Report: SHAKTI CLINIC – COMMUNICATION CAMPAIGN

With a new brand name, identity, logo and brand rituals, Shakti Clinic was revamped internally. However the Shakti make-over had to reach the user. Hence a strategic communication campaign was launched togenerate specific outcome of informing large number of people in the city about the new Shakti Clinic – HIV/AIDS Salah Kendra and its key features in a specified period of time, so as to remove the fear of testing amongst the TG and increase the recognition, recall and response amongst all.

The Communication followed the AIDA model of marketing. First, bring about awareness among potential users, then generate interest and instill a desire in them to try out the service and finally coax them to take action and visit the center.

Phase 1 of the campaign was launched in March 2012. The primary objective of Phase 1 was to create awareness among the target audience about Shakti Clinic. No one knew what it was, so the job at hand was to tell them what it is and do just that – focused approach.

COMMUNICATION CAMPAIGN

Internal communication revolved around three main stakeholders as shown in the image above

1. SHAKTI CLINIC


The most important location where communication had to impact was the Shakti Clinic, the place where the service is offered.Each of the Shakti Clinics was revamped with a new identity complete with the following branding elements:

Branding Rituals within the Shakti Clinic radiating to all 3 senses

i. Sense of Sight: Motivational and PLHA testimonial posters, Shakti coats for counselors, writing material branded with Shakti logo and messages and Map with Shakti clinic locations across the city.

ii. Sense of Sound:  An inspirational music CD will be played within the confines of the clinic to leave a soothing impact on the user.

iii. Sense of Smell: In order to do away with the typical clinical hospital smell, a zestful lemon air freshener will be used in the clinic sprucing up the atmosphere.

Apart from branding the Shakti Clinic in terms of its look, feel, design and cultivating a Shakti experience, peripheral stakeholders like Hospitals and NGO’s were also oriented to Brand Shakti. Majority of referrals to ICTC come from these 2 stakeholders hence they needed to know about the new brand and its features in order to inform the potential users and persuade them to visit the center.

2. HOSPITALS                                  

Signages at each of the following points were displayed at hospitals to inform the user about key messages of ‘free service’, ‘no case papers’ and directions to ‘Shakti clinic’.

• Gate
• Directional
• Façade
• Registration

A majority of people get referred to the ICTC from the hospital OPD’s itself, hence it is critical for the internal staff of the hospitals to know exactly where this center is located for them to guide the user. Image (above) is a directional signage with a specific ward number that was displayed at key locations within the hospitals to inform hospital staff as well as direct users.

Map citing locations of 100 ICTCs across the city of Mumbai was put up in every hospital.

3. NGO

Every NGO was oriented to Brand Shakti – what it stands for --- what is aims to provide. Two materials were given to each NGO:

• A Shakti Clinic – Salah Kendra Poster to be displayed in their NGO premises

• A laminated Shakti Sheet (as shown in image below) which the NGO Outreach Workers will carry along when they go out on field. This sheet not only introduces brand Shakti to potential users but will also guide them with locations of Shakti clinics across the city as shown on the back page of the image below.

MDACS used a multipronged approach for its external communication. This strategy was planned and implemented in a series of bursts through different media including mass media, transportation channels as media and on-ground activities. Strategic PR was implemented simultaneously.

This multi-phased approach ensured that Brand Shakti reaches out to audience from every nook and corner of this city.

A. MASS MEDIA 

Radio is a key mass media channel that is accessed by majority in this city especially during travel hours in the morning and evening. This medium cuts across different groups of people.
Using this element to advantage all radio based communication highlighted 3 important messages of Shakti –

• ‘Free Service’
• ‘Confidential’
• ‘100 Shakti Clinics in the city which means that there is one in the neighbourhood making it convenient for user to visit the center’

Radio communication was implemented in 3 phases over a period of one month:

Newspaper communication was launched simultaneously along with the radio activity. Top dailies in 3 languages; Hindi, Marathi and English were selected.

Given below are the creative for Newspaper Advertisements in Hindi & Marathi papers

Newspaper activity had 3 bursts of Shakti Communication:

Shakti Clinic – HIV/AIDS Salah Kendra Hoardings will be displayed in every hospital premise, featuring key messages of ‘free and confidential’ service.

