Communication through media and from person to person is vital to influence behaviour change that is useful for HIV prevention, according to research.
The recent HIV National Communication Survey shows that more than 80% of South Africans have been exposed to media programmes designed to combat the spread of HIV. The effect of these programmes has been to encourage people to adopt practices that would protect them from infection. The added benefit has been the creation of an enabling environment for people to share information with many others, thus spreading the word of HIV prevention.
"Communication is not just about what the Brothers for Life campaign will say, what loveLife will say, but also communication between couples, people who know each other, friends. That communication has an effect too. People who know about the efficacy of medical male circumcision, people who propagate the use of condoms are also encouraged to talk to each other; men must talk to each other about testing for HIV. Communication is not about us just talking to people and placing communication programmes there. It's also about the listeners communicating in their own homes, in their own circles. The survey shows that people who do that are more likely to take up positive behaviours, they are more likely to test. So, talk to your partner, talk to your friends, talk to your children. That is communication", says Mandla Ndlovu, communications for the Johns Hopkins Health and Education Programme in South Africa.
The survey has found that about 10 million South Africans took the HIV test in the last two years. Respondents have said that they were largely encouraged by President Jacob Zuma and Health Minister, Dr Aaron Motsoaledi who spoke openly and took public HIV tests. According to loveLife's Director of Programmes, Dr Andile Dube, this leadership can also take place at community level.
"Even if you are a young person, but also do go for testing or do encourage or talk about your intention to go for testing, it shows that it does have influence on what people do after that", Dube says.
The survey also sought to find out what impact communication programmes have had on condom usage over the last three years. It found that a significant two-thirds of South Africans have used a condom the first time that they had sex. More generally, it found that condom use varied according to age group and whether sex was with a partner or not.
"It's higher among young people; it's higher among people engaging in casual sex. As people get older and as people get into more stable relationships, they tend to stop using condoms. That's why it's so important to combine the information on condom use with the information on HIV testing because the rational thing that people are saying is: 'You don't know somebody. You don't know their status. You start having a relationship with them. You start off using condoms'. But then, the concern is over time, that people stop using condoms once that relationship develops.
And so, the challenge is to tell people: 'Hold on. At that stage you need to go and have an HIV test. Find out your partner's HIV status (and) your HIV status and then decide: Do you stop using condoms or don't you?", according to Dr Saul Johnson of Health and Development Africa, which managed the study.
Also importantly, the study compared condom use between circumcised and uncircumcised men. It was important to compare the two groups of men as there have been fears that scientific research that has shown that medically circumcised heterosexual men are at low risk of contracting HIV could be misconstrued to mean that if medically circumcised, men may not use condoms.
"It was almost identical - the percentage between circumcised and uncircumcised men - it's about 50%. About half of men said that they used a condom the last time they had sex. There was no statistical difference. It looks like circumcised men seem to know that they still have to use condoms. The message is out there and it doesn't look like circumcised men believe that they are protected and they don't have to use condoms", Johnson says.
Dr Johnson says the findings are encouraging, but warns that there is still a long way to travel in the response to HIV.
"HIV is going to be with us for a long time. There's nothing to suggest that there are any cures around the corner or any magic bullets. But, I think it's encouraging. We can be confident that people are really hearing and trying to take steps to protect themselves", he says.
The HIV National Communication Survey involved a cross-section of 10 000 South Africans across the country.