Zambia revolutionizes HIV prevention among adolescents and youths using SMS
By Mark Maseko UNICEF Zambia Communication Officer - On December 1, 2012, as World AIDS Day (WAD) was observed across the globe, about 1,000 young people living in Kitwe, a mining city of the Copperbelt province were embracing “Zambia U-Report” an innovative, free-of-charge and youth friendly SMS platform that allows real-time, two-way communication with trained SMS-counsellors on issues of HIV and sexually transmitted infections (STI). The theme of this year’s WAD celebration was “Getting to Zero: I am a Youth making a Change for an HIV-free Zambia”.
The launch of Zambia U-Report marked a turning point in the approach to HIV prevention, care and support for adolescents and young people in Zambia. “This innovation leverages the power of new technology and will accelerate the attainment of an HIV-free generation in Zambia” said Bishop Joshua Banda, the National AIDS Council (NAC) Chairperson.
One third (4 million) of the Zambia population is aged 15-24 years; yet every hour, 3 young people become infected with HIV, 2 of them are girls. Over the past 10 years, despite implementation of nationwide HIV education programmes in school and at community level, less than 40% of young people in Zambia have comprehensive HIV knowledge, with lower levels among females. Similar trend is noted for the use of HIV prevention services (condoms, male circumcision) with the exception of HIV testing among girls and delay of sexual debut. Young people’s HIV risk is increased when they have limited knowledge about the means to protect themselves and they are not supported to access and utilize them.
Emerging evidence support the potential of SMS-based interventions to increase young people’s knowledge about HIV and STI, and reduce their sexual risk behaviours. Yet, adaptation of this approach for large scale national HIV prevention programme in high prevalence settings remains limited.
“Zambia U-Report will ensure that all young people using a mobile phone, can request and receive information about HIV prevention and services, in real-time, and in a way that respects their privacy” said Dr. Iyorlumun J. Uhaa, UNICEF Representative during the launch.
The Zambia U-Report has two programmatic modules (Knowledge Bank; Poll/Campaign): The Knowledge Bank is a dynamic repository of up-to-date information on HIV and STI; it is accessible to the SMS-counsellors as a resource to provide correct information to young people as they interact with them through SMS. Whereas the Poll/Campaign module serves two purposes: polling opinions of young people on HIV and STIs issues to inform policy dialogue and programmatic decisions and secondly to establish a baseline on knowledge, access and utilization of high impact HIV prevention services for young people. The information received from the baseline will be used in designing customized behaviour change communication messages, which will be sent to young people through the SMS but will also be given through other mass media (radio or TV programme) to complement the SMS. These linkages with mass media will be important to ensure equity in access to information for young people who do not own a mobile phone and those young people with disabilities.
“I am happy that the programme will ensure confidentiality. Counsellor who will answer my questions will not know my name or phone number. So I can be free to ask anything, clear my mind and empower myself,” said Jack Kafwanka, a male youth in Kitwe.
Zambia U-Report was developed through a participatory process including a two-day design workshop involving young people and programme experts from National AID Council (NAC), Ministries of Health, Education, Youth and Sports, and local NGOs, representatives from mobile companies and IT and software developers. The workshop was also facilitated by a programme officer from UNICEF Uganda where U-Report was first implemented.
SMS is free for young people. Yet, to ensure equitable access for all young people, UNICEF negotiated reduced bulk SMS cost with all three mobile providers in Zambia, namely Zamtel, MTN and Airtel. UNICEF also entered into a strategic partnership with CHAMP, a local NGO, for implementation of the programme. CHAMP hosts the SMS-counsellors hub and manages the Knowledge Bank module for Zambia U-Report. When required, the two-way SMS interaction between young people and counsellors can be supplemented with a voice conversation on a toll free call line already managed by CHAMP.
During the launch, a female youth representative, Musonda Chuulu urged young people to join Zambia U-Report by sending “JOIN” to 878, and enjoy its benefits. “Fellow youths, this programme is for us. Let us all join and freely ask questions that we have. Knowledge is power and if we know what to do, we can make the right decisions that will protect us, our nation and shape our future,” said Chuulu.
Three weeks into its implementation, 714 young people have registered in the programme with age, sex and location information - 47% being female and most people, 75% from Kitwe district. A total of 1000 SMS were exchanged between counsellors and young people on issues related to HIV and AIDS and other STIs. About 50% of all registered young people asked at least one question. The SMS-counsellor web-interface allows for quality control of the conversations by a senior counsellor, who is also consulted on challenging issues.
The first opinion poll question proposed by NAC chairperson on World AIDS Day, “Every day 3 young people are infected with HIV, what should be done to have zero HIV infections in Zambia?” was sent to 351 young people on Day-3 post launch. Results from the first opinion poll will be published in a local newspaper and on the Zambia U-Report and NAC websites.
As the number of people with access to mobile phones increases the world over, Zambia has a fair share of it. According to the Zambia Information Communication Technology Agency (ZICTA), the number of mobile phone subscribers has increased from 400,000 subscribers in 2004 to more than 8 million in 2012. About one in every three young people in Zambia has at least one mobile phone subscription. This presents an opportunity to reach-out to young people with life-saving SMS-based interventions. An evaluation of Zambia U-Report is planned for 2014, and will focus on its effectiveness, scalability and the cost-effectiveness.