Even as the HIV epidemic among men who have sex with men (MSM) rises alarmingly across Asia and the Pacific, including China where HIV infection rates among MSM are increasing, and far too many MSM who are HIV positive remain unaware of their status. Now, an innovative project is using the power of the Internet to see if the approaches of ‘crowdsourcing’ and ‘social entrepreneurship’ can address this challenge and encourage more MSM, and younger men in particular, to get tested for HIV.
“Many MSM don’t get tested regularly for HIV, if at all, for a number of reasons including real or perceived stigma and discrimination from the health care sector itself, a fear of the possible test results, or a feeling that they’re simply not at risk,” explained Dr Joseph Tucker, Director of the University of North Carolina (UNC) Project-China, a collaborative effort on a range of public health issues, including HIV, between UNC and Chinese partner organizations. “This further fuels the epidemic in this key population, with young men at particularly high risk at a time where hook-ups online and via mobile apps are increasingly common. We tried to find a compelling, entertaining and effective way to reach this audience, and we’re hopeful that we’ve hit upon a winning formula.”
‘Crowdsourcing’, is “the practice of obtaining needed services, ideas, or content by soliciting contributions from a large group of people and especially from the online community.”1 It fits under the wider umbrella of ‘social entrepreneurship’ which is the process of pursuing innovative solutions to social problems or challenges, including within the context of public health.
Through Social Entrepreneurship for Sexual Health (SESH) Global, an NGO focused on using innovative methods to create social change to improve sexual health, the UNC Project took the concept of ‘crowdsourcing’, plugged it into the social entrepreneurship model, and came up with “Testing Saves Lives,” an online video contest open to all community-based organizations (CBOs) that provide HIV testing services to MSM and other key populations across China.
A total of seven eligible entries were submitted within eight weeks. The videos were judged on whether they generated excitement about HIV testing, proposed ways to reach untested individuals, and engaged the community. The incentive to participate was increased by promoting the contest, including online discussions, through local, regional and international channels. During an open event in December 2013 at Hong Kong University, a multisectoral panel of five judges (representing the fields of public health, medicine, anthropology, advocacy and business) selected three finalists from three different cities: Beijing Danlan Gongyi, Tongle (Chengdu) and the Shanghai Commercial Sex Worker and MSM Center.
“The entries we received covered a range of themes and messages,” said Julie Ae Kim, the SESH Coordinator based in Guangzhou. “The short films with positive messages that focused on the benefits of HIV testing were generally more highly rated than those that contained negative messages or perceived threats aimed at those who didn’t get tested.”
But the contest didn’t end there. Now that the judges had spoken, it was time for the wider public to have a say.
The judges met again later and chose the top video from the three contenders; the impact of the winner was further tested by letting it ‘compete’ against a more conventional HIV testing video produced by the Guangzhou Center for Disease Control in an online randomized control trial.
“Working with, and learning from, the communities directly affected by HIV is by far the best and most efficient way to tackle the expanding epidemic among MSM in China. Making sure that all those at risk of infection are aware of their status is a critical component of a strong prevention and control programme,” said Dr Bernhard Schwartländer, WHO Representative in China. “This is a great project – because it is about finding innovative ways to do this.”
“The major distinction between crowdsourcing and social marketing approaches in designing HIV or any other public health campaigns is that crowdsourcing is largely driven by community engagement and developed bottom-up, whereas social marketing is driven by public health specialists and developed top-down,” said Dr Ying-Ru Lo, Coordinator, HIV, Hepatitis and Sexually Transmitted Infections at the WHO Western Pacific Regional Office. “What was done here was to make these approaches go head-to-head. We’ll be very interested in seeing which approach eventually encourages more MSM and other key populations to get tested for HIV and adopt health-seeking behavior.”
Even as “Testing Saves Lives” continues to be evaluated, the SESH Global team has launched a new contest along similar lines in time for World AIDS Day 2014. “Sex + Health” is open to all and focuses on young people. Even though unsafe sex is now the primary route for HIV in China, with younger and younger people getting infected, there are still many taboos about discussing sexual health. “Sex + Health” and the images that it produces aims to trigger discussions among young people and promote sexual health among youth.
Dr Tucker concluded, “Whether it’s targeting MSM and other key populations at the heart of the HIV epidemic or the wider public, we hope that our ‘crowdsourcing’ and social entrepreneurship research will contribute to enhanced HIV campaigns, and ultimately lead to decreased HIV infection and transmission now and in the future.”
For more information please contact
Ms WU Linlin
WHO China Office
E-mail: wul@wpro.who.int
Office Tel: +86 10 6532 7191
1. Merriam-Webster online dictionary.