In 2018, Children’s Investment Fund Foundation, Elton John Aids Foundation, and Unitaid invited four firms to develop an early concept to increase the uptake of HIV self-tests by Kenyan men and their partners.
Kenya has made great strides over the past decade in advancing access to HIV care and prevention; however, 51% of new HIV infections occur among youth ages 15–24. In many places, and especially among men, there is overwhelming cultural aversion to any form of testing—despite the fact that, more than ever, people with HIV are living longer and healthier lives.
The IDEO.org team spoke to young men across urban and rural pockets of Kenya about dating, sex, HIV, and seeking care. A lot of them felt uneasy about talking. The messaging of ‘HIV kills’ and its implicit association with promiscuous behavior has ostracized infected individuals, propagating a culture of secrecy. Young men fear that all sense of identity, community, and lifestyle will fall away after taking a HIV test. They hear of people dying from HIV, but they never see people living openly with HIV.
Testing is an entry point to treatment as well as prevention, but people don’t even want to be spotted near centers where testing is offered; and if they’re infected, they most likely keep that information to themselves. It wasn’t until the team started prototyping with different messaging that they had a major breakthrough. They noticed one of the young men wanted to take their educational material home to share with his friend—not to his group of friends, but to his one closest friend. Many people ran away from the idea of talking openly about testing, but having someone, often a best friend, to offer emotional support made a huge difference. The teams assumptions about the importance of privacy and confidentiality were confirmed, but there was more to it.
IDEO.org decided to build off of those tight bonds of friendships to a cultivate camaraderie and connection in the journey towards self testing. “Niko Nao” means “I’m with them” in Swahili. To be part of the Niko Nao movement is to offer support regardless of the results. It’s about coming together as a community to fight against the disease. Niko Nao offers a radically different narrative around HIV: one that celebrates health and leverages the support of close social networks.
We prototyped different ways of delivering the Niko Nao message: an anonymous support line, a Facebook campaign, and an ambassador program where individuals would give out coupons to redeem self-testing kits. Hardly anyone called the support line; people were looking for familial, not anonymous, support. But the ads worked. With the help of the Kepler Group, a team of technologists and marketers that leverage data to customize campaigns, we launched a series of Facebook ads that raised awareness of the kits and ambassador programs. Within one week, the ads drove 114 users to contact an SMS line in order to access a redemption code for a free HIV self-test kit. And of those 114 users who reached out for a redemption code, 26 used this redemption code for a free self-testing kit.
On October 18th, the Niko Nao program won the CIFF Challenge Fund Competition. At IDEO.org, we believe acceptance and hope are necessary precursors to nurturing a community that supports self-testing, and the team is committed to finding ways to share this narrative more broadly.