How do you reach men who have sex with men but refuse conventional labels? Dr. Ron Simmons found one path by studying this group’s language and then aiming his HIV prevention messages “down low.”
Car horns honk. A siren wails. The cacophonous symphony of the inner city plays in the distance as a male voice calls out. “Hey, my brother,” the man begins, “do you know that Washington, DC has the highest number of AIDS cases per capita in the nation?” He doesn’t wait for a reply. “And most of the AIDS cases in the District are black men. It ain’t easy being a black man these days,” he confides. “A man has to know how to protect himself from HIV, especially when you’re on the down low.” He gives you a phone number where you can get more information. “Call it,” he adds, “especially if you have sex more ways than most folks.”
This street scene, produced as a radio commercial for Washington area stations, is part of a carefully conceived and highly-targeted AIDS prevention campaign. The audience is African American men who have sex with other men, but who steadfastly refuse to identify themselves as either “gay” or “bisexual.” For years, traditional AIDS prevention messages have sailed right past these men as a direct result of this identity issue, and the consequences have been grim. AIDS is the number one cause of death for young black men in America today. Moreover, the Journal of the American Medical Association warns that bisexual black men often act as a lethal bridge for HIV transmission to women. Reaching this group may be unusually complicated, but the threat to public health makes it imperative.
Dr. Ron Simmons has been actively engaged in this effort for nearly a decade. In 1992, he became executive director of Us Helping Us, an AIDS prevention and treatment organization in Washington that focuses its resources on African-American men. Under Dr. Simmons’ leadership, UHU’s annual operating budget has grown from $8,000 to over $1,000,000, funding a wide range of activities from condom distribution to HIV case management to holistic health seminars. Despite the group’s success reaching and educating an at-risk black audience, Dr. Simmons sensed a problem in 1997. He told me he started to receive calls from men who would say, “I’m not gay but.” and then go on to describe a sexual experience with another man.
At a conference in Long Beach, Dr. Simmons met Nathan Kerr, CEO of Community Marketing Concepts, a Brooklyn-based firm which specializes in developing HIV prevention materials. He told Kerr he intended to launch a campaign that would reach this group of men who didn’t identify with the terms gay or bisexual, and he enlisted Kerr’s help in shaping this campaign. Kerr ran a workshop on identity where he asked participants what they wanted to be called. “Invariably, they were vocal about not being identified as gay,” he recounted. When I asked why, Kerr surmised, “The imagery of a gay man in the African American community is not one of strength. It’s really perceived as weakness.”
A breakthrough came in one-on-one conversations where men described their situation to Kerr as being “on the down low.” Kerr brought the phrase to focus groups for further testing. “Some had heard it,” he told me, and this was encouraging, but equally positive were the reactions of those who hadn’t. “It makes sense,” they told Kerr. “You hear it once and you got it.” Kerr tested other street slang that surfaced in his conversations – on the quiet tip, hush-hush, bling-bling – but no word or phrase connected with the audience as solidly as “on the down low.”
In 1998, Us Helping Us launched a toll-free help line to provide confidential HIV information, referrals, and related services to African American men who do not consider themselves gay or bisexual. Of course, if the ads promoting this help line used those exact words, the phones would probably have remained silent. Instead, employing direct mail, bus cards, newspaper ads, posters, radio ads, and a website, UHU explicitly reached out to men on the down low. The phones began to ring, and within one year the number of calls to the help-line doubled. “We were right in synch with the term and where it was going,” Dr. Simmons recalled with pride.
Last year, a study by the Center for Disease Control in Atlanta confirmed the trend that Dr. Simmons perceived three years earlier. Nearly 9,000 HIV positive men were interviewed in the study, and of the African American men who participated, 25% identified themselves as heterosexual. (In contrast, only 6% of the white participants chose that label.) Without question, the challenge of reaching, educating, and protecting the health of this audience remains. The success of Us Helping Us is cause for optimism. It also stands as a reminder to every public interest group that speaking your audience’s language is critically important, even when it’s not a matter of life and death.
Knowing the Audience (Clinton Style)
Before Bill Clinton left the White House, Joel Dyer, an award-winning alternative journalist and author, was interviewed by Derrick Jensen in The Sun magazine. The conversation turned to polling, and Dyer pointed out how the outgoing President used polls to determine the precise wording of certain speeches:
“During the Lewinsky scandal, Clinton used pollsters to try to figure out what to tell the country. His political consultants discovered that whenever Clinton used the word ‘truthful,’ everyone got angry. But every time he described what had happened as ‘part of [his] private life,’ people felt empathetic. The result was that Clinton went on television the next day and, in a four-minute speech, used the term ‘private life’ seven times and never once said anything about being truthful. Afterward, another poll found that 70% of Americans approved of Clinton.”
|– Joel Dyer (The Sun, December 1999)
Don’t get me wrong: I’m not endorsing Clinton’s personal behavior or his tactics as a poll-driven politician. What’s worth noting here is the same principle that guided Us Helping Us to success. As my colleague Chris DeCardy of Environmental Media Services eloquently sums it up, “You’ve got to ask yourself: what can my audience hear?”