Abstracts

Introduction

Despite the efficacy demonstrated by antiretroviral treatments, the Human Immunodeficiency Virus (HIV) and Acquired Immune Deficiency Syndrome (AIDS) pose a serious global problem. It is estimated that in 2017 36.9 million people were living with HIV worldwide, of which 1.8 million live in Latin America¹1. UNAIDS. UNAIDS DATA 2018 [Internet]. Geneva; 2018 [cited 2018 Nov 30]. Available from: http://www.unaids.org/sites/default/files/media_asset/unaids-data-2018_en.pdf
http://www.unaids.org/sites/default/file... . Mass media campaigns have become a priority for preventive efforts in the fight against HIV and research has been instrumental in making progress against the spread of the epidemic²2. UNAIDS. Report on the global AIDS epidemic 2013 [Internet]. Geneva; 2013 [cited 2018 Feb 27]. Available from: http://www.unaids.org/sites/default/files/media_asset/UNAIDS_Global_Report_2013_en_1.pdf
http://www.unaids.org/sites/default/file... . However, it is recognized that HIV advertising campaigns in general, and especially those broadcasts on television, have shown very little effect in achieving changes in risk behaviors³3. Agha S. The impact of a mass media campaign on personal risk perception, perceived self-personal risk perception, perceived self-efficacy and other behavioral predictors. AIDS Care. 2003; 15:749-62.. At this moment everything seems to indicate that the epidemic spreads much faster than the preventive actions that seek to stop it. Sharing successes, failures, and lessons learned can contribute to a reverse of this trend⁴4. UNAIDS. How AIDS changed every things [Internet]. Geneva; 2015 [cited 2017 Mar 26]. Available from: http://www.unaids.org/sites/default/files/media_asset/MDG6Report_en.pdf
http://www.unaids.org/sites/default/file... .

According to Breton⁵5. Bretón-López J, Buela-Casal G. Análisis de la publicidad preventiva de VIH/SIDA y su impacto en adolescentes en función de variables psicológicas [thesis]. Granada: University of Granada; 2007., in the absence of a preventive vaccine for HIV, campaigns advocating safe-sex to prevent the epidemic have been positively assessed. In 1987, HIV prevention campaigns began to be broadcast⁶6. Wayling S. The European experience: public education with regards to AIDS prevention. Int J Health Educ. 1988; 7:16-20., becoming in many countries one of the most important resources for transmitting preventive information⁷7. Holtgrave D. Public health communication strategies for HIV prevention: past and emerging roles for mass media. AIDS. 1997; 11:183-90..

There is important literature on prevention-oriented health campaigns that report evaluations of successful campaigns and their most common shortcomings. Since a long time ago, Rogers & Storey⁸8. Rogers EM, Storey JD. Communication campaigns. In: Berger CR, Chafee SH, editors. Handbook of communication science. London: Sage; 1987. p. 817-46., in reviewing campaign history, consider the 1940s and 1950s to be an era of minimal effects, when many large-scale campaign efforts failed. The 1960s and 1970s marked the beginning of campaigns that were successful and, principles of effective campaign design were formulated, including: 1) using a formative evaluation for their design, 2) setting reasonable goals, 3) using audience fragmentation, and 4) considering interpersonal communication networks. These principles coincide with those that Noar⁹9. Noar S. A 10-year retrospective of research in health mass media campaigns: where do we go from here? J Health Commun. 2006; 11(1):21-42. propose recently and considers necessary to guarantee the success of a health campaign. Finally, the 1980s and 1990s are defined as an era of moderate effects.

As for the effect of the campaigns, there has been an important debate. Since the late ‘80s, authors such as Flay & Cook¹⁰10. Flay BR, Cook TD. Three models for summative evaluation of prevention campaigns with a mass media component. In: Rice RE, Atkin CK, editors. Public communication campaigns. Newbury Park: SAGE Publications; 1989. p. 175-95. suggested that social marketing rarely changes behavior directly, but instead creates awareness, modifies or influences perceptions, and provides motivation to change attitudes about an issue¹¹11. Robinson MN, Tansil KA, Elder RW, Soler RE, Labre MP, Mercer SL, et al. Mass media health communication campaigns combined with health related product distribution. A community guide systematic review. Am J Prev Med. 2014; 47(3):360-71.. Based on the results of a 2004 meta-analysis, on the contrary, they affirm that campaigns promoting the adoption of healthy behaviors are associated with small but significant changes in behavior. In the same vein, Noar⁹9. Noar S. A 10-year retrospective of research in health mass media campaigns: where do we go from here? J Health Commun. 2006; 11(1):21-42. argues that the literature is beginning to accumulate evidence that these well-targeted and executed campaigns can have small to moderate effects not only on health knowledge, beliefs and attitudes, but also on behaviors. Coffman¹²12. Coffman J. Public communication campaign evaluation: an environmental scan of challenges, criticisms, practice, and opportunities. Cambridge: Harvard Family Research Project; 2002. states that no progress has been made on innovation in campaign evaluation as funders are more focused on results.

Some reviews on evaluations of HIV prevention campaigns conducted in the first decade of the 21st century considered that HIV/Aids campaigns can have an impact on the knowledge, attitudes, and behaviors related to HIV¹³13. Noar S, Palmgreen P, Chabot M, Dobransky N, Zimmerman R. A 10-year systematic review of HIV/AIDS mass communication campaigns: have we made progress? J Health Commun. 2009; 14(1):15-42. Doi: http://dx.doi.org/10.1080/10810730802592239.
http://dx.doi.org/10.1080/10810730802592...

14. Vidanapathirana J, Abramson MJ, Forbes A, Fairley C. Mass media interventions for promoting HIV testing. Cochrane Database Syst Rev. 2005; 3(3):CD004775.

15. Bertrand J, O´Reilly K, Denison J, Anhang R, Sweat M. Systematic review of the effectiveness of mass communication programs to change HIV/AIDS-related behaviors in developing countries. Health Educ Res. 2006; 21(4):567-97.-¹⁶16. Huedo T, Boyntonb M, Warrena M, LaCroixa J, Careyc M, Johnsona B. Efficacy of HIV prevention interventions in Latin American and Caribbean Nations, 1995–2008: a meta-analysis. AIDS Behav. 2010; 14(6):1237-51.. These reviews questioned the effectiveness of the interventions due to the fact that they continue to use weak designs for evaluating results (ie, pre-experimental).

The most recent reviews continuo to show that there is a growing body of evidence on the effectiveness of social marketing and media interventions to increase condom use, knowledge related to HIV and the adherence to HIV testing. Unlike the previous ones, these studies explored the patterns in the type of study, internal validity and the effectiveness of the interventions¹⁷17. LaCroix J, Snyder L, Huedo T, Johnson B. Effectiveness of mass media interventions for HIV prevention, 1986-2013: a meta-analysis. J Acquir Immune Defic Syndr. 2014; 66 Suppl 3:S329-40.

18. French R, Bonell C, Wellings K, Weatherburn P. An exploratory review of HIV prevention mass media campaigns targeting men who have sex with men. BMC Public Health. 2014; 14:616.

