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National HIV and AIDS Communication Survey 2006. Impact of the Television Drama, Tsha Tsha. D. Lawrence Kincaid Johns Hopkins Bloomberg School of Public Health Baltimore, Maryland USA. November 6-10, 2006 Johns Hopkins Health and Education in South Africa (JHHESA). Tsha Tsha.

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National hiv and aids communication survey 2006

National HIV and AIDS Communication

Survey 2006

Impact of the Television Drama, Tsha Tsha

D. Lawrence Kincaid

Johns Hopkins Bloomberg School of Public Health

Baltimore, Maryland USA

November 6-10, 2006

Johns Hopkins Health and Education in South Africa (JHHESA)


National hiv and aids communication survey 2006

Tsha Tsha

  • Weekly television drama series for

  • youth in the Nguni language with

  • English subtitles.

  • Produced by CADRE in partnership

  • with Curious Pictures

  • With funding by SABC Education

  • and PEPFAR through USAID and

  • the Health Communication

  • Partnership

  • Set in Lubusi, a fictional rural village in the Eastern Cape.

  • In the dusty streets of this impoverished rural town, the series follows the lives of four 20-somethings as they negotiate a bumpy course along the path to adulthood, dealing with HIV and AIDS, relationships, sex and poverty.


National hiv and aids communication survey 2006

National HIV and AIDS Communication

Survey 2006

Research Team

South Africa

CADRE: Warren Parker, Benjamin Makhubele, Helen Hajiyiannis, Pumla Ntlabati,

Cathy Connolly (MRC)

HDA: Saul Johnson, Gill Schierhout, Zethu Matebeni

SOUL CITY: Sue Goldstein, Esca Scheepers

JHHESA: Patrick Coleman

USA

JHSPH: D. Lawrence Kincaid


National hiv and aids communication survey 2006

Survey Research Methodology

  • National sample survey of men and women ages 15 to 65 *

  • Multi-stage, stratified probability sample of 7,006 plus a supplementary sample of 1,501 in 5 local communities served by the Khomanani program.

  • Face-to-face interviews in each household with electronic data entry.

  • Data collected by AC Nielsen with funding by PEPFAR through USAID and the Health Communication Partnership, and the NDoH through Health & Development Africa (HDA).

* Same sampling frame as the National HSRC 2005 AIDS Survey


Series methodology

Series methodology

  • Entertainment Education focusing on creative, insightful and collaborative problem-solving in limit-situations.

  • Based more on deepening understanding of issues than provision of information or delivery of messages.

  • Educational themes or lessons are embedded in the story and encountered

    in contexts of dramatic events.

  • The complexities of problem situations and problem solving unfold in a gradual, realistic way.


Series methodology1

Series methodology

  • A ball-room dancing club provides a metaphoric background for exploring relationships and intimacy.

  • Fantasy, humor and entertaining secondary characters provide dramatic relief and entertainment value.

  • Drama promotes reflection and psychological insight as characters discover their shadows and struggle to find meaningful ways of engaging with the world.


Hiv and aids issues emphasized in the drama

HIV and AIDS ISSUES EMPHASIZED IN THE DRAMA

  • Stigma

  • Disclosure

  • Community support for PLWAs

  • Challenges of young people

  • Caring for sick parents

  • Condom use

  • Secondary abstinence

  • VCT

  • Sexual assault


National hiv and aids communication survey 2006

Viwe, spoiled, relatively wealthy, arrogant, discovers she is HIV positive and learns to face the challenges this brings.

Boniswa, introspective, bookish, but whose heart and mind don’t always follow the same path.

DJ, brash, immature city boy exiled in Lubusi and out of tune with a world he gradually embraces.

Andile, struggling to care for Mother sick with AIDS and little sister, talented but reluctant dancer.


