Social Marketing in HIV/AIDS Prevention: Its Contribution and Challenges

In the realm of public health promotion, where pharmacological, immunological, and medical interventions may not be readily available, an alternative approach has gained prominence — social marketing. This innovative strategy applies commercial marketing techniques to create and execute programs and campaigns that have a sustainable impact on target populations. It has been increasingly adopted by health practitioners and departments as a means to promote beneficial behavioral changes within society. However, in Malaysia, social marketing is still a relatively new concept, and its significance in addressing health issues, particularly in the context of HIV/AIDS, is not widely understood. Raising awareness about the importance and principles of social marketing is crucial in tackling public health challenges effectively. By integrating social marketing into health promotion efforts, Malaysia can harness the power of strategic communication, behavior analysis, and consumer insights to promote positive health behaviors. The potential for social marketing to influence attitudes, beliefs, and practices related to HIV/AIDS prevention and treatment is significant. Efforts are underway to familiarize Malaysians with social marketing and its applications in public health. Through education, training, and collaborative initiatives, the aim is to empower health professionals, policymakers, and the public to embrace this approach and leverage its potential in creating lasting positive change. By adopting social marketing strategies, Malaysia can enhance its response to health challenges, including the prevention and management of HIV/AIDS, ultimately leading to improved health outcomes for its population.


Introduction
In this millennium decade, there is a growing acknowledgement that there is a need for addressing the importance of promoting a healthy. When every nation is competing to gain popularity in the development of science and technology, there is one overwhelming health issue yet to be resolved by many countries-Human Immunodeficiency Virus (HIV)/Acquired Immunodeficiency Syndrome (AIDS). This paper seeks to explore how social marketing is being employed in HIV/AIDS intervention programmes in Malaysia. HIV/AIDS was chosen in this study precisely because it is a global problem that affects every country in this world, yet it is no longer a health problem but a development issue.
The choice to focus on HIV/AIDS in this research stems from its global impact, affecting nations across the globe. What was once solely regarded as a health issue has now become a multifaceted development challenge. By exploring the application of social marketing in addressing HIV/AIDS, this study aims to shed light on effective strategies that can be employed to combat this global problem. Through social marketing approaches, which employ techniques derived from commercial marketing to influence behaviors and promote social good, this research seeks to uncover innovative methods for raising awareness, preventing transmission, and providing support for individuals and communities affected by HIV/AIDS. By examining the implementation of social marketing in HIV/AIDS interventions, valuable insights can be gained regarding the effectiveness of these strategies in the Malaysian context. Findings from this research can inform policymakers, healthcare professionals, and stakeholders involved in public health interventions, enabling them to refine and enhance existing approaches or develop new strategies to address the complex challenges posed by HIV/AIDS.
Ultimately, by comprehensively exploring the role of social marketing in HIV/AIDS intervention programs, this study aims to contribute to the global efforts in combating this pervasive issue and improving the overall well-being of individuals and communities impacted by HIV/AIDS.

Definition of Social Marketing
Within the realm of public relations, health public relations focuses on a very specific function that captured audiences within the health environment or problems. In many ways, public relations specialists adopted a comprehensive approach and tools in the advertising and marketing field. The most popular tool and approach being used successfully in the health public relations is social marketing.
Social marketing is unlike commercial marketing. Nilimaa and Nixon (2004) claimed that social marketing seeks to influence behaviour change rather than seeks to profit. In the interest to address some social environment issues, certain actions which require behaviour changes by an individual or community in order to achieve a quality of life is needed. For instance, Malaysian government mandates all passengers fasten their seatbelts on the back seat since January 1st, 2009. Before that period, advocacy buckle seatbelts on the rear seats had been launched for six months period since June 1st, 2008 through education and persuasive campaign messages. In order to make the message salience and well-implemented among the general population, the media have been used to increase the saliency of the government policy and its seriousness of the law and enforcement (seehttp://pmr.penerangan.gov.my/index.php/component/content/article/402-infoingkas/6963-penjelasan-terhadap-permakaian-tali-pinggang-keledar-tempat-duduk belakang.html).
Hence, fasten your seatbelts securely before driving, do not drive drunk, save our earth, eat healthy foods, stop smoking, use condom while having sex, do not littering, etc are all about social marketing. The challenge underlies in this marketing is a process of timeconsuming, patience and perseverance. (Olujide, et al., 2010) Thus, it is well-known that immediate payback in return for a proposed behaviour is unexpected by social marketers and health practitioners. (Kotler, et al., 2002 andOlujide, et al., 2010) Theoretically, social marketing is "the use of marketing principles and techniques to influence a target audience to voluntarily accept, reject, modify, or abandon a behaviour for the benefit of individuals, groups, or society as a whole" (Kotler, et al., 2002). In sum, social marketing uses commercial marketing principles and techniques to change human behaviour on certain issues or events such as improving life, health, preventing injuries, protecting environment and contributing to the community. The term of "voluntarily" in the given definition refers to willingness of an individual, without coercion and compulsion in achieving behaviour change. The cornerstone of social marketing is actually consumer orientation. (Chance andDeshpande, 2009 &Hsu, 2001) The ultimate outcome of social marketing must achieve behaviour change among people with a willing heart. Morris and Clarkson (2009) claimed that the outcome of commercial marketing and social marketing are slightly different. The outcome from social marketing is uncertain and intangible, and the benefits often reach to third parties. The term of "uncertain" is referring to, for instance social marketing program might not accrue to rectify people perception towards HIV or People Living with HIV (PLHIV) just in short period. This is because a social marketing program should carry on frequently and continuously in order to achieve human behaviour change. In addition, "intangible" and "benefit" are because, for instance if a social marketing program able to rectify people's misconception towards PLHIV and understand HIV/AIDS as a whole, the result will benefit PLHIV which in turn giving these people social support in a way to bring them back to the wider community and even workplace. Whilst, "selling" idea (intangible) rather than selling product (tangible) is the main concept applied in social marketing. Basically, prior to implementing a social marketing campaign or program, social marketers have to clearly identify the objective(s) or product(s) that he or she is going to "sell" for.

