Leveraging input from community leaders, “My Future. My Choice.” takes a multimedia approach to key population (KP) outreach, integrating social media engagement, television, and a new application to schedule HIV testing and services. The project has successfully reached new audiences and contributed to an increased identification of people living with HIV (PLHIV) among KPs who were previously hard to reach.
What was the problem?
Reaching, serving, and tracking KPs across the HIV prevention and treatment cascades is most challenging when attempting to engage the hardest to reach—key populations who do not self-identify, or do not want to be classified, as a member of a KP. Stigma, discrimination, and violence within HIV services, and societal constraints in general, increase the challenge of engaging these populations.
What is the solution?
The “My Future. My Choice.” campaign, a part of the PEPFAR/USAID-supported Healthy Markets (HM) project, was launched in 2015 to channel the leadership of gay men, other men who have sex with men (MSM), and transgender women (TGW) communities to promote HIV prevention, testing, pre-exposure prophylaxis (PrEP), and treatment adherence as integral components of a healthy life.
Harnessing the Power of Social Media
In an attempt to reach KP community members who currently do not access HIV services, HM worked with MSM and TGW community-based organizations (CBOs) to devise innovative strategies to reach and serve these populations. The project utilized various components including:
Creating the Xóm Cầu Vồng (Rainbow Village) Facebook page
Partnering with gay/MSM dating/hook-up apps (Grindr and Hornet) to promote HIV services
Launching Toi Hen (I reserve), a web-based and mobile app that enables anonymous or confidential scheduling of HIV testing appointments, pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP) services, STI screening and treatment, and antiretroviral treatment (ART) enrollment
Capacitating community-based “Online Change Agents (OCAs)” to provide HIV counseling and referrals to HIV testing, self-testing opportunities, and/or direct lay peer-provided HIV testing via Facebook (FB) messenger, Lime/WhatsApp, etc.
Collaborating with the Vietnam television series “MTV I Live”
Strengthening the capacity of CBOs and introducing social enterprise activities for sustainability
This campaign sought to normalize and increase condom and lubricant use, HIV testing, PrEP use, and treatment enrollment and adherence through community-driven change. In addition, the project accessed low-cost HIV commodity and service demand generation through FB, gay/MSM dating/hook-up apps (Grindr and Hornet), MTV Vietnam, and other outlets. In fiscal year (FY) 2017, the Xóm Cầu Vồng (Rainbow Village) Facebook page reached more than 230,000 MSM and TGW with an average of 11,000 users per post. The page attracted new followers with its dynamic content on sexual health, safer sex, and HIV testing. The content was interactive, engaging followers in discussions on real-life dilemmas and experiences using HIV products and services.
The HM project also leverages its reach to promote community-based HIV testing. MSM and TGW followers are now able to contact OCAs via the Xóm Cầu Vồng page. The agents, who are managed by HM and imbedded within CBOs, were trained to provide HIV counseling via FB messenger, Lime/WhatsApp, and other channels; as well as provide referrals to HIV testing or direct lay/peer-provided HIV testing services (at a time and location convenient to the client). Specific training modules focus on the unique challenges of providing virtual counselling. As in other peer educator programs, OCAs are trained in basic peer counseling skills, defining their roles and responsibilities, monitoring and evaluation systems, and support systems for ART enrollment. As of January 2018, HM employed seven active OCAs.
In February 2017, HM launched Toi Hen (I Reserve), a web-based and mobile app that enables anonymous or confidential scheduling of HIV testing appointments for KPs that are reluctant to talk with someone first or seek HIV testing directly from a community group or facility.The app was developed by an in-house app developer; however, as an open source platform, it can be adapted for use by others. Currently, the Toi Hen app is being adapted to include the ability to schedule additional services such as PrEP, PEP, STI screening and treatment, and ART. In December 2018, a relaunch is planned with these additional features.
What was the impact?
