Background
Methods
Search strategy
Criteria for selecting studies
Target population
Intervention
Comparators
Study design
Outcomes
Data extraction and quality assessment
Synthesis of findings
Results
Study focus
Study context and target population
Interventions
Study | Intervention | Theoretical framework | Formative work | Setting | Location of delivery | Population |
---|---|---|---|---|---|---|
Hecht et al. [14] | “Are you Iffy?” a social marketing campaign to encourage MSM to reassess their HIV-negative status. 140 posters, 7 billboards and 10 newspaper ads | Health belief Model | Focus groups and community field-testing | San Francisco, USA | Bars/clubs, toilets, subways, bus terminals and newspaper kiosks | HIV negative MSM |
Hilliam et al. [21]* | “HIV Wake-Up Campaign” to provide information on HIV, benefits of prevention and regular testing and where to get further advice. Posters, web adverts and dedicated website, complemented with small print media, i.e. leaflets | Not stated | Not stated | Scotland | Internet | MSM and non-HIV specialist professionals |
Not stated where print media distributed | ||||||
16 mass media adverts placed in press, on websites and as posters, complemented with small media, such knik-knaks | Not stated | 2007: Themes for interventions identified in meetings with partners. Pre-testing with focus groups. | UK | National and regional press and where appropriate national HIV positive press. Posters in gay bars, saunas and clubs | MSM | |
Adverts and their aims (number of images, launch date, display costs): | ||||||
Assume nothing (4 images, July 1997, £73,000) | London underground | |||||
Think, Talk, Time Test (3 images, Jan. 1998, £67,000) | ||||||
What am I?.. See to it. (1 (1 image, July 1998, £70,000) | ||||||
What on Your Mind? (1 image, Jan. 1999, £70,000) | ||||||
Homophobia – (1 image in gay media, Oct 1999; £4,934; 3 images in general media, Aug 1999, £74,616) | ||||||
Better of knowing – (5 images, Feb 2000; £52,254) | ||||||
Facts for life – to provide information on HIV risks (9 images, Sept 2000, £39, 808; Jan 2003) | ||||||
In two minds - to illustrate dilemmas between “thoughts connected to the head (relating to risk reduction) and with the cock/crotch (less rational…)” (10 images, Nov. 2000; £31,114) | ||||||
Just unbelievable - to highlight the presumption that all HIV positive partners will disclose their status (3 images, Oct 2001, £20, 252) | ||||||
Clever Dick - to promote condom use (5 images, March 2002, £22,046) | ||||||
Biology of transmission – to increase awareness of rectum’s and anus’s fragility and absorbency (3 images, Oct 2002, £20,661) | ||||||
Think again – to show divergent thoughts and concerns about HIV transmission and exposure (6 images, Nov 2003, £20, 326) | ||||||
Infection situations – to illustrate possible adverse outcomes associated with sexual risks (5 images, April 2004, £24, 191) | ||||||
Be confident, be covered – to promote use of condoms (3 images, Feb 2005 £16,923) | ||||||
PEP – to increase knowledge of post-exposure prophylaxis (PEP) and is availability after sexual exposure to HIV (1 image. June 2004 and July 2005, £9, 428) | ||||||
Closer – to increase awareness of local and national HIV prevalence and to get men to reconsider their HIV risk (6 images, Jan 2006, cost not reported) | ||||||
Roedling et al. [29] | A campaign to provide MSM with information about PEP and where it is available | Not stated | Not stated | London and Brighton, UK | Adverts placed in gay press and ‘other material’ | MSM |
Hartfield et al. [22]* | “It’s the Little Prick You Can Deal With” campaign to encourage MSM at high risk of HIV to have HIV test every 3 months. Gay-orientated websites, billboards, pavement chalk drawings, complemented with small print media and knick-knacks (e.g. coasters) | Not stated | Pre-testing with community members | Seattle, USA | Outside and inside gay bars and saunas | MSM at high risk of HIV infection, defined as those who have had unprotected sexual intercourse with a partner of unknown or discordant HIV status in last year |