Social Marketing Mix
Marketing mix is the basic marketing strategy developed by most marketers. When designing a successful marketing strategy, marketers often refer to Four Ps in their assignment. These Four Ps are including Product, Price, Place, and Promotion (Kotler, Roberto, and Lee, 2002;Smith and Strand, 2008) In this bulk of paper, we are going to see using the social marketing plan as a guide and messages to implement a project. The following discussion will be using HIV/AIDS as the example as a whole.
Product. The product is relating to what social marketers are selling? It could be involving tangible product and intangible product such as services that support human behaviour change. In this stage, there are three levels of the product could be explained, which are core product, actual product, and augmented product. Core product is answering the questions: "What benefits will target audiences or consumers receive?" "What problems will it solve?" The core product is not the behaviour or accompanying tangible objects or even services that we will be "selling" (Kotler et al., 2002, p. 195) In a manner of speaking, core product is the benefits that consumers will be experienced by performing desired behaviour. Actual product, however, is the desired behaviour to be performed by audiences or consumers in order to achieve the benefits in the core product, whereas augmented product is the level includes tangible objects and services that the social marketer promotes. More precisely, it supports the behaviour and may provide opportunities and encouragement for people to attain the perceived benefits.
For example, the core product is prevention of HIV/AIDS. Therefore, social marketer asks people to perform an action in order to achieve the perceived benefit by wearing condom during sexual contacts (actual product). Whilst, wearing the Durex condoms will be the augmented product along with the desired behaviour which could be sustain the behaviour as a whole. In sum, by wearing the Durex condoms when during sexual encounters could prevent people from infecting HIV/AIDS.
Price. The price of a social marketing product is the cost that target audiences have to give up and overcome to receive the perceived benefit from the product. There are two types of cost in the price element, which are monetary and nonmonetary. Obviously, monetary costs are the prices charged on the tangible product, whereas nonmonetary associated with time, energy, effort, psychological risks, etc which could not be counted and it is intangible.
Monetary costs: People purchase the product by paying money. Therefore, this is the cost that people have to give up and overcome in a way to gain the perceived benefit through the buying product. Monetary costs, obviously, involved prices charged for purchasing tangible products and services. For instance, in the campaign of "Safe Sex", a box of Durex condoms costs RM20.00. For buying the condoms, target audiences then have to give up RM20.00 each box, but in the fact that he will earn the perceived benefit from those condoms by using it when during sexual contacts with someone, which the condoms will protect the buyers from getting diseases especially HIV and Sexual Transmission Diseases (STDs).
Nonmonetary costs: Target audiences have to give up something which is more valuable than money such as time, effort, energy, psychological risks, etc in a way to adopt the new behaviour. For example, having casual contacts like sharing a same cup of water with PLHIV, shaking hands with PLHIV, even hugging with PLHIV by giving them support are the actions which benefit both parties (general people and People Living with HIV). The perceived cost is people have to pull over their misconception and ego by contacting with People Living with HIV. Giving them support and understand them are an anchor to them. Ultimately, that will give some hopes for PLHIV get back to wider society and workplace. These are the intangible products in nonmonetary costs.
Place. The place in marketing mix is where and when the target audiences will perform the desired behaviour more convenient and ease of access to adopt a new behaviour. Social marketers need to identify which distribution channels are more convenient for target market receiving any related tangible products or services. As aforementioned, our target audiences are very aware in identifying their perceived benefits and costs in the process of receiving a product or service. Target audiences will evaluate the convenience of our offer. After all, target audiences will not take any risk which might accrue their costs and reduce their perceived benefits. As social marketers, therefore, it is pivotal to maximize the convenience of accessing the related products and services, and at the meanwhile minimize any possible costs that our target markets have to deserve. It is also essential for us to bear in mind that place is not the same as media channel, which we are going to promote our products and services. More details about media roles in promoting related products and services will be illuminating on the next discussion.
In the price segment, we have identified the costs (monetary and nonmonetary) that target audiences might pay or experience in a way to adopt a new behaviour. Hence, in the process of developing place, social marketers must develop place strategies well enough to reduce costs, remove access barriers, and boost perceived benefits. Convenience is the simple reason and factor for a target audience to get closer with the related product or service that he or she might interested with. Therefore, there are two examples that have been included in this discussion.