The Xóm Cầu Vồng (Rainbow Village) Facebook page is the anchor of the “My Future. My Choice.” campaign, as well as a platform for reaching LGBT youth. In FY 2017, the Facebook page grew by more than 60 percent, from 140,000 to 230,000 followers. Of those, 87 percent are young people ages 13-24, and 52 percent of them reside in Hanoi or Ho Chi Minh City (HCMC). Each post on Xóm Cầu Vồng reaches an average of 11,000 users. Xóm Cầu Vồng is by far the most popular HIV or lesbian, gay, bisexual, or transgender (LGBT) Facebook page in Vietnam.
Online Change Agents (OCAs)
The HM project model has dramatically increased rates of HIV testing among the MSM and TGW community of Vietnam. In FY 2017, OCAs reached 2,074 MSM and TGW, resulting in 1,429 people being tested for HIV. Of those, 10.8% were confirmed HIV-positive, all of whom were subsequently enrolled in treatment (see Figure 3). This yield of new positive cases is significantly higher than the positive-case yield through traditional testing facilities in the country, reported by the Vietnamese Administration for AIDS Control (VAAC) to be approximately 1.0 percent.
Toi Hen Booking App
From February to September 2017, the Toi Hen app was used by 369 people to find HIV services, 94 percent of whom received HIV testing. Of those receiving a test, 12 percent were diagnosed with HIV, all of whom were successfully enrolled in ART services, as depicted in Figure 4.
HOW DOES IT WORK?
Annual HIV testing uptake was 35 percent among MSM and TGW, and HIV testing services were only offered through public hospitals and clinics. Healthy Markets set out to be creative to reach “hard to reach” MSM and TGW.
The “My Future. My Choice” campaign recognizes several factors as vital for success. The project emanated from gay, other MSM, and TGW community leaders who were part of the project’s creation. Their knowledge of and trust within the community was vital. Community leaders were asked to think of innovative strategies to reach MSM and TGW who were not accessing HIV services.
Through OCAs, the project seeks to identify MSM that are the most at risk, and nearly all of those referred for HIV testing had never been reached before by a peer. Referrals for testing are made based on the client’s preferences. Options include: free testing at community-based or public-sector clinics, or a fee-based service at KP-friendly private clinics. Self-testing is also offered for use in the client’s home or office, or in a clinic where it is facilitated by an OCA/lay provider or healthcare worker. For client’s opting to test at a CBO, public facility, or private clinic, OCAs provide them with a referral code for tracking purposes.
Although the enabling environment for HIV service delivery to KP has improved considerably in Vietnam, barriers remain that limit effective scale-up of interventions for KPs in the country. One barrier is reliance on external funding to sustain HIV prevention commodities and services. In addition, stigma and discrimination continue to inhibit KP’s access to vital HIV services.
The Government of Vietnam (GVN) is concerned about the sustainability of the HIV response as international donors have begun to reduce their contributions. At the same time, the GVN has adopted the ambitious targets of reaching 90–90–90 by 2020 and HIV elimination by 2030. This requires the rapid deployment of cost-efficient strategies that can increase HIV case detection, initiation of ART, and sustained virologic suppression of HIV. Until recently, the GVN has provided all key HIV services free of charge through applying universal access. The GVN acknowledges that it will not be able to sustain free services for all that need them and will need to provide a blend of coverage through social health insurance (SHI) and the private health care sector for those who are able and willing to pay through private health care insurance or out of pocket costs.
The project is at scale, focusing on the two major urban centers of Vietnam, but still reaching MSM throughout Vietnam. While consistently evolving and expanding, the key components of the project took five months to mature, including market research, project design, recruiting and training of OCAs, engaging and contracting with CBOs, pilot testing of ICT components and launch of activities. In the secondary phase, the Toi Hen (I Reserve) took about four months to be designed, developed, tested and launched.
Collaboration between HM, government, private sector partners and KP-led CSOs was also an important factor in success. PEPFAR/USAID and HM started by gaining MOH support, recognizing the need for greater focus on culturally appropriate and sustainable KP programming. After MOH approved of the project, HM worked to engage MSM (and later TGW) leaders and MSM and TGW-led CBOs in the design, implementation, and evaluation. As a result of this early, meaningful engagement, the KP community largely recognizes the campaign as its own rather than as one driven by external entities. The close engagement of private sector (i.e., Grindr, Hornet and MTV) was also vital to the campaign’s success.