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"Abstinence. Ile che," says Simon Lungu, a stylish young man wearing a baseball cap. The catchphrase 'abstinence ile che' — abstinence is cool, in the local language — is making the rounds among young people in Zambia in large part because of a communication campaign targeted at youth and funded by the U.S. Agency for International Development (USAID),” reported The Christian Science Monitor in 2002. Known as the HEART campaign (Helping Each other Act Responsibly Together), the campaign was designed in close collaboration with Zambian youth to have maximum impact. The campaign, designed and implemented jointly by Population Services International (PSI) and the Johns Hopkins University Center for Communication Programs (JHU/CCP) with the active participation of Zambian youth, “is sending out a strong abstinence message and promoting consistent condom use among youths as part of an attempt to combat the spread of AIDS,” according to the Monitor. “USAID says it could be a model for AIDS reduction programs elsewhere in the world.” For the last 10 years, PSI and its Zambian affiliate, the Society for Family Health (SFH), have used social marketing to promote a variety of healthy behavior. In Zambia and elsewhere, PSI has long implemented a comprehensive approach to HIV/AIDS prevention — including abstinence, voluntary counseling and testing (VCT) and, for those who do not abstain, correct and consistent condom use. Research has shown that abstinence and condom use have both increased during the years that PSI/SFH have implemented their social marketing program: A 2001 research study shows that viewers of the HEART campaign TV spots were 1.7 times more likely to report abstinence and almost twice as likely to report condom use than non-viewers. Data through the late 1990s shows that HIV prevalence among young people 15-24 in Zambia has either stabilized or declined. An article in “AIDS 2001” entitled “Declining HIV prevalence and risk behaviours in Zambia: evidence from surveillance and population-based surveys” reported that the “data showed a dominant trend of significant declines in HIV prevalence in the 15-19 years age-group, and for urban sites also in age-group 20-24 years.” There was also evidence of increased condom use and decline in multiple sexual partners in urban areas. New data is expected soon that will shed further light on trends in HIV prevalence. PSI launched the Zambia Social Marketing Project in 1992 in an environment
in which the demand for condoms far exceeded the supply and in which
existing behavior change campaigns were characterized largely by counterproductive
scare tactics. Commercial condom brands sold in private sector outlets
were expensive and free condoms were often not available or inconvenient
to obtain. PSI instituted a consumer-oriented approach in which positive
messages were developed and tested with feedback from the target groups.
PSI also promoted abstinence, delayed onset of sex and VCT through a series of behavior change campaigns. The most recent and well-known of these campaigns, HEART, was designed
by PSI, SFH, JHU/CCP, the Government of Zambia and several young Zambians
specifically for youth aged 15-19. The campaign informed young people
about HIV/AIDS and promoted abstinence, delayed onset of sex and condom
use as ways to protect oneself from HIV/AIDS. Pre- and post-test surveys
were conducted of the first phase. Among the salient findings were the
following:
Focus group discussions with Zambian girls said they wanted concrete messages with reasons to stay virgins or return to abstinence. The decision to abstain was frequently reported as a direct result of exposure to the HEART program. Respondents were more likely to say they chose to abstain rather than to report condom use, a finding that counters the common argument that TV/radio spots about safer sexual behavior encourage promiscuity. “Zambia’s HEART program is a good example of an HIV/AIDS prevention strategy that is working,” said Dr. Paul De Lay, senior HIV/AIDS adviser at USAID at the 14th International AIDS Conference in Barcelona last year. “The data show young people are willing to abstain from sex or use condoms as a result of the HEART spots on television and radio.” To strengthen further its HIV/AIDS prevention program, PSI/SFH opened the New Start voluntary counseling and testing (VCT) center in Lusaka in 2002 (which PSI is now doing in 14 African and Asian countries). Research has demonstrated that VCT is an effective and cost efficient intervention that results in sustained behavior change.
Dr. Kaunda, himself a lay pastor, has facilitated collaboration between PSI/SFH and Christian churches in Zambia on HIV/AIDS prevention activities. Dr. Kaunda also appeared in a series of TV and radio spots promoting openness about HIV/AIDS, compassion for HIV positive people, condom use and VCT. A second phase of the Kaunda campaign focuses on further reducing stigma around HIV/AIDS prevention by involving leaders in Zambian society, including the minister of health, traditional tribal chiefs, people living positively with HIV, young Zambian music stars and actors from a popular soap opera. PSI calculates that use of its HIV/AIDS prevention products and services in Zambia alone has averted 33,500 primary HIV cases (the estimated number of HIV infections prevented as a direct result of program activities) and 54,000 secondary cases (HIV infections prevented during the subsequent 12-month period as a result of program activities). These estimates are based on a model developed by AIDSMark, a USAID-funded AIDS prevention project implemented by PSI, in collaboration with the York Health Economics Consortium in the United Kingdom. The figures do not take into account the result of PSI’s generic behavior change communication, including increased levels of abstinence and reduction in number of partners. The social marketing program in Zambia has clearly had a major health impact in reducing the spread of HIV and PSI has used its Zambian social marketing platform to create even more health impact in family planning (oral contraceptives) and maternal and child health (insecticide-treated nets, vitamins and safe water treatment systems). —David Olson, Senior Manager of Public Affairs, PSI/Washington
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Former
President Kenneth Kaunda, hero of the African independence movement,
launched New Start by being the first patient to be tested for HIV.
The Lusaka center is now testing an average of 800 clients per month.
PSI also promotes VCT at integrated government health centers throughout
the country.
