Transcript

Miguel Gomez: Good afternoon everyone and welcome to our second AIDS.gov Conference Call. I'm Miguel Gomez, the Director of AIDS.gov, and I want to thank you for joining today's call.

As many of you may know, at AIDS.gov we work to help Internet users easily find information on federal HIV/AIDS programs and resources, but we also blog each week on how to use new media in the fight against HIV/AIDS.

We've twice this year had the opportunity to blog on text messaging and we've heard back from a lot of our HIV colleagues about their interest about using text messaging in the fight against HIV/AIDS. We also heard from a lot of our colleagues that they really wanted some of the basic information about texting and how it's being used in the fight against HIV/AIDS.

We wanted to hold today's informational call, which overwhelmingly is for our federal colleagues who work with our grantee community across the United States. It's really important to us to focus on text messaging, especially here in the United States when, in 2007, there were close to 250 million Americans with cell phones and the bulk of those cell phones had text messaging features.

Today we'll provide you with that basic introduction to text messaging. First, What is it? How does it work? Why is it an important tool overall and how can it help in the fight against HIV/AIDS? So some of this might be basic for you but we're really excited about getting into the meat of what people are doing on the ground to make a difference.

We'll highlight two text messaging campaigns, including SexInfo and the KNOWIT Campaign. We also want this to be a dialogue, so we'll take questions twice during today's call. To help us talk about the issue today, we have from the State of Michigan, Rick Broida. He's a technology expert and a frequent blogger for CNET. And joining Rick is Deb Levine in California. She's the executive director and founder of Internet Sexuality Information Services (ISIS). Through ISIS she has developed several youth-focused text messaging campaigns about sexual health.

But most importantly, I have an obligation to let everyone on the call know that this call is being recorded and a transcript and audio file will be made available after the call. We'll also be sending everyone an evaluation and we encourage you to please fill that out so we do a better job next time.

So I want us to get started and I'm going to turn to Rick. Rick, thank you so much for joining us today. We know that you have been writing about technology for over 15 years. Congratulations, sir. We're pleased that you can sort of give us some of the basics, and we'd like to get some quick answers to some basic questions like, sir, what is text messaging?

Rick Broida: Well, sure. Let me answer that for you Miguel. To many people, text messaging probably seems kind of confusing, like one of those strange and complicated activities that only teenagers understand. But in reality it's one more great tool in your communications arsenal, right up there with e-mail.

In fact, text messaging is very much like e-mail but a specialized kind designed for cell phones. It relies on a technology that's actually been built into cell phones for years and this is called SMS, which is short for Short Message Service. This is used to relay very brief messages, usually no more than 160 characters or the equivalent of a couple average-length sentences.

Miguel Gomez: Well, sir, why is it an important tool?

Rick Broida: Well, that's a great question and many people might wonder why you'd want to bother with such a seemingly limited method of communication. One big reason is that text messages arrive almost immediately after being sent. So one reason that BlackBerry users, for instance, love their devices so much is that e-mail arrives on its own. They don't have to manually sign in and retrieve it.

And it's a similar story with text messages. They get delivered to your phone automatically and almost instantaneously. That could come in really handy when you need to reach someone who is, say, in a meeting and not able to answer their phone. Instead of calling, you can send them a text message. It'll pop up on the person's screen without disturbing the meeting and he or she can fire off a quick answer if necessary, again with little or no disruption.

Miguel Gomez: Thank you, Rick. What else can you do with texting?

Rick Broida: Well, let me answer that for you Miguel. In a nutshell, text messaging allows people to send/receive short messages on their cell phones, but that's really just the tip of the iceberg. The technology is now being used for a lot more than just two-way interpersonal communication. For example, you can use Short Message Service or SMS to check the status of an airline flight. You can use it to track the shipping status of a package and you can use it to find the nearest HIV test center and even get driving directions to it. All this and more is possible thanks to various services that leverage this SMS technology. And really, best of all, most of them are free.

Miguel Gomez: You mentioned free but are there costs associated with text messaging?

Rick Broida: Well, sure. Let's talk about that before we actually get into the services themselves. SMS prices do vary depending on your cell phone carrier and your service plan. So your plan might include a fixed number of messages per month, they might include an unlimited number, or they may have none at all.

And if you're not sure what's included with your plan, what you really want to do is call your carrier's customer service department and they'll be able to tell you what you've got coming to you.

Miguel Gomez: Thank you. And just another question – How do you create a text message actually on your cell phone?