19. Friedman A, Kachur R, Noar S, McFarlane M. Health communication and social marketing campaigns for sexually transmitted disease prevention and control: what is the evidence of their effectiveness? Sex Transm Dis. 2016; 43 (2 Suppl 1):83-101.-²⁰20. McDaid L, Riddell J, Teal G, Boydell N, Coia N, Flowers P. The effectiveness of social marketing interventions to improve HIV testing among gay, bisexual, and other men who have sex with men: a systematic review. AIDS Behav. 2019; 23(9):2273-303.. Likewise, they analyzed HIV/Aids prevention programs through reference criteria, in order to identify gaps between the design of the programs and their effectiveness²¹21. Sewak A, Singh G. Integrating social marketing into Fijian HIV/Aids prevention programs: lessons from systematic review. Health Commun. 2017; 32(1):32-40..

In Latin America were observed changing trends. In the 1980s the reign of silence prevailed or messages seemed only whispered. In the 1990s, the voices began to become louder, beginning with the use of social marketing. At the end of the 2000’s, strategies became diversified and a dialogue sprang up among all actors, including the most vulnerable groups, health personnel, opinion leaders, and the general population²²22. Suárez N. Comunicación en estrategias de mercadeo social del condón masculino para la prevención del VIH/sida en Cuba. Rev Comun Salud. 2014; 4:69-83..

Studies aimed at evaluating the impact of campaigns are now considered essential²³23. Páez D, Mayordomo S, Igartua JJ, Ubillos S, Alonso M, Martínez A. Afectividad, cognición y persuasión: un contraste experimental de las variables mediadoras en la prevención ante el VIH/SIDA. Rev Electronica Motivacion Emocion. 2001; 4(7):1-25.. In the initial evaluations, informed condom use, reduction in the number of sexual partners, or the risk of sexually transmitted diseases were highlighted as central issues²⁴24. Hassig S. Measuring the effectiveness of targeted interventions. Network. 1991; 12(1):21-3.. In other evaluations, the psychological dimensions of affection, cognition and behavior were observed for better persuasiveness of the campaigns, as well as the mediating effect of the relevant sociodemographic and behavioral characteristics to adopt healthy behaviors and avoid risky behaviors²³23. Páez D, Mayordomo S, Igartua JJ, Ubillos S, Alonso M, Martínez A. Afectividad, cognición y persuasión: un contraste experimental de las variables mediadoras en la prevención ante el VIH/SIDA. Rev Electronica Motivacion Emocion. 2001; 4(7):1-25.,²⁵25. Anderko L, Uscian M. The effectiveness of a community-level HIV/STD prevention program in a three-country rural area. Fam Commun Health. 2000; 23:46-8.,²⁶26. Millar S, Exner TM, Williams SP, Ehrhardt AA. A gender-specific intervention for at-risk women in the USA. AIDS Care. 2000; 12(5):603-12..

However, despite major efforts and economic investments over the past thirty years to curb the spread of HIV, campaigns often go unevaluated²⁷27. Bretón-López J, Buela-Casal G. Cuestionario para la evaluación del impacto de campañas publicitarias sobre prevención del VIH/SIDA. Psicothema. 2006; 18(3):556-63., or lack rigorous evaluation¹⁴14. Vidanapathirana J, Abramson MJ, Forbes A, Fairley C. Mass media interventions for promoting HIV testing. Cochrane Database Syst Rev. 2005; 3(3):CD004775..

Based on the above considerations, it is necessary to conduct a literature review on the evaluation of HIV prevention campaigns through mass media that have been implemented in Latin America, in order to identify: if campaigns are being evaluated¹⁴14. Vidanapathirana J, Abramson MJ, Forbes A, Fairley C. Mass media interventions for promoting HIV testing. Cochrane Database Syst Rev. 2005; 3(3):CD004775.,²⁷27. Bretón-López J, Buela-Casal G. Cuestionario para la evaluación del impacto de campañas publicitarias sobre prevención del VIH/SIDA. Psicothema. 2006; 18(3):556-63. and the methodological quality of the evaluations¹⁷17. LaCroix J, Snyder L, Huedo T, Johnson B. Effectiveness of mass media interventions for HIV prevention, 1986-2013: a meta-analysis. J Acquir Immune Defic Syndr. 2014; 66 Suppl 3:S329-40.

18. French R, Bonell C, Wellings K, Weatherburn P. An exploratory review of HIV prevention mass media campaigns targeting men who have sex with men. BMC Public Health. 2014; 14:616.

19. Friedman A, Kachur R, Noar S, McFarlane M. Health communication and social marketing campaigns for sexually transmitted disease prevention and control: what is the evidence of their effectiveness? Sex Transm Dis. 2016; 43 (2 Suppl 1):83-101.

20. McDaid L, Riddell J, Teal G, Boydell N, Coia N, Flowers P. The effectiveness of social marketing interventions to improve HIV testing among gay, bisexual, and other men who have sex with men: a systematic review. AIDS Behav. 2019; 23(9):2273-303.-²¹21. Sewak A, Singh G. Integrating social marketing into Fijian HIV/Aids prevention programs: lessons from systematic review. Health Commun. 2017; 32(1):32-40., the approaches and variables that are being used¹³13. Noar S, Palmgreen P, Chabot M, Dobransky N, Zimmerman R. A 10-year systematic review of HIV/AIDS mass communication campaigns: have we made progress? J Health Commun. 2009; 14(1):15-42. Doi: http://dx.doi.org/10.1080/10810730802592239.
http://dx.doi.org/10.1080/10810730802592...

14. Vidanapathirana J, Abramson MJ, Forbes A, Fairley C. Mass media interventions for promoting HIV testing. Cochrane Database Syst Rev. 2005; 3(3):CD004775.

15. Bertrand J, O´Reilly K, Denison J, Anhang R, Sweat M. Systematic review of the effectiveness of mass communication programs to change HIV/AIDS-related behaviors in developing countries. Health Educ Res. 2006; 21(4):567-97.-¹⁶16. Huedo T, Boyntonb M, Warrena M, LaCroixa J, Careyc M, Johnsona B. Efficacy of HIV prevention interventions in Latin American and Caribbean Nations, 1995–2008: a meta-analysis. AIDS Behav. 2010; 14(6):1237-51.,²⁴24. Hassig S. Measuring the effectiveness of targeted interventions. Network. 1991; 12(1):21-3., and the target audiences²²22. Suárez N. Comunicación en estrategias de mercadeo social del condón masculino para la prevención del VIH/sida en Cuba. Rev Comun Salud. 2014; 4:69-83.,²³23. Páez D, Mayordomo S, Igartua JJ, Ubillos S, Alonso M, Martínez A. Afectividad, cognición y persuasión: un contraste experimental de las variables mediadoras en la prevención ante el VIH/SIDA. Rev Electronica Motivacion Emocion. 2001; 4(7):1-25.,²⁵25. Anderko L, Uscian M. The effectiveness of a community-level HIV/STD prevention program in a three-country rural area. Fam Commun Health. 2000; 23:46-8.,²⁶26. Millar S, Exner TM, Williams SP, Ehrhardt AA. A gender-specific intervention for at-risk women in the USA. AIDS Care. 2000; 12(5):603-12., in a way that allows us to make a series of recommendations about the implementation and the evaluation of this type of campaigns in the region.

