Thursday, April 29, 2010

Be a Part of It: NYC Condom and the struggle for inclusiveness – Eliana Meirowitz

Be a Part of It: NYC Condom and the struggle for inclusiveness – Eliana Meirowitz

Overview

This paper will describe three ways in which the NYC Condom campaign is flawed and propose a Boston Condom campaign to correct these mistakes. The paper will detail how the NYC Condom campaign is preferentially targeted to English-speaking White, Black, and Hispanic New Yorkers, ignores couples that have sex with sex toys, and decreases its branding potential by only giving its product away for free. The Boston Condom campaign will learn from the NYC Condom campaign’s flaws and not make any of these same mistakes, creating a more inclusive, accessible, and valuable condom brand.

Get Some Background Information!

The NYC Condom campaign has been a highly successful public health intervention since its debut on Valentine’s Day 2007. Within the first six months, the campaign was giving out 3,000,000 condoms per month (1). These condoms are Lifestyles Brand, regular lubricated condoms, and they’re available, along with female condoms, lubricant, and select extra large Durex condoms, for free at approximately 600 different locations in the city (2).
The NYC Condom campaign has structured itself as a high-profile brand with a highly stylized marketing campaign. It has chic collaborators like Kenneth Cole design competitions for its packaging and seems to pride itself on its media campaigns (3). Its website, www.nyc.gov/condoms, have four main pages, called “Why,” “How,” “Where,” and “More” and three out of the four of those features the media campaign as its first link (4, 5, 1). The advertisements feature artsy photos of three different couples against collage backgrounds of popular New York City sites. What was the tagline in all of the advertisements? “NYC Condom – Get Some!” (6).

