Healthy Penis: San Francisco’s Social Marketing Campaign to Increase Syphilis Testing among Gay and Bisexual Men

Launched by the San Francisco Department of Public Health (SFDPH), Healthy Penis was a social marketing campaign designed to increase syphilis testing and awareness among gay and bisexual men. Introduced to the public during the annual San Francisco Lesbian Gay Bisexual Transgender Parade, the primary objectives of the campaign were to change community norms around syphilis testing, as well as increase knowledge of the syphilis epidemic, and provide information on syphilis symptoms, routes of transmission, and the link between syphilis and HIV transmission. After the campaign launched, it was heavily promoted in neighborhoods with high concentrations of gay or bisexual men and areas where businesses catered to this demographic. Campaign messages were primarily communicated through cartoon strips featuring characters like Healthy Penis and Phil the Sore. Through these stories, the campaign team (1) shared information on syphilis transmission, symptoms, and prevention; (2) highlighted the rise of syphilis among gay and bisexual men; (3) demonstrated the connection between syphilis and HIV; and (4) promoted syphilis testing. Cartoon strips were published semi-monthly in a popular gay Bay Area publication, ran as banner advertisements on internet sites designed to help gay men meet sex partners, and poster-sized versions were posted around town on the streets, in bars, at commercial sex venues, and on bus shelters and bus advertisement spaces. Two rounds of intercept surveys were used in targeted neighborhoods to evaluate the effectiveness of the campaign, with one conducted six months after the campaign began, and the second 2.5 years after the campaign began. Two hundred and forty-four interviews were conducted with San Francisco residents and included in the first evaluation; 150 interviews were included in the second evaluation. For each evaluation, all respondents were men who have sex with men, and most were white and HIV negative. Both evaluations found a positive association between campaign awareness and recent syphilis testing. Evaluation I was associated with a 90% increase in likelihood for having tested for syphilis in the past six months. Evaluation II respondents found each increase in campaign awareness level (none, aided awareness, and unaided awareness) to be associated with a 76% increase in likelihood for syphilis testing. 
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