Materials and methods

We followed the recommendations of Souza, Silva, & Carvalho²⁸28. Souza MD, Silva MDD, Carvalho RD. Integrative review: what is it? How to do it? Einstein (São Paulo). 2010; 8(1):102-6. for conducting integrative review. We searched for articles indexed in the following health and social science communication databases: Scopus, Web of Science, Science Direct, ProQuest, Google Scholar, Dialnet Plus, Redalyc Clacso and Scielo. We conducted this search in both Spanish and English, using the following search terms: “HIV/Aids and health campaigns”, “Evaluation HIV/Aids campaigns”, “Evaluation HIV/Aids prevention campaigns in Latin America”, “Analysis of HIV/Aids prevention campaigns”. Because no Portuguese keywords were used, articles with evaluations of campaigns published in this language, and probably implemented in Brazil, are not included.

This initial search yielded 246 publications that included: articles, guides or government documents, book chapters, conference, and postgraduate theses related to HIV prevention interventions in mass media implemented in Latin America. Bibliographies of these studies were also reviewed to identify relevant assessments omitted from the results of electronic searches. This review provided four additional studies. We reviewed this initial set of documents to exclude those that did not report empirical findings of campaign evaluations; 187 documents were excluded at this stage.

To be included in the present review, documents had to meet the following criteria: a) have been published between 1990 and 2018, since the appearance of the first published document on campaign evaluation; b) present empirical findings of the evaluation of an HIV prevention campaign in mass media in Latin America or reports from the agencies that carried out the evaluations; and c) present findings regarding the impact of the intervention, including variables such as HIV knowledge, attitudes, and behaviors. According to these criteria, 51 documents were excluded.

Initially, only peer-reviewed studies were going to be included, but due to the lack of found documents, it was chosen to include institutional documents and master’s degree thesis. This limitation has also been presented in studies conducted in other contexts¹⁴14. Vidanapathirana J, Abramson MJ, Forbes A, Fairley C. Mass media interventions for promoting HIV testing. Cochrane Database Syst Rev. 2005; 3(3):CD004775.,²¹21. Sewak A, Singh G. Integrating social marketing into Fijian HIV/Aids prevention programs: lessons from systematic review. Health Commun. 2017; 32(1):32-40..

The final set consisted of 12 documents, including: nine peer-reviewed articles, two institutional documents, and one Master's dissertation.

Although, at present, the reviews focus on the characteristics of the evaluations and their internal validity to establish effects and results¹⁷17. LaCroix J, Snyder L, Huedo T, Johnson B. Effectiveness of mass media interventions for HIV prevention, 1986-2013: a meta-analysis. J Acquir Immune Defic Syndr. 2014; 66 Suppl 3:S329-40.

18. French R, Bonell C, Wellings K, Weatherburn P. An exploratory review of HIV prevention mass media campaigns targeting men who have sex with men. BMC Public Health. 2014; 14:616.

19. Friedman A, Kachur R, Noar S, McFarlane M. Health communication and social marketing campaigns for sexually transmitted disease prevention and control: what is the evidence of their effectiveness? Sex Transm Dis. 2016; 43 (2 Suppl 1):83-101.-²⁰20. McDaid L, Riddell J, Teal G, Boydell N, Coia N, Flowers P. The effectiveness of social marketing interventions to improve HIV testing among gay, bisexual, and other men who have sex with men: a systematic review. AIDS Behav. 2019; 23(9):2273-303., the documents found for this review do not allow for similar ways to analyze the evaluations, since there is no homogeneity in the results, designs, methods, and samples.

Subsequently, the rules for the coding of documents were defined. Each document was coded by three of the authors and in case of differences, these were discussed with the set of authors. The results of this coding were organized in two tables: one with the characteristics of the campaigns evaluated (Table 1) and another with the results of the evaluation of the campaigns (Table 2), which are presented below. In order to classify the results in the evaluation of the campaigns, we considered the most common variables in this type of intervention, which emerged in the second filtering of the documents. The first two variables refer to the process of reception of the campaigns (recall and attitude towards the campaigns) and the others to their results:

• Recall: is a measure of expresses the weight of media and the ability of creative execution to attract attention and position either a campaign in the memory of the target audience²⁹29. Donovan RJ, Boulter J, Borland R, Jalleh G, Carter O. Continuous tracking of the Australian National Tobacco Campaign: Advertising effects on remembrance, recognition, cognitions, and behavior. Tob Control. 2003; 12 Suppl 2:30-9..

• Attitude towards the campaigns: degree of favorability or agreement in relation to the messages, clarity or potential results of campaigns.

• Knowledge: refers to how much the target audience knows about different aspects of a campaign. Knowledge is a significant reference for action or response to a stimulus - Theory of Reasoned Action-³⁰30. Ajzen I, Fishbein M. Understanding attitudes and predicting social behavior. EnglewoodCliffs, NewJersey: Prentice-Hall; 1980..

• Attitudes: Coffman¹²12. Coffman J. Public communication campaign evaluation: an environmental scan of challenges, criticisms, practice, and opportunities. Cambridge: Harvard Family Research Project; 2002. states that attitudes are a person’s affection for or against an object.

• Behaviors: for Ajzen & Fishbein³⁰30. Ajzen I, Fishbein M. Understanding attitudes and predicting social behavior. EnglewoodCliffs, NewJersey: Prentice-Hall; 1980., is the end result of a set of predictors in which cognitive or emotional responses are included that are expected to result in the elimination or reduction of obstacles to change.

It would have been interesting to include variables such as the use of theory to understand pathways to change, time of interventions, etc. But the information collected did not allow conclusions to be drawn on those aspects.

Results

A total of 12 documents were identified that presented 15 evaluations of HIV prevention campaigns in the mass media in several Latin American countries. About five evaluate several campaigns³¹31. Vernon R, Ojeda G, Murad R. Incorporating AIDS prevention activities into a family planning organization in Colombia. Stud Fam Plann. 1990; 21(6):335-43.

32. Rico B, Bronfman M, Del Rio C. Las campañas contra el sida en México: ¿los sonidos del silencio o puente sobre aguas turbulentas? Salud Publica Mex. 1995; 37(6):643-53.

33. Burgos M. Argentina: social crisis and AIDS prevention campaigns. Int Med J. 1996; 3:35-7.

34. Roso A. Ideology and gender relations: a reception study about AIDS prevention campaigns. Cad Saude Publica. 2000; 16(2):385-97.-³⁵35. Chile. Ministerio de Salud. División de prevención y control de enfermedades subsecretaria de salud pública. Evaluaciones campañas de comunicación social años 2003 al 2007. Programa nacional de prevención y control del VIH/SIDA y las ITS. Santiago, CHL; [s.d.]., three documents do not assess a particular campaign but rather the recall of HIV campaigns in a specific population³⁶36. Vera-Gamboa L, Cerón B, Góngora-Bianchi RA. Hombres que tienen sexo con hombres: conocimientos y prácticas sexuales en relación a la epidemia del VIH/SIDA en Mérida, Yucatán, México. Rev Biomédica. 2004; 15(3):157-63.

