National HIV and AIDS Communication

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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)
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(No Transcript)
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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.

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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
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Survey Research Methodology

• National sample survey of men and women ages 15
  to 65
• Multi-stage stratified probability sample of
  7006 plus a supplementary sample of 1501 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
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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.

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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.

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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

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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 dont 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.
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TSHA TSHA 2-MINUTEVIDEO CLIP HERE
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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
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CREDITS
Warren Parker (shown) Kevin Kelly CADRE
Larry Kincaid Patrick Coleman Research
Senior Advisor Johns Hopkins
University BSPH Health Communication Program
Pumla Ntlabati CADRE
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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

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Exposure to the Tsha Tsha TV Drama
Percent
N 7006 (15-65 years) weighted population
14137024 of 29366512
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Number of Tsha Tsha Episodes Watched
Percent
Number of Episodes Watched
N 7006 (15-65 years) 30 percent
(weighted) 8686438
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Number of Tsha Tsha Episodes Watched by Sex
Percent
Number of Episodes Watched
N 7006 (15-65 years) Population
(weighted) 29366512
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Number of Tsha Tsha Episodes Watched by Youth
Ages 15-24 Years
Percent
Number of Episodes Watched
N 2814 (15-24 years) Half or more
(weighted) 3983263
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Number of Tsha Tsha Episodes Watched by Sex
among Youth 15-24 Years
Percent
Number of Episodes Watched
N 2814 (15-24 years) Population (weighted)
9518968
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Percent who watched Tsha Tsha in the last 12
months by province
N 7006 weighted
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Percent who watched Tsha Tsha in the last 12
months by province
N 7006 weighted
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Percent who watched Tsha Tsha in the last 12
months by sex and level of education
Percent
Level of Education
N 7006 (15-65 years) Population
(weighted) 29335442
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Measuring Prevention Behavior

• Have you ever had sex before 83
  (5826)
• Have you had sex in the past 12 mo 83
  (4844)
• With the person you most recently
• had sex with did you do anything
• to prevent HIV infection
  49 (2372)
• What did you do to prevent getting
• HIV infection
• DO NOT PROMPT. MULTIPLE RESPONSE
• Nothing used condoms faithful to partner

N 7006
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Condom use to prevent HIV by sex and level of
exposure to Tsha Tsha
Percent
Number of Episodes Watched
N 4844 (15-65 years) Population
(weighted) 20565661
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Condom use to prevent HIV among youth by sex and
level of exposure to Tsha Tsha
Percent
Number of Episodes Watched
N 1610 (15-24 years) Population
(weighted) 5412941
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Percent condom use with non-regular partner last
time by sex and level of exposure to Tsha Tsha
Percent
Number of Episodes Watched
N 2385 (15-65 years) Population
(weighted) 9693241
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• 1. Age
• 2. Sex
• 3. Single vs. ever married
• 4. Level of education
• 5. No children for whom youre 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

List of socio-economic control variables used to
estimate adjusted impact of watching Tsha Tsha
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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
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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
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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
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Impact of Watching Tsha Tsha Talking to
others about getting an HIV test
N 4844 who have had sex in last 12 months
p
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Impact of Watching Tsha Tsha Getting an HIV
test
N 4844 who have had sex in last 12 months
p
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Impact of Watching Tsha Tsha Knowledge of ARV
treatment
N 7006 p
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Impact of Watching Tsha Tsha Caring for
someone living with HIV and AIDS
N 7006 p
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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
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Median Split
Low
High
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Impact of Watching Tsha Tsha Positive
attitude towards PLHA (reversed stigma)
N 7006 p
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Impact of Watching Tsha Tsha AIDS telephone
help services
N 4844 who have had sex in last 12 months
p
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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.
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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.
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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.

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THANK YOU

• HEALTH COMMUNICATION PARTNERSHIP
• and
• JOHNS HOPKINS HEALTH AND EDUCATION IN SOUTH
  AFRICA