HIV support programme uses SMS to keep men connected

This case study illustrates that the use of appropriate mobile technology has a positive impact on maintaining men’s participation in a health programme focusing on HIV testing and education.

Recent research findings on the Imbizo Men’s Health Programme indicate that its male participants responded positively to the use of SMS communications. SMS was used to remind participants to go for HIV testing and inform them of upcoming events promoting AIDS and gender awareness. Taken together, this use of mobile technology has played an important part in ensuring that men have remained involved in this public health initiative.

Imbizo is an HIV support and educational programme run by male counsellors for men between ages of 16 to 55 years. It provides post-HIV testing counselling and runs educational workshops on condom usage and HIV risk reduction, the benefits of knowing one’s HIV status and good fatherhood. The programme is run by HIVSA, a non-governmental organisation, and operates out of the ZAZI voluntary counselling and testing (VCT) centre operated by the Perinatal HIV Research Unit (PHRU) located at the Chris Hani Baragwanath Hospital in Soweto.

To date, the programme has reached over 10,000 men in the Soweto area since its inception in 2005. Soweto, with South Africa’s largest urban population, has some of the high levels of unemployment, poverty, and HIV prevalence in the country.

According to a recent academic study on Imbizo, the use of SMS messaging along with other methods such as distributing branded clothing and educational materials went far in keeping men interested and involved in the Imbizo programme. The study was conducted by Abigail Dreyer, a public health researcher.

As Dreyer has indicated, “It would seem that understanding, flexibility, adaptability and some level of creativity and motivation are required in order to successfully interact with different ages of the male population in relation to HIV related issues.”

One of the biggest problems facing HIV-awareness campaigns is how to engage successfully with men as the group who unsuspectingly create vulnerability to HIV among women and children. The education of men on HIV and AIDS is seen as a key area to changing male attitudes and sexual behaviour to reduce the spread of the AIDS pandemic.

Forty-four black South African men living in Soweto were interviewed for the research. The men were mostly in 33 to 42 year old age range, unemployed, and levels of education that ranged from basic to graduates from tertiary institutions. Four were married, eight had partners and the remaining thirty-two were single. They were all isiZulu first language speakers and either spoke English as a second or third language. Many of the men were long-term participants in the project and had been involved in the Imbizo project for nearly two years.

The positive impact of SMS messaging

Imbizo use SMS messaging to reach programme participants in two ways. Men who test HIV negative, but who may be within a window period, are sent an SMS reminder to retest at a later date. SMS is also used to notify men about events.

For example, in November 2009, Imbizo used SMS to contact men about a campaign promoting the Sixteen Days of Activism Against Gender Violence as well as an upcoming debate:

Imbizo Men’s Health Project will celebrate 16 Days to end violence from 25 November. We will send you more about the events soon.

A reminder that we will be having a debate on Friday 27 November at 10h00. T shirts for all participating in debate. Imbizo Men’s Health.

According to Dreyer’s research, “The men felt that the use of SMS messages was innovative and that it was a good strategy to keep them connected with the programme.”

Several responses from programme participants bear this out. Comments such as “SMSes are personal because no one has my phone but me” and “SMSes are good because I always have my phone with me” are indicative of appropriateness of the technology for this mHealth programme.

In addition, the SMS communications were seen as trendy and adding to a person’s self-esteem: “I think it is cool that they use SMSes, when my phone goes beep beep and I say’ oh it is Imbizo, it’s like they are contacting me because I am so important.”

More importantly, men appreciated the anonymity of the SMS messages which helps in minimising any negative social stigma that may be attached to participating in an AIDS programme. As one respondent indicated, “When my girlfriend reads the message, it has no private details. I just say they got my number from a competition.”

Reducing the cost of community messaging

The Imbizo project team uses BulkSMS’s Community SMS messaging service to send SMS messages from their office computer to men who have registered to participate in the Imbizo Men’s Health Programme. This application-to-person (A2P) service provides Imbizo with a part-sponsored, discounted pricing that helps in reducing the cost of public health related communication campaigns.

The Imbizo programme is one of a number of Health initiatives in South Africa that have found SMS messaging crucial to their promotion of AIDS awareness and voluntary HIV testing or the treatment and care for persons living with AIDS.