Using FM Radio and RapidPro to understand Somali beliefs and practices around HIV/AIDS
Launched: June 2017
Radio station in Mogadishu, Somalia. AU-UN IST, Tobin Jones
Somalia remains one of the most fragile states in the world, with its development trajectory hindered by insecurity, poor governance, and inaccessibility. This not only leads to issues in terms of delivery of aid, but also challenges when trying to understand the needs, concerns and opinions of the different populations we seek to assist. Household surveys, which are the most prominent method of development research provide only limited statistical insights into people's perspectives, and are expensive, infrequent, and cannot overcome barriers of insecurity or access. In particular, what is lost is in-depth ‘social data’ that sheds light on the changing socio-cultural landscape of norms, beliefs, and attitudes.
The HIV/AIDS team at UNICEF Somalia identified this knowledge gap as a key bottleneck. Although HIV/AIDS prevalence is low in Somalia, there is a gradual upwards trend in the number of new HIV/AIDS cases, with an additional 2700-3000 people infected per annum. However this is not just a problem of a lack of services - it is a growing concern that low awareness of the infection and disease, stigmatizing attitudes against those infected, gender inequities, and misconceptions around HIV/AIDS, leave the Somali population vulnerable to increased rates of infection.
A youth behavioral survey in 2012 found that only 8.7% of young men, and 13.4% of young women fully understood how to prevent HIV/AIDS and rejected misconceptions about disease transmission. Of equal concern were findings in 2011 that only 8.6% of people in Somaliland and 8.3% in Puntland accept people living with HIV/AIDS (PLWHA).
An essential part of ensuring the uptake of services, as well as the quality of life of people living with HIV/AIDS, depended on a strong Communications for Development (C4D) programme to improve knowledge and shape social norms and attitudes. For the C4D programmes to be effective they must be adapted to address specific socio-cultural context and designed with a clear understanding of the target audience and work with existing health beliefs. Further an in-depth awareness of the types of misconceptions that are acting as barriers to positive change in norms and practices would be essential..
This is exactly the type of data that is difficult to gather in Somalia in a robust way. Beyond identifying the problem, statistical descriptions of the population need to be complemented by ‘social data’ in order to inform programme design so that it is fine-tuned to social and contextual nuances.
To overcome this problem, UNICEF Somalia, in partnership with Africa’s Voices Foundation (AVF) and and MediaINK, deployed a unique approach that combined the reach and popularity of FM radio with the capabilities of UNICEF’s RapidPro messaging platform. As part of a wider project covering gender, health and child protection issues, AVF broadcast an interactive radio programme on HIV/AIDS, to which participants could respond via SMS to a free short-code. To avoid challenging taboos around contraception, the radio show concentrated on the topic of discrimination against people living with HIV/AIDS. Audiences were asked the question: ‘Do you think people with HIV/AIDS are accepted in your community? Yes or no? Why?’.
The answers to this question served two purposes. First, messages from the audience were read out on the radio show in conversation with experts and decision-makers to promote a participatory and inclusive format and to encourage social norm and behavior change in which positive messaging talks directly to the perspectives of Somali citizens. Secondly, the answers to these questions were complemented with surveys sent through RapidPro to ascertain individuals’ characteristics (age, gender, location) and practices related to testing for HIV/AIDS (specifically, whether they or their spouse would request an HIV/AIDS test during an antenatal care check-up).
Rather than seek to find statistics that could be generalized to the population, the approach taken looked for associations between (1) groups of people and different beliefs and attitudes, and (2) different beliefs and practices. In this way we were able to identify which beliefs were associated with detrimental practices and how these beliefs varied in prevalence between different groups of radio audiences (e.g. male vs female, urban vs rural). AVF used its unique multidisciplinary method to organize, parse, and analyse the large, messy, and unstructured Somali language dataset for insights into the following two research questions:
- What are the collective beliefs in regards to acceptance/discrimination of people living with HIV/AIDS (PLWHA), and how do these vary between demographic groups?