Rick Broida: That's the one I actually get quite a lot, Miguel, and I'm sure at this point some listeners may be wondering how they're supposed to compose a message when their phone has only a numeric keypad. Obviously smart phones that have those little QWERTY keyboards have the edge when it comes to messaging but it is possible to enter text using only those nine number keys; it just takes longer and it takes a bit of practice.

Basically, each number represents three or four letters and you can see the letters printed right on your phone keypad. You push a given key repeatedly until the desired letter appears on screen, then move on to the next letter. That's the process in a nutshell. You'll want to refer to your phone's manual to learn more or find yourself the nearest teenager.

Miguel Gomez: Thank you, sir. And Rick, it is so important because I often talk about texting and I'll talk later about the KNOWIT campaign to help people use text messaging to find an HIV testing site, which you referenced. But again, we sometimes forget that we have to start with the basics with our colleagues to be able to understand this very practical and wonderful tool.

What I would like to do is, as I mentioned earlier, during this call we're going to be able to take questions. I'm going to ask the operator to explain to our listeners how they can ask a question.

Coordinator: Thank you. If anybody does have questions, they may press star 1 on your touchtone phone. Again, that'll be star 1 for any questions.

Miguel Gomez: Again, later I'll turn to Deb Levine from ISIS shortly but, Rick, before I let you go, I want to see if there are any questions for you. Are there some other uses and some other examples you can give us that are helpful tools when it comes to text messaging?

Rick Broida: Absolutely, Miguel. Let's talk about some of the free services that you can tap into from your phone – any phone – using nothing more than a text message. For example, if you're trying to lose weight a service called Diet.com can actually help you count calories. What you would do is create a new text message with the name of a restaurant and menu item then send it to D-I-E-T-1, which is equivalent to 34381 on your keypad. In a matter of seconds, Diet.com will send back a message listing the calories, fat content, protein content, and so on.

Now, if you're looking for driving directions, flight status, movie show times and other information, Google has its own SMS service that's really incredible. If you visit Google.com/SMS on your PC you can get all the details on that.

Miguel Gomez: Thank you. We'll send all this information out to our listeners. And I want to ask Shawn, the operator, if there are any questions before moving on to Ms. Levine.

Coordinator: I show no questions at this time.

Miguel Gomez: Great. Thank you, Shawn. So let's welcome Deb Levine from ISIS and, Rick, thanks to you for joining us as we turn to Deb. And Deb, again, we want to thank you for the work that you've done in disease prevention. We want just to jump into it and if you could explain the program that you've been working on, SexInfo. Could you explain what it is and how it works, ma'am?

Deb Levine: Of course I can and I want to back up to say, Rick, that was the best introduction and explanation of text messaging I've ever heard. I've been trying to do it for about three years now, so I still have a lot to learn.

SexInfo was started in 2006 in San Francisco and it's a very simple SMS text messaging service designed to reach urban, low-income youth with basic information about sexually transmitted diseases, including HIV and local clinic resources.

The way that the service works is that you text "SexInfo" to a five digit short code, which is 61827 (and I always say at this point in the call I have no problem if people take out their cell phones and try it). You get back a menu of five commonly asked questions by young people, including if you want to know about HIV, what to do if the condom broke, what to do if you think you're pregnant.

And then it gives you instructions to text back a number in order to get the answers to those questions as well as to local resources and the hours that they're open, and they're all free resources in San Francisco.

Miguel Gomez: And Deb, could you tell us about your target audience?

Deb Levine: Yes. SexInfo is developed specifically based on epidemiology in San Francisco saying that Chlamydia and Gonorrhea rates were going up among African American youth as young as 12 and up to about 18. And – we were actually asked to build a Web site – we went out to a couple of high schools and stood outside and saw every young person come out with a cell phone. We said, I think that this is a way that we can really reach young people that may not have access to a personal computer and in sort of a mobile and private way. So what we did from there was go and set up focus groups.

We had young men and young women from the target audience sit down and tell us about their experiences, where they get their sexual health information, and then how they would like to receive their sexual health information. They would say that 100% considered a text message to be a private and convenient way that they would want to receive sexual health information.

And the clincher for them, particularly the young women, was as long as they opted in, which means as long as they started the service and were the ones who texted SexInfo to 61827 – that we weren't pushing out information to them on their cell phones when they didn't expect it.

