plan and development of social marketing materials

Social Marketing:

The 4 P’s

1. What are we selling?

**** both the individual and community level, empowerment refers to “people having power to take action to control and enhance their own lives, and the processes of enabling them to do so” (Grace, 1991, p. 330).

We want people that use drugs to:

Individual Level Change

1. Use their local syringe exchange to be:

a. Increase Knowledge of People who Use Drugs (Health Education for Drug Users)

i. Specific emphasis on Knowledge around HCV prevention (stimulants, Pills, Women, injectors)

2. Access Supplies so they have the ability to use new supplies for every shot.

3. Develop skills to be in control of their own injection

( information on disease, transmission, risk and effective prevention practices, including messages about reduction or cessation of drug use when possible, otherwise, use of harm/risk reduction methods; 2) the tools to prevent transmission (specifically, bleach for syringe sterilization, rubber tips for crack pipe stems to reduce lip ulcerations, and male condoms, female condoms and dental dams for protection during sex); 3) opportunities to practice risk/harm reduction skills and to use the information and tools to engage in preventive efforts in a non-threatening situation; and 4) increased sense of efficacy to engage in these risk reduction efforts in increasingly risky situations as a result of this practice)

Community Level Change

social empowerment models of community transformation focus on building change from within the social context of the community in which the problem exists (Brown, 1991; Minkler, 1989; Robertson & Minkler, 1994).

Active engagement in health advocacy with others has been demonstrated to sustain one's own healthy behavior and to maintain one's own reduced risk (Ramirez-Valles, 2002). Thus, trained PHAs' community outreach activity became a mechanism to support their own individual level behavioral and even life style changes to reduce their drug use and their exposure to multiple health risks in their environment (Dickson-Gomez et al., 2006).

Our formative research demonstrated that heroin and cocaine users Greensboro are connected similar to other studies we have read therefore it is suggested by researchers that these connections should be used for teaching prevention behaviors. Our members will strive to become key opinion leaders and change agents to diffuse the adoption of prevention behaviors in the context of real-world practices of drug use and risky sex through the macro network of drug users.

Social relations among impoverished inner city drug users often reflect their need to rely on each other for life support and their dependence on mutual reciprocity in the context of limited resources, the illegal nature of their addiction, and the poverty they face. This is not different in rural areas. In fact we have seen an increased need for support from community groups. Despite the frequent and common rejection of heroin and cocaine users by the larger community, they are residents (even if transient), family members, and sometimes life long acquaintances of non-drug using community members. Multiple aspects of the community intersect to affect drug users, including the laws that restrict them, the threats to health that they encounter, and the potential for mobilization around their own and the broader social interests. As members of the community, they, in turn, shape the community context, for example, to the degree that they respond to health risks or take action against other social and political forces that threaten their ability to survive and thrive.

Approaches to behavior change

Tell me help me Make

Do x b/c Y If you do x I will do y Do x or I will do y

I would be willing to do x if you do Y_____________social marketing

1. Define the problem- identify the behavior change

The Problem:

Hepatitis C is a blood borne virus that affects people who use drugs and inject drugs at epidemic proportions, but because of stigma, limited education, and lack of resources, drug users are[1] often oblivious to simple, life saving strategies, which can prevent them from becoming infected with HCV. Over 60% of HCV in the US is attributed to injection drug use. We estimate that at the USU -NC syringe exchange that between 70%-90% of our participants are infected with HCV. ) Drug users are not learning about HCV until well after they have initiated injection drug use. Our survey data, focus groups, and individual interviews revealed a below average understanding of Hepatitis C risk behaviors among people that inject drugs in the triad area . In spite of the huge push to educate people about Hepatitis C, HCV education and prevention information, has not yet made its way into the NC high school health curriculum, and it is still surprisingly absent from many treatment centers and drug user service organizations. Too often, the HCV classes that are available in drug treatment centers lack cultural competence and fail to teach drug users important tools and strategies that are relevant and useful. In spite of recent efforts to increase access to testing, over 50% of IDU’s are not aware they are infected with HCV and there is substantial misinformation and stigma surrounding HCV which has created a culture of apathy among people who inject drugs. Many drug users believe if they do have it, there is nothing they can do about it, what’s the point of knowing, better just to not deal with it. Why get tested just to upset yourself.

Parents and authorities rarely discuss interventions that actually are appropriate for their teens they suspect or find using drugs. Often time is wasted discussing “just say no” and “abstinence” rarely are there discussions around relevant self-care strategies. Most people know that sharing syringes will result in disease and disease spread; what most people don’t know is that Hepatitis C lives outside the body highly infectious up to 3 weeks which means that sharing cookers, cottons, and water that are contaminated with hepatitis C are just as dangerous as the syringe.[2] People assume if they are sleeping with a partner unprotected they might as well inject with their partner, not realizing the two risk factors are very different. Current messages communicated to drug users are clear: “ no point in trying to be healthy if you are using drugs.”

Gender and Choice of drugs also affects what kind of info you provide. Understanding how gender and drug choice affect risk is vital as well. Women have smaller surface veins making injection drug use more difficult. More blood = more risk. They often require help getting their shot and this increases risk for acquiring HCV. Women are often left to use after their partner, and power imbalances in relationships increases risk among our participants. Domestic violence is increased among injection drug using women. Women are often afraid to seek services for their drug use because they fear seeking help might alert family or social services which put their families at risk for being separated We believe that a campaign that tells drug users they should always try to be the best they can be and that everyone deserves to be healthy, and that everyone can be healthy once given the tools, knowledge and support would greatly benefit people that use drugs. We have found that self stigma and an overwhelming belief (that is supported by disease theory that we (active drug users) are not capable of taking care of ourselves when using, stand directly in the way of people even trying. Our belief is that a social marking campaign promoting messages which encourage community responsibility and promote safer rituals is essential thes messages will encourage community elders and leaders to take responsibility for their “community” that is in great need. User unions will advocate for and heavily promote a culture of health through national communication channels. These messages will underscore safety while actively deterring practices which are unsafe and put users at risk. User unions will head up the promotion of community care and community safety practiced and policed by the members themselves, self care, combined with supportive features such as reminding people they are worth taking care of, that everyone deserves to be disease free.

Stigma and shame prevents drug users from seeking professional help. Research shows that 2 out of 3 patients prefer to suffer in silence rather than discuss personal issues with doctors. Shame prevents drug users from going outside the drug using community for help.

Encouraging people that inject drugs to use a local syringe exchange is one of the main ways we can improve the knowledge and skills of people that use drugs.

Encouraging family members to attend family learning events facilitated by the harm reduction organization

[1] (Morbidity and Mortality Weekly Report (MMWR), 2015)

[2] (Centers for Disease Control, 2016)