Flaw #1 – Race and Language Bias

The NYC Condom advertising and website materials show a bias towards English-speaking White, Black, and Latino New Yorkers. Though the advertisements seem to make an effort to include pictures of diverse New York couples, the people featured present a very Black/White image of racial diversity (6). In addition, the website is not friendly towards people with low English proficiency. These choices reflect a kind of institutional racism – a bias that ignores the needs of more marginalized New York populations who do not fit into the Black/White racial dichotomy (7).
While the NYC Condoms are free and available to anyone, the advertising campaign popularizes the condoms, but it does not explain them. To understand how and when to use the condoms, New Yorkers are directed to www.nyc.gov/condom. This website is well written and clear, providing directions on condom use and information about where to find the condoms. But the website is maximally helpful in English. For the 47.6% of New Yorkers who speak a language other than English at home they have to find the Translate Page button (8). The translation button is hard to find, is only labeled in English, and utilizes Google translate.
The Google Translation is not always accurate. For instance, in the Hebrew translation, sentences are translated with poor syntax, with incorrect parts of speech used, and with some words not translated at all. For example, the Hebrew translation takes sentences with the verb “work” like “Female condoms work as well as male condoms” and uses the Hebrew word for the noun form of “work” instead of the verb. In addition, when the translation function does not know a word, like STD, it leaves it in English (9). Similar issues have been found in the Spanish, French, and Japanese translations (10, 11). If a New Yorker with low English proficiency did not know acronyms like “STD” they would miss out on the entire point a sentence like “they don’t work against STDs,” and be at more risk than someone who spoke English.
New York City cannot afford to ignore its immigrants’ health needs. Immigrants are a high-risk group for HIV requiring special attention according to the New York City Commission on HIV/AIDS (12). The New York Immigration Coalition details federal, state, and city laws that require adequate interpreter services for people with “low English proficiency” (13). The Guttmacher Institute calls for equal access to reproductive health services for immigrants, asking, “Who benefits from withholding voluntary family planning services from immigrant women who themselves do not want to become pregnant? What is gained by denying immigrants services for communicable diseases such as HIV and other STIs?” (14). Just as pre-natal and reproductive care is needed for immigrant populations, so too is contraception and STI prevention in the form of condoms. Lack of language accessibility can lead to entire language communities being alienated, just like they are alienated from accessing other health care services.
The NYC Condom campaign should not make the Fundamental Attribution Error with people’s sexual behaviors; people make decisions differently when they’re in a hot or cold state (15). For instance, a study on Latina showed that condom use can vary significantly between primary and secondary partners (16). This means that the campaign needs the information to be clear enough that people with low English proficiency can utilize it for planned and unplanned sex acts. The impromptu, fast-paced accessing of the website should not be underestimated in an age of handheld Web-browsing devices. If the written materials are only truly comprehensive in English, people who are looking for helpful information -- in depth or at the spur of the moment -- will be discouraged if they cannot access it in their native languages, even though the NYC Condom campaign has done a good job de-stigmatizing condom acquisition. It seems that while the Google Translate function is a valiant effort, it may not be sufficient to truly communicate the importance and effective use of condoms.
In addition to alienating people with low English proficiency, the NYC Condom campaign renders invisible non-White, Black, or Latino New Yorkers. The people in the ads look like White and Black New Yorkers, and while it’s unclear if any are Latino, they certainly do not look to represent New York City’s 30% who are not just White or Black (8). Around 10% of New York City’s population is Asian and yet there are no Asian faces in the advertisements (6). HIV prevention programs have typically overlooked Asians in the past, and it seems that the NYC Condom campaign is no different (17). While Asians’ rates of STI’s are not as high as in many populations, rates of gonorrhea, syphilis, and chlamydia increased in Asian/Pacific Islanders between 2007 and 2008 while some of these rates were decreasing among Whites, Blacks, and Hispanics (18). By not picturing the Asian communities of New York City, the NYC Condom campaign is helping to make them invisible, both to the greater public and to themselves. This kind of institutional racism can help encourage personally mediated racism and internalized racism (7). The personally mediated racism could come in the form of people neglecting to use condoms when having sex with Asian people and the internalized racism could be when Asian people themselves do not think that condom use applies to them. These kinds of racism can compound the increasing rates of STDs. As long as Asians are not viewed as an at-risk population, the social norms will not be strongly enforced enough to make the crowd tip towards consistent condom use (19).
The pictures of couples in the advertisements are not the only ways the NYC Condom campaign makes non-White, Black, or Latino New Yorker invisible. The musical choices that underscore the television ads are Latin, Jazz, and Hip Hop music. While these are very popular urban styles, they are most associated with the Black and Latino communities, and less so with Asian or other communities. As long as NYC Condom has a Harlem advertisement featuring hip hop, and a Greenwich Village advertisement featuring jazz, why isn’t there a Chinatown ad featuring Chinese American music or a Jackson Heights advertisement featuring South Asian music (20)? The social importance of a culture is very palpable through the appropriation of its musical styles and representation of its neighborhoods. Leaving out the musical styles and neighborhoods of these other populations is yet another form of institutionalized racism that makes them more invisible.
It seems that the NYC Condom campaign researchers who sought advice about how to improve the condoms did not seek out a representative proportion of New Yorkers who were not White, Black or Latino, as their sampling had only 7.9% of its population as these “other” races and ethnicities (21). Until the NYC Condom campaign values the opinions of these groups as highly as the opinions of White, Black, and Hispanic New Yorkers, these people will remain at risk of being ignored.

