By Darryl Fears, Washington Post, Tuesday, June 2, 2009
On her drives from one end of the District to the other, Anita Hawkins is struck by the rarity with which she sees billboards or bus stop advertisements telling residents that AIDS is a major health threat in the city.
"I live in D.C., and now I don't see it as visibly as nine years ago," when the virus was killing mostly gay men and the city government mobilized to combat the disease, said Hawkins, an assistant professor at Morgan State University. "We had this big push, and then what happened?"
Hawkins is on to something. Despite evidence showing that advertising increases AIDS awareness, there's almost no marketing to inform District residents of the problem's magnitude.
A report by the city's HIV/AIDS Administration (HAA) says 3 percent of the District's population has HIV and AIDS, the worst prevalence rate in the nation, easily surpassing the 1 percent rate of infection that makes up a severe epidemic.
The problem is probably worse than the report says. Researchers did not count people who are infected but untested. Shannon L. Hader, the HAA's director, estimated that the actual rate is 5 percent.
In the fall, the D.C. Appleseed Center for Law and Justice sharply criticized the city's AIDS awareness effort, saying in a report that it lacked the urgency needed to address such a large epidemic. "You should definitely expect more," said Phill Wilson, head of the Black AIDS Institute, which works to reduce infection in black communities.
City officials say a sustained social marketing blitz is coming.
Mayor Adrian M. Fenty's administration -- alarmed by research showing that heterosexuals in highly infected areas engage in unprotected sex under the mistaken belief that straight people are not at risk -- committed $500,000 annually for five years for a marketing campaign, Hader said.
But there's doubt over whether HAA can mount a meaningful campaign in the expensive advertising market with that small amount. To be effective, advertising experts say, Hader needs millions more from Fenty (D) or more free public service announcements from television and radio stations, billboard companies and Metro.
"This should not be simply a public-health effort," Hader said. "This should be a community effort helped by the folks who have the space."
It's unclear how aggressively the city has sought public service ads. A spokesman for one local television station, WRC (Channel 4), said no one in the NBC affiliate's advertising division recalls being approached by HAA.
"We feel this is an area where a great deal more needs to be done," said Walter Smith, executive director of D.C. Appleseed, a nonprofit group that addresses civic issues. "We believe it's a leadership issue. I mean Fenty, in part, but there's more than one leader in the city."
Another activist, A. Toni Young, defended the city, saying an ad campaign by HAA last year played a strong role in calling attention to an underutilized program that provides free medication to people with HIV and AIDS. Enrollment in the AIDS Drug Assistance Program increased by 50 percent after ads aired on television and radio and were posted on billboards and public transportation, said Young, executive director of the Community Education Group, which engages in AIDS-related social marketing.
"It was very effective," Young said.
Without the support groups and social networks backed by the HAA, advertising would have a short reach, Young said. "To batter HAA has been a fashionable thing to do, but if you took a bus across the river on Pennsylvania Avenue, you would see ads for the Act Against AIDS campaign," Young said.
The Act Against AIDS campaign was started last month -- by the Obama administration and the Centers for Disease Control and Prevention, not the city. But a couple of weeks ago, the HAA started experimenting with its marketing approaches.
The agency launched Realtalk, a promotion aimed at youths. A poster tells them to "drop in for some fun at the Freestyle Youth Center," at 651 Pennsylvania Ave. SE, where they can get free tests for HIV and venereal diseases that can facilitate HIV transmission. They also can get information about other test sites and where to pick up free condoms.
The HAA's office on New York Avenue abounds with AIDS-related posters that have faded from view: "Know Your Facts," "Come Together DC -- Get Screened for HIV," "Sex With One Means Sex With All" and "A Million Ways to Stop HIV: One Million Free Condoms for DC," a giveaway campaign two years ago.
Next month, the HAA plans to announce a marketing campaign aimed at heterosexual couples, said the agency's spokesman, Michael Kharfen, who is also in charge of marketing. The promotion will implore sexually active straight couples to get tested and to know their partner's health status. Heterosexual sex is the fastest-rising mode of HIV transmission in the city, particularly among black residents in wards 6, 7 and 8.
Spreading the word about HIV and AIDS is difficult because of its stigma. Infected people say they feel isolated because of the illness, and straight people say they don't want to be caught with a prevention brochure or researching the disease on the Internet because it might suggest homosexuality, a taboo in the black community.
The HAA will buy space on billboards and public transportation, but broader marketing will depend on public service ads. "We could wipe out our entire budget by buying a few ads on television and newspapers," Kharfen said. "We can't afford it."
Tina Hoff, vice president and director of Media Entertainment Partnerships for the Kaiser Family Foundation, said the foundation has gotten around the expense of advertising by working closely with MTV, Black Entertainment Television and Spanish-speaking Univision to urge minorities and young people to get tested for sexually transmitted diseases.
The marketing challenge faced by the District reflects a nationwide trend, according to a survey released last month by Kaiser. Americans who said they had "heard, seen or read a lot" about HIV and AIDS in the United States fell from 70 percent in 2004 to 45 percent this year. Those who specifically said they've viewed "a lot" of AIDS-related messaging fell from 34 percent to 14 percent.
As she stood at U and 16th streets, District resident Geneen Taylor said she would welcome more information than the few advertisements she has read on buses and heard on radio.
"I'm an African American woman, and we're the fastest-growing group of new HIV infections," Taylor said. "It's always in the back of my mind. It's frightening."