B. TRANSPORTATION

Mumbai has one of the most accessible and wide networks of transport that carry millions of its residents daily from one destination to another. Trains, buses, auto rickshaws and taxis together form an almost indispensible network that is the lifeline of this city.

The backbone of the city's transport, the Mumbai Suburban Railway, is composed of three rail networks and runs along the length of the city. The system is among the largest in the world. In terms of traffic, the Western and Central Rail system carry an estimated 6m people everyday. Anywhere you go you will spot bus stands, auto rickshaws and taxis making it convenient to travel in this city.

Formative research study highlighted that majority of respondents were exposed to advertising media while travelling. Qualitative interviews showed that people use public transport on a daily basis and were constantly exposed to and recalled messages displayed on these vehicles.

The External Communication Campaign of Shakti capitalized on this already existing network and spread the word out through these transportation mediums. Stakeholders including Railway officials, Taxi & auto rickshaw unions and ST bus officials joined the Shakti Campaign and allowed for communication materials to be prominently displayed on their vehicles.

Railway stations in Mumbai attract the maximum crowd every day. Hence ‘Shakti Clinic’ Posters (image to left) were displayed prominently at the ticket booking counters.

These posters feature name and location of clinics around that particular railways station area making it convenient for the potential user to visit the clinic.

After trains, Auto rickshaws and Taxis are the most widely used modes of transport.

• Shakti Clinic stickers were displayed inside the vehicle (as is shown in the image on the left) informing the reader about the new brand and key messages of free service.
• Auto/taxis were given branded rate cards with Shakti Clinic’s address.
• Shakti Clinic Posters have been displayed at ST Bus Depots as well.

C. ON GROUND ACTIVITIES

1. Shakti Clinic board on gates of housing societies

6000 housing societies around the 100Shakti centersin the city were approached and requested to display the ‘Shakti Clinic’ tin board on their building gates. The gate is a prominent point of contact for residents almost on a daily basis, increasing the visibility of Shakti and influencing the recall as well.

2. ‘Loo’ Stickers

Yet another innovative medium for communication, Public & Slum toilets were identified and a small sticker of Shakti branding was spaced inside..This was a static branding effort placed to grab attention of our Target Audience.

3. Street Plays

200 street plays were conducted across railway stations of the city informing people about Shakti Clinic. Each street play mobilized a crowd of 50-80 people with a mixed audience of male and females.

Using HIV Testing as a theme for the plays, actors introduced Shakti Clinic and conveyed key messages like:

• ‘Free Service’
• ‘Confidentiality’
• ‘Shakti clinic is at the hospital near you’.

Actors displayed Shakti Clinic board to the audience and passersby and announced the names of the nearby hospitals that housed the Shakti Clinic.

D. PRESS CAMPAIGN

MDACS executed Shakti Press Campaign in four phases (as shown in image above). Press/Media officials were oriented to Brand Shakti and briefed about the process in which press releases would be implemented according to the 4 phases.

Phase 1 launches Shakti clinic. Press releases in this phase gave the reader a background to the ICTC’s in the city and recent statistics that validate the revamped look of the clinic. It also informed the reader about the vast network of 100 Shakti Clinics in the city of Mumbai.

This initial phase will also introduce the new logo to the masses. The key objective is to convince the reporters to carry logo that will ensure association of the service and the symbol of empowerment.

Phase 2 described the Shakti experience. It takes the reader right from the gate entry point of the hospital to the actual center and initiates them to the brand rituals practiced at the Shakti clinic. The reporters cover the experience of how the service is purely client centric. In this phase, reporters also visited Shakti Clinics and reported Shakti experience to the readers.

Phase 3 carried stories of the stakeholders and the entire campaign implementationincluding all the vehicles of communication

Finally Phase 4 features stories and case studies of key persons in this process including service providers, clients of Shakti, policy makers and PLHA.

Report: THE SHAKTI EXPERIENCE

The HIV counseling and testing centers under MDACS have got a new name and a new identity. It was time to now define the Shakti experience and implement it across all the 100 centers across the city.

Shakti stands for empowerment through correct information but a mere change in name and symbols would not result in behavior change. The Shakti experience has to reach each center and must be practiced by the custodians of this brand i.e. the service providers. An ICTC has a humble staff of a medical officer, counselor and a lab technician.  It is these practitioners who are guardians of the brand and will give users the Shakti experience.

