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HIV:What You Know Thanks to an innovative health campaign, more and more Brazilians are deciding that getting an HIV test is just the thing to do.
Imagine a man with a grand piano balanced on his shoulder. He carries it all day long, everywhere he goes. Occasionally, he passes other people carrying pianos, but he appears to feel all alone in his plight. Finally, his burden is lifted when he gets tested for HIV. The images are from a public service announcement broadcast throughout Brazil as part of a Ministry of Health communication campaign known as Fique Sabendo, which translates loosely as “Be in the Know.” Its message is simple: Anyone can get HIV. In addition to taking precautions, everyone who is sexually active should get tested. It’s worth the effort; it’s the only way to really know. Launched in 2002, Fique Sabendo (pronounced “Feek-ee Sah-ben-doo”) has been singled out by the Pan American Health Organization (PAHO) as worth replicating elsewhere in Latin America and the Caribbean, where some 1.8 million people are believed to be infected with HIV but only 600,000 (one in three) are aware of their status.
PAHO has been working with its member countries throughout the region on initiatives to promote safe sex and increase access to antiretroviral drugs. More than 345,000 people in the region today are getting treatment, up 76 percent from just four years ago. But people who don’t know they are infected don’t know they need these life-saving drugs. Worse, they can unwittingly pass the virus to others by having unprotected sex. The challenge is to get more people to get tested, both to boost prevention and to promote treatment for those who need it. “If this campaign is as successful elsewhere as it has been in Brazil, it will save lives and make a fundamental difference to public health in entire countries,” says Paulo Lyra, PAHO’s top expert on social communication and HIV. Testing is trendy Studies show that people resist getting tested for HIV for a number of reasons. One is fear of the results. Another is fear of discrimination. The former has become less an obstacle as drugs have become available to halt the progression of HIV, so that the disease is no longer a death sentence. A number of public health initiatives have tackled the stigma associated with HIV, and Fique Sabendo is an extension of those efforts. Its aim is to make testing more common, something everyone who is sexually active should do.
Brazilian health authorities took a multipronged approach in developing the campaign. Its centerpiece is a logo that was chosen as part of a contest sponsored by the Ministry of Health. The winning design, submitted by a 22-year-old college student, was a stylized smiley face with plus and minus signs for eyes. The logo premiered during the 2004 São Paulo Fashion Week, at a show in which dozens of svelte models wore cropped T-shirts sporting the winking smiley face. “An important factor was that the logo be associated with modernity and with attitude,” says Emivaldo “Zinho” Souza Filho, publicity coordinator for Brazil’s National STD and AIDS Program. “That’s why we tried to tie it into the concept of fashion.” A number of popular television actors joined the campaign, and the minister of health at the time, Humberto Costa, was photographed having his blood drawn for testing. The piano-themed public service announcements included a voice-over explaining why it’s important to take the test. The campaign also flooded the country with print ads. By now, Fique Sabendo’s logo has become a familiar fixture in Brazilian culture. And the campaign produced tangible results. According to a March 2004 survey, 26 percent of sexually active Brazilians said they had taken an HIV test at least once in their lives; of these, nearly half were tested in 2003 and 2004, during the Fique Sabendo campaign. During the same period, the number of people seeking tests at government testing centers was up 53 percent. Given Brazil’s success, PAHO is hoping other countries in Latin America and the Caribbean will follow suit and launch their own know-your-HIV-status campaigns. Already, a handful have done so, including Belize, El Salvador, Mexico, and Trinidad and Tobago. To encourage others, PAHO is adapting elements of Fique Sabendo for use in English- and Spanish-speaking countries. “In Spanish, we’re calling the initiative Hazte la Prueba,” says Lyra. “It’s much more than just an advertising campaign.”
Hazte la Prueba, Spanish for “Get Yourself Tested,” was previewed last November in El Salvador at a meeting of the Inter-American Commission of Women. The campaign uses materials developed by PAHO based on the Fique Sabendo logo. Other countries in Central America, where HIV rates are among the hemisphere’s highest, have expressed interest in the campaign, and PAHO is discussing English-language versions with several Caribbean countries. A major incentive for countries to jump on the know-your-status bandwagon is the low cost involved. The Fique Sabendo logo is royalty-free, celebrities can be recruited to make pro bono appearances in the campaign, and television and radio stations will usually broadcast public service spots at no charge. Campaigns can also use new media, including portable media players and text messaging on cellular phones. In addition, PAHO is producing traditional print materials, including posters and brochures, which will be available in English and Spanish for download for free from the PAHO website. Higher demand For many countries, being able to offer an HIV test to anyone who wants it was, until recently, a challenge. The newer challenge, says Lyra, “is to create demand, to make an HIV test as common as—or commoner than—a cholesterol check.” Brazilian health authorities caution that countries that decide to emulate their campaign must prepare for the significant increase in demand for testing services. This will require additional blood-collection equipment and more personnel, particularly health care workers trained in HIV testing and counseling. Lyra says a fundamental challenge of each campaign will be to guarantee that anyone who wants to know their HIV status will be able to get not just a test but the essential health services that should go with it, including antiretroviral drugs.
Given these challenges, PAHO recommends that countries with focalized epidemics expand testing and counseling services for their most vulnerable groups before promoting them among the general population. Countries with generalized epidemics should promote these services among both high-risk groups and the population at large. For Brazil, Fique Sabendo is just one of a long series of groundbreaking efforts to battle HIV, from the country’s 20-year-old internationally renowned National STD and AIDS Program to the government’s 10-year-old policy of providing universal access to free antiretroviral drugs. Social communication campaigns have been an integral part of these efforts. More recently, Brazil’s Ministry of Health has carried out two more targeted campaigns, one directed at health care professionals and another aimed at pregnant women. “The goal is to reduce mother-tochild transmission to less than 1 percent and congenital syphilis to zero,” says Alexandre Magno, communication advisor in Brazil’s National STD and AIDS Program. But for Magno and his colleagues, the challenge of keeping all Brazilians alert to the threat of HIV is an ongoing one: “Now we need to get back to talking about the test for the general population.” Rogerio Waldrigues Galindo is a Brazilian journalist who lives in Curitiba.
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