Johannesburg — Venessa Chen – a research program coordinator at the Program for Implementation Equity Research within the Johns Hopkins Center for Public Health and Human Rights – shared her research findings on The impact of the Le Kip Kip Social Influence Campaign on PrEP knowledge, attitudes, and perceptions among women in South Africa – at the 5th HIV Research for Prevention Conference (#HIVR4P2024) in Lima, Peru. The conference served as a global stage for some of the most innovative approaches to combating HIV.
Featured in the Oral Abstract session titled Support Matters: You Are Not Alone!, the study delved into the transformative potential of leveraging social influence to de-medicalize HIV prevention tools and address deep-seated stigma. The Le Kip Kip campaign emerged as a bold reimagining of how PrEP (pre-exposure prophylaxis) is perceived. Targeting adolescent girls and young women (AGYW) and female sex workers (FSW) – two groups at risk of HIV – the campaign aimed to normalize PrEP as a tool for self-care and empowerment.
In this conversation with allAfrica’s Sethi Ncube, Chen shares the creative strategies and community-driven efforts that made Le Kip Kip a success, the challenges it faced, and the lessons it offers for future health campaigns in high-prevalence regions.
Could you explain the key goals behind the Le Kip Kip campaign and why the focus was on adolescent girls, young women, and female sex workers?
The overall goal of the Le Kip Kip campaign was to de-medicalize PrEP and reduce stigma to increase awareness and perceptions of PrEP. The reason why we focused on AGYW and FSW was because the prevalence amongst these groups are much higher than their counterparts (adolescent boys and young men vs women not engaged in sex work)…By focusing on AGYW and FSW, we were targeting groups that are not only at higher risk for HIV but also face unique challenges when it comes to accessing and sticking with PrEP.
What motivated the choice to ‘de-medicalize’ PrEP by rebranding it as Le Kip Kip? How did you expect this approach to resonate with the target audience?
I think PrEP has been often misconstrued as ART, and since HIV is so stigmatized in South Africa and globally, it creates a barrier for folks to adopt it. I think rebranding it with a fun, catchy name, that is less associated with medical terms and negative connotations, and more about women taking control of their own health appeals to AGYW and FSW and their respective communities and makes it more empowering. Moving away from clinical terms, we hoped to create a more approachable entry point for AGYW and FSW, along with their family, friends, and partners, to learn more about PrEP. We spent a lot of time in focus groups with AGYW and FSW brainstorming everything form the name to the campaign’s colours, images, and fonts, so we hoped that this approach really resonated with the target audience. In qualitative interviews with community members and women who saw Le Kip Kip particularly noted the branding and how it was eye-catching, memorable, and appropriate for the intended target audience.
With TB HIV Care as a partner, what role did they play in reaching and mobilizing communities for the Le Kip Kip campaign?
TB HIV Care and Johns Hopkins university has a long-standing and invaluable partnership. TB HIV Care is the largest provider of PrEP to AGYW and FSW, and they have strong community partnerships and connections with both AGYW and FSW local communities which was critical in enabling outreach for the Le Kip Kip campaign. The campaign’s community mobilizers and PrEP champions worked in tandem with TB HIV Care, leveraging trust and relationships within local communities to reach the right people, and adding credibility to the campaign. By integrating the campaign with TB HIV Care’s services, we could translate awareness into action – connecting women who showed interest in PrEP directly to care and services offered by the TB HIV Care programme. I will also say within the context of the Le Kip Kip trial, we had an incredible study team at TB HIV Care. They provided critical feedback on the campaign and its integration into TB HIV Care program activities, led the implementation of data collection, and oversaw the hiring, training, and management of community mobilizers and PrEP champions.
How were PrEP champions selected and trained to ensure they could effectively communicate the campaign’s message?
We wanted to ensure particularly the PrEP champions and community mobilizers were people who could connect and relate to the target audience (aka people who understood the challenges AGYW and FSW face and could share their experiences). The training focused on building their confidence to talk about PrEP, addressing common myths, and equipping them with strategies to engage the community in a way that felt approachable and non-judgmental.
Your findings showed an increase in PrEP knowledge among adolescent girls and young women, especially those exposed to Le Kip Kip. What specific elements of the campaign do you believe contributed to this positive outcome?
I think the campaign’s name and tagline and branding had a lot to do with this positive outcome. The phrase Le Kip Kip was always paired with the tagline, “the pill that prevents HIV”. That clarity simplified the message and really highlighted PrEP’s purpose. For AGYW specifically, the campaign’s youth-friendly design helped break down some of the barriers around discussing PrEP. I also think that since it was on social media, it also made it more accessible to young women.