DEFINING THE SHAKTI EXPERIENCE

This section will orient the readers to the ‘Shakti branding experience’ and ‘branding rituals’.

Most of the ICTCs are located within the premises of government hospitals. One of the key findings that emerged from the research study was that many users found it difficult to locate an ICTC in the hospital.

To address this issue an initial recce was conducted in various ICTCs to understand:

• How easily accessible is it for the user from the entry point of the hospital
• What is the shortest route to the respective ICTC
• Awareness of ICTC within the hospital premise

Challenges identified during the first recce:

• Lack of awareness of ICTC was observed; not many knew where the ICTC was within the hospital premise
• Recce team was sent to ICU, when asked direction for ICTC in a suburban based government hospital
• It was time consuming to reach certain ICTC’s from the entry point of the hospital due to lack of directions and lack of awareness within the hospital staff as well

Recommendations given post the first recce:

1. Have the most effective presence of the branding elements
2. To ensure the best visibility for all the ICTC centers. Thus ensuring that the ICTC centers are easy to find/reach, especially the ones in the big 5 hospitals. Need for proper directional signage to locate the respective ICTC’s with minimal human help
3. Do this in the most efficient way with minimal cost
4. To maintain an optimal balance of visibility elements
5. Increase awareness in Mumbai about HIV testing centers in Govt. hospitals
6. Increase recognition, recall & response

Based on the recommendations of the first recce a second round of visits to the all the ICTCs were made and an exercise drawing up the directions and pathways from the entry point of the hospital to the actual ICTC was conducted. This exercise entailed the following steps:

• Find the shortest distance to reach ICTC within the hospital premises
• Look for the pathways from the nearest Hospital Gate (Main Gate) to the ICTC
• To map the material to be used for the respective branding elements to the specific mounting area
• Look for the pathway from the OPD to the ICTC at the respective hospitals
• Calculate the number of direction signages required to reach the respective ICTC’s with minimal help
• Determine where and how to install the main façade branding at the respective ICTC centers
• Determine where and how to install the Registration area Signage

Both the visits were implemented and a branding plan emerged

1. GATE SIGNAGE

The gate of a hospital is the entry point for all users and potential users. A signage at the start is absolutely critical to guide the user especially in big hospitals where it can take up to 30 minutes to actually locate a testing centre. Image (right) is the actual gate signage that has been displayed on the gates of each hospital. The key message that this signage delivers is “Free Service”. Right at the beginning the 1st aspect / USP of ICTC is that it offers free service, hence the message at the gate.

2. DIRECTIONAL SIGNAGE

As the user enters the hospital he is surrounded by different pathways, lanes and wards. Which one is he supposed to enter?

He asks a few people around, ‘Where is the HIV testing center?’

People look at him with disgust and don’t bother with a reply. He goes to the hospital staff seeking a definite reply on the exact location of the testing centre but to his surprise even the hospital staff is unaware and ask him to go to a particular OPD.

This is the predicament that the user faces. He has mustered up the courage to go get tested, he is at the hospital but does not know how to reach the ICTC.

Directional signages essentially address this predicament, guiding the user along a pathway and making it easier for him to locate Shakti clinic. As shown in the representative images, directional signages will be put up at key points along the hospital pathway to guide the user until he finally reaches the center.

3. FAÇADE SIGNAGE

The façade area is the point before the user reaches the registration. This point tells the user that he has reached his destination.

Image (top left) is the scene of a façade of an existing ICTC. It is difficult to tell if one has reached the ICTC, with absolutely no sign/board/direction of the center.

In the image again, one can find an area marked in area. This spot was chosen for displaying the façade signage.

The Shakti façade signage (image second left) tells the user that he has reached the clinic again reminds him of the free service available here.

Such façade signages were displayed in each ICTC increasing the convenience of the user.





4. REGISTRATION SIGNAGE

The image to the left is that of a registration counter standing bare, with no instructions or details to guide the user.

 The area in the image marked in red was the point identified for display of the Shakti registration signage.

The registration point is the final area that the user needs to cross until he accesses the Shakti services.

Signages at the registration (image to the left) will give the message of:

• ‘Free Service’
• ‘No Case Paper Required’
• ‘Shakti Clinic in Ward no. ….’

