State of Alaska, Section of Epidemiology, HIV/STD Program
IntroductionIn 2014 Alaska experienced a spike in reported HIV cases in addition to an ongoing outbreak of syphilis among gay, bisexual, and other men who have sex with men (MSM). In Alaska, all cases of HIV and syphilis are interviewed for partner services. The primary venue identified by MSM for meeting partners was online sex seeking sites (ie, Craigslist) and mobile phone apps (ie, Grindr, Hornet, Scruff). In response to the increase in cases, the Alaska HIV/STD Program requested and received permission to use $10,000 in federal HIV Prevention carry-over funds for online outreach, specifically targeting MSM. HIV/STD Program staff used the funds to purchase online and mobile-based advertising to educate MSM about the recent increases, and to inform them of a series of free outreach HIV and STD screening events. Advertising and outreach were concentrated in Anchorage, Alaska’s largest city, where the majority of new cases of HIV and syphilis were being diagnosed.Free outreach HIV and STD screening events were offered in conjunction with HIV Prevention sub-grantees, including the Municipality of Anchorage (MOA) Department of Health and Social Services and Alaskans AIDS Assistance Association (Four A’s). Events took place on Saturdays, were hosted at the MOA’s health clinic located in downtown Anchorage, and were staffed by outreach staff from the State HIV/STD Program, MOA, and Four A’s. Rapid HIV testing, syphilis testing, and gonorrhea and chlamydia testing at all anatomical sites (including urine, oral, and rectal sites) was offered.Online OutreachGlossary of TermsBanner AdA form of online advertising which entails embedding an advertisement into a web page or mobile application. It is intended to attract traffic to a website by linking to the website of the advertiser.Broadcast MessageSimple, text-based ads which appear upon opening the app. App users must select past the message, selecting “More” to be linked to the website of the advertiser or “OK” to continue to the app itself. These messages offer advertisers the ability to reach people immediately to inform users about local events, special offers, or relevant information.ClicksThe number of persons who initiated action with respect to an advertisement, i.e. that “clicked” on a banner ad and were redirected to a webpage where they might learn more about a product or service.Click through Rate (CTR)The click-through rate of an advertisement is a measure of the ratio of clicks to impressions of an online ad or email marketing campaign. It is defined as the number of clicks on an ad divided by the number of times the ad is shown (impressions), expressed as a percentage. Generally the higher the CTR the more effective the marketing campaign has been at bringing people to a website.ImpressionThe number of times an ad is viewed or seen. Each time an ad displays it is counted as one impression.Interstitial AdA full-screen advertisement which is displayed before or after an expected content page.Mobile Application (App)A mobile app is a computer program designed to run on smartphones, tablet computers and other mobile devices.MSM Online and Mobile-based Outreach Online and mobile outreach took place through two vendors: Gay Ad Network and Grindr. Gay Ad Network (GAN) is a U.S.-based company which offers “gay audience” targeted advertising to reach demographic- and geo-specified audiences. Using demographic, lifestyle, behavioral, and social online data they offer customized advertising to the gay audience segment across popular websites and mobile applications. Grindr is a mobile phone application (app) which uses GPS-based geo-location to connect users with local gay, bi, and curious men for friendship, dating, and sexual hook-ups. User information provided by Grindr identified as many as 11,200 unique users utilized the Grindr app in the Anchorage area each month.Other MSM OutreachPosters were printed and distributed to gay and bi-sexual friendly venues in Anchorage. Alaska HIV Prevention grantees operating in Anchorage were encouraged to post the event on their social media pages, particularly Facebook. One HIV Prevention agency, Four A’s, posted ads in the gay, bi, and curious app SCRUFF, using the application’s Benevolads program, which provides free in-app advertising for non-profit organizations.State of Alaska HIV/STD Program staff also conducted non-paid online outreach on Adam4Adam (A4A) and Craigslist. Staff