Tsha tsha 2 minute video clip here

TSHA TSHA2-MINUTEVIDEO CLIP HERE


National hiv and aids communication survey 2006

CREDITS

Rolie Nikiwe, Co-Director

David Jammy, Executive Producer, Curious Pictures

Johan Neethling, Executive Producer, SABC-Education

Harriet Gavshon, Executive Producer Head Script Writer, Curious Pictures


Credits

CREDITS

Warren Parker (shown)

& Kevin Kelly, CADRE

Larry Kincaid Patrick Coleman

Research Senior Advisor

Johns Hopkins University BSPH

Health Communication Program

Pumla Ntlabati, CADRE


Research objectives

Research Objectives

  • Determine the reach and nature of the audience that watched Tsha Tsha on TV

  • Estimate the direct effects of exposure to the drama on HIV and AIDS Attitudes

  • Estimate the effects of exposure to the drama on AIDS related behavior.

  • Estimate the indirect effects of watching the drama on AIDS attitudes and behaviour through the identification with characters in the drama


National hiv and aids communication survey 2006

Exposure to the Tsha Tsha TV Drama

Percent

N= 7006 (15-65 years); weighted population, 14,137,024 of 29,366,512


National hiv and aids communication survey 2006

Number of Tsha Tsha Episodes Watched

Percent

Number of Episodes Watched

N= 7006 (15-65 years) * 30 percent (weighted) = 8,686,438


National hiv and aids communication survey 2006

Number of Tsha Tsha Episodes Watched

by Sex

Percent

Number of Episodes Watched

N= 7,006 (15-65 years) Population (weighted) = 29,366,512


National hiv and aids communication survey 2006

Number of Tsha Tsha Episodes Watched

by Youth Ages 15-24 Years

Percent

Number of Episodes Watched

N= 2,814 (15-24 years) * Half or more (weighted) = 3,983,263


National hiv and aids communication survey 2006

Number of Tsha Tsha Episodes Watched

by Sex among Youth 15-24 Years

Percent

Number of Episodes Watched

N= 2,814 (15-24 years) Population (weighted) = 9,518,968


National hiv and aids communication survey 2006

Percent who watched Tsha Tsha in the last

12 months by province

N = 7,006; weighted


National hiv and aids communication survey 2006

Percent who watched Tsha Tsha in the last

12 months by province

N = 7,006; weighted


National hiv and aids communication survey 2006

Percent who watched Tsha Tsha in the last

12 months by sex and level of education

Percent

Level of Education

N = 7,006 (15-65 years) Population (weighted) = 29,335,442


National hiv and aids communication survey 2006

Measuring Prevention Behavior

  • Have you ever had sex before? 83% (5,826)

  • Have you had sex in the past 12 mo? 83% (4,844)

  • With the person you most recently

  • had sex with, did you do anything

  • to prevent HIV infection? 49% (2,372)

  • What did you do to prevent getting

  • HIV infection?

  • [ DO NOT PROMPT. MULTIPLE RESPONSE ]

  • Nothing, used condoms, faithful to partner…

N = 7,006


National hiv and aids communication survey 2006

Condom use to prevent HIV

by sex and level of exposure to Tsha Tsha

Percent

Number of Episodes Watched

N= 4,844 (15-65 years) Population (weighted) = 20,565,661


National hiv and aids communication survey 2006

Condom use to prevent HIV among youth

by sex and level of exposure to Tsha Tsha

Percent

Number of Episodes Watched

N= 1,610 (15-24 years) Population (weighted) = 5,412,941


National hiv and aids communication survey 2006

Percent condom use with non-regular partner

last time by sex and level of exposure to Tsha Tsha

Percent

Number of Episodes Watched

N= 2,385 (15-65 years) Population (weighted) = 9,693,241


National hiv and aids communication survey 2006

List of socio-economic controlvariables used to estimate adjusted impact of watching Tsha Tsha

  • 1. Age

  • 2. Sex

  • 3. Single vs. ever married

  • 4. Level of education

  • 5. No children for whom you’re guardian

  • 6. Level of Living Standard (Household Items)

  • Poverty: Lack of fuel, clean water, medicine, food

  • Owns one or more television sets

  • 9. Frequency of watching television

  • 10. Frequency of listening to radio

  • 11. Listens to local community radio

  • 12. Frequency of reading newspapers

  • 13. Frequency of reading magazines

  • 14. Frequency of internet use

  • 15. Currently employed or a student

  • 16. Geotype: rural, urban, informal, formal

  • 17. Province


National hiv and aids communication survey 2006

PROPENSITY SCORE ANALYSIS

Propensity score is a means to balance the treatment and control units by combining a set of predictors of being exposed into a single variable by means of multivariate logistic regression. (Rosenbaum and Rubin, 1983)

The propensity score is the probability of recalling the messages of a campaign as predicted by the regression of recall on a set of all possible determinants of exposure.

