Transcript No Slide Title

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)
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.
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
Survey Research Methodology
•
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 & Development Africa (HDA).
* Same
sampling frame as the National HSRC 2005 AIDS Survey
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
• 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
•
•
•
•
•
•
•
•
•
Stigma
Disclosure
Community support for PLWAs
Challenges of young people
Caring for sick parents
Condom use
Secondary abstinence
VCT
Sexual assault
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-MINUTE
VIDEO
CLIP
HERE
CREDITS
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
Warren Parker (shown)
& Kevin Kelly, CADRE
Larry Kincaid
Patrick Coleman
Research
Senior Advisor
Johns Hopkins University BSPH
Health Communication Program
Pumla Ntlabati, CADRE
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
Exposure to the Tsha Tsha TV Drama
80
60
Percent
47
48
49
Ever Watched
Watched Last 12
Months
Watched 2005
HSRC Survey
40
20
0
N= 7006 (15-65 years); weighted population, 14,137,024 of 29,366,512
Number of Tsha Tsha Episodes Watched
80
60
Percent
53
40
30
17
20
0
None
Less than half
Half or more *
Number of Episodes Watched
N= 7006 (15-65 years)
* 30 percent (weighted) = 8,686,438
Number of Tsha Tsha Episodes Watched
by Sex
Male
80
60
Female
Percent
55
52
40
27
17
20
32
17
0
None
Less than half
Half or more
Number of Episodes Watched
N= 7,006 (15-65 years)
Population (weighted) = 29,366,512
Number of Tsha Tsha Episodes Watched
by Youth Ages 15-24 Years
80
Percent
60
42
39
40
19
20
0
None
Less than half
Half or more *
Number of Episodes Watched
N= 2,814 (15-24 years)
* Half or more (weighted) = 3,983,263
Number of Tsha Tsha Episodes Watched
by Sex among Youth 15-24 Years
Male
80
Female
Percent
60
41
40
37
40
19
20
45
18
0
None
Less than half
Half or more
Number of Episodes Watched
N= 2,814 (15-24 years)
Population (weighted) = 9,518,968
Percent who watched Tsha Tsha in the last
12 months by province
38
KwaZulu-Natal
North West
55
48
Free State
57
Eastern Cape
0
20
40
60
80
Percent
N = 7,006; weighted
Percent who watched Tsha Tsha in the last
12 months by province
44
Limpopo
Mpumalanga
55
Gauteng
54
38
Western Cape
52
Northern Cape
0
20
40
60
80
Percent
N = 7,006; weighted
Percent who watched Tsha Tsha in the last
12 months by sex and level of education
80
Female
51
52
Percent
60
40
Male
32
58
49
32
20
0
0 to 7 Years
8 to 11 Years
12 Yrs & Above
Level of Education
N = 7,006 (15-65 years)
Population (weighted) = 29,335,442
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
Condom use to prevent HIV
by sex and level of exposure to Tsha Tsha
Male
100
Female
Percent
72
80
57
60
43
42
40
55
29
20
0
None
Less than half
Half or more
Number of Episodes Watched
N= 4,844 (15-65 years)
Population (weighted) = 20,565,661
Condom use to prevent HIV among youth
by sex and level of exposure to Tsha Tsha
Male
100
80
Female
Percent
74
57
60
82
77
61
68
40
20
0
None
Less than half
Half or more
Number of Episodes Watched
N= 1,610 (15-24 years)
Population (weighted) = 5,412,941
Percent condom use with non-regular partner
last time by sex and level of exposure to Tsha Tsha
Male
100
80
Female
Percent
85
80
74
63
72
56
60
40
20
0
None
N= 2,385
Less than half
Half or more
Number of Episodes Watched
(15-65 years)
Population (weighted) = 9,693,241
List of
socioeconomic
control
variables
used to
estimate
adjusted
impact of
watching
Tsha Tsha
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
Age
Sex
Single vs. ever married
Level of education
No children for whom you’re guardian
Level of Living Standard (Household Items)
Poverty: Lack of fuel, clean water, medicine, food
Owns one or more television sets
