Councils across the South West have pooled budgets to carry out research into why certain groups are not coming forward for the HIV-preventative treatment PrEP. The findings of the exercise are now being used to run a social marketing campaign which will be tailored towards those groups and individuals who are least likely to come forward to access PrEP. PrEP is a pill which prevents infection with HIV by stopping the virus from replicating.
The PrEP challenge
There are more than 100,000 living with HIV – with around one in 12 unaware they have it – and every year there are another 4,000 new infections.
The government has set a target of zero HIV transmissions by 2030. As part of the strategy, PrEP (Pre-exposure prophylaxis) has been made freely available to those in at-risk groups from sexual health services.
PrEP is a pill which prevents infection with HIV by stopping the virus from replicating. Evidence suggests it reduces the risk of HIV infection by 86% for men who have sex with men. Since October 2020, councils have been tasked with providing PrEP through their sexual health services.
According to BHIVA/BASHH guidelines, this includes:
- HIV negative men who have condomless sex with other men.
- HIV-negative heterosexual men and women having condomless sex with partners who are HIV positive
- HIV-negative trans women who are identified as being at elevated risk of HIV acquisition through condomless sex
National campaigns have been run to raise awareness of HIV prevention, including PrEP, but by far the highest rates of use have been among white men who have sex with men. But given other groups are also at risk of acquiring HIV it soon became clear information and messages about PrEP need to get out further.
Finding out the barriers to engagement
The South West Sexual Health Network became aware of this trend in late 2021 and decided to do something about it. A sub-group was established with some of the lead sexual health officers across the region and UKHSA.
Torbay Public Health Specialist Sarah Aston, who is on the sub-group, said: “It didn’t help that when councils got this responsibility we were in the middle of Covid. It was not the right time to formally launch PrEP with so many other priorities. There were also anecdotal feedback that some campaigns that were run they didn’t always resonate or connect well with other populations in the South West.
“In late 2021 we began thinking about what we could do to engage more people. One of the things that became very clear was that we did not really have a clear idea of what were the barriers and reasons for people not coming forward.”
To help gather evidence, Lynn PR were appointed in January 2022 to carry out research into what was holding people back with each public health director making a contribution from their public health budgets to cover the cost.
Using social media and targeted Google ads, Lynn PR reached out to the targeted populations and carried out surveys across the region. Nearly 750 people were engaged. The findings were shared with the network in mid- 2022. There were a number of key insights:
- There was a knowledge deficit – 88 per cent of those identifying as heterosexual did not know about PrEP for example with women least likely to have, especially Middle Eastern, Black and those of mixed ethnicity
- Social stigma was an issue. Older age groups perceived HIV to be a “gay disease” – a view that was thought to relate back to the 1980s - while younger age groups did not differentiate it from other STIs seeing it as simply another risk from being sexually active
- Some felt using PrEP encouraged risk-taking behaviour and being promiscuous
- The treatment was not linked to normative behaviours with respondents reporting they did not see or hear others talking about it
- Others reported not knowing where to access it or being concerned about price despite it being provided free on the NHS
“The findings were really interesting and provided a lot of food for thought,” said Mrs Aston. “Different groups had very different reasons for not accessing PrEP and we realised that what was needed was a very nuanced approach that would target the right groups in the right way.”
The next steps
It was agreed that the 15 councils which are part of the South West network would pool some of the PrEP budget to pay for a social marketing campaign. Each council set aside 3% to 6% of their initial PrEP allocation.
Social Change, which specialises in behavioural science, has been brought in to run the campaign. The aim is to launch it in the spring and it will initially target different groups indifferent ways, based on the initial report findings.
By later winter the thinking was that the campaign for older groups will use social media channels like Facebook as well as traditional mediums such as posters and radio advertising. The campaign will be themed around famour 1980s songs with advertising clogans such as ‘No-one put PrEP in the corner’ and ‘Sweet dreams are made of PrEP’.
For the younger age group, Social Change is looking at tapping into social media favoured by these age groups such as Instagram and TikTok.
Mrs Aston said: “The bottom line is that the message is going to be sex positive – that looking after your sexual health should be seen as a natural part of staying healthy. To do that we have to firstly raise awareness about PrEP and tackle some of the stigma associated with it.”