evaluation of smc short term communication strategy - botswana
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Washington D.C., USA, 22-27 July 2012www.aids2012.org
Presented by: Lesego Busang (ACHAP)Onkemetse C. Ntsuape (MOH)
EVALUATION OF SMC SHORT TERM COMMUNICATION STRATEGY -
BOTSWANA
ACHAP Symposium - International AIDS ConferenceWashington DC, USA
23rd July 2012
Washington D.C., USA, 22-27 July 2012www.aids2012.org
Introduction - Overview
• SMC Adopted as HIV prevention add-on strategy 2009
• STCS Implemented since 2009
• Evaluated in September/October 2011– Inform LTCS development– Baseline
• Collaboration between MOH, ACHAP and PSI
Washington D.C., USA, 22-27 July 2012www.aids2012.org
Methodology
• Cross-sectional study (September/November 2011)• Quantitative
– 2,973 males and 375 females aged 15-49 years
• Qualitative approaches– Focus group discussions (35 FGD’s)– Key Informant Interviews (32 KII)
• Basis of sampling was 2011 Census Sampling Frame ensuring:– Urban/Rural, geographical and circumcision prevalence representation
• Hence 7 health districts were sampled
Washington D.C., USA, 22-27 July 2012www.aids2012.org
Circumcised more than 3 years ago
12%
Circumcised within last 3 years9%
(or 40% of Circumcised)
PLANNING on Circumcising
36%
Would ACCEPT Circumcsion23%
Would NOT Accept Circumcision
14% (or 18.2% of Uncircumcised)
Circumcised, No Data on When
1%
Don’t know if Would Accept
4%
No Response on Would Accept
1%
Circumcision Status and Intent
Washington D.C., USA, 22-27 July 2012www.aids2012.org
• SMC helps reduce the chances of HIV infection (All FGD’s) * It reduces infection rate but doesn’t mean that you won’t get infected with the virus. (Gaborone females)
• SMC promotes hygiene (All FGD’s) I take it that circumcision helps one be clean; foreskin accumulates dirt and other diseases (Kweneng females)
Don't KnowOther (Specify
Can have more partnersNo need to use condoms
Increased sexual pleasureSize of penis appears smallerSize of penis appears Larger
Improved appearanceCircumcised penis hygienic
Reduces Woman's infection chancesProtection against STI
Reduces man's infection chancesPartial protection
Complete protection
0.0% 10.0% 20.0% 30.0% 40.0% 50.0% 60.0% 70.0%
1.5%
5.4%
0.1%
0.1%
3.6%
0.2%
0.4%
1.6%
26.8%
2.1%
50.9%
65.0%
21.3%
2.1%
Benefits of SMC – Males Be
nefit
s
Washington D.C., USA, 22-27 July 2012www.aids2012.org
Excessive bleeding – * I take it that if you cut someone’s foreskin what comes to mind would be ‘what if I lose a lot of blood and die?’ and the pain, so these things discourages them to go and circumcise. (Females FGD)
Wound does not healSwelling of penis
InfectionExcessive bleeding
Penis damagedPoor Sexual performance
DeathNo Complication
Other (Specify)Don't Know
0.0% 5.0% 10.0% 15.0% 20.0% 25.0% 30.0% 35.0%
30.6%
14.3%
14.9%
14.2%
9.4%
2.6%
8.6%
23.8%
11.3%
3.7%
Anticipated SMC Risks/Compli-cations
Percent
Ris
ks/C
ompl
icat
ions
Washington D.C., USA, 22-27 July 2012www.aids2012.org
Fear of Pain
Don't belive in SMC
Cultural/Religious Reasons
Have not thought about it
Fear of HCT Results
Don't have enough information
Other
No time for healing process
Too Old
Not Ready
HIV Positive
36%
21%
8%
7%
6%
6%
5%
4%
2%
2%
1%
Reasons WOULD NOT accept MC if Offered
33.8
20.5
16.5
6.1
4.8
3.6
3.1
2.8
1.9
1.3
1.3
1.3
1.0
2.0
0.0 5.0 10.0 15.0 20.0 25.0 30.0 35.0 40.0
Fear for pain/complications/deathNo time for process/healing period
Don’t have enough informationDon't believe/like SMC
Just havent thought of itFacility delays/accessibility/Services
Feared for HCT resultsCultural/Religious
Not readyHealth Reasons/HIV Positive
Using Other PreventionBeleive already old
Financial reasonsOther
Reason for NOT BEING Circumcised
Washington D.C., USA, 22-27 July 2012www.aids2012.org
Health w
orker
Friend/re
lative
SMC Pamphlet
SMC Posters
SMC BTV A
dvert
SMC Rad
io advert
Billboard
Bus/ taxi
advert)
Newsp
aper adve
rt
Visit/ta
lks in w
orkplace
Other0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
29.5%
35.1%
9.6% 8.1%
28.6%
49.5%
10.3%
2.0%
19.1%
3.5%
19.5%
8.9%
32.6%
1.2% 0.8% 1.7%4.0%
0.6% 0.0% 0.6% 0.9%
9.8%
Source of SMC Knowledge and Motivator to Get Circumcised
Source of SMC KnowledgeMotivation to Circumcise
Source/Motivator
Perc
ent
In-cludes Sexual partner
Washington D.C., USA, 22-27 July 2012www.aids2012.org
0.000
1.000
2.000
3.000
4.000
5.000
6.000
7.0006.245
3.355 3.332 3.136
1.982 1.8541.583
1.372
0.383 0.352
The odds of being Circumcised vs not being circumcised during STCS Campaign (excludes circumcised more than 3 years ago)
Odd
s R
atio
2.609
2.837
2.450
2.500
2.550
2.600
2.650
2.700
2.750
2.800
2.850
2.900
Death not seen as a risk Pain during procedure not anticipated
Washington D.C., USA, 22-27 July 2012www.aids2012.org
Don't belie
ve/lik
e (vs H
CT Fear)
Cultural
/Relig
ious (vs
HCT Fear)
Other (vs H
CT Fear)
Fear
pain/co
mplications/d
eath (v
s HCT)
Provides C
omplete Protection
HCT need prio
r SMC
Employe
d
Hygiene benefit k
nowledge0.000
10.00020.00030.00040.00050.00060.00070.00080.00090.000
100.00091.305
75.296
17.886
8.656 6.8040.434 0.361 0.355
Odds of "Would NOT Accept SMC" if offered
Tested for HIV and booked clients still not showing up in large num-bersEver tested for HIV already too high to have an impact; fewer people don’t know their HIV status.