Frequency of watching television
Frequency of listening to radio
Listens to local community radio
Frequency of reading newspapers
Frequency of reading magazines
Frequency of internet use
Currently employed or a student
Geotype: rural, urban, informal, formal
Province
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
Percent using condoms to prevent HIV
by any level of exposure to Tsha Tsha
Exposed Treatment Group
80
60
40
Matched Control Group
Difference
Percent
58.2
58.2
58.2
49.7
51.7
35.3
22.9
20
8.5
6.5
Adjusted by 17
control variables
Adjusted by
controls and 17
other programs
0
Unadjusted
N = 4844 4844 who have had sex in last 12 months; p<0.001
Percent using condoms to prevent HIV
by exposure to Tsha Tsha and marital status
Exposed Treatment Group
Matched Control Group
Difference
Percent
100
73.2 71.9
80
60
58.2
51.7
39.3
40
20
6.5
1.3
31.2
8.1
0
Combined (full
adjustment) *
Single (full
adjustment)
Not single (full
adjustment) *
N = 4844 who have had sex in last 12 months; p<0.01
Impact of Watching Tsha Tsha:
Talking to others about getting an HIV test
Exposed Treatment Group
Matched Control Group
Difference
Percent
80
70.7
73.7
65.8
71.5
60
40
20
5
2.2
0
Discussed HIV test with
one's sexual partner *
Discussed HIV test with
one's friends
N = 4844 who have had sex in last 12 months; * p<0.01
Impact of Watching Tsha Tsha:
Getting an HIV test
Exposed Treatment Group
Matched Control Group
Difference
Percent
80
60
50.2
44.8
40
26.2
26.8
20
5.4
0
Ever had an HIV test *
0
HIV test in last 12 months
N = 4844 who have had sex in last 12 months; * p<0.01
Impact of Watching Tsha Tsha:
Knowledge of ARV treatment
Exposed Treatment Group
Matched Control Group
Difference
Percent
60
48.5
45.5
41.9
44.9
40
20
6.6
0
0
Can name ARV as treatment *
Knows ARV is for rest of life
N = 7,006; * p<0.01
Impact of Watching Tsha Tsha:
Caring for someone living with HIV and AIDS
Exposed Treatment Group
40
Matched Control Group
Difference
Percent
30
21.7
20
10
16.2
9.6
5.5
7.2
2.4
0
Helped someone sick
with AIDS*
Helped child affected by
AIDS*
N = 7,006; * p<0.01
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.
3. People who know they are HIV positive should not
have sex.
4. I would be embarrassed to be seen with someone
who everyone knows has HIV and AIDS.
5. When you learn that you have HIV your life is over
6. People with HIV will soon lose their friends.
* Strongly agree (1) to strongly disagree (4); Reliability a = .61
1
.8
Median Split
High
0
.2
.4
.6
Low
1
2
3
Positive attitudes towards PLWA
4
Impact of Watching Tsha Tsha:
Positive attitude towards PLHA (reversed stigma)
Exposed Treatment Group
Matched Control Group
Difference
Percent
60
47.5
40
39.6
20
7.9
0
High Positive Attitude*
N = 7,006; * p<0.01
Impact of Watching Tsha Tsha:
AIDS telephone help services
Exposed Treatment Group
60
40
Matched Control Group
Difference
Percent
37.9
32.6
20
5.3
0
4.5
3.7
0
Can name any telephone Ever called any help line*
service*
N = 4844 who have had sex in last 12 months; * p<0.01
Knowledge and use of other methods
to prevent getting HIV
After controlling for all sociodemographic 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.
Estimation of the cost-effectiveness of
Tsha Tsha on condom use to prevent HIV
48% of 29,366,512 watched Tsha Tsha = 14,137,024
58.2% of 14,137,024 used condoms:
51.7% of matched control group used:
Difference attributed to Tsha Tsha:
Estimated production costs for 52
episodes broadcast before survey:1
Cost per additional condom user:
1
8,227,748
7,308,841
918,907
R 14,768,000
R 16.05
Joint funding by SABC-Education and USAID; broadcast costs are not
included but are presumed to be offset by commercial advertising.
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
HEALTH COMMUNICATION
PARTNERSHIP
and
JOHNS HOPKINS HEALTH AND
EDUCATION IN SOUTH AFRICA