Internet | ||||||
Katzman et al. [16] | “Community Manifesto” to identify sexual health issues and to promote positive sexual health for MSM | Not stated | Task force meetings with involvement from health agencies and community members | Seattle & King County, USA | Placed in 2 weekly Seattle papers, freely distributed. Also posted on a gay health web site in English and Spanish | MSM |
“Think Again” campaign (adapted from the US “Assumptions” campaign) to encourage men to challenge assumptions around partners’ HIV status. Ultimate goal to reduce unprotected anal intercourse between men of discordant HIV status and thereby reduce HIV incidence. Multi-media complemented with small print media and knick-knacks (e.g. coasters). Cost of campaign = $250,000 | Used social marketing concepts | 9 focus groups (47 participants) | Canada | National campaign - billboards, gay venues and Internet | HIV positive and HIV negative men having unprotected sexual intercourse with men whose HIV status is unknown to them | |
The TASC Agency [27]* | “Equal” campaign to promote safer sex, condom and lube use, and regular sexual health check ups. Posters | Not mentioned | Not mentioned | Scotland | Not mentioned | MSM aged 25-40 years |
McOwan et al. [9] | HIV testing campaign ‘gimme 5 minutes’ which ran between March-May 2000. ‘Peer’ images (different photos representing each of the target groups) with same accompanying text covering topics relating to pre-test discussions, making decision to test and information about testing services at the campaign clinic. Newspaper adverts and posers, complemented with small print media. Cost around £10,000 | Not mentioned | Not mentioned | London, UK | Full page advertisements in a free tabloid newspaper, 100 posters in Central London bars | MSM, particularly targeting men of Black and Southern European origin and men under 25-years-old |
Sherr et al. [17] | “Try this HIV test” campaign to encourage homosexual men to consider having an HIV test in light of recent advances in HIV treatments. | Not mentioned | Not mentioned | London, UK | Gay press | MSM |
Dawson & Hartfield [18] | Newspaper comic strip “Stella Seattle” “to clarify information about controversial transmission issues and to encourage HIV testing” | Not mentioned | Mention formative research was undertaken and focus groups set up to test first few comic strips were tested | Seattle, USA | Comic strip ran weekly for 4 months in 2 local newspapers with a large gay readership | MSM |
Campaign began Aug 1993. Cost $9,500 (included media placement of 15-episode strip, artist fees and staff time) | ||||||
Griffith et al. [19] | Statutory HIV educational campaigns, including television and radio. Early campaigns were general and latter ones were targeted to specific subpopulations, including gay and bisexual men. Of the 38 media interventions 6 aimed at gay men and 2 at bisexual men | Numerous media campaigns | Not mentioned | London, UK | Across TV, radio and gay press | Gay and bisexual men |
Multi-media |
Study design and quality
Study | Aims | Design | Sample | Study process and outcome measures | Results |
---|---|---|---|---|---|
Hecht et al. [14] | To compare certainty of HIV negative status before and after the campaign | Repeat pre-test/post-test cross-sectional study (campaign May - July 2008, post-test July - Oct 2008). Part of National HIV Behavioral Surveillance | Recruitment: MSM venue-based, time-space sampling | Campaign awareness | 45% reported they had seen the campaign. Of these: |
Response rate: Not reported | 64% correctly identified the subject of the campaign | ||||
Sample size: 316 men | |||||
Analysis confined to 255 men who reported being HIV negative | |||||