The intent behind the messaging of ‘No case papers’ was that any user can enter the ICTC without a case paper, but many a times he is not aware of it since any general procedure in a Municipal Hospital needs a case paper. ICTC apart from being a free service ensures that the client does not have to go through the cumbersome process, he can walk into an ICTC directly and he should be aware of this. Bright signages of Shakti at the registration area, gives the user this information.

Signages will have two important elements:

1. Standardization

i. All directional signages will be standardize across all the ICTC’s
ii. All Gate signages will be standardized
iii. Branding elements for all the PPP’s would be standardized

2. Customization

i. The main Façade branding for the big 5 hospitals will be customized
ii. The Registration Signage for the big 5 hospitals will be customized
iii. Signages with the ward number will be put up at every hospital, every signage will be customized as per the ward / room no at the hospital

SHAKTI BRANDING RITUALS

“A ritual is a set of actions, performed mainly for their symbolic value. It may

 be prescribed by the traditions of a community.”

Apart from giving the product (ICTC) a revamped look, feel and design; it is also imperative to translate this into an actual experience at an ICTC such that this experience reflects what the brand stands for.

MDACS devised a set of practices or in other words ‘rituals’ that would make up the Shakti experience at every ICTC. These rituals are simple yet strategic actions that will radiate ‘Shakti’ to all the senses.

SENSE OF SIGHT  

All visual elements will be consistent with the Shakti brand colors.

1. Motivational Posters

• As the user enters the Shakti clinic s/he will be welcomed with 4 motivational posters both in Hindi and Marathi.
• The messages on each of these posters are aimed to lift the spirits of those waiting for their turn of counseling.

2. Testimonial Posters

• The user will also find 4 posters of PLHA and their trysts with the disease.
• More importantly it tells the user that even with HIV/AIDS their life goes on normally and urges them to use the benefits at the Shakti Clinic. There will be 4 testimonial posters both in Hindi Marathi.



3. The Counselor 


Once the user reaches the counselor and is set to begin his counseling session, he will encounter the next element of the Shakti experience.

The counselor will be wearing a specially designed lab coat that carries that Shakti colour and symbolizes the empowering experience. This also helps distinguish the Shakti counselor from the other service providers at the hospital.

4. Branded Materials

Apart from these sight points, materials used in the centre will also be branded with the Shakti look. For instance:

a. Personal Identification Slip – This slip will have motivational messages for the user.
b. Consent form
c. Referral slip – This slip that has details of the user is usually handled by external hospital staff. There have been instance of stigma against positive users by external staff. This slip will now have an anti-stigma message that can be read by user and the others (hospital staff).

5. Map with all the 100 ICTC locations in the city of Mumbai

Each ICTC will have this map so if someone is at a big hospital which has a crowd to handle, he can go to another ICTC which is close by, all he has to do is look at the map. This material intends to provide users with convenience so that he saves his time.

6. SENSE OF SOUND    

Music has the power to influence emotion.

Every counselor will be given an inspirational music CD that will be played at the Shakti Clinic.
This ritual aims to motivate users through music and leave a soothing effect on them.

7. SENSE OF SMELL  

 A visit to the hospital or a health clinic most often guarantees a typical clinical smell which creates a dull and sick environment.

The third sense that Shakti experience touches upon is that of smell. Every Shakti clinic will have a zestful lemon air freshener which will remove unpleasant clinical smells and fill the room with a pleasing light fragrance.

Each of these rituals right from the counselor’s wearing a Shakti coat to inspirational music being played in the clinic constitute the Shakti experience of treating the user with the highest regard and giving him a positive and hassle-free experience and most importantly taking away the fear of testing as well as that of the disease.

Report: PRE-TESTING 'SHAKTI CLINIC'

Pre-testing is key to ensuring that themes, messages and activities reach the intended target populations. It is important to pre-test at every stage with all audiences for whom the communication is intended, both primary and secondary.

Keeping this important element in mind, MDACS pre-tested Shakti with general and target audience. Several versions were pre-tested and audience reactions compared. Pre-testing and discussions were also done with stakeholders, since their views could have differed from those of the target population.

