EVALUATION OF SMC SHORT TERM COMMUNICATION STRATEGY - BOTSWANA

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


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


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


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


• 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

tmoeti

1st line - is the word HIV missing t the end?


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

tmoeti

again- is this a quotation from an individual in Machaneng - or a collective view. if it's a quotation from one individual then need to state it this way.

Lesego Busang

It is a quote from an inidividual representing to dipict how strong the general view was.


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


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


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


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

tmoeti

seems like a potentially complex slide. HCT features prominently - so might we not want this in the title? may help the presenter if we did.

Lesego Busang

It the opposite of the last 3 variables. So it part of this chat in reverse.


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.


Credits and Acknowledgements:• Health Education Officers• Districts Health Management Teams• Community leaders• Study Participants

THANK YOU


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.


One week after2%

Two/Three weeks after5%

Four/five weeks after13%

Six wks or more80%

Period before starting sex


Continued using; 83%

Reduced/ Stopped, 7%

Other; 4%

Increased; 3% Started; 1% Continued not using; 1%

Condom use change after SMC


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


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


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.


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


SAMPLE SLIDE 3


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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EVALUATION OF SMC SHORT TERM COMMUNICATION STRATEGY - BOTSWANA

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