3.07
2.3022.769 2.815
.000
1.000
2.000
3.000
4.000
5.000
6.000
7.000
No knowledge on HCT need prior SMC
Unemployed No knowledge on hygiene benefit
Washington D.C., USA, 22-27 July 2012www.aids2012.org
Recommendations• Strive to achieve high levels of correct knowledge.• Develop targeted messaging for identified gaps; ie
for concerns on “pain/complications” and “believes”• Use circumcised men to respond to perceptions on pain. • Educate communities on use of local anesthesia to address pain. • Explore use of non-surgical devices; ie PrePex.
• Increase use of interpersonal communications.• Promote other SMC benefits such as cleanliness.• Develop/customize messages to local context.• Strategically assign mobilizers to communities. • Empower leaders on SMC facts (buy-in and cultural concerns). • Pilot materials extensively before roll out.
Washington D.C., USA, 22-27 July 2012www.aids2012.org
Credits and Acknowledgements:• Health Education Officers• Districts Health Management Teams• Community leaders• Study Participants
THANK YOU
Washington D.C., USA, 22-27 July 2012www.aids2012.org
Evaluation Objectives
• Establish the extent to which the objectives of the STCS were met; ie establish if– the general public is informed about the Government of
Botswana/Ministry of Health/ position on SMC as an HIV prevention strategy.
– men currently seeking SMC services at health facilities have adequate information on SMC
– service providers at health facilities and the media personnel have capacity to disseminate and report correct and accurate messages on SMC and HIV prevention to the general public.
– political and social leaders at all levels advocate for SMC.– SMC stakeholders effectively communicate facts on SMC in line with the
SMC short term communication strategy.• Provide a baseline levels for the role out of SMC in Botswana• Provide Knowledge, Attitudes and Practice (KAP) levels.
Washington D.C., USA, 22-27 July 2012www.aids2012.org
One week after2%
Two/Three weeks after5%
Four/five weeks after13%
Six wks or more80%
Period before starting sex
Washington D.C., USA, 22-27 July 2012www.aids2012.org
Continued using; 83%
Reduced/ Stopped, 7%
Other; 4%
Increased; 3% Started; 1% Continued not using; 1%
Condom use change after SMC
Washington D.C., USA, 22-27 July 2012www.aids2012.org
Circumcis
ed durin
g Cam
paign
Circumcis
ed befo
re Cam
paign
0.0%10.0%20.0%30.0%40.0%50.0%60.0%70.0% 60.6%
50.0%
31.1% 26.2%
8.3%
23.8%
Change in number of sexual partners after Circumcision by period of circumcision
Stayed the same
Decreased
Increased
Period circumcised
Perc
ent
Washington D.C., USA, 22-27 July 2012www.aids2012.org
Now feel
protected
from HIV
Condom avail
abilit
y/affo
rdabilit
y
Maturity
Sexual
varie
ty/des
ire
Separa
ted or c
ircumcis
ed pre
debut
Other0.0
5.0
10.0
15.0
20.0
25.0
30.0
35.0
7.4 7.4
29.6
7.4
33.3
14.8
Reason for increasing number of sexual partners
Reason
Perc
ent
Washington D.C., USA, 22-27 July 2012www.aids2012.org
Conclusions Cont.• Generally the higher the knowledge levels the better the results;,
regardless of whether the knowledge is on a negative factor or not; ie NO KNOWLEDGE of HCT as a requirement for SMC did not have negative impact on SMC uptake. – It is important to increase knowledge across all SMC facts. – Hence strive to achieve high levels of correct knowledge (deemed
positive or negative knowledge), to take advantage of positive outcomes brought about by higher knowledge.
• Fear for pain/complications/death is a key challenge that needs to be addressed.
• Interpersonal communications are important vehicles for SMC message delivery and motivators to SMC.– However radio provides the best coverage.
• Community leaders are willing to mobilize for the program but are not empowered.
Washington D.C., USA, 22-27 July 2012www.aids2012.org
SAMPLE SLIDE 2
• Speaking at AIDS 2012• What to think about?
– Keep it simple– Larger text is easier to read– Single words rather than sentences
• Bullet points are there to remind you, not to tell the whole story
Washington D.C., USA, 22-27 July 2012www.aids2012.org
SAMPLE SLIDE 3
Washington D.C., USA, 22-27 July 2012www.aids2012.org
SAMPLE SLIDE 4
• Credits and Acknowledgements• List credits and acknowledgements
– Insert organization credits acknowledgements as opposed to individuals
– Insert Organization logo’s where required and with the permission of the organizations being acknowledged.
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