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The Foundation’s Largest Initiative Ever Aims To Curb HIV Infection Among South African Youth

The initiative is a bold and ambitious attempt to reduce HIV infection among South African adolescents by promoting sexual health and healthy futures for young people. The main target group of the campaign is 12- to 17-year-olds, but special programs focusing on children 6 to 12 years of age are also part of the campaign. The focus and program components of the initiative were developed through a two-year process of investigation, consultation, and planning, including a review of international HIV-prevention programs, an evaluation of existing HIV-education efforts, and extensive focus-group research among young South Africans.

The result is a comprehensive sexual health strategy that harnesses popular culture to promote sexual responsibility and healthy living, while at the same time developing frontline services that are more responsive to the sexual health concerns and needs of adolescents. By combining sexual health education with popular culture, this approach is designed to grab and hold the attention of young people, but also to produce benefits beyond HIV prevention such as decreasing teenage pregnancy and sexually transmitted infections (STIs) and to confront deeply ingrained attitudes toward sex and sexuality and relationships between men and women, which impede more conventional efforts to combat HIV in South Africa.

Organized by the Henry J. Kaiser Family Foundation, is being implemented by a consortium of four partner organizations: Advocacy Initiatives, the Planned Parenthood Federation of South Africa, the Reproductive Health Research Unit, and the Trust for Health Systems Planning and Development (HST). The national advisory board, chaired by First Lady, Mrs. Zanele Mbeki, meets twice a year.

The program has four main components:

  • Awareness and Education: is using a combination of television, radio, and outdoor media such as billboards, taxis, and water towers to encourage more responsible sexual behavior. The media components are backed by printed educational materials and a national telephone helpline, which provides sexual health information, counseling, and referrals for clinical care.

    In the first few years, the main focus of the media component of the campaign is to encourage more open discussion about sex and sexuality and the connection between sexual behavior and HIV and other sexual health problems. The emphasis is on encouraging teenagers to better inform themselves about sexual health and to seek help if they need more information or clinical care. has initiated a parallel campaign aimed at encouraging parents to talk to their children about sex. It has a telephone helpline for parents to call when needing advice on how to talk to their children about sex, as well as a printed guide for parents.

    About 75 percent of South African households have access to a television set and a recent national survey of South African youth confirms that television is the most popular form of entertainment among teenagers, with more than two-thirds of respondents saying they watch television more than five times per week. For this reason, television is used in combination with radio to drive s awareness and education component.

    s main television show S camto ( talk about it ) began airing its third 13-week series in February 2001. S camto s part documentary, part talk-show format has developed a cult following among young people in both urban and rural areas. The television show is supported by S camto:Print a monthly newspaper for young people focusing on lifestyle issues and sexual health. S camto:Print is distributed through a partnership with the Sunday Times to approximately three million readers. The television and print components of S camto are supported by radio programming produced by and broadcast on nine major regional and national radio stations six broadcasting in ethnic languages.

    In addition, the messages of talk about sex and inform yourself are promoted on billboards throughout the country (particularly in rural areas) and on taxis. Through a partnership with the World Bank and the South African government’s Department of Water Affairs, has also been given messaging space on 160 water towers in rural parts of the country.

    is currently working with the South African Broadcasting Corporation (SABC) to develop a youth television game show with a sexual health orientation.

    Codi: Loud and Clear s first television program targeting younger children airs on SABC television six days a week. Codi: Loud and Clear is a series of two-minute inserts designed to encourage children and parents to talk about such difficult issues as sex, HIV/AIDS, substance abuse, and violence. The television component is also supported by a booklet designed to help parents initiate discussion about difficult issues with their children.

    Both the broadcast and print media promote the telephone helpline. Since it was first advertised, the helpline has averaged between 80,000 to 100,000 calls per month about 85 percent of South Africans now have access to a telephone and approximately 65 percent of calls to the helpline are from young people in rural parts of South Africa. In response to the high demand and callers need for more in-depth information and counseling, the number of operators has doubled and their training in sexual health issues has been substantially enhanced. A more sophisticated referral system has also been set up, enabling operators to refer calls to trained sexual health and HIV counselors. These counselors, where possible, are able to refer callers for clinical care.

    has developed a website (www.lovelife.org.za) as an interactive source for sexual health information. Even though Internet access is still relatively limited in South Africa, the website averages 50,000 hits per month. The website is also strategically important in developing s connection to schools because the government with the backing of a consortium of computer technology companies has launched a major drive to connect schools to the Internet. The Y-Centres also include Internet cafes that not only provide Internet access for local teenagers, but also training to encourage increased computer literacy among young people in remote parts of the country.

