cheap, it is still unaffordable and not common in most households. Public TV, as with all media, is controlled by the state. Three national TV stations dominate (VCV1, 2, and 3 report 100% coverage) while each province or region will have a channel broadly available (coverage above 75-80%). Cable TV, such as MTV and English stations, with some material dubbed or subtitled in VN dominate cable, and more specific town stations are available in up to 25% of homes. Popularity of stations is not available but VTV 3 is anecdotally the most popular as it is dominated by news and entertainment.

Over 28% of those viewing report watching TV ads with interest, while a further 40% report

watching advertisements “only if they are interesting.’ Relatively small percentages flip channels or watch through the ads w/little interest.

The use of television programming as a powerful, credible information source across all economic and geographic classes and should not be underestimated. Vietnamese consumers are highly influenced by this visual medium and it is an excellent manner in which to address consumers and opinion leaders. In addition, televised messages are particularly powerful to rural audiences who are less exposed to media than their more sophisticated urban counterparts. It is, however, expensive, with costs running from $64/minute in rural provinces to $1,150 in HCMC at low time to $350 to $2,200 at prime time/per minute.

Radio

Radio has not taken hold widely in Vietnam, in part perhaps because state owned stations are dominated by news and contemporary music is not widely available. Only 31% reported listening to radio the day before, and is more popular with those 35 and older.

23% report ‘listening as usual’ and 11% report ‘listening with great interest’ when advertisements come on the air.

Local Broadcasting stations have the highest coverage (% listened to in the last 3 months) at 30%, while Voice of Vietnam had coverage to 28%. Each province and even city will have their own provincial radio station. Only 5% of listeners reported listening to the most popular national radio station, Voice of Vietnam, every day of the week.

Only 18% reporting access to the internet (much higher in Hanoi and HCMC then rural provinces) and 26% have ever accessed the internet.

Most popular shows cited were music requests, News, VN moden music, and local news. Cost per minute on the radio is approximately $50/30 second spot.

Outdoor: Billboards were by far the most prominent ‘noticed in last week’ outdoor advertisements cited.

While reported rates were higher in urban areas than peri ruban and rural, similar advertisements were consistently noticed in varios areas: In response to the question:”Which type of outdoor advertisement have you noticed in the past week?” the response was:

o Billboards: 67%o Poster: 62%o Bus stop/station 53%o Banner 51%o Light box 38%

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o Telephone booth 38%o Bus/transportation 36%o LCD: 33%

Print: the print market is fractured, with higher readership captured by a variety of newspapers and magazines.

Loudspeakers: With high reach in nearly every commune and transmitted at peak periods twice a day, loudspeakers are a government communications technique that is a reliable if not incredibly effective method of transferring knowledge based messages to the target group. No data is available for loudspeaker penetration, but it is conceivable that VCT messages could be transmitted and would serve to increase awareness and knowledge of what VCT, including the key messages of confidential, availability of counseling, voluntary, HIV testing, and location. Loudspeakers must be carefully considered as, being known to be a favorite transmission source of community party organizations, they may overly associate VCT services with govt run health system in the minds of IDUs and SWs. If so, it may reinforce the perception that VCT is another non confidential government service,

Recent research in Hai Phong w/IDUs and SWs is inadequate but provides insight to how information on HIV/AIDS was received and/or perceived in the past. IDUs received information about HIV/Aids from various sources, but sited the most useful information about HIV/AIDS was through mass media (48.9 %), peer educators (16.3 %), and health workers (11.3 %). CSWs received information about HIV/Aids from various sources, but sited the most useful

information about HIV/AIDS was obtained from mass media (50.5 %), peer educators (12.5 %), health workers (12.5 %), and friends (12%).

Mass Media and VCT

The proposed allocated budget below outlines tentative resource allocation to each media, and takes into account existing programming such as peer education and outreach, and will leverage existing budgets available to the provinces.

With increased funding, a limited television campaign would go far in addressing communication objectives in phase one and two while serving to destigmatize not only the use of VCT, but HIV/AIDS as a whole. However, funding for TV does not exist. Client perception of television has proven to be trustworthy, credible information source and can be put to best advantage for increasing client awareness of VCT services and building confidence in quality of services. In addition, key messages can successfully raise personal conviction in the benefits of managing one’s serostatus. Since television’s primary audience is popular across the board, a television campaign will help increase demand for those who need it while increasing social support in the community for VCT.

In addition, television will help secure supportive opinion leaders and referral makers. This is an important first step for VCT related communications, especially since most VCT centers are based in urban areas and many current early adopters are urban/periurban. However, existing resources do not permit a broad rollout of TV campaign.

Outdoor and select print campaigns will serve as the main thrust of advertising and promotion. Outdoor will be complemented by both IEC materials (brochures) to reinforce key messages transmitted by outdoor and print and provide an interactive forum for discussions of key related issues.

Advocacy and Interpersonal Communications

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Advocacy and IPC currently play important roles in encouraging individuals to access VCT services. Current VCT users reported referral makers, PWLAs and public announcements as types of communications that encouraged them to seek VCT services.

Future IPC and advocacy campaigns should expand this role of providing linkages between potential clients and VCT centers. In addition, these campaigns should focus on building personal conviction to know one’s serostatus, increasing skills related to self-efficacy and reinforcing safer sexual behavior related to serostatus management.

There are many excellent advocacy and IPC programs currently functioning in Vietnam. These include funded programs from DFID/WHO, CDC/LG, FHI, PSI, and local NGOs.. Many IPC programs have the capacity to integrate VCT key messages into its programming. These programs have the advantage of “translating” VCT messages in ways that are culturally understandable and persuasive as well as providing interactive fora. In addition, the staff in these programs are best able to identify the individual and community-wide constraints to the strategic objectives and implement creative, impactful solutions.

In addition, innovative IPC approaches that were developed specifically for VCT services should be considered, such as expanding the availability of the popular Post Test clubs. In addition, serious interest was indicated on the part of potential and current VCT users to act as VCT educators in their communities. These people would benefit from advocacy skill building trainings and follow-up to become an important IPC channel.

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