The campaign’s focus on de-medicalization might’ve made PrEP feel more relevant to AGYW, catching their attention and encouraging them to learn more. It’s worth noting that AGYW had lower baseline knowledge about PrEP compared to FSW, so the campaign might have had more room to make an impact there.
That said, there still are gaps in knowledge. We categorized correct knowledge of PrEP as correctly describing its purpose and how long and when it should be taken. Overall, there were significant increase in understanding PrEP’s purpose among both AGYW and FSW, many still lacked awareness that PrEP should be taken during periods of risk to HIV, and it is not a lifelong medication. I think this really highlights the importance of education beyond just what PrEP is but providing women with the information they need to be able to assess for themselves when they should be taking PrEP.
Despite the knowledge increase, there was limited impact on PrEP stereotypes. Could you share your perspective on why stereotypes remained challenging to shift, even with increased awareness?
This is one of my favourite questions. While the campaign strategically framed PrEP as a tool for empowerment and health protection, some level of negative PrEP-user stereotypes persisted. This has been seen in previous social media campaigns as well about advertisements being stigmatizing when specific key populations are featured. They’re great for spreading the message, but if certain groups feel like they’re being specifically targeted, it can influence how it is perceived. Even though the campaign didn’t explicitly reference AGYW or FSW in its messaging, those were the intended audiences, and that might’ve reinforced some stereotypes. Additionally, stigma operates at so many levels and is so complex and deeply ingrained that it’s not something that can be fully tackled by one campaign, especially recognizing this campaign was run for only a year.
The campaign significantly impacted PrEP approval among female sex workers but had limited effects on adolescent girls and young women. What factors do you think contributed to these differences in approval across groups?
The differences may reflect some of the different social dynamics AGYW and FSW face. AGYW are navigating traditional gender norms and expectations around sexuality, which can make it harder for them to openly embrace something like PrEP. For example, young men in rural South Africa reported concerns about their female partners taking PrEP, seeing it as a sign of infidelity. That kind of moralizing attitude can create real barriers for AGYW. FSW, on the other hand, the messaging of empowerment in the campaign may have shifted FSW community beliefs about PrEP given the nature of their work and the risks they may face. Interestingly, while we saw an overall increase in approval, when we looked at approval more closely, there were significant changes in approval specifically amongst friends and family. This suggests there may need to be additional focus on partners of FSW in future PrEP social influence campaigns.
Considering the campaign’s challenges with stereotypes, what changes or new strategies would you suggest for future campaigns?
I think including narratives from partners, families, and friends can help future campaigns frame HIV prevention as a collective effort, reducing the focus on AGYW and FSW (which may have reinforced stereotypes) and encouraging networks of AGYW and FSW to support prevention. I also think diversifying channels of dissemination ex. Storytelling or other community dialogues can support finding the right balance between raising awareness and fostering empathy and connection in a culturally relevant way. I also think future campaigns need to focus more on creating supportive environments. For AGYW, that might mean engaging families, partners, and communities to directly challenge those gendered stereotypes and moralizing attitudes.
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Based on the campaign’s outcomes, what would you say are the critical elements for de-medicalizing PrEP and making it relatable for diverse communities?
Making it approachable and relevant. It’s not just about changing the name or the branding – it’s about framing PrEP as something that aligns with the values of the target audience. I think framing PrEP as a tool for empowerment and control over one’s health really resonated with our audience. Social media also played a big role, helping disseminate the campaign’s message widely and engaging audiences in a space where they’re already active.
What are your key takeaways on using social influence campaigns to shift health attitudes and behaviours, especially concerning HIV prevention in high-prevalence regions?
Social influence campaigns like Le Kip Kip have so much potential to shift attitudes within a community. I think the U=U campaign is a great example – it achieved global recognition by sticking to a simple, empowering message that people could easily understand and share. While Le Kip Kip is vastly different in its purpose, message, and audience, it shares the idea that campaigns can break down initial barriers and spark dialogue. One of my key takeaways though is to ensure campaigns are thoughtfully designed and co-created with the communities they aim to serve – maybe an obvious takeaway, but I really think involving AGYW and FSW in the development process through focus group discussions, made all the difference in ensuring the message of Le Kip Kip is appropriate and impactful.
Ncube was in Lima, Peru, for the 5th HIV Research for Prevention Conference, HIVR4P 2024, and reported from the only global scientific conference focused on the challenging and fast-growing field of HIV prevention research.
