The Drum Beat 166 - South Africa HIV/AIDS Communication Strategies

STRATEGIC COMMUNICATION ANALYSIS

HIV/AIDS poses a considerable strategic test for development communication. In South Africa HIV/AIDS has become a major development issue with some parts of the country having 20% or higher infection rates. South Africa also has a reasonably developed, though inequitably shared and acccessed, communication sector. Within that environment the full range of HIV communication strategies and activities have been implemented - from local community action to national scale programmes.

An important goal of The Communication Initiative is to share and facilitate strategic analysis of development communication activities. This Drum Beat presents excerpts, with links to the full document, from a paper written by Nancy Coulson, a communication researcher in South Africa. In "Developments on the use of mass media at the national level for HIV/AIDS prevention in South Africa" she critically analyses the effective use of mass media in addressing HIV/AIDS by focusing on 3 major programmes - loveLife, Soul City and the Beyond Awareness II Campaign. This issue also includes excerpts and links to responses to Nancy's critique from the 3 organisations which implemented these programmes.

Click here to access the full paper.

Click here to access the full response from Beyond Awareness II Campaign.

Click here to access the full response from Soul City.

Click here to access the full response from loveLife.

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DEVELOPMENTS IN THE USE OF THE MASS MEDIA AT THE NATIONAL LEVEL FOR HIV/AIDS PREVENTION IN SOUTH AFRICA
- extracted from the paper by Nancy Coulson

Communication Context

1. "In South Africa it is estimated that 99% of people have access to the radio, 75% have access to television and 7% readership of newspapers. 69% of young people watch TV 5 or more days a week". Click here for more.

Focus of the Strategic Review

2. "This review examines 3 critical areas for mass media work; the conceptualisation and strategy, the research and development phase, and the evaluation, impact and cost effectiveness of mass media work for HIV/AIDS prevention." Click here for more.

3. loveLife: "...loveLife describes itself as a "deliberate departure from traditional approaches to HIV prevention, relying on a combination of commercial marketing and public health techniques to promote a new healthy lifestyle among 12-17 year old target group..." Click here for more.

4. Soul City: "...Now in its 9th year, this multi-media edutainment project is in the development phase for its 6th television and radio series and estimates to have spent up to 70% of their total budget on HIV/AIDS work. (Soul City has also covered a wide range of other health promotion topics in addition to HIV/AIDS.)..." Click here for more.

5. Beyond Awareness: "...Beyond Awareness I and II had a much stronger strategy that extended beyond the traditional boundaries of the mass media and involved working partnerships between government and civil society. Beyond Awareness II was a 2 year [Department of Health] campaign that ended in October 2000 with a total budget of R26 million..." Click here for more.

Critical Observations

6. loveLife...emphasise[s] the need for a fresh approach to HIV/AIDS prevention that is not led by the mass media...60% of the total loveLife budget is spent on work that does not involve the mass media. Notably, loveLife promotes the establishment of youth Y-centres (which operate as multi-functional lifestyle and health centres), support to the National Adolescent Friendly Clinic Initiative, and a school sports programme. Click here for more.

7. Beyond Awareness II identified the promotion of social action through targeted projects as one of their 5 main objectives. This commitment was met through the initiation of a number of national projects including the AIDS Memorial Quilt Project, The Tertiary Institutions Project, The AIDS Mural Project and a Care and Support Project. These projects reflected 15% of their total expenditure. Click here for more.

8. Soul City believes that their mass media success creates opportunities for further health promotion work. They argue that their media success provides the credibility necessary for advocacy work, for example. Click here for more.

9. The Beyond Awareness campaign has succeeded in popularising the red ribbon. In their sentinel site research, they found that 74% of respondents report having seen the red ribbon before. However, recognition of having seen the red ribbon is much higher than the ability to think of a symbol that stands for AIDS without prompting. Exposure to the red ribbon was generally found to be high... Despite the high exposure, there is no documented evidence by Beyond Awareness II of what the red ribbon symbol means to the public. Click here for more.

10. In a study looking at the value associations of the Soul City brand, it was found that the brand is largely defined as educational, but with entertainment value. The value associations with Soul City are positive. The "Soul City" brand is found to be trustworthy, healthy, experienced, reliable, knowledgeable, aspirational, reflecting values of selflessness, understanding and togetherness... Click here for more.

11. In the evaluation of the 1st year of loveLife, one of their greatest successes is thought to be creating brand recognition among almost 60% of South Africans nationally. More than 90% of those who are aware of loveLife correctly identify the brand with healthy living and positive lifestyle, and 60% said that loveLife had caused them to think and talk about issues related to sex, sexuality and HIV/AIDS. Click here for more.

12. Beyond Awareness did not document any pre-testing of their messages neither did they specifically evaluate recall of messages in their sentinel site research. The mass media component of the Beyond Awareness campaign that promoted specific messages spent approximately 34% of the total budget over 2 years. Click here for more.