Flaw #2 – Phallocentric Bias

Though NYC Condom advertisements are fun and friendly towards gay men, they only feature couples that are a man-woman and a man-man; there are no woman-woman couples shown (6). Though women cannot get pregnant during sex with other women, this helps propagate the myth that woman-woman sex acts would never require a condom. In addition, while there are comprehensive instructions on using male and female condoms, there is no mention of sex toys on the instruction page (22). This blind spot ignores the risks that a woman-woman couple -- and everyone else -- undertakes when sharing toys during sex.
There may be a reluctance to discuss condom use for women who have sex with women, because of the lack of pregnancy risk and the low HIV transmission rate between women, but the sex toys that women use could transmit other STIs (23). Women who have sex with women are at risk for many STIs, through many kinds of sexual activities, including the use of sex toys (24).
When sex toys are shared between partners, they can carry the bodily fluids of one person into the body of anther person unless they are disinfected in between. Some toys are porous enough that even with cleaning, they can transmit infections between users. Because of this, sex toy shops recommend using condoms when sharing toys (25). These recommendations do not only come from merchants, though. The CDC recommends condoms be used for sex toys as well (23).
Marrazzo described common attitudes towards safe sex among women who have sex with women. She noted, “Sexually transmitted diseases (STDs) can be spread between female sex partners, probably through the exchange of cervicovaginal fluid and direct mucosal contact. Additionally, lesbians have a high prevalence of bacterial vaginosis, which may represent an STD in this population.” She noted that while women often share sex toys without cleaning them during sex, they did not have a thorough understanding of the health risks they take with these actions. Among the reasons they cited for not using condoms during sex was a feeling that condoms were for man-woman or man-man sex, but that the risks for woman-woman sex were not high enough outweigh the inconvenience of consistent condom use. In addition, Marrazzo said, “Women agreed that using condoms is advantageous, but said that they are generally not likely to use them.” Marrazzo noted that this could be heavily attributed to poor sexual health education for women who have sex with women (24).
Much like featuring only White and Black couples in advertisements is institutional racism, featuring only couples that include a man in them is institutional sexism and a form of phallocentrism (7). The designers of the NYC Condom campaign does no acknowledge sex acts that do not include a man’s penis as carrying any risk because the only situations where condom use is discussed is when a penis is involved. The NYC Condom campaign seems uninterested in expanding its understanding of who needs a condom, both because of its advertising content and because of the people it considers relevant to ask for advice. In the above-mentioned interview study with New Yorkers that was intended to gather data on user preferences, researchers blatantly disregarded interviewees who were women only having sex with women (21). This shows that the exclusion of women-women pairing is not just an advertising oversight, but also a programmatic decision to exclude women who have sex with women from the pool of encouraged NYC Condom users. This blind spot disadvantages women who have sex with women as well as helping to ignore all other populations who are putting themselves at risk by sharing sex toys.

Flaw #3 – Lowering Brand Value

The NYC Condom campaign is explicitly aiming to be a brand (6). Its efforts do not mirror the traditional public health interventions. This campaign does not use the Health Belief Model to teach how to weigh the costs and benefits of condom use (26). The campaign does not even use the Theory of Reasoned Action to compel people to think that the social costs of their condom use and the costs and benefits of action (26). Those kinds of campaigns would use arguments about the benefits of condom use as the centerpiece of their messages. They would elaborate on the risks of not using condoms, both medical (Health Belief Model) and social (Theory of Reasoned Action). The NYC Condom advertisements do not use these methods.
The advertising methods of the NYC Condoms have stylized collages of New York City, images of happy couples, and the tagline: NYC Condom – Get Some (6). There are no bullet points. There are no threatening messages about risks of unprotected sex. There’s only a stylish image of New York, hip people, and a double entendre encouraging New Yorkers to have sex with the condoms. These advertisements use Advertising Theory to drive home their messages (27). The promise? NYC Condoms will help you have sex that is imbued with New York City hipness. The support? The condom tagline is linked with the cool, iconic, classic elements of the New York experience like the Brooklyn Bridge, the subway, and buildings in specific neighborhoods (6). The ads seem to imply a pride in being a New Yorker, not a tourist, which further emphasized the in-crowd nature of the product. These all lead to the core values of being part of the New York scene, having a place in The City, and being happy.
Though this campaign is fully utilizing some aspects of Advertising Theory, it is missing out on a large component – pricing sets the value of the product (28). Though giving away the condoms for free raises accessibility, it runs the risk of lowering the esteem of the product in the public eye. As the case studies have shown, if the condoms are free, they may not be respected as worthwhile to use (28). The public is concerned enough about the quality of the condoms to criticize them publically on the NYC Condom Facebook page (29). This is evidence of an outgrowth of suspicion of a product distributed for free when all other condom brands cost money. Why would a free condom be trustworthy, let alone fashionable? That being said, Cohen showed that raising a condom’s price from free to 25 cents sharply decreased its use (30).
Therefore, it would not be appropriate or advantageous to raise the prices of the NYC Condoms. This would decrease the efficacy of the intervention by discouraging use.
Currently, people can obtain condoms one at a time. They can access dispensers, bowls, or vendors distributing condoms in popular locations (2). This distribution method is focused on taking single condoms on an as-needed basis. While this is a crucial need for a public health intervention, it is not ideal for building a brand. The act of collecting reinforces the value of a brand. Collections can let people feel like they are seeking out the brand, giving them ownership over the process (15). Once people have ownership over the process, they have a much stronger buy-in to the mission of the product. In this case, the mission is condom acquisition and use. Though acquiring NYC Condoms can help people showcase their ownership over the identity of a New Yorker, the campaign would be more prestigious if it encouraged people to feel ownership over the product itself, not just its core values. This is like the difference between people wanting to be champions and great basketball players like Michael Jordan and people specifically wanting Nike sneakers. The NYC Condom campaign is making a mistake if it concentrates its advertising on making sure that people want to associate with New York cool; it needs to make sure that people want to have the NYC Condoms.

