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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) Slide2: Slide3: 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 Tsha Tsha 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. Slide4: 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 Slide5: 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 andamp; Development Africa (HDA). Survey Research Methodology * 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 methodology: 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 Slide9: Viwe, spoiled, relatively wealthy, arrogant, discovers she is HIV positive and learns to face the challenges this brings. Andile, struggling to care for Mother sick with AIDS and little sister, talented but reluctant dancer. 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. TSHA TSHA 2-MINUTEVIDEO CLIP HERE: TSHA TSHA 2-MINUTE VIDEO CLIP HERE Slide11: Rolie Nikiwe, Co-Director Johan Neethling, Executive Producer, SABC-Education David Jammy, Executive Producer, Curious Pictures Harriet Gavshon, Executive Producer Head Script Writer, Curious Pictures CREDITS CREDITS: CREDITS Pumla Ntlabati, CADRE Warren Parker (shown) andamp; Kevin Kelly, CADRE Larry Kincaid Patrick Coleman Research Senior Advisor Johns Hopkins University BSPH Health Communication Program 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 Slide14: Exposure to the Tsha Tsha TV Drama Percent N= 7006 (15-65 years); weighted population, 14,137,024 of 29,366,512 Slide15: Number of Tsha Tsha Episodes Watched Percent N= 7006 (15-65 years) * 30 percent (weighted) = 8,686,438 Number of Episodes Watched Slide16: Number of Tsha Tsha Episodes Watched by Sex Percent N= 7,006 (15-65 years) Population (weighted) = 29,366,512 Number of Episodes Watched Slide17: Number of Tsha Tsha Episodes Watched by Youth Ages 15-24 Years Percent N= 2,814 (15-24 years) * Half or more (weighted) = 3,983,263 Number of Episodes Watched Slide18: Number of Tsha Tsha Episodes Watched by Sex among Youth 15-24 Years Percent N= 2,814 (15-24 years) Population (weighted) = 9,518,968 Number of Episodes Watched Slide19: N = 7,006; weighted Percent who watched Tsha Tsha in the last 12 months by province Slide20: N = 7,006; weighted Percent who watched Tsha Tsha in the last 12 months by province Slide21: Percent who watched Tsha Tsha in the last 12 months by sex and level of education Percent N = 7,006 (15-65 years) Population (weighted) = 29,335,442 Level of Education Slide22: 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 Slide23: Condom use to prevent HIV by sex and level of exposure to Tsha Tsha Percent N= 4,844 (15-65 years) Population (weighted) = 20,565,661 Number of Episodes Watched Slide24: Condom use to prevent HIV among youth by sex and level of exposure to Tsha Tsha Percent N= 1,610 (15-24 years) Population (weighted) = 5,412,941 Number of Episodes Watched Slide25: Percent condom use with non-regular partner last time by sex and level of exposure to Tsha Tsha Percent N= 2,385 (15-65 years) Population (weighted) = 9,693,241 Number of Episodes Watched Slide26: 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 List of socio-economic control variables used to estimate adjusted impact of watching Tsha Tsha Slide27: 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 Slide28: 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; pandlt;0.001 Slide29: Percent using condoms to prevent HIV by exposure to Tsha Tsha and marital status N = 4844 who have had sex in last 12 months; pandlt;0.01 Slide30: Impact of Watching Tsha Tsha: Talking to others about getting an HIV test N = 4844 who have had sex in last 12 months; * pandlt;0.01 Slide31: Impact of Watching Tsha Tsha: Getting an HIV test N = 4844 who have had sex in last 12 months; * pandlt;0.01 Slide32: Impact of Watching Tsha Tsha: Knowledge of ARV treatment N = 7,006; * pandlt;0.01 Slide33: Impact of Watching Tsha Tsha: Caring for someone living with HIV and AIDS N = 7,006; * pandlt;0.01 Slide34: 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. Items Used to Measure Attitudes towards People Living with HIV and AIDS (Reversed Stigma) * * Strongly agree (1) to strongly disagree (4); Reliability a = .61 Slide35: Median Split Low High Slide36: Impact of Watching Tsha Tsha: Positive attitude towards PLHA (reversed stigma) N = 7,006; * pandlt;0.01 Slide37: Impact of Watching Tsha Tsha: AIDS telephone help services N = 4844 who have had sex in last 12 months; * pandlt;0.01 Slide38: 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. Knowledge and use of other methods to prevent getting HIV Slide39: 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. Slide40: 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 You do not have the permission to view this presentation. In order to view it, please contact the author of the presentation.