Youth programs take pop-culture approach
Two national campaigns showing some success
The typical HIV prevention message often is ignored by teen-agers, who don’t relate to the same issues that concern adults. Yet young people need to know more about HIV and prevention because studies show they are far more likely than adults to engage in risky behavior.
"A lot of people think, We did this HIV prevention already, so why aren’t the kids getting it?’" says Donna Futterman, MD, director of the Adolescent AIDS Program at Montefiore Medical Center in the Bronx, NY. "And part of the reason is that until teens see it validated in popular culture, it doesn’t seem real to them," Futterman adds.
So the key is to design prevention messages for youths that reach them in their favorite hangouts and are written in the language of their own popular culture.
And because young people with HIV are much less likely to know their serostatus than are adults with HIV, prevention programs designed for youths focus on HIV testing as much as on HIV prevention.
The Adolescent AIDS Program’s multicity project, called "HIV. Live With It. Get Tested," has tried to break through the barriers that discourage youths from becoming tested. For instance, the program includes youth-friendly testing sites that offer confidential or anonymous testing. Youths who test positive are provided HIV care.
"One of the things we’ve learned is that to reach young people, we have to speak to them in their language, using messages that they understand," Futterman adds. For instance, the HIV "Get Tested" campaign uses the slang terms "get busy" and "hitting it" as euphemisms for having sex.
Youth-oriented campaigns also make use of media and public places that appeal to young people. The Adolescent AIDS Program includes a peer outreach component in which youths speak with other young people and hand out materials at schools, youth clubs, skating rinks, and parks. The program also will expand to the Internet in August, with a Web site at www.hivlivewithit.org. Montefiore’s Adolescent AIDS Program initiated the campaign and drew on the help of advertising agencies in designing it to be replicated in other cities.
So far, the project has built tremendous interest and HIV awareness in each of the cities involved, Futterman says. "Hundreds of kids called local hotlines and came in for testing."
Pulling in community leaders
Another national prevention campaign for teens, called Project ACTION, uses a four-pronged approach that focuses on community mobilization, mass media messages, skills building, and making condoms available, says Janet Livingstone, director of U.S. programs for Population Services International (PSI) in Washington, DC.
PSI coordinators meet with local community leaders and health care workers to explain the program’s goals and approach to protecting teens’ reproductive health. "It means meeting with youth services organizations that provide social support such as shelters and rehab centers for addiction treatment, and meeting with school boards and schools to the extent they are interested in the program," Livingstone says.
Then program directors research the target audience of youths before developing mass media messages. They find out what sort of media are available and will reach teens, including television, print ads, radio, billboards, and Internet Web sites.
The third step is to help youths understand their risk and help them acquire the skills necessary to communicate with their peers about protecting themselves from HIV and pregnancy. "We help them to negotiate condom use, in other words," Livingstone says.
The final step is to make condoms inexpensive and accessible to youths. PSI has placed condom vending machines in local businesses in targeted communities. For example, the organization has installed 125 condom machines in Portland, OR.
"We put these in places where kids are hanging out," Livingstone says. "The machines have a positive mental health message on them, such as Protect yourself, use a condom,’ or Don’t think about it without a condom.’"
The machines sell condoms at a subsidized price of 25 to 50 cents, and they are located in recreation centers, pizza shops, record stores, and video arcades.
"There were no objections to the machines, because we had already talked to everyone we could think of beforehand," Livingstone says. "I believe we were able to bring the religious groups in at the beginning and say, We know these kids are having sex and pregnancy rates are high, and we want to make it easier for them to protect themselves even if we can’t stop them from becoming sexually active.’"
The project was replicated in San Jose, NM, and Seattle, and each city had positive results, Livingstone says.
"Mainly through quantitative research among the target audience, we were able to show that these kids during and right after the project were using condoms at a much higher rate," she explains. "For example, in Portland, condom use with new or casual partners increased from 72% before the project to 90%."
Even with businesses donating space for the machines and with thousands of minutes of free public service ad time, the project was expensive, costing $500,000 in Portland over the two-year period, Livingstone says.
PSI has begun a fourth Project ACTION campaign in the Santa Cruz, CA, area, targeting rural Latino communities.
"We’re developing bilingual materials and a culturally appropriate version of the Project ACTION model," she says.
[Editor’s note: For more information about the "Get Tested" campaign, call Montefiore’s Adolescent AIDS Program at (718) 882-0232.]
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