Background : In New York City, women of color represent over 90% of all new HIV diagnoses among both cis- and transgender women. Data also reveal extremely low awareness and utilization of pre-exposure prophylaxis (PrEP) among women of color who reside in high diagnosis rate areas, showing that only 21% of sexually active Black and/or Latina women in New York City were aware of PrEP, compared to 85% of men who have sex with men. In response to these findings, the New York City Health Department developed a sex-positive bilingual social marketing campaign, the city’s first PrEP campaign to include messages that specifically address the concerns of cis- and transgender women.
Methods : Using qualitative research methods (e.g., community consultations, focus groups), we engaged groups of cis- and transgender women to assess interest, acceptability, and cultural appropriateness of a PrEP-focused social marketing campaign. Phase one of the research comprised of two community consultations with cis- and transgender women who work in clinical and social service settings. These were semi-structured discussions with stakeholders that serve the impacted population and are thus in direct contact with the intended target audience. The consultations informed the campaign’s creative direction and general campaign messages. In phase two, five focus groups comprised of both cis- and transgender women were conducted. Participants were asked to provide feedback on the campaign’s images (which depicted a diverse set of cis- and transgender women), along with messaging that would accompany the images. To account for social desirability bias, four of the five groups were comprised exclusively of cis- or transgender women.
Results : Overall, participants showed support for developing a singular campaign to reach both cis- and transwomen. Women in phase one overwhelmingly endorsed emphasizing themes of inclusion and equality with the caveat that they were the audience by proxy and likely to carry an implicit positive bias. In phase two, focus group participants (which more closely reflected the intended campaign audience) confirmed the views explored in phase one; results from the focus group were also used to refine campaign messaging as well as the call to action. The final campaign featured thirteen different images of diverse cis- and transgender women and was placed in New York City subway trains, subway stations, bus shelters, buses, local businesses, and digital media.
Conclusions : Formative research is critical to developing a culturally responsive social marketing campaign. The “Living Sure” campaign was developed with input from key community stakeholders and members of the target audience. This campaign is an integral component in the New York City Health Department’s approach to addressing the substantial racial disparity in new HIV diagnoses among women. The campaign quickly gained popularity for its sex-positive and gender-affirming messaging and was nominated for the 2018 Best HIV Prevention Campaign Award issued by POZ magazine.