Pre-testing was conducted at 3 levels:

1. Shakti as a Name
2. Positioning the Shakti Clinic
3. Logo of Shakti Clinic

1. PRE-TESTING SHAKTI AS A NAME

Audience:

A target audience of 30 respondents was interviewed about the name ‘Shakti’. Respondents included:

• Waiters
• Auto Drivers
• Office Boys
• Taxi Drivers
• Pan Tapri Walas

Key Questions asked:

1. Is the name ‘Shakti’ easily understood by anybody - immaterial of educational / cultural background, economic status?
2. Does it cut across languages?
3. Does the name hold any religious implication - checked for religion neutrality?
4. Does the name or the colour scheme - does it skew towards any faith or religion, does it have a religion bias - either positive or negative by the members of the TG?

Key Responses derived:

• Power
• Himmat (Strength in Hindi)
• Strength
• Positive vibe
• Did not reflect religion

2. PRE-TESTING THE POSITIONING OF SHAKTI CLINIC

Audience:

A target audience of 25 respondents was interviewed about the positioning of the Shakti Clinic. Respondents included:

• Counselor / Lab Technician
• Doctors
• Clients
• Media Professionals

Key Questions asked:

1. Should Shakti Clinic be positioned purely as a counseling ‘Salah’ center or should it be propagated as both counseling and testing center?
2. Salah Kendra v/s Salah and Jaach Kendra

Key Responses derived:

• There was a debate for the two positions. Should Shakti be a testing center, since testing is available? Or should the focus be on the counseling element?
• Conclusive responses: The objective of getting tested is met, since a person has to be go ICTC to get counseled, the counselor will help he assess his risk behaviour which will gradually lead to testing if required.
• Consensus was gained on positioning Shakti Clinic as a ‘Salah’ (counseling) Kendra.

3. PRE-TESTING THE LOGO

Audience:

A target audience of 50 respondents was interviewed about the logo of the Shakti Clinic. Respondents included:

• Counselor / Technician
• Client
• Non User -at the hospital
• Professionals
• Admin Staff
• Hospital Staff
• Waiters
• Auto Drivers
• Office Boys
• Taxi Drivers
• Pan Tapri Walas

Key Questions asked:

1. Respondents were shown the logo of the red ribbon curled into a fist. They were asked about what they felt on looking this logo.
2. Orange and Green colour options were taken for logo and these separate versions were tested with the respondents. Yellow as a background colour for the name was pre-tested.
3. Apart from logo, background colour, the pre-testing samples also included the positioning statement for the clinic.

Key Responses derived:

• People felt that the logo was a very different take on the red ribbon and was approved by respondents.
• Colour combinations were found to be appealing, grabbed attention, the positivity of the name was coming in the colours and the font
• The name, logo, colors were talking the same language of power and empowerment
• Logo was easily understood by all

Pre-testing the Shakti concept helped immensely in retaining only those ideas that got an overall nod from the audience.

Mumbai is a melting pot of people from different cultures and communities. This diversity was the key element that Shakti communication had to address as it was important to cater to all audiences. Hence the positioning is in both Hindi and Marathi so that we appeal to those who are originally from the resident state of Maharashtra and those who are from others states in India and have made Mumbai their resident city.

Hence, Shakti Clinic –HIV/AIDS Samupadeshan Kendra and HIV/AIDS Salah Kendra

Report: SOLUTION – BIRTH OF A BRAND

Challenges exposed by research study                 

• The research study clearly highlighted that majority were not aware of ICTC. They were aware of HIV testing in government hospitals but did not recognize this service as ICTC.

• Exploratory visits to ICTCs revealed that both users and non-users found it difficult to locate the centre especially in a big hospital. This was a primary issue, as there were no signages guiding the client to the center. The ICTC was most often referred to by the OPD. No. and not by its actual name, implying the difficulties that users had with recalling the name and more importantly identifying with it.

• The name ICTC did not resonate with Users or Non-users. The name ‘ICTC’ had a technical feel to which people could not relate to. This in turn discouraged recall and possibly even response.

• Only respondents from High risk groups showed almost universal awareness of ‘Free’ testing element of the ICTC. People across all groups need to be aware that HIV testing in an ICTC is free. This is one of the key messages that will encourage access and enhance the turnout at the centres.

