Developments in the Use of the Mass Media at the National Level for HIV/AIDS Prevention in South Africa: Concept and Strategy in South African Campaigns
The development of a theoretical model
The development of models for public health campaigns is largely uncharted territory in SouthAfrica. Despite a UNAIDS report which indicates that theory-led campaigns tend to be moresuccessful and provide better evaluative data, there hasn't always been the necessary followthrough in South Africa. Soul City is leading the way in this respect. In their model, the role ofthe individual is found at the centre of a set of concentric circles that represent the communityand the social and political spheres. In this model of "social and behaviour change", advocacy isproposed as one major method to help exert change at all three levels. Soul City describes thismodel as "a dynamic integration of existing models of behaviour change… In short (it) includes modelsand theories which focus on the individual, contextualised in his/her immediate interpersonal and socialenvironment, as well as looking at community and broader societal impact on behaviour change."[5]
loveLife and Beyond Awareness demonstrate in their literature an appreciation of theoreticalframeworks but have not or did not formally develop a working model. Although the evaluationof Soul City's model is a recent development, it is surprising that others working in the fieldmake no reference to it.
The mass media, the Ottawa Charter and social mobilisation
One of the marked characteristics of the South African mass media initiatives discussed in thischapter is that they all extend the traditional boundaries of mass media work. Their underlying thinking reflects the ideas of the Ottawa Charter, emphasising that mass media programmes that only promote individual behaviour change messages will inevitably fail. Successful healthpromotion develops robust strategies incorporating a number of the pillars of action identifiedin the Charter.
Beyond Awareness II identified the promotion of social action through targeted projects as oneof their five main objectives[6]. This commitment was met through the initiation of a number ofnational projects including the AIDS Memorial Quilt Project, The Tertiary Institutions Project,The AIDS Mural Project and a Care and Support Project. These projects reflected 15% of theirtotal expenditure.
Soul City believes that their mass media success creates opportunities for further health promotion work. They argue that their media success provides the credibility necessary for advocacy work, for example. Their present AIDS advocacy campaign is the provision of poverty relief and grants to children affected by AIDS. Likewise, they have launched a social mobilisation unit within theirorganisation to set up and promote Soul Buddyz clubs and other community-based interventions.
In their evaluation of the 4th series, Soul City uses qualitative techniques to evaluate their impacton the reorientation of health services (another pillar of the Ottawa Charter). The evidence shows that Soul City facilitates an awareness and a better understanding of issues and a more caring attitude on the part of health workers. However, there is no information on how extensive this impact is on service delivery as a whole. For example, clinic nurses in rural KwaZulu-Natal wereparticularly struck by the way in which condoms were so openly advocated. They reported that,due to Soul City's influence, the clinic which used to have a specific day of the week for condomdistribution and family planning, now has condoms permanently and freely available [7].
loveLife is at pains to emphasise the need for a fresh approach to HIV/AIDS prevention that isnot led by the mass media and their strategy is the most strongly reflective of the Ottawa Charter.Sixty percent of the total loveLife budget is spent on work that does not involve the mass media.Notably, loveLife promotes the establishment of youth Y-centres (which operate as multi-functionallifestyle and health centres), support to the National Adolescent Friendly Clinic Initiative, and aschool sports programme. In fact, loveLife's strategy is well captured by the framework described in the Ottawa Charter. The box below indicates how neatly the loveLife strategy reflects the multi-pronged approach to health promotion identified in the Charter.
The application of the Ottawa Charter to loveLife
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Generally, there are two schools of thought about the role of social mobilisation in HIV/AIDScampaigns. One is that the mass media can be used to promote participation. loveLife reflectsthis approach. School children are perhaps more willing to participate in loveLife school sportsif they have heard of the project before and this is captured in their triangular model of practiceshown below.
Figure 1: loveLife structure [8]
The alternative theory is that the mass media can be used to support a ground swell of mass activity that is bottom-up rather than prescriptive. Soul City say that they have received requests from individuals asking to get involved in local action. Their evaluation of Soul City 4 also describes examples of community action inspired by positive role modeling. This is discussed further in the section on evaluation and impact.
5 Soul City. Soul City 4 - Evaluation Integrated Summary Report, July 2001, p.2.
6 Beyond Awareness II. Overview of the Beyond Awareness II Campaign (year 1).
7 Soul City. Soul City 4 - Evaluation Integrated Summary Report, July 2001, p.54.
8 Stadler, J. Looking at loveLife the first year - Preliminary monitoring and evaluation findings of the first year of loveLifeactivity: September 1999 - September 2000, Reproductive Health Research Unit, 2001, p.9.
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