MXit HIV Counselling - Red and RedChatZone

 

HIV and AIDS information provision and counselling via mobile

Background

South Africa had about 5.2 million people living with HIV and AIDS in 2009, more than any other country[i] HIV prevalence for youth aged 2-14 years is 5.6%, and for those 15-24 years it is 9.3%[ii] A survey of over 3,000 South African youth found that almost half of youth aged 16 years engaged in risky sex (previous unprotected sex) and that knowledge of HIV and AIDS was generally not sufficient to support appropriate behaviours in a context of high HIV prevalence[iii] There are a wide range of mass media interventions in the country aimed at the prevention, treatment and support of those with HIV. A challenge, however, is to reach youth in a medium familiar to them, that allows for interaction, and that they can afford to access.

Mobile subscription rates are high at around 93%[iv] which presents a golden opportunity to reach youth with a device that sits in many of their pockets. MXit is a very popular instant-messaging (IM) chat application used on mobile phones that claims 29.6 million subscriptions in South Africa[v]

Aims

The aim of Red is to give South Africans, particularly youth, easy access to HIV and AIDS-related information to improve their levels of knowledge around how to prevent HIV, and how to live with it. The aim of RedChatZone is to make HIV counselling cheaply available in a completely private medium that does not involve the client having to travel to get counselling.

How it’s implemented

In 2009 Cell-Life, a South African NGO, set up two HIV services using MXit: Red, and RedChatZone. Red provides basic HIV information that can be browsed via MXit. It is very cheap to use as the reader just pays a data charge, say US$0.05 to read most of the content. The Red content is also available via a mobile phone browser, at redhiv.mobi.

The content provided in Red was mostly developed from Treatment Action Campaign treatment literacy documents used to provide education and information for HIV activists, treatment supporters and members of the public. The content was reviewed by the Communications Task Team of the South African National AIDS Council.

RedChatZone is an HIV counselling service run in partnership with LifeLine, which runs the National AIDS Helpline, South Africa’s official telephone HIV counselling line. It is available free via landline, but people have to pay normal rates when calling from a mobile. Given that only 9 out of 100 South Africans have a landlineiv, making HIV counselling available via mobile at very low cost to the client is essential to making counselling widely available.

RedChatZone uses IM chat via MXit to allow the client to text-chat from their mobile phone with a counsellor who is chatting from a computer connected to the Internet. Counsellors are able to attend to multiple clients at the same time, which makes it possible to help more clients with fewer counsellors. The holding of multiple concurrent conversations is standard practice in IM chat. Providing counselling in this way is also more efficient as hoax callers can be ignored (unlike on the telephone where protocols take time before the call can be terminated).

For the MXit user the counselling is completely private; no one need know who they are chatting with, and they can get counselling wherever they are. Cost is a major factor in the popularity of the service. A counseling conversation using mobile-voice costs the user in the region of US$1 (for a four-minute call); a similar conversation on MXit costs less than US$0.05.

Outcomes

Red has been available since late August 2009. In that time, over 1.6 million pages of content have been viewed. Currently 59,000 people have Red as a contact on MXit (MXit is like Facebook where people have to a ‘friended’ each other to connect/read each other’s material). This level of use has happened with minimal advertising, and is especially pleasing given that MXit users have to find out about and then add Red as a ‘contact’ in order to see the content. It shows the promise that if information is made accessible to youth in a medium that is familiar to them and cheap to access, it will be read.

RedChatZone has been available since September 2009, from Monday to Friday 3-5pm. To end April 2011, over 26,000 people had made use of the service, in over 24,000 conversations (like on a telephone counselling line, some clients cannot be attended to or drop off the service). Cell-Life is busy with an evaluation of the service, which includes analysis of counselling conversations, interviews with counsellors, analysis of usage statistics and a client survey. Initial analysis of the conversations indicate that:

  • 44% dealt with HIV prevention;
  • 29% were with clients who disclosed their HIV-positive status;
  • 24% dealt with non-HIV topics (like relationships, general health, abuse, pregnancy);
  • 3% were ambiguous/not classifiable.

The analysis has shown that users are surprisingly revealing of things like their HIV status and sexual behaviors. This could be because IM text-chat is a completely private medium. It is also clear that people still need basic information on HIV (like whether it is transmitted by kissing, or the fact that with medication you can live a long life). Counsellors have also indicated that mobile-chat counseling affords the client a degree of privacy not possible with telephone counseling: with the latter the counselors often hear background traffic noise (from public telephones) and clients using ‘bland’ language (not mentioning HIV), whereas on mobile clients can text-chat from anywhere.

A RedChatZone client survey has yielded some interesting feedback (in the shortened text-speak used on MXit!):

thanx 2 redchat zone.i gt al da advise i nided.ws pregnant n knew al bwt testing n da health f da baby.nw i hav a healthy 10 mnths old boy:D

Thankx for givin us support n info when we chatin we realy need it coz sumtymz i scared 2go 2d clinic nd talk 2nurses thankx

U guys helpd me 2 protect the wman i lv. I neva had 2 much information abt the viruse bt u guys tought me alot. I jst nid 2 go 4 test knw. Bth of us.

redchatzone is de 1 if u nd advse or hlp dz is de bst way dnt wry abt prvcy ur cht wth de councelr wl b cnfidentl



[i]Republic of South Africa (2010), South Africa UNGASS Country Progress Report. http://www.unaids.org/en/KnowledgeCentre/HIVData/CountryProgress/2010CountryProgressAllCountries.asp

[ii]Shisana O, Rehle T, Simbayi LC, Zuma K, Jooste S, Pillay-van-Wyk V, Mbelle N, Van Zyl J, Parker W, Zungu NP, Pezi S & the SABSSM III Implementation Team (2009) South African national HIV prevalence, incidence, behaviour and communication survey 2008: A turning tide among teenagers? Cape Town: HSRC Press

[iii]Peltzer, K & Promtussananon, S (2005). HIV/AIDS Knowledge and Sexual Behavior Among Junior Secondary School Students in South Africa. Journal of Social Sciences 1 (1): 1-8

[iv]International Telecommunication Union (2008). ICT Statistics Database. Accessed 4 June 2010. http://www.itu.int/ITU-D/ICTEYE/Indicators/Indicators.aspx#

[v]Personal communications of Katherine de Tolly, Cell Life, with Laura Hallam of MXit, 22 February 2011