• Although there is lack of awareness of ICTC as a brand, respondents were in favour for HIV testing. Majority agreed that they could go to a nearest health facility and get tested and they also added that they would be able to take right decisions in future if they got tested. This positive intent needs to be catalyzed upon and awareness of the vast network of 100 ICTC’s in the city needs to spread. People should know that within this vast network, there is a testing center in their neighbourhood thus making it convenient to visit and get tested.

• One third of respondents felt that less than 25% of their community members would approve of them getting tested for HIV. This finding has a major implication as we live in a collective society driven culture and give high regard to community approval. Respondents associated testing with lack of approval from community and a resultant fear of being stigmatized upon being tested. Communication strategy has to address this fear of testing and transform HIV testing into a positive behavior.

• Even though ICTC and government testing facility are the same, respondents were still confused about the co-existence of the two. Respondents have gone to the government hospital to get tested for HIV but are not aware that this facility is called the ICTC.

KEY CHALLENGES

1. Low awareness
2. Technical & complicated name: low recall
3. Lack of openness to the service due to fear / ignorance

OBJECTIVES

With the aforementioned key challenges at hand, the next step was to define core objectives of the communication that would guide the strategy and the campaign implementation. Objectives were drawn upon:

• Appropriate audience should be aware of this service
• Change image of the testing center from a commodity to a brand
• Increase recognition, recall and response
• Induce behavior change towards counseling
• Change perception and normalize HIV testing --- ‘HIV testing is like any other test’
• Create a positive climate of HIV counseling and encourage people at risk to get counseled and tested

ETHOS - THOUGHT PROCESS

Banking on the good quality of the existing service….

The ICTC implemented under MDACS is the only such health testing service which has an integral element of counseling. Counseling is an important part of this service and is given both before and after a person gets tested. This ensures that s/he is completely prepared for the results, will act responsibly and will have information and access to the required services in the future to lead a normal, healthy and balanced life.

The counselor takes on the role of a friend and a guide and guides the client/user regardless of the test results. This element of counseling is found to have a positive impact on clients and is something that they continue to vouch for.

The ICTC has at its advantage a strong service element that needs to be ‘in marketing’ terms packaged to appeal to more people thus realizing its ultimate goal in HIV/AIDS control.

Eliminating the fear associated with HIV testing…….

HIV/AIDS has a heavy morality tag attached to it and subsequently HIV testing gets linked to being immoral and hence deserving of social ostracism or stigma.

Over the years HIV testing has retained its negative connotation and people continue to fear lack of social approval on getting tested. They perceive fear even before they get the results.

Hence the approach of this communication strategy would be to curb this fear and transform it into a positive feeling. Going to a HIV testing center should not stand for fear instead it should connote a sense of empowerment and wellbeing. This is because, only once one is tested and detected positive, can he treat himself and thereby lead a healthy life. Hence, testing is important and must be looked at a life savior instead of a threat. It should be viewed as any other diagnostic test without any morality label attached to it.

With the thought process churning the following words emerged that resonated with the new identity for ICTC that was to be created……

A NEW NAME – A NEW IDENTITY

MDACS stands for an HIV-free Mumbai. It aims to empower people through services and knowledge and Help them take responsibility for themselves, their family and society at large.With this key thought of empowering the user through the use of the HIV counseling and testing service, a new brand was born.

‘Shakti Clinic – HIV/AIDS Salah Kendra’ the overhauled transition of ICTC’s was conceptualized with three major attributes in name - neutral language, power and simplicity.

The logo

The brand logo was created keeping in mind that it should be religion neutral considering the cultural melting pot that Mumbai is. The international symbol - red ribbon of AIDS awareness, has been transformed to a red ribbon that curls up to a fist symbolizing strength i.e. ‘Shakti’. The strength of accessibility of information and services in the name itself is a step forward in reducing the stigma and being approachable.

The new logo signifies the coming together of all stakeholders to support people living with HIV/AIDS - A symbol of the energy and power to fight HIV.

REPOSITIONING ICTC TO SHAKTI CLINIC – HIV/AIDS SALAH KENDRA

The testing centers will be given their new name – Shakti Clinic.

Along with this name comes a positioning statement which will help reposition this service to the target audience.

This new brand will not be known as a testing center but will have a reformed identity of an information center that aims to empower people. Calling it the ‘Shakti Clinic – HIV/AIDS Salah Kendra’, this service centre uses ‘Salah’ (counseling) to reduce fear and empower the user. The user can fearlessly access the center, empower himself with information and take an informed decision.