Hilliam et al. [21]* | To measure campaign awareness; HIV awareness; attitudes toward testing, prevention and safe sex; and behaviour change | Repeat pre-test/post-test cross-sectional study - post-test 4-5 months after launch | Recruitment: Via LGBT and HIV organisation websites, and Gaydar (post-test only). Men recruited via Gaydar (G) were analysed separately from those recruited via other non-Gaydar (nG) websites due to differences observed between samples | Campaign awareness | 3-13% reported non-prompted awareness of campaign |
Response rate: Not reported | 69%nG and 82%G reported prompted awareness of campaign (men most commonly reported seeing the web adverts 50%nG and 77%G, followed by the web site 17%G and 29%nG, and finally by the posters 27%G and 32%nG) | ||||
Sample size: Pre-test sample = 88, Post-test sample = 775 | Campaign attributes | Campaign attributes most commonly reported by men: clear message (62%nG and 63%G) and relevance (51% G and 61%nG). Campaign attributes least commonly reported by men: motivating (11%nG and 20%G) and trustworthy (23%nG and 25%G) | |||
HIV test | Men who had seen the campaign were more likely to report having had an HIV test in the last 6 months than those who had not seen the campaign, 33%G and 38nG% versus 9%nG and 16%G, respectively | ||||
Repeat cross-sectional surveys – Gay Men’s Sex Survey (GMSS) questionnaire | Recruitment: Via Pride-type events across UK and the Internet | Campaign Awareness | 2005 | ||
Focus groups and interviews | A variety of recruitment methods described for nested qualitative component, including established agency networks, e-newsletters, fliers and use of snowballing techniques. Purposive sampling, UK cities |
Be confident, be covered: 32% recognised, and of those 52.4% had read | |||
Response rate: Not reported |
PEP: 16.1% recognised, and of those 56.6% had read | ||||
Sample size: | 2004 | ||||
Surveys |
Infection situations: 18.6% recognised, and of those 51.6% had read | ||||
Between 1997-2000 data gathered via face data collection at Pride events, then from 2001 via booklets and online |
Think again: 29.1% recognised, and of those 54.0% had read | ||||
2005: N = 12,322 | 2003 | ||||
2004: N = 11,909 |
Biology of transmission: 26.1% recognised, and of those 50.3% had read | ||||
2003: N = 9,482 | 2002 | ||||
2002 N = 11,046 (booklet = 3515, online = 7531) |
Just as unbelievable: 30.7% recognised (40.4% of booklet users and 26.5% online users), and of those that recognised 64.6% (booklet) and 58.2% (online) had read | ||||
2001 N = 9226 (Pride attendees = 2401, booklet = 2384, web = 4441) |
Clever dick: 31.9% recognised (43.9% of booklet users and 26.7% online users), and of those that recognised 72.2% (booklet) and 64.8% (online) had read | ||||
2000 N = 312 | 2001 | ||||
1999 N = 313 |
Facts for life: Recognised by 42.1% of Pride attendees, 43.0% of those using the booklet and 24.8% of those online, and of those that recognised 54.5% (booklet) and 41.4% (online) had read | ||||
1998 N = 294 |
In two minds? Recognised by 62.9% of Pride attendees, 59.6% of those using the booklet and 39.3% of those online, and of those that recognised 71.5% (booklet) and 63.1% (online) had read | ||||
Focus groups | 2000 | ||||
2009: 6 groups, 49 men |
Better off knowing: 48.1% recognised | ||||
2004: 7 groups, 33 men |
What’s on Your Mind: 31.7% recognised | ||||
2003: 5 groups, 46 men |
What am I?.. See to it: 47.1% recognised | ||||
2001: 5 groups, 37 men | 1999 | ||||
Interviews |
Homophobia: 34.1% recognised image in gay press, 36.5% recognised images in general media | ||||
2000: 68 |
What’s on Your Mind: 54.3% recognised | ||||
1998: 71 |
What am I?.. See to it: 47.9% recognised | ||||
1997: 62 |
Think, Talk, Time to Test: 35.1% recognised | ||||
1998 | |||||
Think, Talk, Time to Test: 40.5% recognised, and of those 62.5% had read | |||||
Assume nothing: 44.6% recognised, and of those 56.1% had read | |||||
