What the Rap-it-Up Campaign for HIV can learn from social theories - Raqiyah Dixon

HIV/AIDS is a major public health problem in the United States, especially within the African American population. HIV/AIDS disproportionally affects African Americans (Center For Disease Control, 2009). African Americans make up 12% of the US population, but they represent 45% of new HIV infections. HIV was the 4^th leading cause of death for African American men and the 3^rd leading cause of death for African American women in the 25-44 age groups in 2006 (Center For Disease Control, 2009). Black women alone account for 61% of new HIV/AIDS cases among women in the US. HIV/AIDS rates in the African American community are so alarming that the rates in some cities are higher than the rates in some Sub-Saharan African. 3% of Washington DCs population is HIV positive, three times the Center for Disease Control’s definition of what constitutes an epidemic. Media reports of this finding were alarming, and it was stated that DC’s rates were on par with Kenya and Uganda (Vargas & Fears, 2009). Due to these rates there are a number of interventions and campaigns to make people more aware of the epidemic. One widely recognized campaign is the Black Entertainment Television (BET)/ Kaiser Family Foundation media campaign entitled Rap-it-Up. The aim of this campaign was to create public service ads that targeted the African American community during television shows to educate about HIV/AIDS.

Rap-it-Up began in 19998 with collaboration between Kaiser Family Foundation and Black Entertainment Television (BET), and later Viacom in 2000. The PSAs created were to reduce stigma and misconceptions for HIV/AIDS and to help to increase HIV testing among African Americans. The 30 second PSAs was original, creative and it included a number of celebrities, such as Alicia Keys, Kelly Rowland, and Jill Scott. At the end of each commercial the audience was given a number to a hotline where they could receive information on testing centers and HIV education. The phrase Rap-it-Up was a play on word to encourage people to “rap” (talk) about HIV and testing, as well as (w)rap it up by using protection when having sex. After collaborating with Viacom, HIV education was implemented into television shows (Girlfriends, One on One, The Parkers) on the UPN television network. The Rap-it-Up campaign was successful in reaching a large African American population, and getting the messages about HIV education and testing to a large number of people. Despite the success of the campaign, I found a few flaws in the approach. After watching the 55 PSAs on the Kaiser Foundation website, as well as the three television show episodes from the UPN network, this paper will critique the campaign through the social learning theory, the social expectations theory and the theory of gender and power. The focus will only be on the PSAs. The paper will also present a possible intervention that may improve the approach used to teach about HIV and to help to increase testing.

Today mass media is an effective way to get a message out to a large number of people. It is one of the channels of socialization in a society (Defleur & Ball-Rokeach, 1989). Socialization of individuals into a society occurs through a number of ways, such as embracing culture and traditions. Socialization’s aim from society’s standpoint is to bring individuals into a social order, conformity and continuity (Defleur & Ball-Rokeach, 1989). However during the socialization process there are often contradictory messages from peers to family members to the media. The use of the media by the Rap-it-Up campaign was a smart way to encourage socialization of HIV education and testing. Despite the well intentioned methods, the campaign was competing against its own channel (figuratively and literally) of the message. The PSAs were displayed on Black Entertainment Television (BET), a music channel that showcases hip-hop music videos. Much of the content in the videos showcase promiscuity, drinking, flamboyant lifestyles and negative messages about sex (Peterson, Wingwood, DiClemente, Harrington, & Davies, 2007). Through constant portrayal of these images, those who watch channel daily are presented with lessons of what a certain lifestyle entails, whether or not these messages are true or not. These images become informal agents that function as teachers, which the audience may not be fully aware of (Defleur & Ball-Rokeach, 1989). According to the social learning theory members of an audience who observe certain portrayals may try out and ultimately adopt the modeled behavior on a more or less permanent basis (Defleur & Ball-Rokeach, 1989). The Rap-it-Up campaign may have used this theory as the reason for choosing the mass media as the format to reach the audience, yet they failed to take into account the context in which they were presenting the information. If the 30 second PSAs is shown in between hour long shows of music videos, that showcase risky behaviors in a glamorous setting, chances are the risky behaviors will take precedence over the PSAs. Another component of the social learning theory is reinforcement and gratification, is the adapted behavior results in some sort of gratification the behavior is more likely to be reinforced by those adopting the behavior (Defleur & Ball-Rokeach, 1989). The behaviors glamorized in the music videos, highlight status, popularity and satisfaction, all characteristics that may appeal to the audience and provide some form of gratification. The Rap-it-Up campaign PSAs aim was to educate not to entertain or provide gratification. Therefore their messages in the midst of entertainment can be lost in translation.