37. Vera-Gamboa L, Cen-Chablé M, Góngora-Bianchi RA. HIV/Aids: Knowledge attitudes and sexual practices in a group of men who have sex with men in a rural community of Yucatán. Arch Hispanoam Sexol. 2003; 9:191-204.-³⁸38. Flores F, De Alba M. El SIDA y los jóvenes: un estudio de representaciones sociales. Salud Mental. 2006; 29(3):51-9. and four evaluate a specific prevention campaign³⁹39. Nielsen R, Luengo M, Mello M, Paz J, Pantin C, Erkkola T. Social media monitoring of discrimination and HIV testing in Brazil, 2014–2015. AIDS Behav. 2017; 21 Suppl 1:114-20.

40. Porto MP. The fight against AIDS among adolescent girls: the impact of the 2003 Carnival campaign by the Brazilian Ministry of Health. Cad Saude Publica. 2005; 21(4):1234-43.

41. Ahumada M, Ruiz M, Parra V. Observatorio de Políticas Públicas en VIH/SIDA desde la Perspectiva de Derechos Humanos: “Campaña de comunicación social de prevención del VIH/SIDA”. Chile: Savia Foundation; 2012.-⁴²42. Reynaga C. Evaluación del impacto de una campaña de prevención del VIH e ITS en adolescentes del Perú [tesis]. Barcelona: Universidad Autónoma de Barcelona; 2015..

Description of the campaigns

Table 1 presents the description of the 15 related campaigns in the 12 documents reviewed. The first evaluation of a campaign was found in Colombia in 1990³¹31. Vernon R, Ojeda G, Murad R. Incorporating AIDS prevention activities into a family planning organization in Colombia. Stud Fam Plann. 1990; 21(6):335-43. and the most recent in Brazil in 2017³⁹39. Nielsen R, Luengo M, Mello M, Paz J, Pantin C, Erkkola T. Social media monitoring of discrimination and HIV testing in Brazil, 2014–2015. AIDS Behav. 2017; 21 Suppl 1:114-20..

About eight of the campaings evaluated targeted a general audience³¹31. Vernon R, Ojeda G, Murad R. Incorporating AIDS prevention activities into a family planning organization in Colombia. Stud Fam Plann. 1990; 21(6):335-43.,³³33. Burgos M. Argentina: social crisis and AIDS prevention campaigns. Int Med J. 1996; 3:35-7.,³⁵35. Chile. Ministerio de Salud. División de prevención y control de enfermedades subsecretaria de salud pública. Evaluaciones campañas de comunicación social años 2003 al 2007. Programa nacional de prevención y control del VIH/SIDA y las ITS. Santiago, CHL; [s.d.].,³⁹39. Nielsen R, Luengo M, Mello M, Paz J, Pantin C, Erkkola T. Social media monitoring of discrimination and HIV testing in Brazil, 2014–2015. AIDS Behav. 2017; 21 Suppl 1:114-20., six targeted adolescents and young adults³²32. Rico B, Bronfman M, Del Rio C. Las campañas contra el sida en México: ¿los sonidos del silencio o puente sobre aguas turbulentas? Salud Publica Mex. 1995; 37(6):643-53.,³⁴34. Roso A. Ideology and gender relations: a reception study about AIDS prevention campaigns. Cad Saude Publica. 2000; 16(2):385-97.,³⁸38. Flores F, De Alba M. El SIDA y los jóvenes: un estudio de representaciones sociales. Salud Mental. 2006; 29(3):51-9.,⁴⁰40. Porto MP. The fight against AIDS among adolescent girls: the impact of the 2003 Carnival campaign by the Brazilian Ministry of Health. Cad Saude Publica. 2005; 21(4):1234-43., three were designed for women³²32. Rico B, Bronfman M, Del Rio C. Las campañas contra el sida en México: ¿los sonidos del silencio o puente sobre aguas turbulentas? Salud Publica Mex. 1995; 37(6):643-53.,³⁴34. Roso A. Ideology and gender relations: a reception study about AIDS prevention campaigns. Cad Saude Publica. 2000; 16(2):385-97.,⁴⁰40. Porto MP. The fight against AIDS among adolescent girls: the impact of the 2003 Carnival campaign by the Brazilian Ministry of Health. Cad Saude Publica. 2005; 21(4):1234-43., and two were designed for at-risk groups (e.g., men who have sex with men, transgender people and sex workers)³²32. Rico B, Bronfman M, Del Rio C. Las campañas contra el sida en México: ¿los sonidos del silencio o puente sobre aguas turbulentas? Salud Publica Mex. 1995; 37(6):643-53.,⁴¹41. Ahumada M, Ruiz M, Parra V. Observatorio de Políticas Públicas en VIH/SIDA desde la Perspectiva de Derechos Humanos: “Campaña de comunicación social de prevención del VIH/SIDA”. Chile: Savia Foundation; 2012..

The most common message in the campaigns was the promotion of condom use (n=6)³¹31. Vernon R, Ojeda G, Murad R. Incorporating AIDS prevention activities into a family planning organization in Colombia. Stud Fam Plann. 1990; 21(6):335-43.,³⁴34. Roso A. Ideology and gender relations: a reception study about AIDS prevention campaigns. Cad Saude Publica. 2000; 16(2):385-97.,³⁵35. Chile. Ministerio de Salud. División de prevención y control de enfermedades subsecretaria de salud pública. Evaluaciones campañas de comunicación social años 2003 al 2007. Programa nacional de prevención y control del VIH/SIDA y las ITS. Santiago, CHL; [s.d.].,⁴⁰40. Porto MP. The fight against AIDS among adolescent girls: the impact of the 2003 Carnival campaign by the Brazilian Ministry of Health. Cad Saude Publica. 2005; 21(4):1234-43.,⁴²42. Reynaga C. Evaluación del impacto de una campaña de prevención del VIH e ITS en adolescentes del Perú [tesis]. Barcelona: Universidad Autónoma de Barcelona; 2015.. Abot two focused on stimulating discussion of HIV/Aids³³33. Burgos M. Argentina: social crisis and AIDS prevention campaigns. Int Med J. 1996; 3:35-7.,³⁵35. Chile. Ministerio de Salud. División de prevención y control de enfermedades subsecretaria de salud pública. Evaluaciones campañas de comunicación social años 2003 al 2007. Programa nacional de prevención y control del VIH/SIDA y las ITS. Santiago, CHL; [s.d.]., two promoted HIV testing³²32. Rico B, Bronfman M, Del Rio C. Las campañas contra el sida en México: ¿los sonidos del silencio o puente sobre aguas turbulentas? Salud Publica Mex. 1995; 37(6):643-53.,³⁵35. Chile. Ministerio de Salud. División de prevención y control de enfermedades subsecretaria de salud pública. Evaluaciones campañas de comunicación social años 2003 al 2007. Programa nacional de prevención y control del VIH/SIDA y las ITS. Santiago, CHL; [s.d.]., two reported on HIV behaviors, practices and risk perception³⁵35. Chile. Ministerio de Salud. División de prevención y control de enfermedades subsecretaria de salud pública. Evaluaciones campañas de comunicación social años 2003 al 2007. Programa nacional de prevención y control del VIH/SIDA y las ITS. Santiago, CHL; [s.d.].,⁴¹41. Ahumada M, Ruiz M, Parra V. Observatorio de Políticas Públicas en VIH/SIDA desde la Perspectiva de Derechos Humanos: “Campaña de comunicación social de prevención del VIH/SIDA”. Chile: Savia Foundation; 2012., one focused on non-discrimination towards people living with HIV or AIDS³⁹39. Nielsen R, Luengo M, Mello M, Paz J, Pantin C, Erkkola T. Social media monitoring of discrimination and HIV testing in Brazil, 2014–2015. AIDS Behav. 2017; 21 Suppl 1:114-20., and one emphasized the importance of the media in the social representation of AIDS³⁸38. Flores F, De Alba M. El SIDA y los jóvenes: un estudio de representaciones sociales. Salud Mental. 2006; 29(3):51-9..