Solution: Boston Condom

This paper proposes that the NYC Condom campaign spin off into a larger brand. This could be called the Get Some campaign and it could set up branded condoms in several major cities. This initiative could provide other cities to benefit from the expertise and experiences of the NYC Condom campaign while infusing their own local style into their campaigns. As explained above, there are elements of the NYC Condom campaign that need improvement and the Boston Condom will benefit from New York’s mistakes.
The Boston Condom campaign will largely emulate the NYC Condom campaign but will have several key changes to increase its efficacy and brand management. The campaign will include a wider diversity of users featured and included in informational materials, will include information and targeting of woman-woman couples and other sex toy users, and will provide collectors’ packs of condoms for a price. The details of three changes are expanded in the rest of this paper.

Fix #1 – Diversify the Message

As discussed earlier, the NYC Condom campaign does not take into account the vast diversity of New Yorkers’ races, ethnicities, and languages spoken. With a campaign that focuses on English-speaking White, Black, and Hispanic New Yorkers, large proportions of New Yorkers are left behind, alienated or under-informed by the campaign. The Boston Condom campaign will rectify this error in two ways. The advertising campaign will feature a larger diversity of couples in a wider range of neighborhoods and the website will provide top-notch translation, making the information more widely and equitably available to all Bostonians.
The Boston Condom campaign will feature a much wider array of advertisements than the NYC Condom campaign. While NYC Condom showcases advertisements with three different couples in three different neighborhoods, with a highly stylized design, the Boston Condom campaign will highlight Boston’s less flashy, more human scale (6). Real Bostonian couples will appear in the ads in real Boston neighborhoods, proudly holding the Boston Condom and yelling, “GET SOME!” Some couples will be mixed race and some will be both of the same race. Because the ads will be less stylized, the couples will speak, revealing the different accents of Bostonians. Some accents will be classic blue-collar and Brahmin Boston accents, but some will be the accents of immigrants, highlighting Boston’s place as an international city with one quarter of its population as foreign-born (31). These people will also appear from many socioeconomic statuses. While some immigrants will be college students and doctors, some will be taxi drivers and janitors. Because condom use is important for everyone, the campaign will make an effort to include the widest range of Bostonians possible.
As the advertising campaign makes people from all walks feel included, the website will be accessible in many languages. Boston Condom will not rely on Google Translate’s faulty syntax and selective translation. Boston Condom will take advantage of one of Boston’s strengths – its world-class hospitals. The Get Some campaign will standardize its website content across many cities, so Boston Condom will benefit from the quality information that NYC Condom already provides and Boston Condom will team up with its hospital translation services to properly translate all of the content on the sites into the other languages. This will mean that important terms like “STD” will not be left in English, the syntax will be appropriate, and words will be used in their intended parts of speech.
When Boston Condom uses an advertising campaign and website translation model that includes the full diversity of Bostonians, the campaign will be more effective at fighting the institutionalized racism that views issues in Black and White. Immigrants with low English proficiency – whether they’re from Haiti, Somalia, India, China, Russia, Brazil, or anywhere else – can feel noticed and included in the Bostonian pride. Giving these residents who are so often marginalized by media and medical campaigns ownership over the Boston Condom brand will make them more inclined to use it and value it more highly (15). The more value people put in the campaign, the more likely they are to use the condoms and protect themselves.