The social expectations theory is another theory that the Rap-it-Up campaign should have taken into account. The theory asserts that people act in behaviors that are expected of them based on their role in a group or organization (Defleur & Ball-Rokeach, 1989). Every society is broken down into groups, from two people (i.e. husband and wife, mother and child) to larger groups (i.e. peers, classmates, neighborhoods). People tend to choose course of actions based on what they think other people will perceive of them. The Rap-it-Up campaign contained PSAs of friends going together to get tested and it showed friends convincing each other to get tested, as well as celebrities encouraging the audience to take HIV seriously and to practice safe sex. These efforts were essential for influencing social groups and encouraging friends to begin talking about HIV with each other. The aim of the PSAs was to show the audience that people who were just like them were comfortable with talking about HIV and getting tested, with the hopes of influencing social norms and expectations. While this was an excellent approach, the campaign did not take into account all social groups. The target age group for the campaign was 18-24 year olds and their PSAs contained people in that age group. The commercials did not show a wide range of age groups. The age group with the highest incidence of HIV infections are among 25-44 year olds, yet this age group was not represented in the PSAs. The social expectations of these age groups may be different than the expectations of 18-24 year olds. Failure to target this age bracket would not help to impact the social expectations of those who are mainly impacted by the disease. Also the campaign did not contain adolescents who are more likely to contract STDs (Wingwood & DiClemente, 2002). Another component of the social expectations theory is the larger a group gets the more complex the dynamics of the group’s behavior and expectations (Defleur & Ball-Rokeach, 1989). African Americans as one group are a large, complex group with a wide range of behaviors and relationships. The campaign did not speak to a wide range of relationships. It did not take into account the various influences that may impact a person’s behavior. The main focus in the campaign was peer influences and the influence of friends on attitudes towards HIV. They did not take into consideration possible parental and familial influences, the influences of religious institutions or even influences of a mentor or teacher. Watching television introduces young people to a wide range of expectations and dynamics that they should play in relationships. By introducing a wide range of relationship dynamics in the campaign, it could influence and teach the audience social norms and expectations, not mutually exclusive to their peer groups.

Another aspect that the Rap-it-Up campaign should have taken into account is the power dynamics of intimate relationships, specifically male-female relationships. Black women account for the majority of new HIV cases about 66% (Center For Disease Control, 2009). Black women are more likely to contract HIV through high risk heterosexual sex, such as unprotected sex with an HIV positive man or multiple partners. There are a number of factors that contribute to women participating in risky sexual behavior such as poverty, abusive relationship and substances abuse. Wingwood and DiClemente (2002) break down many of the factors that contribute to a woman participating in risky sexual behaviors through the theory of Gender and Power. Women who live in poverty are less likely to have the money to purchase condoms and other preventive reproductive health items. If their partners do not have them, they have no choice but to have sex without protection. The poverty rates among African Americans are 33% compared to 11% among whites (Wingwood & DiClemente, 2002). The campaign did not provide information outside of a hotline that would enable women who could not afford condoms to know where to get protection. Women who rely on husbands or male partners for economic support are less likely to be able to negotiate condom use with their partners due to the dynamic of power in this relationship (Wingwood & DiClemente, 2002). While it would be hard to demonstrate this dynamic in a PSA, women who can’t negotiate condom use will not be able to relate to the information in the PSA, and the message would fall on deaf ears. Another power dynamic in relationships that might impact condom use is age difference. Teenage girls have higher STD rates than any other age or gender group (Wingwood & DiClemente, 2002). Teenage girls are less likely to feel like they have control over their bodies and negotiate condom use. The PSAs in the Rap-it-Up campaign did not address different forms of intimate relationships, and ways in which women could potentially negotiate condom use. The PSAs addressed relationship dynamics that may be characterized as ideal relationships where partners may be able to talk with each other about condoms. Another component mentioned by (Wingwood & DiClemente, 2002) is women who have steady partner are less likely to use condoms and it places them at increased risk for HIV. If they have partners who participate in sexual relations outside of the relationship, then they are more susceptible to STDs and HIV. These women will not use condoms with the belief that their partners are only having sexual relations with them. The Rap-it-Up campaign would have been dynamic if it addressed this dynamic in their PSAs. It did not showcase the different ways in which people could contract HIV. If they showcased examples of relationships where people have multiple partners it may have impacted a different dynamic of the population and may have caused more people to pay attention.