Roedling et al. [29] | To compare clinical data, exposure characteristics, follow-up and awareness of post-exposure prophylaxis following sexual exposure to HIV pre and post campaign | Retrospective case note review from 2004 pre and post campaign | Recruitment: Not applicable. Case notes for all those attending for PEP in 2004 included | Sexual behaviour | Condom use |
Campaign launched in July 2008 | Response rate: not applicable | Pre-campaign 20/33 (61%) | |||
Sample size: 216 attendees requested PEP, data available on 197 (91%) | Post-campaign 39/66 (59%), p = 1.00 | ||||
Analysis: Confined to 112 MSM commencing PEPSE, pre-campaign n = 36 and post-campaign n = 76 | Median number of sexual partners in the previous 3 months | ||||
Pre-campaign 3 (range 1-50) | |||||
Post-campaign 4 (1-100), p = 0.51 | |||||
Hartfield et al. [22]* | To evaluate campaign coverage and impact | Repeat pre-test/post-test cross-sectional study. Campaign launched June-Aug 2008. Pre (March – May 2008) and post campaign (June-Dec. 2008) survey | Recruitment: Via MSM venues | Campaign awareness | 75% reported exposure (24% unaided and a further 50% prompted) |
Response rate: Not reported | Campaign acceptability | 80% of those who saw campaign very positive/positive. Only 3% negative | |||
Sample size: Baseline survey n = 197 | Intention to have HIV test | 38% of those who had seen the campaign and were HIV negative (n = 279) said they would test more frequently due to the campaign | |||
Post-campaign survey n = 464 | |||||
Katzman et al. [16] | To examine the potential impact of the manifesto | Cross-sectional survey and focus groups (in English and Spanish) | Recruitment: Survey posted on web, left in 38 gay venues for mail-in and distributed by street intercepts. Method of focus group recruitment not stated | Campaign awareness | 84% seen or heard manifesto |
Response rate: 2506 surveys distributed in gay venues and 137 surveys returned (5.5%). 69 surveys from women and men without a partner excluded | Campaign acceptability | Of those who had seen it: 61% strongly agreed/agreed with the manifesto, 19% disagreed/strongly disagreed | |||
Sample size: Survey n = 103 | HIV testing | 13% had HIV test | |||
9 Focus groups (139 participants) with representation of gay men both HIV positive and negative | HIV status disclosure | 12% disclosed HIV status 10% asked partner to disclose status | |||
Sexual behaviour | 16% increased condom use | ||||
To assess impact | Cross-sectional survey | Recruitment: Via “gay spaces” across Canada | Campaign awareness | 79% average national exposure Top messages received “rethinks risks” 47%, “protect self and partner” 37% and “use condoms”35% | |
Response rate: Not reported | Campaign acceptability | 73% found messages appealing | |||
Sample size: N = 417 | Sexual behaviour | 48% report message prompted them to change “something” about sexual practices, but men were not asked about the direction of change | |||
The TASC Agency [27]* | Not stated | Cross sectional surveys (2006) and online survey (2007), focus groups and in-depth interviews | Recruitment: For surveys via Internet and a Pride event in Glasgow. Not stated for focus groups and interviews | Campaign awareness | Survey 2006: 82% had seen phase 1 and 2 poster images. 5.3% had visited the Equal website |
Response rate: Not reported | Online survey: 8/26 had previously seen the Phase 1 posters; 9/24 the Phase 2 posters and 15/25 the Phase 3 ones | ||||
Sample size: Survey 2006: 222 men responded. Analysis confined to men aged 25-40 years, N = 116 | Campaign acceptability | Survey 2006: Phase 1 posters 57% reported that they “Love’em” or “They’re good”; Phase 2 posters 53% | |||
Online survey: N = 27 | |||||
6 focus groups with 28 participants | |||||
10 interviews | |||||
