Evidence: HIV Communication Programs, Condom Use at Sexual Debut, and HIV Infections Averted in South Africa, 2005
Participating organisations in the Global Alliance for Social and Behaviour Change - Building Informed and Engaged Societies were asked to identify, in their opinion, the 5 most compelling research and evaluation studies that demonstrate the direct impact of this field of work on a major development issue. This was one of the nominees. For the full compiled list, please click here. For the compilation of the key impact data across all research evidence identified, please click here.
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Title of paper, article, book (chapter), publication?:
HIV Communication Programs, Condom Use at Sexual Debut, and HIV Infections Averted in South Africa, 2005
Name(s) of author(s)?:
D. Lawrence Kincaid, Stella Babalola, and Maria Elena Figueroa
Who published this paper, article, book (chapter) or other publication?:
Journal of Acquired Immune Deficiency Syndrome (JAIDS), v66, Supp 3, August 15, 2014, S278-S284.
What are the best extracts that highlight the evidence for the impact of a communication for development, social change, behaviour change, public engagement, or informed citizen strategy on a development issue and priority?:
Over the past 20 years, communication programs in South Africa have educated the public about AIDS, emphasizing use of condoms. A systematic review of HIV/AIDS mass communication campaigns has shown that they have increased condom use (Noar SM, Palmgreen P, Chabot M, et al. 2009) Secondary analysis of the 2008 Human Sciences Research Council survey found a positive association between exposure to HIV communication programs and condom use at last sex (Peltzer K, Parker W, Maboso M, et al., 2012). Yet doubts remain that this change can be attributed to condom use, primarily because, at the individual level of measurement in population surveys, the correlation between condom use at sexual debut and HIV-positive status can be positive rather than negative. Many may already be infected before they start using condoms consistently or because condoms are used inconsistently and/or incorrectly. The role of condom use at sexual debut has been overlooked. Two interrelated hypotheses are tested: that HIV communication programs have an indirect effect on HIV status through their direct effect on condom use at sexual debut and that condom use at sexual debut assists in the prevention of HIV infection. Results: After controlling for 17 socioeconomic variables, awareness of HIV communication programs had a positive, dose–response relationship with self-reported condom use at sexual debut. Those who used condoms at sexual debut were 1.38 times more likely to have remained uninfected. HIV-negative status was 3.6 percentage points higher among those who used condoms at sexual debut, corresponding to an estimated 139,835 infections averted among sexually active adults by 2005. Never using injectable drugs and having one trusted partner also predicted HIV-negative status.
To which development issue does this evidence and impact data relate?:
HIV prevention, infection prevention
To which strategic approach(es) does the evidence and impact data relate?:
Mass communication condom use campaigns.
What research methodology (ies) was/were used to produce this evidence and impact data?:
All persons over 2 years of age living in households in South Africa were sampled by means of a multi-stage disproportionate, stratified sampling approach, using a sampling frame provided by Statistics South Africa for the 2001 census. The data were adjusted for nonresponse and weighted by gender, age, race, locality type, and province to produce a representative sample of the population. Our analysis used a subsample of 6829 adults aged 15–84 years who reported having sexual intercourse during the previous 12 months (sexually active), answered the question about condom use at sexual debut, and agreed to be tested for HIV. This subsample represents a frequency-weighted population of 18,922,667 adults. A combination of existing statistical methods was used to test the assumptions required for enhancing causal arguments. These include structural equation modeling with multivariate probit regression to test the path from communication awareness to condom use to HIV status, and propensity score matching (PSM) with sensitivity analysis to estimate the proportion of HIV-negative status that can be attributed to condom use at sexual debut. These complementary statistical methods provide mutually reinforcing strength to arguing that statistical associations might have a causal element.
What is the URL to access this paper, article, book (chapter) or other publication?:
Why was this research evidence found to be useful?:
This is one of the first studies to validate the causal link between recall of condom use messages in media campaigns to condom use at first sex and subsequent HIV status. This is also one of the first (perhaps only) study to estimate the number of HIV infections prevented at the population level as a result of communication exposure and condom use at first sex.