Description of the evaluations

Table 2 presents the methodological characteristics and results of the evaluations carried out on the campaigns.

The results will be presented according to the main variable evaluated, which may be: means of exposure, recall and attitude towards the campaigns, knowledge, attitude and behavior.

Means of exposure

A total of six documents agreed that television is the most effective medium: between 80% and 96% of those who remembered a campaign saw it through this medium. Radio and posters are secondary media where participants remember seeing or hearing campaign advertisements³⁴34. Roso A. Ideology and gender relations: a reception study about AIDS prevention campaigns. Cad Saude Publica. 2000; 16(2):385-97.,³⁵35. Chile. Ministerio de Salud. División de prevención y control de enfermedades subsecretaria de salud pública. Evaluaciones campañas de comunicación social años 2003 al 2007. Programa nacional de prevención y control del VIH/SIDA y las ITS. Santiago, CHL; [s.d.].,³⁸38. Flores F, De Alba M. El SIDA y los jóvenes: un estudio de representaciones sociales. Salud Mental. 2006; 29(3):51-9.,⁴⁰40. Porto MP. The fight against AIDS among adolescent girls: the impact of the 2003 Carnival campaign by the Brazilian Ministry of Health. Cad Saude Publica. 2005; 21(4):1234-43.,⁴²42. Reynaga C. Evaluación del impacto de una campaña de prevención del VIH e ITS en adolescentes del Perú [tesis]. Barcelona: Universidad Autónoma de Barcelona; 2015..

Recall

Most of the documents reviewed (n=9) include results related to the evaluation of campaign recall. There is a high recall of these campaigns: between 67-100% of the participants in the different studies reported having seen, heard, or read a message about HIV or AIDS in the media. There is less recall when evaluating campaigns aimed at specific segments of the population³⁶36. Vera-Gamboa L, Cerón B, Góngora-Bianchi RA. Hombres que tienen sexo con hombres: conocimientos y prácticas sexuales en relación a la epidemia del VIH/SIDA en Mérida, Yucatán, México. Rev Biomédica. 2004; 15(3):157-63.,³⁷37. Vera-Gamboa L, Cen-Chablé M, Góngora-Bianchi RA. HIV/Aids: Knowledge attitudes and sexual practices in a group of men who have sex with men in a rural community of Yucatán. Arch Hispanoam Sexol. 2003; 9:191-204.,⁴²42. Reynaga C. Evaluación del impacto de una campaña de prevención del VIH e ITS en adolescentes del Perú [tesis]. Barcelona: Universidad Autónoma de Barcelona; 2015..

Recall is also lower when evaluating campaign-specific messages, themes or texts³¹31. Vernon R, Ojeda G, Murad R. Incorporating AIDS prevention activities into a family planning organization in Colombia. Stud Fam Plann. 1990; 21(6):335-43.,³³33. Burgos M. Argentina: social crisis and AIDS prevention campaigns. Int Med J. 1996; 3:35-7.,⁴⁰40. Porto MP. The fight against AIDS among adolescent girls: the impact of the 2003 Carnival campaign by the Brazilian Ministry of Health. Cad Saude Publica. 2005; 21(4):1234-43..

Attitude towards the campaign

The results in eight studies show that there is no consensus on attitudes towards messages and campaigns. In some cases, the campaigns have been criticized for using crude and direct language that generates rejection and does not help to increase risk perception or safer practices⁴¹41. Ahumada M, Ruiz M, Parra V. Observatorio de Políticas Públicas en VIH/SIDA desde la Perspectiva de Derechos Humanos: “Campaña de comunicación social de prevención del VIH/SIDA”. Chile: Savia Foundation; 2012.. Other authors argue that progress in HIV prevention cannot be achieved using the same traditional approaches and that innovative campaigns are needed, even if they ruffle some feathers among the general public³²32. Rico B, Bronfman M, Del Rio C. Las campañas contra el sida en México: ¿los sonidos del silencio o puente sobre aguas turbulentas? Salud Publica Mex. 1995; 37(6):643-53..

Differences were also observed in attitudes towards campaigns, even when they are aimed at the same population group. For example, in a study with Brazilian women with similar characteristics in terms of age and stratum, it was evident that the message is received in a different way. The participants who were part of organizations that fight against HIV/Aids do not agree or identify with most of the messages, while those of the other group do (women who participate in pre-existing groups that are not directed to the prevention of HIV/Aids)³⁴34. Roso A. Ideology and gender relations: a reception study about AIDS prevention campaigns. Cad Saude Publica. 2000; 16(2):385-97..

Knowledge

Only three of the 15 evaluations show evidence of results in terms of knowledge about HIV prevention. The research of Vernon et al.³¹31. Vernon R, Ojeda G, Murad R. Incorporating AIDS prevention activities into a family planning organization in Colombia. Stud Fam Plann. 1990; 21(6):335-43. in Colombia shows increases between baselines from 9 to 30% in the knowledge of condom use as a behavior to prevent HIV. Similarly, in Chile’s campaigns, the majority of people (82%) believe that condoms are a good way to prevent HIV, and 97% recognize that AIDS is a disease that can affect anyone³⁵35. Chile. Ministerio de Salud. División de prevención y control de enfermedades subsecretaria de salud pública. Evaluaciones campañas de comunicación social años 2003 al 2007. Programa nacional de prevención y control del VIH/SIDA y las ITS. Santiago, CHL; [s.d.]..

Attitudes

Only in two of the documents are attitudinal aspects evaluated and specifically related to condom use. Vernon et al.³¹31. Vernon R, Ojeda G, Murad R. Incorporating AIDS prevention activities into a family planning organization in Colombia. Stud Fam Plann. 1990; 21(6):335-43. found an increase in the attitude towards the condom score from 4.76 in the baseline to 6.75 in the final line (p <0l). Likewise, the exposure to the “Campaña del Carnaval” among adolescent women in Brazil⁴⁰40. Porto MP. The fight against AIDS among adolescent girls: the impact of the 2003 Carnival campaign by the Brazilian Ministry of Health. Cad Saude Publica. 2005; 21(4):1234-43. was significantly associated with more positive attitudes towards the purchase of condoms.

Behaviors

Results are reported in four behaviors: discussion on issues related to HIV and sexual and reproductive health in general, use of telephone counseling for HIV prevention, HIV testing, and condom use.

