Councils in the south west started looking at ways of increasing equity of access of PrEP in other groups to address this in late 2021.
- Councils across the south west have pooled budgets to run a health promotion campaign at heterosexual groups and the wider population
- The emphasis has been on creating a sex positive message to tackle the stigma surrounding PrEP
- A new website promoting PrEP and providing access to sexual health clinics has been set up.
Since the rollout of PrEP, the highest rates of use have been among white gay and bisexsual men who have sex with men. But given other groups are also at risk of acquiring HIV, councils in the south west started looking at ways of increasing equity of access of PrEP in other groups to address this in late 2021.
A subgroup of the South West Sexual Health Network was established with some of the council public health sexual health officers across the region and UKHSA.
Torbay Public Health Specialist Sarah Aston, who is on the sub-group, said: "When councils got this responsibility in 2020, we were in the middle of COVID-19 pandemic response. It was a challenging time to launch PrEP with so many other priorities.
“There was also anecdotal feedback that some national 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 were.”
The stigma surrounding PrEP
To help gather evidence, Lynn PR were appointed in January 2022 to carry out research into barriers to PrEP uptake with south west directors of public health making a contribution from their budgets to cover the cost of the campaign.
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. It was agreed that the 13 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 three to six per cent of their initial PrEP allocation.
A fun, sex-positive campaign
Social Change, which specialises in behavioural science, was brought in to run the campaign. It was launched in June 2023 with a focus on underserved groups, as identified in the data and initial scoping exercise.
Mrs Aston said: “Social Change ran some focus groups to see what would work best. We were specifically looking to target older groups, the black African community, trans and non-binary people and other minority ethnic groups. A further challenge was in addressing the geography and rurality of the south west and updating the knowledge of the general population.
“We looked at theming the campaign around 1980s songs with advertising slogans such as ‘No-one put PrEP in the corner’ and ‘Sweet dreams are made of PrEP’ for older groups. But what we found was that people just wanted something different.
“The user-testing showed that the retro references didn't work as well, but that a fun and sex-positive, feel-good campaign that delivered candid, confident but reassuring information about HIV and PrEP worked better, so that is what we did.”
‘Love sex? Love PrEP?’
The result was adverts headlined “Do you know how to PrEP for sex?” and “Love sex? Love PrEP!” They were run on the back of buses and in local newspapers such as The Cornish Guardian, Swindon Advertiser, North Devon Journal and Bristol Post alongside some social media promotion.
Local public health teams and local sexual health services teams also heavily promoted the campaign, which included the creation of a new website. The website provides information about PrEP, including what it is and what happens at the assessment as well as information about HIV testing. It also provides links direct to local sexual health clinics to make a PrEP appointment.
In the first six months of the campaign more than 335,000 were reached online and more than one million via print and outdoor advertising. The campaign has now been extended into early 2024 and a full evaluation report will be available in the summer.
But Mrs Aston is delighted with the impact so far. “It has worked well. We’ve tried to make it as easy as possible for people to find out what they need to know and then to make a booking, which at some clinics can be done online.
“We wanted to ensure that the message was sex positive – that looking after your sexual health should be seen as a natural part of staying healthy. To do that we had to first raise awareness about PrEP and tackle some of the stigma associated with it.”