took shifts staying logged into the HIV/STD Program A4A account (including evenings), with the outreach testing information in the program’s AKPublicHealth profile. Observations from staff indicate that users viewed the AKPublicHealth profile approximately every 30 minutes, with heavier traffic of around every 15-20 minutes in the evenings. Staff also responded to all men seeking men (M4M) listings posted in Craigslist Anchorage’s “Casual Encounters” section in the four days leading up to the Outreach event, providing posters with information about Alaska’s current outbreak of syphilis and increase in HIV and referring people to the free outreach screening event or other local testing locations.Sample Campaign MaterialsCampaign materials were developed by Glenn Harvey, a Publications Specialist with the Alaska Department of Health and Social Services, with the assistance of HIV/STD Program staff (Figures 1-3). All media was approved by the Alaska HIV Materials Review Committee, the Public Information Office (PIO) of the State of Alaska Department of Health and Social Services (DHSS), and the PIO of the Municipality of Anchorage Department of Health and Human Services (DHHS).Figure 1: Grindr Banner AdsFigure 2: Grindr Interstitial Ad Figure 3: Grindr Broadcast Message2590800-190500-952504762500Outreach Testing ResultsIn total, online and mobile advertisements about HIV/STD in Alaska and the screening events were viewed 1,302,154 times. Advertisements were actively “clicked” and redirected to the Alaska HIV Program website for additional information 9,428 times. A combined total of 52 persons attended the outreach events and were screened for HIV and/or STD (Table 1). It is not possible to calculate how many persons sought out HIV/STD testing at their private medical provider or at another HIV/STD testing site due to the information and education which was shared by the ads. However, anecdotally, HIV rapid testing sites in Anchorage reported an increase in clients who referenced having seen the online and mobile-based advertisements.Table 1: Outreach testing results by eventDateAdvertising MethodTotal AttendeesTotal New HIV+Total Positive for Bacterial STD08/2014GAN; Other web-based Outreach1904 (21%)11/2014Grindr603 (50%)12/2014Grindr; Other Outreach1806 (33%)01/2015Grindr; Other Outreach904 (44%)AllAll, combined52017 (33%)Although no new cases of HIV or syphilis were identified during the screening event, 17 persons were diagnosed with a bacterial STD. Of particular note is that, of the 17 persons who tested positive for a bacterial STD, 12 (71%) tested negative on urinalysis but positive via aptima (swab) at an extra-genital site (rectal and/or oral-pharyngeal). This supports recent publications which indicate that urine-only screening for bacterial STD can miss the majority of infections in MSM, and indicates that the HIV/STD program must continue to educate providers about the importance of asking their patients about their sexual risk and screening all sites appropriately.The majority of the persons who attended the outreach events and responded to the ‘How Heard About’ survey indicated that they heard about the event through mobile app advertising (Table 2). Table 2: Outreach event attendee response to ‘How did you hear about today’s event?’Response Options to “How did you hear about today’s event?”#/% ResponseMobile App (Grindr, Scruff, etc)14 (40%)Online (Craigslist, A4A, etc)4 (11%)Poster (Bar, etc)5 (14%)Social Media (Facebook, Twitter, Instagram, etc)2 (<1%)Friend/Word of mouth10 (29%)Other0 (0%)TOTAL35On the ‘How Heard About’ survey, attendees were also invited to provide event organizers with any other feedback about the advertising or outreach event. Comments which attendees shared included:“Great idea! Thanks!”“Thank you for using social media to get the message across!”“Great job!”“I like that it was put on advertisements like Grindr.”“Great way to reach out on Grindr. Just saying thanks.”“Ones [sic] of these events is how I did my first testing with an unexpected STD. I really appreciate the opportunity.”One stand-alone HIV testing site in Anchorage reported hearing from on individual who saw the ads and came in for HIV testing, but felt that the media campaign was inappropriate and implied that members of the gay community who identify as a bear were at higher risk of having syphilis. The individual could not be reached for follow-up. ................
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