The Rap-it-Up campaign conducted a study to test the success of their PSAs. They conducted a telephone survey among 800 African Americans 18 years old and older. The participants were asked information about the campaign and the PSAs. They were also asked if the PSAs encouraged them to think differently about HIV and if caused them to get tested for HIV. 40% of participants said they took an action to improve their health and to protect them after watching the commercials. The most common behavior change by the participants was talking to their partners about safe sex (Kaiser Family Foundation, 2004). While these results are commendable, the report did not give information on how they recruited the study participants. One of the key components of conducting epidemiology studies is knowing if the study participants are vastly different from the general population of interest. For example, are those answered the survey questions more likely to be health conscious and practicing safe sex as compared to those who did not participate in the study. I think the campaign was beneficial and it was commendable for the creative ways in which it reached a large audience but there is a lot more that could have been done.

Interventions

The Rap-it-Up campaign has a number of strengths- the use of mass media, creativity and originality. The use of these strengths to expand the intervention campaign would be the ideal way to make a greater impact. Although the intent of the campaign was to target African Americans age 18-24 years old (Kaiser Family Foundation, 2004), they would make a greater impact by including other age groups, especially adolescent girls. A very compelling study was conducted by (Peterson, Wingwood, DiClemente, Harrington, & Davies, 2007) on rap videos and its impact on African American adolescent girls’ risky behaviors. Girls who perceived more images of stereotypes in rap videos were more likely to engage in binge drinking, test positive for marijuana and have multiple sex partners (Peterson, Wingwood, DiClemente, Harrington, & Davies, 2007), all activities that place them at risk for contracting HIV. While this study had its limitations it gives a good inclination that the adolescent girls who are watching BET, the channel for the PSAs and majority of rap videos, should be targeted by the campaign. The campaign could create PSAs that target adolescents’ age 12-18 years old. The PSA could entail a group of adolescents who choose not to engage in risky behaviors and they are not afraid to let their peers know why. This group of adolescents could also tell their peers why they always use protection when they have sex, especially the adolescent girls. When young girls see that it is okay to practice safe sex it might cause them to feel that they have more control over condom negotiations with their partners than they previously thought. Also adolescents usually have a role model or someone that they look up to outside of their peers. The creators of the PSAs should talk with adolescents to figure out who they look up to and influences them the most. The suggestions made by the teens should be used by the PSA writers. This is an important age group to target because of their risks (Wingwood & DiClemente, 2002). Also socialization begins at a young age and if you can teach them healthy practices it can carry into adulthood.

Another age group that the Rap-it-Up campaign should target is the 25-44 year olds. As mentioned previously this age group has the highest incidence of HIV infections (Center For Disease Control, 2009). The PSAs focused on the 18-24 year old age bracket. The campaign did target the 25-44 year old during an episode of two television shows, Girlfriends and One on One (Kaiser Family Foundation, 2004). The Girlfriends episode highlighted a friend of the cast who contracted HIV from her husband. The One on One episode highlighted the main male character’s stress as he waited for the results of an HIV test. These characters were in their early 30s, thereby targeting the 25-44 year old age bracket. The campaign could continue these messages subtly throughout sitcoms primarily watched by African American aged 25-44 years old. The campaign could also create PSAs that target this age group. The social norms of this group are very distinct and PSAs that speak to these norms would be ideal in increasing HIV testing.

One of the important points of the (Wingwood & DiClemente, 2002) analysis of HIV through the theory of Gender and Power, is the lack of financial independence for women. These women may not have the ability to buy condoms and other preventive reproductive health products. As an extension of the campaign Rap-it-Up could include condom distribution. These condoms could have a unique logo and be available in stores, schools and other locations of social gatherings. The distribution locations could be researched and they would be places that are frequented by those who watch BET (the target audience for the campaign). Not only would the audience get the message (w)rapping-it-up but now they would be able to get the supplies. Kaiser and BET could negotiate with condom makers to get a discount price for the condoms and they would be able to afford to distribute them for free. This condom distribution method was used by the New York City Department of Health with the distribution of the NYC condom in stores around the city. The condom wrapping resembled the subway symbols and they were available for anyone to pick up at stores throughout the city. The distribution was successful and research showed that the condom was used by the people who picked them up in the stores (Burke, et al., 2009). Rap-it-Up could market their own condoms within the PSAs and have them available for free. This method could help to brand Rap-it-Up and help them to reach a larger audience.