Exposure to the campaigns generally stimulated discussions in the social environment about prevention, and most respondents reported that the campaign made them rethink their position on HIV/Aids, generating reflection and a more open discussion about prevention with their partner, friends, teachers, doctors and family³²32. Rico B, Bronfman M, Del Rio C. Las campañas contra el sida en México: ¿los sonidos del silencio o puente sobre aguas turbulentas? Salud Publica Mex. 1995; 37(6):643-53.,³³33. Burgos M. Argentina: social crisis and AIDS prevention campaigns. Int Med J. 1996; 3:35-7.,³⁵35. Chile. Ministerio de Salud. División de prevención y control de enfermedades subsecretaria de salud pública. Evaluaciones campañas de comunicación social años 2003 al 2007. Programa nacional de prevención y control del VIH/SIDA y las ITS. Santiago, CHL; [s.d.].,⁴⁰40. Porto MP. The fight against AIDS among adolescent girls: the impact of the 2003 Carnival campaign by the Brazilian Ministry of Health. Cad Saude Publica. 2005; 21(4):1234-43..

Regarding HIV testing, in research conducted in Chile, only 3.6% of 137 respondents said they had taken the test after seeing the campaign⁴¹41. Ahumada M, Ruiz M, Parra V. Observatorio de Políticas Públicas en VIH/SIDA desde la Perspectiva de Derechos Humanos: “Campaña de comunicación social de prevención del VIH/SIDA”. Chile: Savia Foundation; 2012..

In the evaluation of behavioral aspects, 6 studies were found where there is an increase in condom use³¹31. Vernon R, Ojeda G, Murad R. Incorporating AIDS prevention activities into a family planning organization in Colombia. Stud Fam Plann. 1990; 21(6):335-43.,⁴⁰40. Porto MP. The fight against AIDS among adolescent girls: the impact of the 2003 Carnival campaign by the Brazilian Ministry of Health. Cad Saude Publica. 2005; 21(4):1234-43., a greater demand for testing³²32. Rico B, Bronfman M, Del Rio C. Las campañas contra el sida en México: ¿los sonidos del silencio o puente sobre aguas turbulentas? Salud Publica Mex. 1995; 37(6):643-53.,³⁹39. Nielsen R, Luengo M, Mello M, Paz J, Pantin C, Erkkola T. Social media monitoring of discrimination and HIV testing in Brazil, 2014–2015. AIDS Behav. 2017; 21 Suppl 1:114-20.,⁴¹41. Ahumada M, Ruiz M, Parra V. Observatorio de Políticas Públicas en VIH/SIDA desde la Perspectiva de Derechos Humanos: “Campaña de comunicación social de prevención del VIH/SIDA”. Chile: Savia Foundation; 2012., and a reduction in the number of sexual partners³³33. Burgos M. Argentina: social crisis and AIDS prevention campaigns. Int Med J. 1996; 3:35-7.. Although most of the campaigns included messages focused on promoting condom use, only one of the documents assessed behavioral aspects of condom use³¹31. Vernon R, Ojeda G, Murad R. Incorporating AIDS prevention activities into a family planning organization in Colombia. Stud Fam Plann. 1990; 21(6):335-43..

Discussion

Low number of prevention campaigns and limited evaluation of the campaigns

The results show that there are few publications of evaluations carried out on HIV prevention campaigns in the mass media in Latin America. Chile ranks first in the number of published evaluations, where - between 2014 and 2017 - there is almost one campaign evaluation per year, and significantly higher in comparison with other countries in the region. The absence of publications can be explained by the fact that: 1) countries do not carry out the respective evaluations of the prevention campaigns that they implement either due to budgetary limitations or due to the lack of an evaluation culture, 2) there are few published and easily accessible evaluations, 3) in recent years HIV prevention has not necessarily prioritized these type of campaigns.

In the first case, it is clear that despite the importance and usefulness that literature confers on measuring the results and incidence of HIV prevention campaigns⁵5. Bretón-López J, Buela-Casal G. Análisis de la publicidad preventiva de VIH/SIDA y su impacto en adolescentes en función de variables psicológicas [thesis]. Granada: University of Granada; 2007.,²³23. Páez D, Mayordomo S, Igartua JJ, Ubillos S, Alonso M, Martínez A. Afectividad, cognición y persuasión: un contraste experimental de las variables mediadoras en la prevención ante el VIH/SIDA. Rev Electronica Motivacion Emocion. 2001; 4(7):1-25., this awareness has barely been assumed by governments and institutions working on this issue in the region. Likewise, there are not always sufficient resources to cover the costs of evaluations when working with limited prevention budgets.

In the second case, many times the same institutions or entities contracted by sponsors of the programs do the same, more for administrative than academic purposes, which, added to a disarticulation of the academy with these processes, does not allow its scientific validation. The existence of evaluations by the institutions that implement the campaigns in this region is valid. Although not studied by the academy, these initiatives demonstrate that the significance of evaluating the prevention campaigns is not being overlooked. Therefore, in the absence of academic evidence, the inclusion and analysis of these technical management documents becomes relevant when making integrative reviews that allow an approach to these processes.

In the third case, it is observed that in recent years there has been an awareness that the epidemic is concentrated in at-risk populations, and usually prevention messages aimed at these populations use other types of strategies through channels other than the mass media. However, limiting the number of published assessments is a global problem¹³13. Noar S, Palmgreen P, Chabot M, Dobransky N, Zimmerman R. A 10-year systematic review of HIV/AIDS mass communication campaigns: have we made progress? J Health Commun. 2009; 14(1):15-42. Doi: http://dx.doi.org/10.1080/10810730802592239.
http://dx.doi.org/10.1080/10810730802592... ,²¹21. Sewak A, Singh G. Integrating social marketing into Fijian HIV/Aids prevention programs: lessons from systematic review. Health Commun. 2017; 32(1):32-40..

Moving from general audiences to targeted audiences

Most of the strategies evaluated in this review are designed for the general population and not for specific groups at risk. In fact, campaigns that attempt to develop messages based on the needs of these populations are criticized because they are not within the moral and prevention standards that have been traditionally handled in Latin countries³⁶36. Vera-Gamboa L, Cerón B, Góngora-Bianchi RA. Hombres que tienen sexo con hombres: conocimientos y prácticas sexuales en relación a la epidemia del VIH/SIDA en Mérida, Yucatán, México. Rev Biomédica. 2004; 15(3):157-63..

Only the most recent campaigns are beginning to take into account the issue of high risk in targeted populations, as in the case of the “Hazte el examen” campaign in Chile in 2011⁴¹41. Ahumada M, Ruiz M, Parra V. Observatorio de Políticas Públicas en VIH/SIDA desde la Perspectiva de Derechos Humanos: “Campaña de comunicación social de prevención del VIH/SIDA”. Chile: Savia Foundation; 2012.. This result coincides with the review carried out by Noar, et al.¹⁵15. Bertrand J, O´Reilly K, Denison J, Anhang R, Sweat M. Systematic review of the effectiveness of mass communication programs to change HIV/AIDS-related behaviors in developing countries. Health Educ Res. 2006; 21(4):567-97. on HIV/Aids mass communication campaigns, considering that the campaigns reviewed between 1998 and 2007 have increasingly employed the strategy of using defined and specific audiences through audience segmentation procedures.

From moral speeches to speeches on rights

The campaigns analyzed clearly were slow at first in succeeding to transmit their intended messages, going from preventive behavior messages in the first campaigns of the 80s and 90s³¹31. Vernon R, Ojeda G, Murad R. Incorporating AIDS prevention activities into a family planning organization in Colombia. Stud Fam Plann. 1990; 21(6):335-43.

32. Rico B, Bronfman M, Del Rio C. Las campañas contra el sida en México: ¿los sonidos del silencio o puente sobre aguas turbulentas? Salud Publica Mex. 1995; 37(6):643-53.