McOwan et al. [9] | To evaluate effect of an HIV testing campaign | Retrospective case note review of GUM attendees – comparing the same time points across two years and comparing campaign clinic with two other sexual health clinics | Recruitment: Not applicable. Those testing in the three clinics were retrospectively identified through a central laboratory | HIV testing | In the campaign clinic 4.5 fold increase in numbers of men testing in 2000, n = 292, compared to 1999, n = 65, (p < 0.001), 14.0 fold increase in men of Southern European origin (n = 42 in 2000 vs. n = 3 in 1999, p < 0.001), 6.5 increase in Black men (n = 13 in 2000 vs. n = 2 in 1999, p = 0.003) and 9.5 increase in men under 25 (n = 57 in 2000 vs. n = 6 in 1999, p < 0.001) |
Response rate: Not applicable | No significant differences for these outcomes observed in two control clinics. Total number of men testing in 2000 = 236 and in 1999 = 239 (p = 0.982), Southern European men testing n = 37 and 25, respectively (p = 0.341), Black men testing n = 3 and 5, respectively (p = 0.864) and men aged less than 25 years n = 32 and 36, respectively (p = 0.807) | ||||
Sample size: See Results | Sexual behaviour | Unprotected anal intercourse (campaign clinic only) | |||
Pre campaign 35/65 (53.8%, 95% CI 41.0 - 66.3%) | |||||
Post campaign 156/292 (53.4%, 95% CI 47.5-59.1%) | |||||
Sherr et al. [17] | To evaluate permeation (picture recognition), recall of message, endorsement, and decision to have a test | Cross sectional survey | Recruitment: Two sexual health clinics | Campaign awareness | 80.1% reported seeing the campaign pictures |
Clinics attendees having an HIV test. In one clinic this included heterosexual men and women, and homosexual men requesting an HIV test and in the other all homosexual men | Decision to have HIV test | 25.5% recalled the message (half of this group had correct recall) | |||
Response rate: Not reported | 9.3% reported campaign played important part in decision to have a test | ||||
Sample size: | |||||
667 individuals completed questionnaire, of these 339 reported they were homosexual or bisexual | |||||
Dawson & Hartfield [18] | To look at exposure to and satisfaction with campaign | Repeat cross sectional surveys | Recruitment: Gay bars and a Pride event at different points in time | Campaign awareness | 1993 interviews – 73% familiar with comic |
Structured-interviews | Response rate: Not reported | 1993 clinic forms - 32% gay and bisexual clients who tested reported seeing the campaign | |||
Review of clinic HIV testing and voice mail calls | Sample size: | 1994 bar survey – 47% had seen comic strip | |||
Oct 1993 gay bar structured interviews - number unknown | 1994 rally survey – 44% had seen comic strip | ||||
July-Nov 1993 clinic review – number of case notes reviewed not reported | Campaign acceptability | 1993 interviews - Of those familiar, 89% positive. Negative comments mainly around format, such as confusing and hard to read | |||
May 1994 gay bar survey, n = 662 | 1994 rally survey – Of those who had seen it, 57% liked a lot and 41% thought OK | ||||
June 1994 Gay Pride Rally survey, n = 198 | Voice mail – weekly average of 200-400 calls. Report that most were positive | ||||
Griffith et al. [19] | To describe association between HIV educational campaigns and long-term testing trends between Sept 1985 – Sept. 1993. Of the 38 media interventions, 6 aimed at gay men and 2 at bisexual men | Continuous – prospective collection of demographic and behavioural data from all GUM attendees having an HIV test | Recruitment: Not applicable | HIV testing | Unable to extract data - trends in testing amongst homosexual and bisexual men annotated with media campaigns shown graphically. Authors report periods of peak testing generally corresponded temporally with increased media coverage |
Response rate: Not applicable | |||||
Sample size: | |||||
19 242 tested in three London sexual health clinics, UK | |||||
12 183 men (37.6% homosexual and 7.9% bisexual) |