(our 17 socio-demographic control variables)

Approximates the conditions of a randomized experimental design by constructing a matched control group that is statistically equivalent to the treatment group (viewers) in terms of the probability (propensity) of watching the drama.

What would have happened. . . The counter-factual condition


National hiv and aids communication survey 2006

Percent using condoms to prevent HIV

by any level of exposure to Tsha Tsha

N = 4844 4844 who have had sex in last 12 months; p<0.001


National hiv and aids communication survey 2006

Percent using condoms to prevent HIV

by exposure to Tsha Tsha and marital status

N = 4844 who have had sex in last 12 months; p<0.01


National hiv and aids communication survey 2006

Impact of Watching Tsha Tsha:

Talking to others about getting an HIV test

N = 4844 who have had sex in last 12 months; * p<0.01


National hiv and aids communication survey 2006

Impact of Watching Tsha Tsha:

Getting an HIV test

N = 4844 who have had sex in last 12 months; * p<0.01


National hiv and aids communication survey 2006

Impact of Watching Tsha Tsha:

Knowledge of ARV treatment

N = 7,006; * p<0.01


National hiv and aids communication survey 2006

Impact of Watching Tsha Tsha:

Caring for someone living with HIV and AIDS

N = 7,006; * p<0.01


National hiv and aids communication survey 2006

Items Used to Measure Attitudes towards People Living with HIV and AIDS

(Reversed Stigma) *

  • 1. Getting aids is the result of sinning.

  • 2. It is a waste of money to train/educate someone who is HIV positive.

  • People who know they are HIV positive should not have sex.

  • I would be embarrassed to be seen with someone who everyone knows has HIV and AIDS.

  • When you learn that you have HIV your life is over

  • People with HIV will soon lose their friends.

* Strongly agree (1) to strongly disagree (4); Reliability a = .61


National hiv and aids communication survey 2006

Median Split

Low

High


National hiv and aids communication survey 2006

Impact of Watching Tsha Tsha:

Positive attitude towards PLHA (reversed stigma)

N = 7,006; * p<0.01


National hiv and aids communication survey 2006

Impact of Watching Tsha Tsha:

AIDS telephone help services

N = 4844 who have had sex in last 12 months; * p<0.01


National hiv and aids communication survey 2006

Knowledge and use of other methods to prevent getting HIV

After controlling for all socio-demographic variables and the other 17 AIDS communication programs, watching Tsha Tsha had no statistically significant effects on abstinence, sticking to one partner, and faithfulness to your partner.


National hiv and aids communication survey 2006

48% of 29,366,512 watched Tsha Tsha = 14,137,024

58.2% of 14,137,024 used condoms: 8,227,748

51.7% of matched control group used: 7,308,841

Difference attributed to Tsha Tsha: 918,907

Estimated production costs for 52

episodes broadcast before survey:1 R 14,768,000

Cost per additional condom user: R 16.05

Estimation of the cost-effectiveness of Tsha Tsha on condom use to prevent HIV

1 Joint funding by SABC-Education and USAID; broadcast costs are not

included but are presumed to be offset by commercial advertising.


National hiv and aids communication survey 2006

Summary

  • Tsha Tsha was watched by almost 50% of the population ages 15-65 years: 14 million viewers.

  • After controlling for 17 socio-economic control variables and all the other AIDS communication program, Tsha Tsha was sound to have significant impact on seven important attitudes and behaviors related to HIV and AIDS.

  • The estimated cost of reaching each person in the Tsha Tsha audience was R1.04 and the estimated cost of each additional condom user was R16.05.


Thank you

THANK YOU

HEALTH COMMUNICATION PARTNERSHIP

and

JOHNS HOPKINS HEALTH AND EDUCATION IN SOUTH AFRICA


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