33. Burgos M. Argentina: social crisis and AIDS prevention campaigns. Int Med J. 1996; 3:35-7.-³⁴34. Roso A. Ideology and gender relations: a reception study about AIDS prevention campaigns. Cad Saude Publica. 2000; 16(2):385-97., to content with a human rights perspective in more recent years³⁵35. Chile. Ministerio de Salud. División de prevención y control de enfermedades subsecretaria de salud pública. Evaluaciones campañas de comunicación social años 2003 al 2007. Programa nacional de prevención y control del VIH/SIDA y las ITS. Santiago, CHL; [s.d.].,³⁹39. Nielsen R, Luengo M, Mello M, Paz J, Pantin C, Erkkola T. Social media monitoring of discrimination and HIV testing in Brazil, 2014–2015. AIDS Behav. 2017; 21 Suppl 1:114-20.

40. Porto MP. The fight against AIDS among adolescent girls: the impact of the 2003 Carnival campaign by the Brazilian Ministry of Health. Cad Saude Publica. 2005; 21(4):1234-43.

41. Ahumada M, Ruiz M, Parra V. Observatorio de Políticas Públicas en VIH/SIDA desde la Perspectiva de Derechos Humanos: “Campaña de comunicación social de prevención del VIH/SIDA”. Chile: Savia Foundation; 2012.-⁴²42. Reynaga C. Evaluación del impacto de una campaña de prevención del VIH e ITS en adolescentes del Perú [tesis]. Barcelona: Universidad Autónoma de Barcelona; 2015.. In fact, Ahumada et al.⁴¹41. Ahumada M, Ruiz M, Parra V. Observatorio de Políticas Públicas en VIH/SIDA desde la Perspectiva de Derechos Humanos: “Campaña de comunicación social de prevención del VIH/SIDA”. Chile: Savia Foundation; 2012. consider that all the prevention campaigns carried out in Chile prior to the year 2010 maintained strong prevention content, in some cases moralistic, understood as the modification of personal behaviors that incorporated abstinence from penetrative sexual activity, keeping monogamous and faithful couples, as well as the consistent and correct use of condoms.

Since the mid-1990s, there have been major criticisms in this regard. Burgos³³33. Burgos M. Argentina: social crisis and AIDS prevention campaigns. Int Med J. 1996; 3:35-7. considered that prevention was possible, as long as both the pleasure and the social forms acquired were respected. It recognized, however, that most AIDS campaigns fell back on “moralizing” messages aimed at populations with homogeneous customs.

Recall and attitudes towards the messages: there is no identification and representation in the contents

Audience recall was high on most assessments³⁵35. Chile. Ministerio de Salud. División de prevención y control de enfermedades subsecretaria de salud pública. Evaluaciones campañas de comunicación social años 2003 al 2007. Programa nacional de prevención y control del VIH/SIDA y las ITS. Santiago, CHL; [s.d.].,³⁷37. Vera-Gamboa L, Cen-Chablé M, Góngora-Bianchi RA. HIV/Aids: Knowledge attitudes and sexual practices in a group of men who have sex with men in a rural community of Yucatán. Arch Hispanoam Sexol. 2003; 9:191-204.,⁴²42. Reynaga C. Evaluación del impacto de una campaña de prevención del VIH e ITS en adolescentes del Perú [tesis]. Barcelona: Universidad Autónoma de Barcelona; 2015.. However, in some cases respondents reported low recall of the campaign and specific themes or texts³¹31. Vernon R, Ojeda G, Murad R. Incorporating AIDS prevention activities into a family planning organization in Colombia. Stud Fam Plann. 1990; 21(6):335-43.,³³33. Burgos M. Argentina: social crisis and AIDS prevention campaigns. Int Med J. 1996; 3:35-7.,³⁵35. Chile. Ministerio de Salud. División de prevención y control de enfermedades subsecretaria de salud pública. Evaluaciones campañas de comunicación social años 2003 al 2007. Programa nacional de prevención y control del VIH/SIDA y las ITS. Santiago, CHL; [s.d.].

36. Vera-Gamboa L, Cerón B, Góngora-Bianchi RA. Hombres que tienen sexo con hombres: conocimientos y prácticas sexuales en relación a la epidemia del VIH/SIDA en Mérida, Yucatán, México. Rev Biomédica. 2004; 15(3):157-63.-³⁷37. Vera-Gamboa L, Cen-Chablé M, Góngora-Bianchi RA. HIV/Aids: Knowledge attitudes and sexual practices in a group of men who have sex with men in a rural community of Yucatán. Arch Hispanoam Sexol. 2003; 9:191-204.,⁴⁰40. Porto MP. The fight against AIDS among adolescent girls: the impact of the 2003 Carnival campaign by the Brazilian Ministry of Health. Cad Saude Publica. 2005; 21(4):1234-43.,⁴²42. Reynaga C. Evaluación del impacto de una campaña de prevención del VIH e ITS en adolescentes del Perú [tesis]. Barcelona: Universidad Autónoma de Barcelona; 2015.. In this case, it is noteworthy that the campaigns aimed at specific audiences or in which specific audiences were evaluated are those with the least recall. It would be necessary to ask about the form of delivery of the messages or the individualization with respect to its punctual necessities.

A little more than half of the documents show evidence of results in terms of attitudes towards the messages and the campaigns carried out³²32. Rico B, Bronfman M, Del Rio C. Las campañas contra el sida en México: ¿los sonidos del silencio o puente sobre aguas turbulentas? Salud Publica Mex. 1995; 37(6):643-53.,³⁴34. Roso A. Ideology and gender relations: a reception study about AIDS prevention campaigns. Cad Saude Publica. 2000; 16(2):385-97.,³⁵35. Chile. Ministerio de Salud. División de prevención y control de enfermedades subsecretaria de salud pública. Evaluaciones campañas de comunicación social años 2003 al 2007. Programa nacional de prevención y control del VIH/SIDA y las ITS. Santiago, CHL; [s.d.].,³⁸38. Flores F, De Alba M. El SIDA y los jóvenes: un estudio de representaciones sociales. Salud Mental. 2006; 29(3):51-9.,⁴¹41. Ahumada M, Ruiz M, Parra V. Observatorio de Políticas Públicas en VIH/SIDA desde la Perspectiva de Derechos Humanos: “Campaña de comunicación social de prevención del VIH/SIDA”. Chile: Savia Foundation; 2012.. On the one hand, campaigns have been criticized for using uncensored language, which generates rejection⁴¹41. Ahumada M, Ruiz M, Parra V. Observatorio de Políticas Públicas en VIH/SIDA desde la Perspectiva de Derechos Humanos: “Campaña de comunicación social de prevención del VIH/SIDA”. Chile: Savia Foundation; 2012., and on the other, it is considered necessary to use questioning messages to generate change³²32. Rico B, Bronfman M, Del Rio C. Las campañas contra el sida en México: ¿los sonidos del silencio o puente sobre aguas turbulentas? Salud Publica Mex. 1995; 37(6):643-53..

Exposure to the media. TV is the most effective medium

One of the results most reported by the evaluations conducted in Latin America is the coverage of the campaigns implemented.

