Key facts of the National Communication Survey on HIV/AIDS, 2009

Background

• The National Communication Survey on HIV/AIDS (NCS), 2009, examines the effectiveness of 11 South African HIV/AIDS communication programmes.
• It is the second such survey to be conducted, the first having taken place in 2006.
• The survey was co-funded by:
  • the Department of Health through Khomanani campaign
  • the United States Agency for International Development (USAID) and
  • Centres for Disease Control and Prevention (CDC) through the US President's Emergency Plan for AIDS Relief (PEPFAR).
• Partners are:
  • Johns Hopkins Health and Education in South Africa (JHHESA)
  • Health and Development Africa (HDA)
  • Soul City
  • the Community Media Trust.
• A total of 9 728 people aged between 16 and 55 years, from all nine provinces and representative of the country's population, took part in the survey.
• Respondents underwent a thorough interview, in which they were asked to provide answers to a structured questionnaire.
• Respondents were interviewed in their home language.

Survey objectives

• To evaluate several major communication programmes in South Africa
• To understand the key drivers of the HIV epidemic in South Africa
• Special emphasis on multiple partners
• To strengthen HIV communication programmes so that they are strategically aligned to important risk behaviours and key drivers of the epidemic.

Findings

Exposure

• 90% of South Africans were reached by at least one of the 11 HIV/AIDS communication programmes examined in the study.
• Younger audiences had a higher level of exposure to (five or more) communication programmes (42%) than older audiences 20%. 
• 86.8% of South Africans (89.6% of men, 84.1% of women) listen to the radio;  86.5% of men and 86.4% of women watch television; 56% of people (54.7% of men and 57.4% of women) read magazines; 67.3% of people (71.9% of men, 62.9% of women) read newspapers; and 18.4% of people (20.8% of men, 16.1% of women) use the Internet.

Knowledge

• Knowledge of HIV prevention methods is high - 87% for condoms on average across age groups. Knowledge of other HIV prevention methods - such as faithfulness, partner reduction and abstinence - is lower, but has improved since the 2006 NCS.
• Knowledge of treatment allowing people living with HIV to be healthy, is high and has significantly increased - of those who know of treatment, 87% (85% male and 88% female) identified antiretroviral therapy (ART) as a treatment, and 73% know that ART is for life (in 2006, 42% identified ART and 40% knew it was for life).
• A high proportion of respondents - 81% in total, but more women than men - know that HIV can be transmitted through breastfeeding; 14.9% are aware of formula feeding as a way to prevent mother-to-child transmission, and only 1.7% know that exclusive breastfeeding prevents mother-to-child transmission.
• Knowledge that male circumcision reduces the risk of HIV infection is low (7.5%) - and 12-22% of men and 12-17% of women across age groups (15% in total) also believe that circumcised men do not need to use condoms.
• 44% of men aged 16-40 report that they have been circumcised - 27% of them before the age of 18.
• Tuberculosis (TB) - the majority of respondents know what the duration of TB treatment is (75% male and 80% female), but knowledge of the curability of TB in people living with HIV needs to be addressed (49% of men and 45% of women believe people with HIV cannot be cured of TB).

Testing

• A total of 61% of all sexually active people men and women have ever been tested - 48% of men, and 74% of women (the discrepancy due to many women being tested because they are pregnant).
• 60% of all men and women (63% men, 59% women) reported being tested in the past 12 months.
• Many youth have been tested - of those ever tested, 75% of men aged 16-19, and 78% of women aged 16-19, have been tested in the past 12 months.
• 61% of men and 65% of women with high exposure to communication programmes reported being tested in the past 12 months.
• Talking with one's sexual partner about HIV testing also increases with exposure to more communication programmes.
• People discussing testing with their partners are almost four times more likely to actually  test for HIV.
• Being tested increases with exposure to the number of communication programmes.
• The percentage of both young men and women (aged 15-24 in 2006 NCS, 16-24 in 2009 NCS) who have ever been tested for  HIV has increased dramatically - in 2006, 17% of men and 38% of women had been tested; in 2009, 31.8% of men and 71.2% of women had ever been tested.

Relationships

• Stable relationships (married/living together) are uncommon amongst young people. Only 3% of men and 15% of women aged 20-24 are in stable relationships.
• Men tend to have more casual sexual relationships, while women tend to be in more stable relationships.
• Condom use

Condom use at last sex by age and gender

• Condom use is lowest in stable (married or living together) relationships and highest by people with less stable relationships:
  • 15% of married men and women
  • 25% of men and 29% of women living together
  • 62% of men and 51% of women with main partners
  • 74-83% of men and 56-66% of women with other partners (casual, friends and one-night encounters).
• Condom use increases with exposure to more communication programmes:  Of those not exposed to communication programmes only 33% used condoms, while 50% of those who were exposed to all 11 programmes used condoms. (This was after adjusting for 15 socio-economic variables - clearly demonstrating the effect of communication.)