- Is the practice of people requesting a HIV/AIDS test during ANC visits associated with perceived acceptance of PLWHA in their community and how does this practice vary between demographic groups?
In addition, the concern was whether interactive media was a culturally appropriate and effective tool for conducting C4D interventions around HIV/AIDS. Out of a series of 16 shows on health, the radio programme on HIV/AIDS had the highest level of engagement with over 6800 people participating - 45.8% of whom were women. 8,624 messages were received by RapidPro in response to the initial question aired on the radio, of which 3890 were estimated to be suitable for in-depth analysis of collective beliefs. See this interactive graph for a full breakdown of the radio show participants.
Figure 1. Audience participation rates across districts in Somalia.
- Interactive radio has been demonstrated to be a powerful research and evidence-driven C4D tool for HIV/AIDS. The one-off interactive radio show on HIV/AIDS was a successful format for sparking inclusive discussions at scale around HIV/AIDS in Somalia. AVF also showed its capabilities to analyse large RapidPro datasets for much needed social data and generate insights that can be used to optimize UNICEF’s C4D programming around HIV/AIDS. This method could be expanded to meet other programmatic needs - for example tracking social change over time to contribute to UNICEF’s monitoring and evaluation of HIV/AIDS programmes.
- Those who perceive acceptance of PLWHA in their communities are more likely to have requested HIV/AIDS testing during ANC visits, particularly if they live in major urban centres. Behavioural change campaigning to combat stigma of PLWHA, should therefore be integrated into a wider programme strategy to increase uptake of HIV/AIDS services, as well as contribute to the well-being of PLWHA.
- Beliefs that support discrimination of PLWHA are most prevalent among young people (up to 20 years old), especially men, living in major urban centres. Conversely, beliefs that support acceptance of PLWHA are more prevalent among women (20-29 years old) living outside urban centres. Given the association between perceived discrimination and uptake of services, HIV/AIDS programming that engages these broad groups in a targeted fashion will be a essential to achieving desired social, behavioral, and even biomedical outcomes.
- A lack of knowledge of how HIV/AIDS is transmitted is seen as a clear obstacle to developing acceptance of communities towards PLWHA. This was reinforced by the converse finding, that accurate knowledge of transmission was given as a common reason for the belief that PLWHA are accepted in the community. C4D programming that combats misconceptions around HIV/AIDS transmission will therefore be key to reducing discrimination against PLWHA. However, messaging around this must be careful to avoid reinforcing another misconception amongst radio audiences - that HIV/AIDS can only be transmitted through adultery or immoral sexual practices.
- The belief that HIV/AIDS quickly results in death and cannot be managed by medication is also related to negative attitudes towards PLWHA. UNICEF’s multimedia C4D HIV/AIDS strategy should work with those in its existing network of PLWHA who are comfortable to speak publicly about their lives, to allow audiences to understand that PLWHA can live normal lives with appropriate support.
- Religious beliefs are related to both acceptance and discrimination towards PLWHA. Evidence gathered here suggests that some Somalis hold the belief that as the status of PLWHA is determined by God’s will, PLWHA should therefore be accepted in society. UNICEF Somalia’s behaviour change programming should build from existing beliefs such as these amongst groups of citizens, and include voices of moral authority in disseminating acceptance beliefs, rather than risk polarising the discussion and hardening negative viewpoints.
These findings are now being folded into the next cycle of UNICEF’s HIV/AIDS programming along with the recently completed Stigma Index Survey for Somalia. At the same time, the programme will continue its work with the HIV/AIDS team to gather further insight into beliefs and practices of Somali citizens, with particular attention to how they change over time to track the impact of programming.
For more information, please contact:
Partha Moman, Project Manager, Africa Voice’s Foundation, firstname.lastname@example.org
Ben Grubb, Innovation Specialist, UNICEF Somalia, +254714606733, email@example.com