About ISCI’s Supplement Project Spotlight Series: This series does a deep dive on research and findings from supplement projects funded by the National Institutes of Health (NIH) as part of the Ending the HIV Epidemic in the United States (EHE) Initiative. Keep reading to learn more about this process and click here for additional information on supplement project funding.
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Through her work as a primary care physician, Harita Shah, MD, saw that Latine people experience disproportionately high HIV incidence and barriers to accessing PrEP. Shah’s observations parallel national trends—Latine communities account for 33 percent of new HIV infections but only 18 percent of the US population. Barriers to accessing PrEP are also evident on a national scale, seen through disproportionately low PrEP uptake among Latine communities compared to their non-Latine, white peers. Perpetuated by longstanding systemic inequities and marginalization, disparities in HIV diagnoses and PrEP uptake persist despite national strides in HIV prevention efforts.
Recognizing that disparities will only continue to widen without change, Shah developed an EHE supplement project that piloted a social marketing campaign to increase PrEP awareness and uptake among Latine communities in Cook County, Illinois. She worked in partnership with the Chicago Queer Latine (CQL) Collaborative, a group of local Latine individuals representing HIV-focused community-based organizations (CBOs). Pedro Serrano, the leader of CQL Collaborative, was the co-primary investigator on the project. He now works as the Senior Project Manager for Northwestern University’s Evaluation, Data Integration, and Technical Assistance program. The project was awarded as a supplement to the Third Coast Center on AIDS Research.
Shah and Serrano’s project developed a social marketing campaign called PrEPárate, meaning “be PrEPared” in Spanish. The project team created culturally tailored materials to effectively communicate information about PrEP with a focus on Latino sexual minority men and Latina transgender women, as these groups experience some of the largest disparities in HIV incidence. The PrEPárate campaign disseminated the materials using digital and in-person avenues, ultimately identifying effective strategies for marketing PrEP that can be adapted to different cultural contexts and regions.
The PrEPárate campaign was initially modeled after PrEP4Love, a 2016 sex-positive social marketing campaign that increased PrEP awareness and uptake among Black sexual minority men and transgender women in Chicago. The campaign was led by the AIDS Foundation of Chicago and the Illinois PrEP Working Group.
“PrEP4Love successfully promoted PrEP among African American people who identify as LGBTQ+ because of how it used social marketing, which can effectively reach people who might not be plugged into traditional health systems,” Shah said. “Local Latino community members and leaders were motivated to find a way to adapt this kind of messaging for different Latine audiences.”
Shah and the PrEPárate team conducted qualitative interviews, focus groups, and surveys with Latine sexual minority men and transgender women to identify what PrEP4Love campaign elements would be most effective for the community.
Elements and adaptations that participants responded favorably to included:
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- Using colorful images to reflect vibrant colors in Latine cultures
- Hiring community members to be the face of the campaign
- Empowering viewers through messaging on love and sex positivity
- Providing information in both Spanish and English
- Featuring Latine people of varying skin tones to reflect diversity in the community
- Disseminating materials through digital and in-person avenues
- Using images of relatable Latine people in everyday scenarios
- Avoiding oversexualized images to minimize sex stigmatization
Armed with these insights, the project team began developing the campaign materials, starting with a public crowdsourcing contest to solicit the campaign name through a post on CQL Collaborative’s Instagram. People submitted names by directly messaging the team or commenting on the post, with the incentive that those who came up with the top three campaign names would receive a $100 gift card.
“Crowdsourcing is a really great way to quickly solicit community input and amplify community voices,” Shah said. “Historically, there’s been a lot of top-down and fear-based messaging around public health campaigns, but we received a lot of strength-based and empowering messaging and tried to emulate that throughout the campaign. We wanted this to be a celebration of health and of community values.”
Shah, Serrano, and the PrEPárate team then hired local Latine artists, designers, social media influencers, and members of CBOs to be PrEPárate Ambassadors—the faces of the campaign. The team developed videos, posts, and advertisements with the Ambassadors that provided culturally relevant information about PrEP and how to access it.
“In order to improve the public health of a specific community, it’s essential to have members of that community participate in the development and implementation of those projects, because that’s the only way to truly understand what the current community priorities are,” Shah said. “The PrEPárate Ambassadors helped make this intervention effective because they had that community perspective.”
PrEPárate Ambassadors:
Amparito
Memo
Cindy Nero
Emilio
Juan
Salvador
Regina Rodriguez
Carlos Andres
The team also developed a website, available in both Spanish and English, which became a central part of the PrEPárate campaign. The website hosted campaign materials along with local resources for accessing PrEP.
Shah, Serrano, and the PrEPárate team then partnered with an advertising agency focused on LGBTQ+ populations to promote the website across different social media platforms, including Facebook, Instagram, TikTok, YouTube, and Grindr. The campaign used social media as a way to reach audiences that the traditional healthcare system does not. Shah met regularly with the advertising agency to review ad performance and make adjustments to campaign materials.
In addition to disseminating digital materials, the PrEPárate campaign team conducted in-person outreach at local organizations, clubs, and bars that were geared towards Latine and LGBTQ+ people. This team included bilingual outreach workers who helped provide PrEP information to community members.
“The idea behind in-person outreach was to complement online messaging, so people could tell the campaign was ‘real,’ that it was trustworthy, and that it came from a safe space,” Shah said.