Multiple partners

• Cheating is perceived by most South Africans as a social norm - 86-95% of men and 90-95% of women across age groups believe this is so; but the reality is different.
• Multiple partners is highest among youth, especially among young men (around one-third of men aged 16-24 have had more than one partner in the past year, compared with 6-9% of women aged 16-24), but decreases by age (4% of men aged 50-55 and 1% of women aged 50-55)
• 14% of respondents have had inter-generational sex (defined as having at least one partner 10 years older or younger) and 37% of men aged 50-55 have partners who are 10 years younger or more.
• 20% of men and 3% of women report having multiple partners in the past 12 months.
• There is evidence that people have decreased the number of sexual partners from one year ago - men have had 2.6% fewer partners and women 3.1% fewer partners, for a net total partner decrease of 2.8%.
• Decreases in multiple partners by women can be more clearly correlated to exposure to communication programmes than men: 1.9% of women with no exposure to communication programmes, compared to 7.2% of women exposed to all 11 programmes (a more than threefold difference); with men there is no statistical difference*.

* It should be noted that communication programmes about multiple and concurrent partners were less than a year old when the study was conducted. Condoms have been promoted over the past 12 years.

Alcohol

• There is a significant correlation between heavy drinking (defined as four or more alcoholic drinks in one sitting for women, and five for men) in nightclubs, bars and shebeens, and having multiple partners, and 68% of men and 56% of women believe it is easier to have sex with people who frequent nightclubs, bars and shebeens.
• Men and women of all age groups believe that when they are drunk, neither they nor their partners will care about HIV.
• Of all respondents, 7% said that the last time they went to a nightclub, bar or shebeen, they had had sex with someone they had never met before.

Social capital and attitudes

• 44.6% of respondents countrywide agreed with the statement that leaders in communities take HIV/AIDS seriously.
• 42.1% of respondents countrywide agreed with the statement that people in communities are joining together to help people with HIV and AIDS.
• 53.4% of respondents countrywide agreed with the statement that they trust most people in their communities.
• 57.3% of respondents countrywide disagreed with the statement that people with HIV will soon lost their friends.
• 79.6% of respondents countrywide disagreed with the statement that when you learn that you have HIV, your life is over.
• 83.4% of respondents countrywide disagreed with the statement that they would be embarrassed to be seen with someone who everyone knows has HIV.

Comparison of 2006 NCS and 2009 NCS

Implications and conclusions

• The survey findings indicate that communication programmes are impacting significantly upon young people, knowledge levels and behaviours in relation to condom usage and HIV testing. There are indications that communication programmes are beginning to impact on knowledge levels in relation to numbers of partners and risk of HIV infection. Programmes therefore need to continue to emphasise the need to reduce partners.
• Communication programmes have been very successful in promoting condom use in high risk sexual partnerships, such as with friends, people just met or known for a while and one night encounters. Programmes need to focus more on condom messaging for people in long-term and stable relationships, such as married, living together and main partner. Condoms need to be promoted beyond HIV and AIDS prevention, to include their use in family planning
• Programmes have excellent reach among adults and youth, but need to focus more on reaching older people, especially men.
• Multiple partners are not the norm, however they are perceived as the norm by the majority of people. Multiple partners is highest among youth, especially among young men (around one-third of men aged 16-24 have had more than one partner in the past year). Messaging around partner reduction and multiple partners need to be carefully crafted such that audiences can appreciate that these are not being presented as the norm that must be redefined, but rather that where they are practiced they present an increased HIV risk.
• The survey shows that there has been increased communication with sexual partners and friends about HIV testing and that there has been an increase in HIV testing.
• Knowledge around safe infant feeding options for HIV-positive women is low. As part of accelerating PMTCT and other communication programmes, greater efforts need to be made to reach people with the correct messages on safe infant feeding practices.
• The majority of people are aware that ART is a treatment for HIV and that it needs to be taken for life.  This is a boost on communication efforts on treatment literacy over the past few years, and needs to be sustained.
• The survey shows that levels of knowledge around male circumcision in relation to HIV risk reduction are low. Once the policy on male circumcision has been finalised, it will be critical for communication programmes to embark on public education on the sexual and reproductive health benefits,  including the HIV risk-reduction benefits.
• Beliefs about the link between alcohol consumption and risky sexual behaviour are evident from the survey. Communication programmes need to highlight the linkages between alcohol, sex and HIV.  Legal and other avenues to reduce heavy alcohol consumption need to be explored and put in place.

Further information on the survey can be accessed at www.jhhesa.org

Source: www.info.gov.za

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