Fix #2 – Be Queer Friendly

While the NYC Condom campaign excludes woman-woman couples and does not provide any education about sex toy safety on its website, the Boston Condom campaign will embrace the issue. The advertisements will feature Bostonian couples in several permutations. There will be pictures of man-man, woman-man, and woman-woman, and there will be multiple couples of each to account for a diversity of forms of gender expression.
Including woman-woman couples in the advertisements for Boston Condom will be a form of agenda setting (32). Sometimes the public is not ready to talk about a difficult topic until it’s brought to the forefront. With woman-woman couples in the Boston Condom advertisements, Bostonians who don’t already understand will be curious to explore why two women would need a condom. Because it’s clear that a woman-woman couple couldn’t get pregnant by having sex and there are not high HIV rates among the lesbian community, people would wonder what the condoms are for in a woman-woman couple (23). Because this question could now be opened, it could increase conversation about using condoms on sex toys and decrease the stigma of using them (24).
Like the NYC Condom advertisements, the Boston Condom advertisements will not feature explicit mentions of the different sex acts that should incorporate condoms. Instead, the NYC Condom website will be updated to include instructional information about sex toy use (22). The website can draw data from the CDC and provide simple, informative, non-threatening steps for using condoms with toys (23). Like the NYC website, the Boston website will not specify which types of sex acts require which kinds of condoms; it will only include a reminder that all sex toys should be used with a condom if they’re going to be used by more than one person.

Fix #3 – Increase Brand Value

As elaborated above, the NYC Condom campaign undermines its own branding effort by only giving away its products for free. By only providing the condoms for free, the campaign reinforces a message that the product is not worth paying for. If the Get Some campaign wants its products to be viewed as worthwhile and trustworthy, it should show that the products have a market demand even if they cost money.
The Boston Condom campaign will provide free condoms so it can provide ample access to the product, but it will also sell collectors’ packs to increase its brand prestige. NYC Condoms are already being sold online, outside of the authority of the NYC Condom campaign, demonstrating that there could be a market demand for the product (33). To take advantage of that kind of enthusiasm and to create more commitment to the brand, Boston Condom will sell collectors’ packs. These will include the publically available designs as well as some designs that are only available for sale.
Once these condoms are sold for money, the public will come to realize that the Boston Condoms are an impressive product -- not just a cheap freebie from the city. This will also increase the value of the free condoms because they will seem like a good deal for a great product, instead of something that can only be given away for free. As Ariely explains, the draw of a free product is very great, especially if it already has prestige (15).
Because the Boston Condoms will be viewed as a valuable product, people will trust them more. Products that have known brands and are sold for money are often viewed as higher quality than those that are free (28). Given that, the Boston Condoms could become the condom of choice for Bostonians and a status symbol to use. If people think that the condoms bring status with them, it seems likely that they’d be more inclined to use them as a means of impressing sex partners. The act of using a Boston condom could heighten the sexual experience because, in addition to its intrinsic pleasures, it will come with another level of status. This status will be a good public health strategy because it could increase overall condom usage.

Wrap Up

Though the NYC Condom campaign is innovative, successful, and well intentioned, it still has room to improve. When Get Some expands to the Boston Condom market, New York City’s mistakes will be corrected. The Boston Condom campaign will be inclusive of Bostonians of all colors and languages, provide condom information for all risky sex acts, and garner brand loyalty and prestige. These fixes will allow the Boston Condom campaign to help make condom use chic, popular, and a way of expressing hometown pride.


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1 Comments:

At April 30, 2010 at 7:41 AM , Anonymous Edward Depp said...

yes i have heard about that campaign and i appreciate this kind of campaign...

 

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