Miguel Gomez: Deb, that's really helpful. So when you got started you did the right thing in public health, you went to the community and asked them first. It is really interesting that they wanted to be able to initiate the process to get information so that they could get some data on sexual health on their cell phones. But how did young people learn about it? What was your marketing tool?

Deb Levine: We did a multi-prong campaign. We find that the more saturation into your target audience, the better. So we had palm cards or business size cards advertising the service. Those are handed out both in local high schools through the school-based clinics and then also through street outreach in the target neighborhoods. We had posters in bus shelter billboards in the target neighborhoods, we had online banner ads, and we put out a press release and got a lot of press as well.

Miguel Gomez: The program's been up and running. Where are you today with this service?

Deb Levine: We have actually enhanced and improved the service along the way. That's one of the beautiful things about technology. As opposed to a print publication, you can just continually go out, talk to your target audience, and find out how they're using the service and what enhances can be made. Then, you can simply make them.

So we conducted usability testing about a year into the service. We found that all the young people who knew about the service were using it and they really liked it, but they weren't getting past the first menu of questions; we originally had 11 questions. So we sent a market researcher and a youth from population out onto the street with video cameras and watched how they texted through the menu. And from that we made some very simple changes to the site, such that 100% of the young people who access SexInfo right now get to the sexual health information and the referrals to services.

We also conducted evaluation. It's limited but it really showed us that what we were doing was working. We worked with a Berkeley grad student in public health who went into three of the clinics to which we were referring young people to find out if they knew about SexInfo. Now that they knew about it, would they use it and were they possibly in the clinic that day because of a referral from SexInfo?

We had great results that were actually published in the American Journal of Public Health in March of this year. The youth who are living in the target areas were very likely to report awareness of the service, and the youth in the target areas with the least extensive cell phone providers were more likely to report awareness, which was also really interesting

So we found that we were really reaching the youth at-risk. We also did street outreach and 44% of the youth interviewed remembered seeing the ads for SexInfo. Similar to the other survey, 93% were African American, 77% lived in the target neighborhoods, and 90% had a cell phone.

Miguel Gomez: Whoa. Deb, I'm going to let our listeners ask questions – I won't hog all of your time – but your program has also started to expand and I believe there's actually a program now in the Washington, DC area. Correct, ma'am?

Deb Levine: Yes. Thank you. We launched Real Talk DC, which is a replication of the SexInfo service for young people in Washington, DC. We did that in coordination with the Department of Health's HIV Prevention Office as well as Metro TeenAIDS. And it's great. It just launched last week.

Miguel Gomez: Well, terrific. And we all look forward to hearing more about that and other work. I know I have more questions for you but I'd like to move on to see if the audience, our listeners, have any questions for you. Shawn, can you explain again to our folks how to ask a question?

Coordinator: Sorry. I apologize. I was talking and nobody heard me. Once again, to ask a question you may press star 1 on your touchtone phone. Again, that'll be star 1 for any questions. And we do already have a question from LaShaun Polk; your line is open.

LaShaun Polk: Yeah, I actually have a question in terms of – I think you mentioned it towards the end about using the least expensive cell phone service. And I was wondering, with that in mind, many times some of the least expensive cell phone services don't have the capability to put in those numbers.

So did you all do a survey on what cell phone services – I don't know, in your area - Metro PCS or those kinds or by the minute because I know a lot of times you have used those pay as you go cell phone services. Which ones were applicable and how did you determine if they can use it for their services?

Deb Levine: Right. And thank you. That's a good question. Some of the carriers are local, especially the smaller carriers. Here in Northern California it is Metro PCS.

LaShaun Polk: Okay.

Deb Levine: And there's also Booth Mobile and I believe there's two other companies that really target youth. They don't make you sign a contract, there's month to month service, et cetera.

These carriers do provide SMS text messaging service. It is usually an unlimited amount that they add to your bill per month and it's usually about $5 per month. I don't know of any cell phones that don't provide for text messaging.

LaShaun Polk: Okay. And what the teenager gets – is it more informational? So you've not used this really with any partner notification in tight situations. It's just more for health information around STD and HIV?

Deb Levine: Yes. I would wholeheartedly advise against using cell phones for partner notification services right now for a number of reasons, but the biggest ones being confidentiality and HIPPA.

LaShaun Polk: Sure. Yeah. And that's what I was going to ask, if that was being done, how did you deal with the confidentiality issues or if they have a cell phone in their hand and things of that nature?

Deb Levine: No. I don't think that the technology is developed enough to be able to provide the levels of confidentiality and HIPPA appropriateness that we need in public health. I do know that many clinics are looking at it to use as a reminder service.

LaShaun Polk: Okay.

Deb Levine: So let's say you've got your HIV test but you have to come back in order to receive your results. If a person opts in when they're in the clinic and they've taken their test – let 's say they're not doing the rapid test and they do need to come back for a counseling session – you can say to them, "Would you like to receive a text reminder for your counseling session?"

If they say "yes" or check off a box that says "yes", you take their cell phone number and then you can actually send out a reminder. I still wouldn't say specifically you need to come back for your HIV test results.

LaShaun Polk: Right.

Deb Levine: I would say you need to come back for your test results and then a phone number or an address of the clinic or something that's discreet.

LaShaun Polk: Okay. Now one final question. Again, how did you indicate that the teenager would use it? How would they go about using the service? What do they have to do? What's the process on their cell phones?

Deb Levine: Oh. You'd text the word SexInfo, S-E-X-I-N-F-O – that's your text message and you send it to 61827.

LaShaun Polk: Oh, okay.

Deb Levine: That's the phone number.

Miguel Gomez: And I don't think it's possible to – can you do that any place around the country?

Deb Levine: Yes. Yes. Absolutely.

Miguel Gomez: Well, thank you so much for those questions. Shawn, is there another question from our speakers/listeners?

Coordinator: Absolutely. Once again, if you do have any questions, you may press star 1 on your touchtone phone. Your next question will come from Mario Majette; your line is open.

Mario Majette: Yes. I have a question about the confidentiality and the privacy. What kind of information is collected, who keeps the information, and how is it used?

Deb Levine: There's no information collected and we don't use it other than to provide requested sexual health information in the moment.

Mario Majette: And then to follow up, are there any plans or ideas to collect information for public health purposes in aggregate form in the future?

Deb Levine: I love that question and, you know, we really are always delicately balancing the importance of collecting demographic information so that we have some evaluation data and we can really prove scientifically that our projects work with the community need for trust in the service and privacy. And so I appreciate that you used the word aggregate.

We don't right now collect anything other – we can search by area code to see who called in but the issue with that is young people are mobile and so, you know, someone might have a 202 area code on their cell phone but they may not live in Washington, DC. They could live in Virginia or Maryland or even Florida. So that's the only information we have now.

We don't want to ask any extra questions. We don't want to provide any barriers to young people getting the information they need but there's a possibility of doing the random convenience sample kind of surveys where after someone has texted into the service, asking them are you willing to answer a few questions and we'll give you a coupon for XYZ. So we could do that for, let's say, a one-week period or a two-week period.

Mario Majette: And one last question. Has that been a problem with any of the teens thus far with being concerned about their privacy, someone knowing that they're asking about an STD?

Deb Levine: Not one little bit.

Mario Majette: Okay. Thank you.

Deb Levine: Thanks.

Miguel Gomez: Thanks for your questions. Shawn, is there another question?

Coordinator: Absolutely. Your next question will come from a Michael Kharfen; your line is open.

Miguel Gomez: Michael?

Michael Kharfen: Hi. Hi Deb. I'm with the DC Department of Health and we're very excited about the Real Talk project that we just launched.

Deb Levine: Oh, hi Michael. I've got to talk to you.

Michael Kharfen: Good to talk to you, Deb. I was just wondering that the technology seems to be fairly limited right now with these options in terms of length of messages and connectivity. So do you see in the future or near future the ability to have longer messages, more interactive features with respect to text messaging?

Deb Levine: That's a good question and it's pretty much multi-pronged. As far as more interactive features, that's already available. What we have to do really is continue to watch how young people interact. So we could set up a multi-layered system but if they're not going to get past the first page or the first screen, then it won't work.

So it depends on what young people are used to. They're used to playing games on their cell phones, they're used to watching videos on their cell phones, and they're also used to listening to music on their cell phones. So those are things we already know that they're doing. And can that change? Yeah, there's lots of different features that can be added to it.

SMS, as I think Rick explained really well, is simply a text-based service; it's the lowest common denominator. It's like, right now, programming for people who have dial-up modems on their computers. And so we think it's really important to stay with the lowest common denominator for a while as we watch the patterns of what's happening out there.

Every three to six months, we send a street outreach team on the street and they ask the same five questions, which are to the effect of, What cell phone service do you have? What brand of phone do you have and what features do you use? And what do you most do on your cell phone?