The new identity builds an ambiance of care, positivity, trust and friendliness making it easy to access information on HIV/AIDs and increase the number of patients undergoing tests. It will also encourage a behavioral change towards Counseling and testing.

Report: IDENTIFYING THE PROBLEM

Situational Analysis                                       

Since its inception in 2001, the ICTC’s in Mumbai have been consistently delivering quality services across its vast network. People were visiting the centers, getting counseled, tested and referred for further treatment. However, even a decade after its existence, certain problem areas were identified by MDACS.

• Lack of Visual Identification for ICTC: Even within a government hospital, a client could not identify the ICTC. The ICTC had no visual image that the user/non-user could relate to.

• The brand ICTC is almost unknown: An ICTC was an HIV testing center that was a unit of the hospital and that was the end of their (user & non-user) understanding of this service.

• Fear of Testing: There is a fear associated of being stigmatized / discriminated against if one uses the ICTC

Research Strategy

With the identified issues at hand, MDACS planned to develop a comprehensive, evidence based communication strategy to increase awareness about the HIV counseling and testing facilities available in the city; and motivate andmove appropriate population to get counseled and tested in these centers.

As a prerequisite to the strategy development, it was proposed to conduct a  formative study with quantitative and qualitative research methods in order to confirm the above stated premise of the problem areas and also establish baseline indicators on the city residents’ knowledge, attitudes and practices about HIV testing and ICTC.

Research Objectives

• Gauge awareness of, attitude towards and utilization of ICTC and HIV testing
• Understand the motivators and barriers in accessing ICTC services
• Client’s perception about ICTC services
• Gain insights into the media reach and media habits of the target populations so as to ensure maximization of the reach of the resultant communication campaign

Research Questions 

1. Knowledge about HIV testing & ICTC
• Sources of Information for HIV testing & ICTC
• Specific service related knowledge
• Reasons for visiting HIV testing center

2. HIV related knowledge, perceptions and practices
• Self-risk perception of HIV
• Community risk perception of HIV
• Actual HIV testing in last 6 months
• Place of HIV testing
• Reasons for getting tested for HIV
• Intent to get tested for HIV

3. Media Habits of different population groups
• Access to different forms of media
• Exposure to folk media
• Access to advertising media

Sampling – Primary Research

1. Quantitative Survey: A cross sectional study was conducted among 5 target population groups with a total sample size of 450 respondents.

2. Qualitative Research

        a. Rapid Exploration Exercise was conducted among 58 stakeholders to gauge the awareness of, attitude towards and utilization of ICTC and to explore issues in access to these centers.Stakeholders included Users of public health services (Users and Non-Users of ICTC),  Counselors and ICTC administrators from different types of ICTCs, Hospital staff and NGO staff and Potential friends of ICTC (Paanwala, Medical shop owners, Bar owners, Taxi, Rickshaw drivers etc.)
        b. Media habits of different groups of population: Titled ‘A day in the life of’ this research exercise of in-depth interviews was conducted with 15 participants from 5 target groups of population, to understand their media touch points and the type and flow of ICT that reaches them on a typical day.
        c. Structured in-depth interviews was conducted with 3 Communication Professionals from the Advertising Industry with an aim of understanding the most effective media channels to reach different groups of populations in the context of creating universal awareness of ICTC.

Secondary Research

A total of 23 health related communication campaigns were studied out which 14 were national campaigns while the remaining 9 were international.

Findings & implications

One of the key findings that emerged was that although there was a universal awareness of HIV testing; very few had actually heard about ICTC.

HIV testing is a mandatory health routine for pregnant women. Yet it is astounding to see that even though 84% of pregnant women had heard of HIV testing; only a miniscule 7% heard of ICTC, inferring a lack of recognition and identity of this service.

Free HIV testing is one of the key features of the ICTC as it offers a crucial service for all and removes the economical barrier for demand generation.

Universal awareness of free testing was found only among High Risk Group. Two in three respondents from bridge and pregnant population were aware of the free testing element. Only 59% of non-slum based general population feel that HIV testing is voluntary.

Low self-risk perception of HIV was observed across respondents.

