Impact and Cost-Effectiveness of the Scrutinize Communication Campaign on Condom Use in South Africa R. Delate

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1 Impact and Cost-Effectiveness of the Scrutinize Communication Campaign on Condom Use in South Africa R. Delate

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3 Scrutinize Audience & approach Primary Target Audience: Youth Secondary Audiences: All sexually active persons aged 16+ Objectives: Increase people s knowledge, attitudes and perception of risk to HIV infection in relation to multiple and concurrent partners Reduce the number of multiple and concurrent partners Promote correct and consistent condom usage with all partners Increase the number of people who test for HIV on regular basis

4 Approach Approach: Evidenceinformed Mass media (Advertising) Interpersonal Communication using entertainment education approaches at schools and universities.

5 The use of animation Audience fatigue around HIV messaging required a new approach. Animation has a diverse appeal Able to construct meaning to a virus that remains unseen.

6 Why social and behavioural communication Able to convey the message over multiple channels within popular programming watched by the target population Promotes the desired behaviour amongst young people who are becoming sexually active. Promotes the behaviour amongst those that may not be or have stopped practicing the desired behaviour. Positive reinforcement of those that are practicing the behaviour Encourages those that may have stopped practicing the behaviour to do so again.

7 Scrutinize Mass Media Development Formative research Pre-testing concept Pre-testing Animerts Adjustment Broadcasting Post-Broadcast Analysis Audience Reception Analysis & NCS

8 Frequency of Television Broadcasts per Animert June 08 July 09

9 Strategic Communication How does communication have effect? Exposure to Scrutinize Direct Effects of Communication Ideational Effects Knowledge & Skills Beliefs & Attitudes Social Influence Social Norms Others... Reducing New HIV Infections HIV Prevention Behavior Indirect Effects of Communication

10 Condom use in South Africa

11 Percent that used a condom with one s last sexual partner by gender and age group, 2009 Percent 100 Males Females years years years years years years years years Age Group N = 3149 males; 3645 females who had sex in the last 12 months; p<.001

12 Used a condom to prevent HIV last time you had sex N = 4,121, 3,720 partners; p<.001

13 Measuring recognition and recall of Scrutinize on TV In the past 12 months have you seen this on television, What s my Risk SHOW SCRUTINIZE PICTURE [aided recognition] In these TV spots, what does the term SCRUTINIZE mean to you? [Do not read out. Unaided response Multiple responses possible.]

14 Measuring the Impact of the Scrutinize Campaign 2009 National Communication Survey National sample survey of men and women, 16 to 55 years of age representing a population of 27,410,651 1 Multi-stage, stratified probability sample of 9,728 men and women (16 55) in all nine provinces of which are between years of age. Face-to-face interviews in each household Data collected by Development Research Africa (DRA) and Health and Development Africa (HDA) Joint funding from by USAID (PEPFAR), the NDoH (Khomanani), JHHESA, Soul City, and Community Media Trust (CMT) 1 Weighted by gender, age, race, settlement type, and province (based on StatsSA's 2007 Community survey)

15 Socio-economic control variables used to estimate the adjusted impact of communication programs 1. Age (16-55 years) 2. Sex 3. Marital status (single vs. ever married) 4. Level of education 5. Level of living standard (Household Items) 6. Poverty: Lack of fuel, clean water, medicine, food 7. Currently employed or student (versus unemployed) 8. Frequency of watching television (SABC 1-3, e.tv) 9. Frequency of listening to radio 10. Frequency of reading newspapers 11. Frequency of reading magazines 12. Frequency of internet use 13. Type of settlement (urban, urban informal, peri-urban, tribal, farming) 14. Race (Black African, Coloured, Indian, White) 15. Province * Weighted by gender, age, race, settlement type and province

16 Undercover Lover (Sexual Networking) Undercover HIV (acute infectious period) Booza Brain Shebeen Queen

17 Nine-Item Scale Used to Measure Recall of Scrutinize Meaning of the Messages 1. Correct answer for the meaning of Scrutinize 2. Correct understanding of the sexual network spot 3. Correct understanding of the Booza Brain spot 4. Correct understanding of the undercover HIV spot 5. Correct meaning for the ninja in the sexual network 6. Able to identify the small round character as HIV 16-32* Recall of Specific Content 7. Able to complete Flip HIV to HIVictory slogan 8. Able to complete Undercover lover... can bring you HIV from another 9. Able to complete If the playa is too drunk... don t put him in the game Recall of one or more of nine items: Total population exposed: 8,346, % % * Intended audience: Ages years who have had sex in the last 12 months, weighted by gender, age, race, settlement type and province representing a population 10,784,684.