The PrEPárate team put up advertisements at community centers and on public transportation to expand the reach of campaign materials.
After the PrEPárate campaign ended in September 2022, Shah received a KL2 career development award to evaluate the campaign. Shah conducted evaluations with the CQL Collaborative, which included over 500 surveys and 14 qualitative interviews with Latine adults in Cook County.
Overall, findings showed that recalling exposure to the PrEPárate campaign was significantly associated with increased PrEP awareness and, to a lesser degree, increased PrEP use. Approximately 87 percent of survey respondents who were exposed to the PrEPárate campaign reported being aware of PrEP, compared to only 52 percent of respondents who were not exposed to the PrEPárate campaign. People exposed to the PrEPárate campaign also had a higher likelihood of taking PrEP relative to people who were not exposed, which was statistically significant with a p-value less than 0.05 for the model adjusted for age, education, limited English proficiency, sexual orientation, and the number of sexual partners in the last three months. The unadjusted model was highly statistically significant with a p-value of less than 0.001.
Out of the survey respondents who were exposed to the PrEPárate campaign, nearly 83 percent said it impacted them in at least one way, including learning about PrEP and HIV prevention, finding a PrEP provider, and/or starting PrEP. In qualitative interviews, the respondents recognized the name, ambassadors, and sex- and health-positive language as key strengths of the campaign that contributed to its impact.
The PrEPárate team examined social media metrics as well, which showed high levels of engagement with posts on Instagram, TikTok, and Grindr.
“By using social media, we were able to reach a large audience and specifically saw a lot of success with the short video ads featuring the PrEPárate Ambassadors,” Shah said. “The campaign was seen and heard among the local communities we were trying to reach, and social media was a big part of that.”
The PrEPárate campaign’s in-person presence helped establish trust that aided digital campaign efforts while engaging people who may not consistently access social media.
“There are so many different populations under the umbrella of Latino populations, and some groups have limited access to social media, such as certain immigrant populations with limited resources. Having that in-person connection was particularly important in ensuring all people had access to the information, which I want to expand in future iterations of the campaign,” Shah said.
Shah and the PrEPárate team are now in the process of developing a multi-level intervention that combines the social marketing campaign with peer-based support to bridge gaps in outreach for Latine folks. Shah received a K23 award through the National Institute of Mental Health to support this work.
“It is absolutely critical to engage with community members and financially support them when doing this research because they are the experts and should be treated that way as equal partners in the work. Community engagement is key to addressing HIV disparities across the country.” – Dr. Harita Shah
Throughout her work improving PrEP access and uptake for the Latine community in Cook County, Shah repeatedly noticed the effects of additional social determinants on access to PrEP. To identify the most prominent determinants, Shah conducted a needs assessment in Cook County. The assessment included in-depth group interviews with staff of five local CBOs and cross-sectional surveys with over 500 Latine community members.
“As we continue to work on improving access to PrEP, I want to address some of the other basic social determinants we came across, like housing insecurity, food insecurity, and mental health,” Shah said. “While we often study social determinants at an individual level, we recognize that many of these factors are determined by where a person lives. Hopefully, by understanding these social determinants and unmet needs at individual and neighborhood levels, we can develop another iteration of this project that addresses a wider range of barriers to PrEP.”
Shah is also adapting the PrEPárate campaign to apply to different regions in the United States. She recently partnered with a team at Johns Hopkins University that is interested in adapting the PrEPárate campaign to the Baltimore area Latine community. Together, they have identified major elements to maintain, such as the overall messaging, and elements to adjust, like using more Spanish audio for videos, to meet the needs of Baltimore’s large, first-generation Spanish-speaking immigrant population.
“Cook County was the PrEPárate campaign’s initial home, but now our goal is to reach a wider audience,” said Shah. “My hope is that we can continue to adapt and tailor the campaign to other settings and build on this work to help address HIV disparities across the country.”
Creative leads for the PrEPárate campaign include:
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- Verónica Martínez – artist
- Alejandro Muñoz – web design
- André Perez – videography
- Daniel Reyes – photography
- José Rosa – branding and graphic design
- Commando, LLC – social media
CBOs were instrumental in designing and implementing the PrEPárate campaign. They include:
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- CQL Collaborative
- Association of Latinos/as/xs Motivating Action (ALMA)
- Comprensión y Apoyo a Latinos en Oposición at Retrovirus (CALOR)
- Center on Halsted/HIV Resource Hub
- Corazón Community Services
- Esperanza Health Centers
- Howard Brown Health
- Impulse Chicago
- Medical Organization for Latino Advancement (MOLA)
- Project VIDA
- Puerto Rican Cultural Center
Interested in learning more about the PrEPárate campaign and its findings? Check out the project article in JMIR Formative Research >>
More on supplement projects: In support of the EHE Initiative, the NIH funded implementation science projects through its network of Centers for AIDS Research and the National Institute of Mental Health’s AIDS Research Centers. Research reported in this spotlight was supported under award number P30AI050410. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.
More on the spotlight series: ISCI’s EHE Supplement Project Spotlight series does a deep dive on the research and findings from these projects, providing insight into how researchers, providers, and community members can advance health equity by scaling up HIV prevention and treatment strategies. Visit HIV.gov to learn about the EHE initiative and check out the NIH website for more information on supplement projects.
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