Although most respondents feel that they have low/no chance of contracting HIV; nearly 1 in 5 (19%) non-slum based general population reported being at moderate risk of contracting the infection.

When asked if they could go and get tested for HIV in a nearest testing facility majority of respondents across all target groups said that they agreed/strongly agreed with this statement.

Almost half of slum and non-slum based general population felt that they could go to the nearest testing facility and get tested for HIV, highlighting the intent to adopt this behavior.

When respondents were asked they would be able to take the right decisions for future actions if they get tested, most agreed/strongly agreed with this statement implying that people are aware of the benefit of getting tested for HIV.

Respondents were asked about their community’s approval for getting tested for HIV. They were asked to estimate how much percentage of their community would approve of them getting tested.

Although high support for testing was observed from HRG community, 1 in 3 respondents from the remaining groups felt that less than 25% of their community members would approve of them getting tested for HIV. These figures highlight the low extent of social/community acceptance attached to the behavior of testing which further blocks the person from getting tested.

Respondents were asked if they had tested for HIV (ever tested/tested in last 6 months preceding the survey). High testing figures were observed among respondents from High risk group and pregnant women.

The lowest proportion of respondents who had ever been tested for HIV was from bridge and non-slum based general population. Testing behavior needs to be encouraged especially among risk groups.

Majority of respondents from all groups except non-slum based general population got tested in a government facility.

Even though ICTC and government testing facility are the same, respondents were still confused about the co-existence of the two. This is evident in the divided responses between ICTC and government hospital.

Respondents have gone to the government hospital to get tested for HIV but are not aware that this facility is called the ICTC.

Respondents were asked about their intent to get tested for HIV in the next 6 months, on which almost 40% of HRG responded affirmatively.

Low intent to testing was observed among bridge, pregnant and non-slum based general population. However almost 1 in 3 respondents from slum based general population showed intent to get tested for HIV in the next 6 months.

Respondents who showed intent to get tested in the next 6 months were further asked about where they would get their HIV test done. Majority said that they would go to a government facility.

• 79% of HRG will go to ICTC
• 82% of Bridge population will go to Government hospital
• 77% of pregnant women will go to Government hospital
• 55% of Slum based general population will go to Government hospital
• 100% of Non-Slum based general population will go to Private lab

Except for HRG, respondents who want to go to the government facility are not aware that it is called the ICTC.

Top 2 reasons why people from the community might not get tested for HIV

Clearly more than 50% of the low risk groups feel that people from their community may not get tested because of the fear of being stigmatized.

Media Access & Exposure

• Access and exposure to television was high across all groups.
• In the case of newspapers however, low risk groups (pregnant and general population) had higher exposure.
• Majority of slum-based general population (35%) and bridge population (20%) confirmed to have watched ‘Nukad Naatak’ (street plays).

Top forms of advertising media that respondents’ came across while travelling

Proportion of respondents that came across print media on HIV testing

Qualitative Findings Revealed:

NONE OF THE USERS of ICTC except one from the HRG group knew what ICTC was and did not know the testing centre by the name of ICTC. It was known by the OPD no. For instance in one of the Hospital examined it was called ‘OPD no. ‘401’.

Clients would refer to the ICTC in the dispensary, by the name of the dispensary (‘XXX Dawakhaana’)

All USERS knew that HIV testing was free but did not know that they can walk in without doctor’s prescription. Awareness about ‘Voluntary testing’ is essential.

NONE OF THE NON-USERS around ICTC (even those sitting in the same hall or the next OPD very close to ICTC) knew about ICTC or where the HIV test is done.

There were no clear prominent signages highlighting the facility. Long form of ICTC was written in English or Marathi- but this did not make sense to the users& non-users.

OUT OF 14 STAFF of the hospitals (including nurses, attendants, security guards) only 2 had heard the name ICTC. Most did not know the full form.

They all knew about HIV testing and refer to the ICTC by the OPD No.They also guide clients by using the OPD No.

People do not know about the services- though the current ad says how one can get HIV and importance of testing, they don’t say that every BMC hospital next to your house offers free HIV testing - That line is missing from the communication.

Poster and map at the gate (all entrances) is required for easier access and Map with clear indication for direction. Also center/brand name should be in Marathi or Hindi. For referred patients who are illiterate so particular colour for identifying the OPD will help.