Lastly another possible intervention for the Rap-it-Up campaign is making better use of the celebrities in their PSAs. The celebrities used in the current campaign stated facts and statistics on HIV. Some talked about personal experiences with friends and family who had HIV, and the work that they were doing in HIV awareness. I think it would be beneficial id the PSAs showcased the celebrities personal beliefs and attitudes towards HIV risk and possibly getting HIV tests themselves. Now this may seem a bit personal, but unfortunately (or fortunately) today we are a celebrity driven society, and many people look up to then as role models. With the increase in reality shows on celebrities’ lives, people are interested in what celebrities do in their daily lives. The Rap-it-Up campaign could capitalize on this. Creating PSAs with celebrities with a reality show feel would be ideal. Celebrities could showcase some of their anxieties with HIV testing, the lessons they learned about HIV risk and getting tests themselves. The PSAs could be mini-sodes (two minute episodes), that could show case celebrities experiences with HIV over a series of a few episodes. The mini-sodes could also show how the celebrities discuss HIV and testing with friends and family in order to normalize HIV discussions among friends and families. One of the problems with traditional public health marketing and PSAs is the use of statistics and facts to get the message across. The traditional marketing campaign may include a celebrity who states the facts and statistics, in an effort to make the PSA popular. However the impact is still the same. It turns people away and in the end they do not get the message. By using celebrities in a creative and entertaining way it can help get beneficial and helpful health information out to a broad audience. The media or celebrities can become formal or informal agents that function as teachers to an audience that is unaware of their role (Defleur & Ball-Rokeach, 1989). This an ideal concept in “selling” HIV education and teaching safe sex, and for the Rap-it-Up campaign to go to the next level.

Another way the Rap-it-Up campaign can improve their use of celebrities is by encouraging the celebrities who rap and sing about risky behaviors to talk about how they protect themselves. Many people, specifically young people (Peterson, Wingwood, DiClemente, Harrington, & Davies, 2007), watch these videos and do not think about the risks involved with the glamorous lifestyle. The images they see show gratification for this glamorous lifestyle and in turn cause those who are watching to want to engage in the same behaviors (Defleur & Ball-Rokeach, 1989). If the rappers or singers who talk about how they practice safe sex despite the lifestyle they live, it would be a monumental step in HIV awareness education. These celebrities would be able to influence those who they influence already, but in a positive way. The Rap-it-Up campaign would benefit from using these celebrities and gain popularity with the message that they are trying to get across. They could possibly encourage these same artists to rap about safe sex in a creative and catchy way that would become popular among the consumers of their music.

Conclusion

The Rap-it-Up campaign was a successful campaign that won numerous awards for the PSAs and for public health education (Kaiser Family Foundation). Yet the rates of HIV/AIDS in the African American community remain high (Center For Disease Control, 2009). This campaign could be even stronger if they focused on their strengths and utilized the different social theories in their future campaign. The use of the social learning theory and the social expectations theory will help the campaign to take into account the social dynamics in which people live, and target those dynamics in the creation of the PSAs. This would be better than creating ads that only target one aspect of people’s social settings i.e. their peers and friends. The use of the theory of gender and power would allow the campaign to take into account power dynamics in intimate relationship as well as the context of the environment in which they women that they are trying to reach may live. By these theories in to consideration it will help to make the campaign much better. Also implementing the proposed interventions would help to expand the campaign. I think that the Rap-it-Up is a good first step in teaching HIV/AIDS education but there is more to do. I hope that BET and Kaiser Family Foundation will take the campaign into the future and expand on their efforts.

Works Cited

Burke, R., Wilson, J., Bernstein, K., Grosskopf, N., Murrill, C., Cutler, B., et al. (2009). The NYC Condom: use and acceptability of New York City's branded condom. American Journal of Public Health , 2178-2180.

Center For Disease Control. (2009). HIV/AIDS among African Americans Fact Sheet. Atlanta: CDC.

Defleur, M. L., & Ball-Rokeach, S. J. (1989). Socialization and Theories of Indirect Influence. In M. L. Defleur, & S. J. Ball-Rokeach, Theories of Mass Communication (pp. 202-227). White Plains: Longman Inc.

Kaiser Family Foundation. (2004). Assessing Public Education Programming on HIV/AIDS: A National Survey of African Americans. Washington DC: Kaiser Family Foundation.

Kaiser Family Foundation. (n.d.). Public Education Partnerships: BET. Retrieved 4 24, 2010, from Kaiser Family Foundation: http://www.kff.org/entpartnerships/bet2/awards.cfm

Peterson, S. H., Wingwood, G. M., DiClemente, R. J., Harrington, K., & Davies, S. (2007). Images of Sexual Stereotypes in Rap Vidoes and the Health of African American Female Adolescents. Journal of Women's Health , 1157-1164.

Vargas, J. A., & Fears, D. (2009, March 15). At Least 3 Percent of D.C. Residents Have HIV or AIDS, City Study Finds; Rate Up 22% From 2006. Washington Post . Washington DC: Washington Post.

Wingwood, G. W., & DiClemente, R. J. (2002). The Theory of Gender and Power: A Social Structural Theory for Guiding Public Health Interventions. In R. J. DiClemente, R. Crosby, & M. Kegler, Emerging Theories in Health Promotion Practice and Research (pp. 313-346). San Francisco: John Wiley & Sons.