Stop Aids: Federal Office for Public Health, Swiss Aids Foundation
Stop Aids is an example of one of the longest running and most carefully evaluated social marketing programs for AIDS prevention in the world. Its initial audience was gay men, but as the epidemic began to expand it reached out to a truly national audience. Its most important difference was to constantly measure not only condom use, but changing attitudes toward the epidemic. Condom use among men between the ages of 17-30 yrs old, for example increased from 8% to almost 50% between '87 and '90. One product was the condom, but another product was anti-discrimination and later needle exchange. The Swiss were convinced that as long as AIDS was feared, risky sex would remain underground. The price of prevention was lower than the price of high-risk behavior, because the price of prevention no longer included the fear of discovery. In addition to condom promotion and needle exchange being promoted on radio and TV, community groups were organized, a special Hot rubber brand created for gay men, and new distribution points opened throughout the country for condoms and for counseling and testing.
Evaluation of the STOP AIDS prevention campaign was based on a model that assumes that acceptance and retention of protective behavior is due in part to changes in attitude, opinion and knowledge motivated by intervention and prevention programs. The program was evaluated from the onset using both qualitative and quantitative measurements; and because it was often not possible to measure individual campaign segments, the evaluation included a variety of the elements affecting protective behavior including the attitude and level of awareness of the general population and targeted groups.
Increased condom sales: Observed changes in the market for condoms, the central focus of the campaign, was one of the key factors used to measure the program's impact on the population. After systematic market observation of the manufacturers supplying at least 80 percent of condoms in Switzerland, results indicated that between 1986 and 1990, condom sales had increased by 80 percent (from 7.6 million to 15 million units).
Increased condom use: The campaign's impact attitude and behavior change was measured through recorded changes in condom use among targeted age groups. Between 1987 and 1990 condom use among 17-30 year-olds increased from 8% to almost 50%. Condom use among 31-45 year-olds also increased during that time (from 22% to 35%).
STOP AIDS did not increase the number of partners: It had been suggested that the campaign's support of condom use would promote promiscuity among young adults and result in an increase in the number of individuals' sexual partners. This argument was contradicted by a study conducted between 1987 and 1989 that found the number of people that considered mutual faithfulness effective protection against HIV transmission had increased from 18% to 49% between those years. In the 17-20 year age group, the number of those who had had more than three partners actually decreased slightly.
The STOP AIDS Campaign
Created by a joint task force of the Swiss AIDS Foundation and the Swiss Federal Office for Public Health, STOP AIDS is the longest running HIV/AIDS prevention program in the world. It was launched in 1987 as a national, multi-media campaign designed to: (1) increase condom use among Switzerland's general population and targeted risk groups, (2) reduce discrimination against individuals with HIV/AIDS, (3) increase solidarity among those living with HIV/AIDS and with the rest of the population. Through an advertising strategy of persuasive, gradually phased in messages and mainstream imagery, and a system of constant evaluation, the program achieved successful results during the first few, critical years of its operation. The STOP AIDS campaign remains in place as Switzerland's primary AIDS prevention program, and is one of the hallmark examples of successful social marketing.
Introducing a new condom product for gay men: The Hot Rubber
Prior to the STOP AIDS campaign, there were two successful national prevention efforts initiated in Switzerland. The first occurred in 1985 when the Swiss AIDS Foundation established its own brand of condom, Hot Rubber, to market to gay men. Through its own distribution channels and targeted marketing, the Swiss AIDS Foundation set out to make condoms readily available, to diminish the stigma and embarrassment associated with purchasing them, and to encourage consistent use. The effectiveness of the Hot Rubber brand's promotion is illustrated in its sales volume from that time. In just a nine- month period of 1985, condom sales rose from 2,000 units per month to more than 55,000, leveling off a year later at 75,000 units.
The Early Effort: Build Awareness
The second effort, initiated by the Swiss Federal Office for Public Health in 1986, was an informational brochure about the AIDS virus mailed to every household in the country. Its main purpose was to confront the population with an official government recognition of the virus, to present the known facts about transmission, and to dispel some of the fear-inducing rumors that had developed out of media speculation. A survey conducted immediately after the brochure's distribution showed that at least 75 percent of the population had looked at the pamphlet, and that 56 percent said they had read it.