18 Recognition of Scrutinize TV Spots by Age Group Males Females 100 Percent Ages Ages Full Sample Intended Audience N= 9,728, 6060 (16-55 yrs.), weighted scrutseen

19 The Impact of Scrutinize on condom usage

20 Condom use with any partner in the last 12 months by the number of Scrutinize items answered correctly and gender amongst youth (Adjusted) 100 Percent Females Males point spread 6 point spread Number of Items Answered Correctly N=2,171, p<0.14; 1,938, p<0.001; ages yrs. who have had sex in the last 12 months; adjusted with logistic regression for 16 socio-economic and demographic control variables scrutcamp9s

21 Condom use with other types of partners in the last 12 months by the number of items answered correctly (16 32)* Adjusted 100 Percent point spread Number of Items Answered Correctly * Friend, known for a while, just met, or one night encounter N=1,282 who had sex in the last 12 months; adjusted by logistic regression, p<0.01, no other programs stat. sig. scrutcamp9

22 Condom use with any partner in the last 12 months by the number of items answered correctly (16 55 years) Unadjusted Adjusted without other programs Percent point spread 11 point spread Number of Items Answered Correctly N=6794, those who had sex in the last 12 months; Adjusted with logistic regression for 15 socio-economic and demographic control variables scrutcamp9

23 Condom use with any partner in the last 12 months by the number of items answered correctly (16 55 years) Unadjusted Adjusted without other programs Adjusted with other programs* Percent point spread 11 point spread 6 point spread Number of Items Answered Correctly N=6794, those who had sex in the last 12 months; weighted, adjusted for 15 socio-economic control variables, and then with 3 other statistically significant programs (Khomanani Campaign, lovelife campaign, and Journey radio) scrutcamp9

24 Behavioural Outcome Increased Condom Usage Percent that used a condom in the last 12 months by any level of exposure to Scrutinize on television 80 Percent x 13,597,918 exposed = 761,483 additional condom users attributed to Scrutinize Matched Control Group (Unexposed) Treatment Group (Exposed) Net Difference N= 6,769 (16-55 yrs), p<0.001; based on propensity score matching to estimate the average treatment effect on the treated (atts), using 19 socio-demographic control variables and 8 other communication programs.

25 SCRUTINIZE TV CAMPAIGN Reach and condom use to prevent HIV infection Cost-effectiveness of the South African Scrutinize campaign (TV only, production costs not yet available): Cost to the client (broadcast only): US $ 2,647,504 Added (leveraged value): US $ 2,740,484 Total cost to the client (broadcast only): US $ 5,387,988 Cost-effectiveness of the South African Scrutinize campaign Audience Reach: Client cost per person: Total cost per person: US $ 0.14 per person reached US $ 0.29 per person reached Condom Use: Client cost per additional condom user: US $ 3.48 Total cost per additional condom user: US $ 7.08

26 Summary The animated format broke through the media clutter with high levels of recall and a correct interpretation of the meaning intended amongst youth aged The campaign reached a large proportion of the population in a relatively short period of time and was cost effective. 69% of the population reached aged = 18.9 million people. 77% of youth ages reached = 8.3 million young people The total cost per person reached was R 2.10 Those with a higher level of recall of the Scrutinize campaign were more likely to use condoms than those with lower levels of recall even when controlling for socio-economic and

27 Summary The logistic regression analysis shows that when controlling for certain socio-economic factors and other communication programmes that there is still a significant impact of Scrutinize on condom usage across the entire population but this also shows the benefit of multiple communication programmes. While there are equal levels of recall between males and females; the behavioral outcomes appear to be more likely with younger males than younger females. More research is required as to what actions can be undertaken to empower young women around condom use. The Scrutinize campaign is effective in relation to the cost per person reached every additional condom user is a potential infection averted. The results presented are only for Year1 of the campaign more time is needed to fully understand the impact of the campaign over time.

28 Acknowledgements Dr Larry Kincaid, Johns Hopkins University, Bloomberg School of Public Health, Centre for Communication Programmes. Mr P Coleman, Ms B Pearce and Ms L. Mahlasela, Johns Hopkins Health and Education in South Africa. Dr S Johnson, Ms S Laurence, Ms F Chikwava, Health and Development Africa. Ms D. Gebhardt, Levi s Strauss, South Africa Mr C Bruns and Mr J Coetzee, Matchboxology Ms Ana Oxlee-More and Monique Clark, Mediology

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