South Africans Take Action: Key Findings of the Third South African National HIV Communication Survey 2012

This 7-page report shares the results of the 3rd South African National HIV Communication Survey (NCS). According to the survey, new data shows substantial increases in behaviours that reduce the risk of HIV: condom use, HIV counselling and testing, and voluntary medical male circumcision. The data also confirms that exposure to HIV communication programmes have a direct impact on people practicing these behaviours. The third NCS was conducted jointly by Johns Hopkins Health and Education in South Africa (JHHESA), loveLife and Soul City Institute for Health and Development Communication, with data analysis by Health and Development Africa (HDA) and Johns Hopkins Bloomberg School of Public Health, with funding from the United States (U.S.) President’s Emergency Plan for AIDS Relief (PEPFAR) through U.S. Agency for International Development (USAID).

The NCS was a national cross-sectional survey undertaken between February and May 2012 comprising 10,034 respondents from 398 sub-places across all nine provinces of South Africa. The survey is representative of the South African population aged 16-55 years. The structured questionnaire included socio-demographic and exposure to HIV communication programmes questions, together with questions about HIV knowledge, attitudes, self-efficacy, and behaviour. This survey examined the impact of a number of communication programmes and their components in South Africa, which total to 19 communication interventions. The programmes include the following (see Related Summaries below for more information on most of these initiatives):

• Community Media Trust that produced Siyayinqoba Beat;
• Ilife community radio talk show produced by ABC Ulwazi;
• Johns Hopkins Health and Education in South Africa, that oversees Brothers for Life; Scrutinize; 4Play: Sex Tips for Girls; and Intersexions;
• loveLife - including loveLife’s youth magazine UNCUT, Radio programmes (foxy chix and radio talk shows), TV programmes (Make your Move and I am Mzansi), and social media (MYMsta), face to face programmes and the call centre;
• The SANAC "I am responsible" campaign; and
• Soul City, including the One Love and Phuza Wise campaigns; Love Stories in the Time of AIDS; and Soul Buddyz TV and Clubs.

The report outlines the following results:

• Condom Use a Social Norm: One of the most remarkable changes noted in HIV prevention behaviour in South Africa over the last 20 years has been the dramatic increase in condom use at first sex. From 1992 to 2012, condom use at first sex increased from 18% to 66%, a 48% increase. Condom use at first sex increased consistently after 1995, which marks the beginning of large-scale HIV communication programmes that promoted the use of condoms to prevent HIV. Today condom use is a social norm in South Africa: two-thirds of people who had sex for the first time during the last 3 years said they used a condom the first time they had sex. The results on condom use at last sex show that it differs by the nature of one’s sexual relationship - the survey revealed that 76% of respondents used a condom at last sex with a casual partner, 65% used a condom at last sex with a main/regular partner, and 28% used a condom at last sex with one’s spouse or live-in partner. The NCS found that the more that one was exposed to communication programmes the more likely they were to use condoms irrespective of the nature of their relationship.
• Increased Testing: The National HIV Communication Surveys have shown that the percentage of people ever tested increased from 55% in 2009 to 64% in 2012, for a total of 17.4-million people tested. The study found that these changes are the result of powerful communication programmes together with strong leadership that promoted HIV testing over the last 12 months. Among survey respondents who knew that President Zuma tested for HIV, 52% were more likely to discuss testing with their sex partners compared to 39% that did not know. People who talked about testing with their sex partner, in turn, were more likely to test for HIV (63%) than those who did not talk about testing with their partners (33%). People who were exposed to more HIV communication programmes were more likely to get tested for HIV: 57% of men and women with high levels of exposure to the communication programmes were tested in the last 12 months, while only 37% of those with low levels of exposure did so.
• Increased Demand for Medical Male Circumcision: The survey revealed a huge increase in the knowledge that the risk of HIV infection is reduced by male circumcision: 47% of men and women now know that male circumcision reduces the risk of HIV infection, compared to just 8% in 2009. There has also been an increase in the prevalence of medical male circumcision: from 32.7% in 2009 to 48.1% in 2012. During the previous year's campaign, 350,000 men got circumcised, of which 64% were medical circumcisions. Moreover, just about one million men who are not circumcised, say that they definitely intend to get circumcised in the next 12 months. HIV communication interventions during the last 12 months have led to this increase in intention: 56% of men with high levels of exposure to communication programmes say that they will definitely get circumcised in the next 12 months, while only 25% of those with low levels of exposure intend to get circumcised. There is little evidence of behavioural disinhibition: 85% of both men and women know that a man who is circumcised still needs to use a condom, and there is no significant difference in condom use at last sex between circumcised (52%) and uncircumcised (48%) men.
• Social Stigma Disappearing: HIV communication programmes and cumulative behaviour change have reduced social stigma substantially in South Africa over the last ten years. Among those sexually active, 48% said that they have talked to others about HIV testing, asked or have been asked by one’s partner to get tested and 32% said that they had an HIV test together with their partner in the last 12 months. Among those who have ever been tested and know the results, 86% were willing to share their HIV status during the interview. Among those, self-reported HIV status was negative for 88% and positive for 12%. Along with positive changes in condom use, HIV testing, and male circumcision, this change in public attitudes towards the disease can only make prevention and treatment much easier over the next five years.
• 8 out of 10 South Africans Reached: Eighty-three percent of the population was exposed to at least one of the 19 communication interventions in the last 12 months, and over one third were exposed to 6 or more interventions. On the average, people were exposed to 4 communication interventions. This high level of exposure was the result of the combination of communication channels used by the programmes – television, radio, print media, and community mobilisation - and also of the collaboration that media channels in South Africa provided for the distribution of these programmes. These communication programmes also benefitted from the involvement of leaders who promoted campaign messages. When leaders speak, the media report on what they say and do, and people talk about what leaders think and say, and emulate their example. The survey findings show a strong dose response effect of HIV communication on condom use at last sex, condom use at first sex, HIV testing and medical male circumcision during the last 12 months after other potential explanatory variables (statistical controls) have been taken into account.

In conclusion, the 2012 NCS findings show that communication programmes have a direct effect on behavioural outcomes such as HIV counselling and testing, condom use, and male circumcision. Communication programmes also have an indirect impact on these outcomes by addressing norms and attitudes regarding HIV and providing people with information, knowledge, and motivation to exercise decisions that best work for them and that keep them healthy. The findings show that the effect of the communication on people's behaviour resembles a dose-response, the more people are exposed to the HIV communication programmes, the more likely they are to adopt and maintain positive behaviours such as condom use, HIV counselling and testing, and to undergo male circumcision.

Note from the Editor: The short version of the survey report is no longer available online. See below link for the full report.