For example, in order to reduce the risk of getting HIV infection among the community and increase the public awareness about safe sex behaviour, condoms or sexual lubricates vending machines could be placed at the respective areas such as airports, streets, hospitals, etc. In Japan, we could see various types of vending machines in anywhere. The accessibility of the products and services are extremely convenient in Japan. As a result, consumers just have to insert currency or credit into the machine and it will dispense the product that the consumer has chosen. In a manner of speaking, sometimes people refuse to buy a box of condoms at retail shop simply because of their egomaniac, and the location of retail shops are either far away from their staying place. Hence, by developing or placing condoms and sexual lubricates vending machines, people then have no excuse in purchasing condoms for their own sake. Other example like needle exchange tables on street corners (Kotler et al., 2002) It has described that the rates of HIV infection in Malaysia are attributed immensely by injecting drug users (IDU) from sharing needles and syringes. (UNGASS, 2010, Malaysian AIDS Council, 2009& Reid, Adeeba Kamarulzaman & Sangeeta Kaur Sran, 2007 In accordance to that matter, respective organizations could make needle exchange tables on street corners more accessible. Promotion. The last but not least in the marketing mix is promotion, which planners or social marketers select specific media channels and vehicles for promotional strategies. Promotion strategy also is a primary focus in marketing communication mix. Early we have discussed the place in marketing mix is not the same as media channels used in promotion segment. However, it does a bit relevant in the sense of the accessibility of receiving either products and services or information and messages. It is most agree that there is an association between social marketing and media channels for achieving behaviour change among the community as a whole. Dearing, et al (1996) Media is an influential vehicle in shaping our definitions of social phenomenon through the way they represent and report on different experiences and angles of an event or issue. In other words, the media that we consumed often help us to understand and perceive social environment and even ourselves. Social marketers use various media channels to promote a program or campaign throughout the target audiences. Obviously, in the promotional strategies, social marketers apply various tactics to attain their goals and objectives such as advertising, public relations, printed materials, special promotional items, signage and displays, personal selling, and popular media.
For examples, social marketers use promotional item by using condom mascot with the slogan "Condoms protect U and Me-I Love U" on a "Safe Sex Campaign" in a way to attract audiences' attention in conveying a message of wearing condoms during sexual encounters will prevent both partners from getting HIV and Sexual Transmission Disease (STD). Besides, to reinforce the message of preventing AIDS, social marketers select billboards, posters, advertisements on newspapers, etc to convey the message towards target market. Literature showed that the inexpensiveness and accessibility of newspapers have been used by health practitioners and departments to change the behaviour of the people to adopt to a quality of life (Ibrahim et al., 2010) However, social marketers always have to bear in mind that the use of languages must be understandable, reachable, and applicable. Using appropriate languages is very important in conveying the messages accordingly and effectively throughout the target audiences. It must be easy to understand what the main message that social marketer or the program would like to distribute or promote. (Mallika and Katare, 2004) For instance, "Say Goodbye to HIV/AIDS". This slogan is very clear and it gives a better sense to target audiences that "We have to say goodbye (stop) to HIV/AIDS. No more HIV/AIDS in this region". This slogan is also easy to recall in audiences' mind. Social marketers can also use "trigger words" in their slogan or message. Trigger words are words or phrases like little bombs which can trigger an idea and reaction among the target audiences. Using right and effective words, phrases or metaphors can spur target audiences to take action. For example, "STOP AIDS". The term of "STOP" is very powerful to remind target audiences that "We have to do something to STOP the AIDS in our community".

Conclusion
Social marketing, an innovative approach that utilizes commercial marketing techniques for public health promotion, has gained prominence as an alternative strategy in the absence of readily available medical interventions. This study highlights the significance of social marketing in addressing health issues, particularly HIV/AIDS, in Malaysia. The findings reveal that while social marketing is still relatively new in the country, its potential to drive positive health behaviors and shape attitudes towards HIV/AIDS prevention and treatment is substantial. Raising awareness about the principles and importance of social marketing is crucial for effectively tackling public health challenges. Integrating social marketing into health promotion efforts enables Malaysia to tap into the power of strategic communication, behavior analysis, and consumer insights to drive positive health outcomes. Ongoing initiatives aim to familiarize Malaysians with social marketing, its applications, and its potential impact on public health. Through education, training, and collaborative efforts, health professionals, policymakers, and the public can embrace social marketing as a catalyst for enduring positive change. By adopting social marketing strategies, Malaysia can bolster its response to health challenges, including the prevention and management of HIV/AIDS, thereby advancing the overall health and well-being of its population.