  • Service Development: A major obstacle to HIV prevention is the alienation of young people from public health services. Most teenagers express fear and reluctance about using public health services for a sexual health problem.

    In partnership with the South African Department of Health, has developed national standards for adolescent-friendly services in primary care clinics. These standards provide the basis for an adolescent-friendly clinic accreditation program. This program includes intensive technical assistance and training to help clinics meet the accreditation criteria, as well as monitoring clinics compliance with the standards. The goal is to get all 5,000 clinics, countrywide, to comply with the adolescent-friendly standards within three to five years.

  • Outreach: is working to strengthen and replicate existing successful sexual health education programs. Peer groups are one of the most effective mechanisms for sexual health education. is building on the strength of existing peer-education programs by using peer educators who will train a national youth corps of young people to work as community mobilizers and sexual health educators in more remote parts of the country.

    The work of these young people is supported by the loveTrain a sexual health education center and clinic on rails and the loveTours a mobile radio broadcast unit. The approach is to motivate young people to participate in sexual health education programs through recreational opportunities and entertainment.

    Since September 1999, has opened five Y-Centres at Orange Farm in Gauteng; at Motherwell in the Eastern Province; at Kutwalanong in the Free States; and at Mandeni in KwaZulu-Natal. Y-Centres are multipurpose recreational venues for young people, designed to demonstrate that sexual health services for young people can be more effectively provided in non-clinical settings. What is learned in the Y-Centres also informs s work in making government clinics more accessible to young people. s Y-Centres are the key components of what will eventually be a national network of government-funded youth-friendly centers incorporating sexual health services.

    The basic ingredients of all Y-Centres are: sexual health education, counseling, and care; partnership with a radio station; and a basketball court. Additional elements of each Y-Centre are developed in partnership with the local community. The primary purpose of the Y-Centre is to demonstrate the effectiveness of a non-clinical environment in providing sexual health education and care for adolescents. Y-Centres also provide venues for peer education programs and a regional base for the corps of community mobilizers.

    In addition, in a special effort to reach the four million students in secondary and high schools in South Africa, has entered into a partnership with the United Schools Sports Association of South Africa to create a yearlong calendar of school sports competitions called the Games culminating annually in a weeklong mini-Olympics national sports competition.

  • Monitoring and Evaluation: Ongoing monitoring and evaluation is essential to help ensure that the campaign reaches its target audience, help inform the development of public policy and government programs and services, and to track the impact of on young people s sexual behavior and the incidence of teenage pregnancy, HIV, and other STDs. Baseline surveys in each of the five Y-Centres have been completed. In addition, evaluation sites have been identified in each of the nine provinces to track the increase in clinic attendance by adolescents, condom usage among the target age group, reported STIs and teen pregnancies, and cases of HIV. Besides monitoring these key measures in the five core sites, is also helping to inform bigger government surveys such as the annual national survey of women attending antenatal clinics, which is the primary source of HIV data, and the biannual national household and demographic survey, which tracks a variety of behavioral measures including condom usage.

    So far, has completed four separate brand-awareness and message-impact surveys using different methodologies, including random intercept interviews, focus groups with teenagers and parents, and in-person interviews with a random sample of 1,000 respondents (half who were adults and half who were teenagers). The results of all four surveys have been very positive. More than two-thirds of respondents spontaneously recognized the brand and, of those who recognized the brand, more than 80 percent described it as a program promoting sexual responsibility. Brand-recognition is higher among rural respondents, who were also more supportive of the urgency to talk about sex as part of the effort to prevent HIV. About 75 percent of all respondents rated as innovative and effective in getting me to think. Adults and teenagers were almost even in their support of . The low level of negative responses to were mostly attributable to white adult respondents.

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Filling the need for trusted information on national health issues, the Kaiser Family Foundation is a nonprofit organization based in Menlo Park, California.