Every hour, about three Zambian youth aged 15-24 years old get infected with HIV. Young people are more vulnerable when they have limited comprehensive HIV prevention information, are not equipped with life skills and do not utilize HIV high impact prevention services such as condoms, male circumcision, HIV testing and treatment.
It is 11pm on November 30, 2012. I sit in my office chair and longingly look at my ticket to a live performance by an international artist. The show started at 8pm and ends in half an hour. I put the ticket back into my purse and pick up my phone to call technicians from the mobile phone companies as none of the networks have configured the line to be used for the Zambia U-Report SMS platform. The launch is tomorrow at 10am during the World AIDS Day celebrations and people will surely turn up and want to register. What will happen?
With over 24,000 young Zambians registered as U-Reporters, I look back now to that day with so much pride and, sometimes, awe at how far the Zambia U-Report has come. I also cherish the difference we have been able to make in helping the young get free information about HIV and AIDS through their mobile phones in the comfort of their chair, bed or favorite hang out.
It is November 30, 2013 and I am, once again, sitting in my office chair. But this time, it is only 11am and I am watching a TV public service announcement (PSA) for Zambia U-Report that features local celebrities and the Zambian First Lady Dr. Christine Kaseba You don’t really get a much higher endorsement than that!
We knew from the very start when we held a design workshop with stakeholders and young people in October of 2012 that for the Zambia country office and its partners, showing results and making a difference in young people’s lives would be the focus. We therefore ensured that the majority of the participants in the design were young people and our Monitoring and Evaluation team helped guide them in creating a results framework that has acted as a compass for the programme. The facilitator from the UNICEF Uganda office, which we adapted the U-Report platform from was also young, vibrant and very optimistic that our approach of targeting a specific problem that was a huge challenge for Zambian adolescents and youth was going to be a huge success.
The design workshop identified three programme outputs: Effective SMS-based mechanism to increase young people participation in the national HIV prevention response available; Young people have increased comprehensive knowledge of high impact HIV prevention measures and services; and young people demand for and are referred to HIV high impact prevention services (HIV Testing and Counselling, Condoms, Male Circumcision, Anti-Retroviral Treatment).
We have been able to have very quick wins in all three during the pilot phase. The software environment was built on from the original application by a local developer using open-source software (RapidSMS) and the counseling is provided by CHAMP, an organization with over 10 years of experience in phone counseling.
The platform provides confidential, free of charge, individualized and interactive counseling services on HIV and STIs to adolescents and youth. Over 70% of all signed up U-Reporters have started conversations with the counselors by asking questions. The counselor web-interface allows for quality control of the SMS counseling to ensure that the right knowledge is being transferred in a respectful and empathetic way. In addition, the platform enables tailored SMS demand creation for available services, and referral to the U-Reporter’s closest location for HIV Testing and Counseling, Voluntary Medicalised Male Circumcision and Anti-Retroviral Treatment. We analyze incoming SMS traffic to track and report periodically on key knowledge gaps and emerging issues related to HIV and STIs among young people.
In addition to the SMS counseling, polls are conducted periodically to get the opinions of young people. In order to ensure a high response rate, all polls that are sent to U-Reporters are first vetted by a closed Facebook group comprising only young people below the age of 24. The closed group is responsible for ensuring that the messages endorsed by the National AIDS Council are re-phrased into a language that they can relate to and respond to honestly without feeling pressured to give ‘textbook’ or ‘correct’ answers. The group is even allowed to completely turn down a poll question and replace it with one they feel is more relevant and/or adolescent-friendly.
The Facebook group was used to prepare messages for a campaign that was aimed at increasing demand for HIV Testing and Counseling (HTC). U-Reporters were polled on whether they had been tested recently and divided into two groups based on their response. The two groups were then targeted with different sets of messages. Particular attention was given to the young people who had not been tested and messages of encouragement were sent and referrals to close test sites provided when requested. At the end of the campaign period, a post-campaign poll was conducted and 35% responded as having tested during the campaign. It was heart-warming to hear a story from a young girl about how the campaign had affected her and inspired her to share with friends so they could get tested together.
Another event that made missing the show on that pre-launch night worth it was the 3rd Zambia National HIV Prevention Convention. Unlike previous years, adolescents and youth were invited to participate in the convention and give the opening statement dubbed ‘Voices of Youth’. Prior to the convention, 50 adolescents from all across the country were convened in the capital to discuss issues such as condom use, Male Circumcision, and HIV Testing and Counseling. In order to get broader participation, all U-Reporters below the age of 24 were asked, via SMS to their phones, the exact same questions that the group in Lusaka were discussing. The results of the polls were nearly identical to the recommendations that were made by the adolescents and youth in Lusaka. The inputs were combined and used in preparing a powerful statement that was read during the opening ceremony of the convention by two representatives, a 14 year old female and an 18 year old male.
We realize that the possibilities for Zambia U-Report are many and we still have so much work to do to ensure that we get to zero infections in Zambia, especially among adolescents.
For me, the Zambia U-Report journey has been so exciting, so much fun and very rewarding every time I think of the contribution we are making to these young people’s lives. The evidence is there, what more can I ask for?
By the way, did I mention that the Zambia U-Report abstract I did won one of the three awards at the Prevention Convention? And, I bought a DVD for the show I missed so all’s well that ends well!
ICT Assistant, UNICEF Zambia
See the U-Report PSA (60 sec) here
See a documentary on U-Report in Zambia here
Read more about U-Report: