Communication Campaigns in the Context of a Severe HIV and AIDS

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					Communication Campaigns in the
Context of a Severe HIV and AIDS
   Epidemic in South Africa




                      Dr Warren Parker
    Centre for AIDS Development, Research and Evaluation
                      www.cadre.org.za
     The HIV epidemic in SA
      The HIV epidemic is severe, affecting all age groups
      Large prevalence variations exist between sexes, age
       groups, race groups and communities
      Most severely affected are females <20; females aged
       20-40 and males aged 25-45
      Children and older age groups significantly affected
40


35                                                     3 3 .3


30
                                                                     2 6 .0
25                                       2 3 .9                 2 3 .3        2 3 .3

                                                                                   1 9 .3                                                 Male
20
                                                                                            1 7 .5                                        Female
                                                                                                                          1 4 .2
15
                                                  1 2 .1                                         1 2 .4
                                                                                                          1 0 .3
                           9 .4                                                                                    8 .7
10
                                                                                                                                   7 .5
                                  6 .0
5       3 .2 3 .5   3 .2


0
          2-14       15-19         20-24            25-29         30-34         35-39         40-44         45-49           50-54



     HIV prevalence by age and gender, South Africa, 2005 (NM/HSRC)
Antenatal HIV trends in SA
 Antenatal data show steady increase from 0.7% in 1990
  to 30.2% in 2005
 Recent national trends for pregnant females 15-49 are
  27.9% in 2003, 29.5% in 2004 and 30.2% in 2005
 No declines amongst females under 20 in past 5 years
  (proxy HIV incidence indicator)
  17.0%
                                                   16.1%
                                      15.8%                      15.9%
  16.0%
           15.4%

  15.0%                 14.8%


  14.0%


  13.0%


  12.0%


  11.0%


  10.0%
           2001          2002         2003          2004         2005


  Antenatal HIV prevalence of women under 20, South Africa, 2001-2005 (DOH)
Regional trends
 Southern African countries remain most severely affected
  by HIV and AIDS
 Increases in knowledge, reduction in stigmatising
  attitudes, increases in condom use, and increased uptake
  of services such as VCT or ARV provision occur year-on-
  year in all countries
 HIV prevalence declines have been observed recently in a
  number of African countries – eg. Zimbabwe, Namibia,
  urban Rwanda, urban Ethiopia, urban Kenya, Malawi and
  Zambia
 Declines have occurred without major differences in socio-
  economic context, and have largely been linked to
  delayed sexual debut and having fewer sexual partners,
  with some changes attributed to using condoms with
  casual sexual partners (ie. significant behavioural change
  in relation to exposure to HIV)
AIDS communication
 AIDS communication can be defined as any
  communication activity involving content that is related to
  HIV and AIDS
 AIDS communication occurs through diverse ‘channels’:
  - mass media (television, radio, print, outdoor)
  - small media (leaflets, posters, booklets, stickers)
  - events (exhibitions, rallies, conferences, drama)
  - icons and artifacts (red ribbon, AIDS quilts, memory
    boxes, artworks, photographs)
  - interactive communication (teaching/learning in small
    groups, counselling, information provision)
  - interpersonal dialogue (talking to friends, family,
    colleagues and others)
  - involvement (working in AIDS field, volunteer activities,
    organisational involvement)
Purposive and non-purposive
communication
 AIDS communication is defined by varying degrees of
  formality and ‘purpose’ (or intention)
 AIDS organisations generally have a formal mandate to
  communicate about the disease, and a number of
  organisations have specific communication functions and
  objectives
 AIDS communication extends beyond formal education-
  oriented communication interventions. It includes
  discourses about AIDS in:
  - news, feature, talk show and entertainment programmes
    - promotional and public relations communication,
    advocacy, lobbying
  - conversations, arguments, discussions
Purposive AIDS communication
Purposive AIDS communication:
 … typically relates to a continuum of HIV and AIDS focal
  areas including prevention, care, treatment, support and
  rights
 … occurs in a layered fashion at international, regional,
  national, provincial, local community and individual level
 … occurs within a general conceptual framework of
  Western science, but can include alternative (and
  contested) frameworks of meaning
 … is framed by principles or assumptions of health and
  social betterment
 … is ever changing in relation to content, timing and
  intensity
Non-purposive AIDS communication
Non-purposive AIDS communication:
 … encompasses individual and social responses related
  to living in/through a severe AIDS epidemic
 … includes wide-ranging interpretations of the disease
  and the epidemic
 … includes processes of making meaning, including
  involvement in AIDS response, but also a relation to
  myths, stereotypes, and other forms of sense making
 … is related to direct experience of the epidemic and
  includes knowing people living with HIV, and/or who have
  died of HIV, and/or living with HIV oneself
 … is ever changing in relation to content, timing and
  intensity
Context of the present study
 People living in South Africa are exposed to wide-ranging
  AIDS communication
 A number of national and sub-national studies have
  addressed knowledge, behaviour and HIV prevalence and
  some have included an AIDS communication focus
 A number of evaluative studies have been conducted by
  AIDS communication organisations, but these have
  largely focused on specific/single interventions
 This study sets out to inform understanding of national
  communication interventions that use mass media. Focal
  areas include: demographic characteristics of audience;
  knowledge, attitudes and behaviours relevant to AIDS;
  exposure to interventions; impacts of interventions
 The overall goal is to identify successes and gaps and to
  inform future strategy
Methodology
 A cross-sectional household survey with a sample size
  of 7006 individuals aged 15-65 (one person per
  household)
 Stratified by province, race and locality type
 Probability of household selection proportional to 2001
  census. Additional sampling procedures and weighting of
  data used to achieve representivity
 Approach similar to that used by HSRC/Nelson Mandela
  survey (2002/2005) and RHRU survey (2004)
 Questionnaire-based using electronic questionnaires and
  administered by AC Nielsen
 Fieldwork conducted in first six months of 2006
Findings:
economic & educational status
 Amongst youth 15-24, nearly half (48.6%) are
  learners/students and a third (31.8%) are unemployed and
  looking for work
 Amongst 25-34 year olds, nearly half (49.3%) are
  unemployed and looking for work
 Nearly all respondents in formal urban areas (95.2%) had
  access to water in home or on stand, compared to 70.6%
  for informal urban areas and 48.1% in rural areas
 Nearly a third of respondents in formal urban areas
  (29.1%) went without fuel for cooking or heating often or
  sometimes, compared to 47.2% for informal urban areas
  and 41.6% for rural areas
 Respondents with less than grade 7 education included
  10.6% of 15-24 year olds, 21.4% of 25-49 year olds and
  47.5% of those aged 50+
Findings:
Exposure to AIDS
 A third or more of respondents in all age groups have
  attended funerals of people who they know have died of
  AIDS in the past year
 Nearly half (49.6%) of all respondents aged 25-49
  attended two or more funerals of people who have died of
  AIDS in the past year




Funeral attendance in past year      15-24   25-49   50+
Not attended funeral                 38.5    19.9    23.0
Attended funeral but not AIDS        30.3    30.5    38.6
Attended one AIDS funeral            13.0    12.8    7.0
Attended two or more AIDS funerals   18.2    36.8    31.4
Findings:
Relation to AIDS
Relation to AIDS                                 15-24   25-49   50+    All

Have received information about AIDS from a       2.7     3.8    4.0    3.5
traditional healer
Have helped or volunteered at an AIDS             5.0     7.8    8.3    7.0
organization or group in community
Attended a meeting on AIDS in the community      14.3    18.0    13.7   15.3
where I live
Attended a workshop on AIDS                      15.2    19.0    13.0   15.7

Have helped care for a person sick with AIDS     12.6    20.8    16.5   16.6

Have received information about AIDS from an     24.1    24.1    21.3   23.2
organization in my community
People in my community are joining together to   33.4    34.7    37.9   35.3
help people with HIV and AIDS
Have worn a red ribbon for AIDS                  40.6    38.1    28.2   35.6

Attended meetings about AIDS in workplace        27.0    42.1    38.7   35.9
(of all who are full time employed)
Heard HIVAIDS spoken about at a place of worship 43.7    45.6    46.9   45.4

Have received information about AIDS from a      47.1    53.9    37.1   46.0
nurse/doctor
Attended AIDS education classes in school        74.4
(full-time learners only)
Findings:
Exposure to media
 Exposure to radio highest, but TV not far behind
 Community radio reasonably high, relative to coverage by
  community radio stations
 Regular newspaper exposure applies to between a third
  and half of respondents


Exposure tw o days a w eek or more   15-24   25-49   50+
Radio                                84.3    84.9    79.9
Community radio                      46.3    42.9    37.4
Television                           80.9    77.3    74.6
Magazine                             28.0    25.8    22.7
Newspaper                            39.1    45.8    37.4
Internet                              7.3     5.9    5.1
Findings:
Exposure to AIDS interventions: TV
 High overall exposure of programmes relative to their
  target audiences
 Reach of interventions remains low in 50+ age group

TV exposure in past year          15-24   25-49      50+

Lovelife (advert or programme)    78.3    67.1       42.7

Soul City                         74.4    66.2       42.8

Takalani Sesame                   65.1    54.2       40.0

Soul Buddyz                       69.2    52.3       29.2

Khomanani (advert or programme)   59.8    53.9       35.8

Tsha Tsha                         61.4    47.3       21.8

Beat It Š Siyannqoba              32.2    27.5       15.0

Choice TV talk show               22.7    18.2       8.5
Findings:
Exposure to radio and ‘other’
Radio exposure in past year   15-24   25-49   50+

Lovelife                      66.5    57.4    37.2

Khomanani (advert)            50.4    48.6    33.2

Soul City                     39.8    36.9    24.7

Soul Buddyz                   30.5    24.3    13.5

Other exposures               15-24   25-49   50+

Heard of Choice condoms       88.4    76.4    48.9

Seen loveLife billboard       79.9    71.2    49.5

Read Khomanani Leaflet        39.2    38.1    20.7

Heard of TAC                  25.3    33.7    28.0

Read Khomanani Newspaper ad   32.6    34.7    19.2

Know of AIDS helpline         23.5    19.0    10.2

Read ScamtoPrint              18.6    10.1    4.0

Know of ThethaJunction         5.8     3.5    1.4
Findings:
Knowledge
 Knowledge of condoms for prevention very high
 Abstinence recognised by all age groups
 Considerably lower ‘top of mind’ awareness of limiting
  numbers of sexual partners
 Knowledge of partner numbers vs HIV risk is poor
HIV prev ention (Unprompted)                             15-24   25-49   50+
Using condoms                                            92.0    90.9    76.2
Sticking to one partner, being faithful                  18.9    28.8    31.3
Reducing number of sex partners                           5.1     7.6    5.4
Abstaining from sex                                      46.4    37.3    31.3
Avoiding contact with blood                              26.0    21.8    19.6
Using drugs for PMTCT                                     1.4     1.3    1.2
Key knowledge questions                                  15-24   25-49   50+
If you have fewer sexual partners, you are less likely   49.0    50.3    56.5
to get infected with HIV
Composite score of all other knowledge questions         79.0    79.9    74.8
Findings:
HIV testing
 Very high awareness of a place nearby that provides HIV
  testing
 Around half of all 25-49 year olds have been tested
 Very high proportion – more than 50% of those ever
  tested – were tested in past year

HIV Testing                                           15-24   25-34   35-49   50+
Know of place near where live or work where can get   87.9    91.9    90.1    80.9
tested for HIV
Ever been tested (of all respondents)                 26.3    52.6    49.2    33.1

Tested in past year (of all respondents)              15.2    27.1    23.7    14.3
Findings:
Age of sexual debut
  One in ten young people aged 15, one in five aged 16,
  two in five aged 17, and more than half aged 18, have had
  sex


 100                                                                          93.5
                                                         87.2   87.1   88.8
 90
                                                  82.9
 80

 70                                    63.8

 60                            57.4

 50
                       40.9
 40

 30
              22.6
 20
       10.2
 10

  0
       15      16      17      18      19         20     21     22     23     24


 Ever had sex by single age, South Africa, 2006
Findings:
Sex in past year/month (of had sex before)
In high prevalence age groups (15-24; 25-34)…
 Some secondary abstinence…
 Variances between males and females with 2+ partners
 2+ partners in past year high risk, 2+ partners in past
  month very high risk
Sexual partners in past YEAR    Male 15-24   Female 15-24   Male 25-34   Female 25-34
None / Secondary abstinence       16.6           14.5          9.6           12.3
One                               50.2           72.9         66.4           81.4
Two                               15.8           7.8           11.5          4.9
More than two                     17.4           4.8          12.6           1.4
Sexual partners in past MONTH   Male 15-24   Female 15-24   Male 25-34   Female 25-34
None / Secondary abstinence       32.3           32.6         20.8           25.0
One                               56.9           63.8         71.3           72.8
Two                                8.0           2.6           4.6           1.6
More than two                      2.8           1.0           3.3           0.5
Findings:
High risk partnerships in past month
 High levels of 2+ partners in past month in all three
  locality types amongst youth aged 15-24
 Relatively high amongst 25-49 year olds, but very low
  amongst 50+
 Levels considerably lower amongst married respondents

Sexual partners in past MONTH                  0      1     2     >2
Urban Formal (15-24)                          34.7   58.4   5.3   1.7
Urban Informal (15-24)                        24.9   68.5   3.6   3.1
Rural (15-24)                                 31.4   60.2   6.3   2.2
Urban Formal (25-49)                          21.5   75.4   2.3   0.8
Urban Informal (25-49)                        28.2   67.7   2.8   1.4
Rural (25-49)                                 24.5   70.9   3.0   1.6
Urban Formal (50+)                            40.3   59.3   0.5   0.0
Urban Informal (50+)                          40.9   59.1   0.0   0.0

Rural (50+)                                   57.0   41.6   1.1   0.3
Married (25+ living with husband/wife)        12.0   87.1   0.8   0.1
Unmarried (25+, living with boy/girlfriend)   14.8   80.9   3.4   0.9
Findings:
Marital patterns in South Africa
 Very few young people under 25 are married and living
  with their partner (1.9%)
 Only one in five (20.4%) 25-34 year olds are married, and
  only around half of 35-49 and 50+ years olds are married
 Very few youth (15.6%) are in a steady relationship, and
  54.8% of young people aged 25-34 define themselves as
  single
Relationship status                        15-24   25-34   35-49   50+
Married [living with husband/wife]          1.9    20.4    48.3    54.1
Married [not living with husband/wife]      0.3     1.6     4.9    5.3
Have cohabiting boyfriend/girlfriend        2.3    10.6     9.8    2.9
Have non-cohabiting boyfriend/girlfriend    9.0    11.0     6.3    0.3
Single                                     86.4    54.8    21.1    10.0
Widowed / divorced / separated              0.0     1.6     9.6    27.4
Findings:
Condom use at last sex
 Condom use at last sex overall high, and highest amongst
  youth <25, and similar by locality type
 17.1% for married; 51.9% for unmarried (amongst 15+)

              Ages 15-24             %
                Urban formal        72.7
                Urban informal      67.1
                Rural               63.5
              Ages 25-34
                Urban formal        45.5
                Urban informal      48.9
                Rural               48.7
              Ages 35-49
                Urban formal        27.1
                Urban informal      30.5
                Rural               25.6
              Ages 50+
                Urban formal        12.6
                Urban informal      25.4
                Rural               10.6
Conclusions
 Findings consistent with other surveys
 Overall high awareness of and exposure to the epidemic
  - high exposure to context and consequences of the
    epidemic (eg. community-level activities, funerals)
  - involvement relatively high (eg. wearing a red ribbon)
  - high exposure in workplaces, religious gatherings and
    via health services
 High levels of access to radio and television, and high
  exposure to mass media components of national
  interventions
 High levels of response to VCT and condom promotion
 Relatively low awareness of importance of limiting sexual
  partners and delaying sexual debut
 Situation exacerbated by late and low levels of marriage
 Reducing partner turnover and delaying sexual require
  urgent intensified focus

				
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