13. ...by their own admission, the billboards and taxi adverts appear to have been more successful in communicating AIDS awareness than loveLife's intended message of "talk about it", highlighting the fact that branding and messages are undifferentiated in the loveLife campaign. Although it is not clear from the evaluation report what messages respondents were asked to comment on, one of the results is that 32% of the sample perceived the main message to be "advising people to wear condoms". This is an interesting conclusion because there are no loveLife messages communicating this, so this is information that young people are getting from other sources. Click here for more.

14. Soul City...estimate that the development phase for an edutainment product amounts to 50% of the project time. The Soul City AIDS messages have included a full range of prevention and care support messages...Soul City does not have a sustained media presence as their messages are primarily woven into TV and radio series. The TV series, when flighted [screened], runs over a period of 13 weeks. Click here for more.

15. Beyond Awareness II was criticised at the end of their campaign period for failing to have any assessment of their impact. Although they had evaluated many of their component parts, they had no evidence of the impact of their mass media campaign or of the campaign as a whole. The call rates to the AIDS Helpline were reported to increase with advertising bursts, but there was not any attempt made to factor in other programmes that also promoted the call line... Click here for more.

16. In their evaluation of the 4th series, Soul City has tested their theoretical model and demonstrated a "dose" related response. (The greater the "dose" or amount of Soul City to which the respondent has been exposed to the more likely he/she is to adopt health-seeking behaviours.)... 38% of [young respondents] who watch Soul City television a lot always used condoms. In comparison, 26% of those who watch television, but did not watch Soul City, reported that they always used condoms. Click here for more.

17. loveLife states that 71% of rural South Africans know about them although they cannot say what the impact of this is. They refer to a number of media strategies to serve rural communities such as 120 branded water tanks in communities without reticulated water, 2 outdoor broadcasting units in rural KwaZulu-Natal and Eastern Cape and the Love Train used as an outreach vehicle to rural towns. Despite this, the question that is left unanswered is who takes responsibility to ensure that mass media interventions are reaching rural and poor communities and that these communities do not remain behind with respect to prevention indices. Click here for more.

18. To underpin their own strategy...loveLife quote the following statistics. "...South Africa spent some 11 years and millions of Rands on the traditional HIV messaging... to little effect. The result is 98% awareness of HIV and virtually zero behaviour change. Condom usage across all population groups has remained almost unchanged at 12% for more than five years."...not everyone [agrees]...it is argued by Parker that there is "wide ranging evidence in numerous studies of youth behaviour in South Africa that condom use is high, and that it has increased appreciably over the past five years."...280 million condoms were distributed or sold during 2000 and that this equates to 224 million acts of safer sex. He then quotes figures from the antenatal HIV and STD prevalence study that show there is a decline in prevalence over 3 years - in particular amongst youth. Click here for more.

19. The impact of careful "pro-social" role modeling is shown in [Soul City's] evaluation to go far beyond individuals. In their evaluation of the 4th series, there is a powerful case study of an informal settlement area in Mamelodi, Gauteng that renamed itself "Soul City". The case study gives qualitative insights into the process unfolding in this community. However, what is striking is how closely the community identifies with the people of the Soul City TV series and their struggle for development. Click here for more.

20. Lastly, the framework developed by UNAIDS for African communication campaigns is not reflected in the present documentation of the programmes reviewed here. Given the conclusion of this review and of the UNAIDS review that communication strategies need to unfold at a community level, this may be an appropriate moment to consider the application of the 5 domains... Click here for more.

COUNTER ARGUMENTS

21. Response from loveLife:
"The biggest concern is that there have been at least two subsequent pieces of evaluation of loveLife that need to be taken into account... The other major concer...is that loveLife's mass media has been separated from the service components of loveLife. While obviously one of the objectives of the mass media is exactly that - mass media - the other main objective is to provide the framework and content for direct interaction with young people through all of loveLife's service programs - from the call centre, to the 15 Y-Centres, to the 107 NGOs engaged with young people through the loveLife franchise, to the 80 government clinics doing the same, to the 600 groundBREAKERS at the point of interaction with 12-17 yrs olds, through the loveLife Games with 250 000 participants, to the Love Tours and Love Train...

22. Response from Beyond Awareness:
Coulson appears to have misunderstood the nature and purpose of the sentinel site research. In essence, the premise was that most campaigns study their impact via specific reference to themselves, and there was a need to come up with a generic frame of reference to understand what the general communication and behavioural environment was about - media access, differentials between rural and urban contexts, behavioural risk factors, amongst others... Another issue Coulson raises is that "pre-testing" of messages was not documented. Quite frankly, all of the campaigns described by Coulson would be hard pressed to provide documentation of "pre-testing" in relation to all of their multilayered communication activities. There is a disturbing "monotheism" that seems to exist around pre-testing that runs counter to a number of alternative methodologies for message development...

23. Response from Soul City:
Soul City evaluations strive to look at change and then to look at whether Soul City is associated with that change - this of course does not preclude other inputs into that change. However, the consistency of change associated with Soul City and the dose response relationships as well as the qualitative research outlining numerous stories of change directly attributed to Soul City strongly suggests that the impact can be measured and is positive over a range of aspects of behaviour change...

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