Several analyzed evaluations conclude the importance of television as one of the priority sources of transmission of information related to HIV/Aids⁴⁰40. Porto MP. The fight against AIDS among adolescent girls: the impact of the 2003 Carnival campaign by the Brazilian Ministry of Health. Cad Saude Publica. 2005; 21(4):1234-43.,⁴²42. Reynaga C. Evaluación del impacto de una campaña de prevención del VIH e ITS en adolescentes del Perú [tesis]. Barcelona: Universidad Autónoma de Barcelona; 2015., which is corroborated by Vidanapathirana et al.¹³13. Noar S, Palmgreen P, Chabot M, Dobransky N, Zimmerman R. A 10-year systematic review of HIV/AIDS mass communication campaigns: have we made progress? J Health Commun. 2009; 14(1):15-42. Doi: http://dx.doi.org/10.1080/10810730802592239.
http://dx.doi.org/10.1080/10810730802592... , who concluded that mass media interventions for the promotion of HIV testing showed an immediate and global effect, but no long-term effects were observed.

From evaluating knowledge and attitudes to evaluating behaviors

While most of the publications reviewed have focused on assessing campaign recall and messages, there is also a latent interest in assessing the impact of campaigns on knowledge and behaviors related to HIV prevention. Despite the fact that only 3 of the 15 evaluations reviewed show evidence of results in terms of knowledge about HIV³¹31. Vernon R, Ojeda G, Murad R. Incorporating AIDS prevention activities into a family planning organization in Colombia. Stud Fam Plann. 1990; 21(6):335-43.,³⁵35. Chile. Ministerio de Salud. División de prevención y control de enfermedades subsecretaria de salud pública. Evaluaciones campañas de comunicación social años 2003 al 2007. Programa nacional de prevención y control del VIH/SIDA y las ITS. Santiago, CHL; [s.d.]., in general, it is observed that knowledge of condom use as a means of preventing HIV increased.

Nonetheless, two articles describe the evaluation of attitude towards condom use, with positive results in both cases³¹31. Vernon R, Ojeda G, Murad R. Incorporating AIDS prevention activities into a family planning organization in Colombia. Stud Fam Plann. 1990; 21(6):335-43.,⁴⁰40. Porto MP. The fight against AIDS among adolescent girls: the impact of the 2003 Carnival campaign by the Brazilian Ministry of Health. Cad Saude Publica. 2005; 21(4):1234-43..

With regard to behavioral assessments, campaigns are associated with an increase in condom use³¹31. Vernon R, Ojeda G, Murad R. Incorporating AIDS prevention activities into a family planning organization in Colombia. Stud Fam Plann. 1990; 21(6):335-43.,³⁵35. Chile. Ministerio de Salud. División de prevención y control de enfermedades subsecretaria de salud pública. Evaluaciones campañas de comunicación social años 2003 al 2007. Programa nacional de prevención y control del VIH/SIDA y las ITS. Santiago, CHL; [s.d.]. and HIV testing³⁹39. Nielsen R, Luengo M, Mello M, Paz J, Pantin C, Erkkola T. Social media monitoring of discrimination and HIV testing in Brazil, 2014–2015. AIDS Behav. 2017; 21 Suppl 1:114-20.,⁴¹41. Ahumada M, Ruiz M, Parra V. Observatorio de Políticas Públicas en VIH/SIDA desde la Perspectiva de Derechos Humanos: “Campaña de comunicación social de prevención del VIH/SIDA”. Chile: Savia Foundation; 2012.. They also encourage the use of telephone counseling services for HIV prevention³²32. Rico B, Bronfman M, Del Rio C. Las campañas contra el sida en México: ¿los sonidos del silencio o puente sobre aguas turbulentas? Salud Publica Mex. 1995; 37(6):643-53. and to talk to those in their social circle about HIV prevention and about sexual and reproductive health issues, in general³⁵35. Chile. Ministerio de Salud. División de prevención y control de enfermedades subsecretaria de salud pública. Evaluaciones campañas de comunicación social años 2003 al 2007. Programa nacional de prevención y control del VIH/SIDA y las ITS. Santiago, CHL; [s.d.].,⁴⁰40. Porto MP. The fight against AIDS among adolescent girls: the impact of the 2003 Carnival campaign by the Brazilian Ministry of Health. Cad Saude Publica. 2005; 21(4):1234-43.. The fact that the majority of these campaigns are directed to the general public and not specific populations such as risk groups -men who have sex with men, expectant mothers, drug addicts, etc.-, could explain why they do not address preventive messages from other forms of infection such as the exchange of syringes, among others.

Methodological limitations of evaluations

Regarding the evaluation methods of the campaigns, it can be observed that very basic methods were used and only one evaluation carried out pre- and post-evaluation³¹31. Vernon R, Ojeda G, Murad R. Incorporating AIDS prevention activities into a family planning organization in Colombia. Stud Fam Plann. 1990; 21(6):335-43.. In addition, only half of the evaluations used large sample sizes, and most used general population samples. This picture is in line with UNAIDS²2. UNAIDS. Report on the global AIDS epidemic 2013 [Internet]. Geneva; 2013 [cited 2018 Feb 27]. Available from: http://www.unaids.org/sites/default/files/media_asset/UNAIDS_Global_Report_2013_en_1.pdf
http://www.unaids.org/sites/default/file... assertion that, in the first decade of the 21^st century, socio-behavioral HIV prevention programs lacked rigorous evaluation - on an appropriate scale - for widespread implementation¹⁵15. Bertrand J, O´Reilly K, Denison J, Anhang R, Sweat M. Systematic review of the effectiveness of mass communication programs to change HIV/AIDS-related behaviors in developing countries. Health Educ Res. 2006; 21(4):567-97..

Conclusions

This review contributes to an understanding of the status of the evaluation of mass media campaigns focusing on HIV prevention in Latin America. First, there is a shift from general-public campaigns to a focus on specific audiences, although there is still a major challenge in addressing the information needs of groups considered to be at risk. Second, there has been a slow shift away from moralist messages, and human rights discourses have started to emerge as guiding frameworks in the campaigning of HIV prevention. Third, in terms of the results of the campaigns evaluated, researchers have focused on campaign recall, messages and media exposure. Although knowledge, attitudes and behaviors have been included since the first evaluations in the 1990s, the emphasis has been placed on the evaluation of knowledge and attitudes. However, it is clear that behaviors are increasingly assessed.

In terms of limitations, it is observed that very few articles published report results on HIV prevention campaigns in mass media in Latin America. This limited the analysis by the different types of documents analyzed, which is a major challenge, both for the executing institutions and for the academy. It is essential to generate alliances that allow for the design of studies with more sophisticated methodologies and with external evaluations, whose reports can be subjected to peer review that can be published. In this way, there would be references for greater rigor and strength, from the planning itself to the evaluation of the campaigns, based on the evidence.

For future research in the field, it is advisable to carry out a review that includes not only evaluation documents of mass media campaigns, but also interventions based on other communication strategies, other than social marketing, in order to differentiate between them. On the other hand, we also recommend that is necessary to promote alliances with leadership from the academy, seeking the access to support resources from the science and technology institutions, which allow the development of the external evaluations of this type of campaigns implemented by the government and non-governmental institutions, with the purpose that these evaluations can be subject to an external peer of revision.

References

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History