And we have found that in the last six months there's been a giant change such that 35% of the young people are now surfing the Web on their cell phones. And so we were able to develop, at least for the San Francisco site, what's called the WAB site, which is a very, very light Web site that's very easy to view through your cell phone.

So that was the next thing – we thought this is going to reach a large number of young people. We're trying to be careful and not to make it too high tech and keep the focus on the messages, but also be watching and testing to see what's next.

Miguel Gomez: Deb, thank you and Rick, I know you need to leave at the half hour. But on the last question about future direction of cell phones, do you have any additional comments? And I again want to thank you for joining us today.

Rick Broida: No. It's my pleasure. I don't know that text messaging as it exists right now is ever going to really change that much. Obviously, the evolution that has happened in the last couple years is MMS, which is Multimedia Message Service, and that allows you to send pictures and even short video clips.

But beyond that, in terms of message length and so forth, I think we're kind of where we're going to be for the foreseeable future.

Miguel Gomez: Alright. And I think to add to that – Michael, in DC I don't think it's something limiting us right now. It's actually just a big opportunity and also, which is very exciting, Deb mentioned a lot of providers with Federal grants are starting to use appointment reminders through texting.

And on AIDS.gov in the future, you'll be able to get a fact sheet on how several of the Federal grantees are using texting for appointment reminders, and I believe some of the Ryan White grantees are actually doing reminders for people to take their medication.

I want to see if there's a last question because I recognize that we're already at our 30 minutes. Shawn is there another question?

Coordinator: Absolutely. Once again, if anybody does have any additional questions you may press star 1 on your touchtone phone. Your next question will come from Nicola Jurgens; your line is open.

Nicola Jurgens: Hi. We have a quick question. We're located here in Minnesota and we're interested in developing this particular service. We're wondering if it's recreating the wheel and if this is more something that we should refer people in our area to call out to your service out in North California.

We're concerned, though, about directions for services – how to kind of navigate that and if that's a partnership option, or if there's something that we could do to help tailor that to Minnesota or our area?

Deb Levine: You know, partnership is my favorite word. And so you can certainly direct people to the SexInfo service but I don't think that it would be useful in that all the resources are San Francisco-based. All the Real Talk resources are DC-based. What we usually do is partner with a Department of Public Health or a local NGO to set up these services and to inform us about the youth-friendly resources that are available.

Our staff goes out and calls every single one of them to make sure that they haven't changed their hours, they're still open when they said they're open, to find exactly what services they provide, etcetera. So all of that is possible. We're about to set up for the entire State of California all of the Title X clinics that will be searchable by zip code.

So that's in the reproductive health arena but it's certainly all very possible to set up with a partnership.

Nicola Jurgens: Great. And just specifically, we've worked with InSPOT in the past to develop that for Minnesota. Would that be a similar process where it's kind of purchasing into it?

Deb Levine: Yeah, yeah. I think it's been working well for us. We love InSPOT Minnesota. Big old state you have.

Nicola Jurgens: Yeah. Yup.

Miguel Gomez: And actually thank you for that because we're also seeing across the world people and states that have a large rural population – there's a very wonderful popularity of texting. Again, recognizing that we've gone over time. I really want to thank Rick and Deb for joining us today and I'm sorry for those that we couldn't get to your questions.

Please do fill out your evaluation forms and also, again, you'll get a report on today's call. We do want you to know about a campaign called KNOWIT that's a partnership between the CDC, the Kaiser Family Foundation, and AIDS.gov. It's a wonderful program that allows folks to use their mobile phone or their cell phone. If an individual types "KNOWIT" or the digits associated with the phrase "KNOWIT" – 566948 – and then enter your zip code in the text box and send your message, you'll receive a text message with the name of a testing center near you and its phone number.

And the Department of Health and Human Services is encouraging all of its grantees to promote the KNOWIT campaign to once again provide people on the ground another vehicle to find a local HIV testing site. To learn more about this KNOWIT campaign, you can go to our AIDS.gov Web site and on the left-hand side you'll see a green button that talks about it. Just click on that or go to a very comprehensive [Web site], and one of the best sites out there to find information about HIV testing, that CDC manages called HIVtest.org.

Again, I really want to thank all of you for joining today and if you didn't register for this call, do send us an e-mail – or you won't get a copy of that report – to contact@aids.gov so we can send you that report and a transcript of the call.

I hope that you all have a good day and we look forward to you participating in our next AIDS.gov Conference Call. Take care everyone. Thank you.

Deb Levine: Thank you.

Rick Broida: Thank you.