Family Health Centers of San Diego’s (FHCSD) Gay Men’s Health Program launched a comprehensive social marketing campaign on June 20 designed to encourage and normalize safe sexual behaviors, specifically pertaining to HIV and STD prevention.

“I think when you look at all trends and the epidemiological data, new infections continue to happen here in San Diego, in the state and across the country,” said Victoriano Diaz, the campaign’s coordinator. “I think this is an opportunity to do something a little bit different to get the message out there that the HIV epidemic continues and people still need to take precautions to protect themselves.”

Various print ads will appear in gay newspapers, in bus shelters, on billboards and in small displays at local businesses throughout Hillcrest and North Park. The campaign will also put banner ads with pop-up windows on Web sites and in Internet chat rooms frequented by San Diego gay men. Some of the sites include Gay.com. Planetout.com and OutinSanDiego.com.

The campaign’s Web site, gaymenshealth.org, will include information about HIV, other STDs, the impact of substance use and related San Diego resources, and serve as a hub for community feedback regarding the campaign.

Robert Lewis, FHCSD’s director of HIV services, said the planning process behind this campaign was complex and started well over a year ago. The state put out a request for proposal to different agencies throughout California, he said, and FHCSD worked with the County of San Diego to devise a proposal, which won them the contract and funding for the three-year campaign.

The San Diego Association of Governments (SANDAG) serves as the evaluator for the campaign, along with a strategic planning team made up of service providers and community members including the HIV, Hepatitis & STD Branch of the San Diego Health and Human Services Agency, The Center, Stepping Stone of San Diego and the Council of Community Clinics, as well as members of San Diego’s community of men who have sex with men (MSM).

SANDAG and the strategic planning team started meeting last July, and developed an intensive market research plan to help craft the campaign’s messaging and overall tone. Focus groups were conducted with HIV-positive and HIV-negative MSM during September and October of 2004, gathering valuable qualitative data.

Key informant interviews were also a major part of the elaborate research process. SANDAG staff talked extensively with service providers and community members who shared their opinions regarding why MSM engage in risky sexual behavior and how they could be encouraged to change those behaviors. Researchers concluded that many MSM often engage in risky sexual behavior and fail to discuss HIV and STD status with their sexual partners due to any combination of self-hatred, fear of rejection, alcohol or drug use, misinformation and financial concerns.

“All those are also very valid reasons why somebody may not disclose [their status],”said Felipe Garcia, programs manager for HIV prevention at FHCSD. “Part of what the hopes are with this campaign is that we can change some of those community norms and start seeing things differently.”

Another major component in the campaign planning process was street intercept surveys. During a nine-day period occurring in late October 2004, research staff conducted anonymous and confidential surveys with gay and bisexual men in the Hillcrest area at various bars and clubs and at a bathhouse. The surveys assessed their safer-sex practices and knowledge and opinions regarding HIV transmission and testing.

“The great thing about it was people were very open to want to disclose information, which was great for us,” said Diaz. “We really wanted to make sure that we got the high-risk population – the people who are outside of the bars, the people who go to Club San Diego. We actually sat in the smoking lounges, and while people were smoking, they sat there and took a five-page questionnaire about what was going on in their lives.”

Out of the 134 surveys conducted, one in two respondents said they did not regularly ask for their partner’s HIV or STD status. Two-thirds reported they do not always use a condom during anal sex, and that they don’t think their friends do either.

Diaz said he was surprised by some of the candid responses. “It’s funny that when you talk one-on-one with someone on a survey, they were really willing to divulge these really personal innermost secrets, but when you’re talking with someone who’s your partner, they can’t have that conversation,” he said. “We felt that was really unusual, that as gay men we can talk about this guy we had sex with, but we can’t talk to that guy about ourselves. We’re open to talk about our sex lives, but as long as it’s not someone we’re having sex with.”

Lewis said having SANDAG involved in the process added value to the campaign. “It kind of gives that outside perspective,” he said. “… Even the strategic planning team that has been involved in this is very much involved in the community, and throughout the community. This is an outside set of eyes to make sure that we aren’t overlooking anything … or creating images or messages that are based on our own assumptions.”

SANDAG and the strategic planning team reviewed existing data and input received from the focus group, key informant interviews and street intercept surveys. The team used the findings to identify the key issues to be addressed by the campaign, as well as appropriate media outlets.

Garcia said SANDAG is going to be looking at some behavioral outcomes from the campaign, asking people how they responded to it and if they did anything differently afterward. They will conduct further analysis and alter some of the messaging in the campaign, if necessary.

“We’re hoping this will spark some talk, some discussion in the community, and lead to further discussions that we can be involved in,” Diaz said.