The STOP AIDS marketing plan was designed to maximize behavior change and individual responsibility through a series of products and messages promoting increased knowledge, awareness, and action. The central strategy of the campaign was based on the learning method, a concept that assumes that individuals are capable of both changing their behavior and taking responsibility for protecting themselves. As part of this strategy, inducement of fear was eliminated as possible means for altering behavior. Scare tactics were seen as a cynical method for affecting change, and because they often produced their own set of negative results, fear was deemed inappropriate as a credible prevention technique. The campaign, instead, used a positive message promoting individual awareness and self-determination, and avoided imposing a judgmental or moralistic view on any particular behavior. This was seen as a more effective way to address the socially sensitive subjects of sexuality and illicit drug use, while encouraging safe prevention habits.
Target Condom Use
Building on the success of the Hot Rubber Program and the raised awareness of the national brochure, STOP AIDS made condoms the central focus of its campaign, promoting their use as the most reliable and effective method of preventing the spread of HIV. The campaign's logo itself incorporates a pink, rolled condom within the STOP AIDS title, and delivers a clear visual message about preventing HIV transmission. In less than a year's time, the logo enjoyed a recognition factor of over 90% among the Swiss population. Initially, the condom was treated more as a neutral technical aid, but as the campaign evolved it was shown in its unrolled form placed over a model's thumb to illustrate its use for foreigners, tourists and adolescents that didn't understand the symbol's meaning. Later on, the STOP AIDS condom ads also began to feature individuals as the focal element in order to inject reality, voice and emotion into the campaign's message. These ads used young adults from different walks of life and sexual orientations to show their support for condom use and responsibility.
Monitor and Readjust Strategy
An important element of the STOP AIDS campaign was its strategy of gradually phasing in different messages over a period of several years. This approach had the effect of allowing the population to slowly digest the information being presented while making subtle changes in attitude and behavior. Soon after the initial condom campaign, the media strategy began to include ads targeting the issues of needle sharing and faithfulness.
Target Needle Exchange and Faithfulness
Because media campaigns addressing drug use are relatively ineffective due to their inability to influence drug availability or distribution, STOP AIDS concentrated its messages around preventing needle sharing and first-time drug-users while making the connection between drug use and the spread of AIDS. That same year, the campaign also promoted the concept of mutual faithfulness among partners as an important means of protection from infection and as a complement to the central message of condom use.
Target Isolation and Discrimination
In 1989, to address the stigma and isolation felt by those living with HIV and AIDS, the concept of mutual solidarity was introduced into the campaign. With large-scale exposure on numerous television and print ads, the campaign sought to fight all the various forms of discrimination taking place against those living with HIV/AIDS. The ads showed prominent Swiss personalities, elders and AIDS victims making a public appeal for solidarity and promoting the basic human rights of dignity, equality and respect. It was thought that by promoting unity among those with the disease and between those infected and the rest of the population, the HIV/AIDS issue would be dealt with in a more effective and caring manner. With the other elements of the campaign, this additional message formed a more complete package of social awareness.
During its first five years, the STOP AIDS campaign's multi-media strategy featured numerous messages and employed every media available to reach the maximum number of sexually active individuals. By 1992, the campaign had produced and placed over 75 different billboards and posters in three languages at 1,200 locations around Switzerland. Billboards were used because of their wide exposure and ability to impose the maximum visual image with minimal copy, an ideal format for communicating simple messages to the population at large. For the more complex messages, print, radio and television ads were employed. Television ads ran on all of the major networks and in each of the three language areas to achieve a reach of 72.6% of the overall population. Other targeted populations such as adolescents and foreign nationals were reached through movie theater advertisements, student newspapers, and sporting events. In the two months in which they ran, movie theater commercials were successful in reaching more than 50% of Switzerland's 14-34 year age group. Because of lessening attention in the media and the lack of effective treatment available for HIV/AIDS victims, the STOP AIDS Campaign enacted a policy of permanent presence.
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