AIDS to Design a Prevention Strategy

Tapping into Batswana Tertiary Youth’s Knowledge and Perceptions of HIV/AIDS to Design a Prevention Strategy Results and Lessons Learned Février 2014...
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Tapping into Batswana Tertiary Youth’s Knowledge and Perceptions of HIV/AIDS to Design a Prevention Strategy Results and Lessons Learned

Février 2014

research coordination Mrs Margaret Baiketsi  |  Director  |  teAIDS Programme) research and writing Scott Bohachyk  |  Elizabeth Lougheed  |  Onaopemipo Onadipe review and editing Astrid Froese  |  Uniterra photo  |  cover page David Aimé  |  teAIDS 2013

Key Messages •

Despite a plethora of HIV and AIDS information disseminated since the mid-1990s aimed at prevention and support, Botswana continues to suffer from an HIV prevalence rate of approximately 17.6% (GoB, 2008).



In order for Botswana to maintain its impressive growth of the past half century, a decline in new infections among youth is imperative. New and creative ideas need to be generated by an empowered youth population to communicate messages and implement interventions relevant to their needs.



In 2008, the Tertiary Education Council (TEC) initiated a research project with the support of the Uniterra program to better understand the knowledge, behaviours, attitudes, experiences and opinions of youth studying in the tertiary sector to examine the successes and challenges of previous interventions. This sector includes both university and college training institutions.



One of many free condom distributers. Photo credit: David Aimé

AIDS project (teAIDS), a coordinated strategy that aims to strengthen the capacity of tertiary education institutions to respond to the causes and consequences of HIV epidemic among Batswana tertiary youth.

As a result of this research, TEC was awarded 18 million Botswana pula (approx. $2, 155, 000 CDN) by the Botswana National AIDS Prevention Support Project (BNAPS) in mid-2012 to implement the Tertiary HIV and

Current Context Botswana is considered to be one of the great development stories of the late 20th and early 21st centuries. Since gaining independence in 1966, the nation has remained politically and economically stable and has seen its per capita gross national product rise from $70 USD to $12,500. However, the country still faces many challenges, including persistent poverty and inequality, a lack of economic diversity, rapidly declining mineral reserves, and above all, the world’s second highest prevalence of HIV infection.

was identified by UNAIDS as the country with the highest rate of HIV infections in the world (Arnad, 2010; Jensen et al., 2012). Since that time, there have been dramatic multi-sector efforts to increase HIV and AIDS education and improve access to medical care and antiretroviral (ARV) drugs. These efforts have resulted in an estimated 90,000 citizens receiving ARV treatment as well as a significant decrease in mother-tochild transmission rates (Jensen et al., 2012). However, new infections continue to occur and the government of Botswana recognizes that it is imperative to reduce these in order to counter the loss of human life, the erosion of skills and

The first case of HIV in Botswana was reported in 1985 and in little more than a decade, Botswana

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This project is coordinated by TEC, an umbrella body responsible for coordinating tertiary education and setting standards for teaching, examination and research. It is also mandated to provide services in the areas of registration, advocacy, policy, accreditation and funding. TEC has the authority to make recommendations to private and public institutions regarding HIV and AIDS.

capacity throughout society and the enormous cost of funding ARV therapy and other related interventions. In an attempt to address the serious gaps in the areas of prevention and support for a young generation that has suffered great hardship, the Tertiary Education Council initiated the teAIDS project, its most ambitious attempt to plan HIV and AIDS interventions for youth in the tertiary sector.

Working with Uniterra to Address Key Challenges Following consultation with World University Service of Canada (WUSC) in 2007, the need to address the health and wellness of tertiary students and staff became one of TEC’s main objectives. WUSC’s Regional Director, and the Director of Policy and Planning at TEC, started discussing HIV prevention in more detail, recognizing that student health is crucial to academic achievement and, ultimately, to the development of a skilled workforce which is key to Botswana’s future growth. At the time, there was no coordinated effort in Botswana to organize a tertiary campus response to the HIV crisis elsewhere than at the University of Botswana. The lack of prevention and support services at the tertiary level was identified as a gap that needed to be addressed. This led to the idea of conducting a study of over 10% of the tertiary student body to collect more information and to determine a baseline of existing programs and services.

In order to answer these questions, the research team needed to know students’ opinions about their current behavior, how their peers were behaving, and what their perceptions of the relevance of messages and campaigns were. Born in the early 90s, this generation had not only grown up with the devastating effects of HIV and AIDS on their families and friends, but also with exposure to the gamut of HIV prevention campaigns, talks and commercials, yet their behaviors and attitudes remained surprisingly risky. TEC led the research process by funding the project and creating an external advisory team made up of HIV and tertiary level stakeholders. They were involved in all decisions, guided the research team and facilitated input from all of the institutions. The Uniterra program supported this process through the advice and guidance of a Canadian volunteer, Melissa Godwaldt.

Research Process The first steps of the study were to create the research questions and apply for a permit from the Government of Botswana to interview students and conduct focus group discussions on campus. Two of the main questions that guided the research team were: •

Why is there no coordinated response across tertiary institutions?



What can we (TEC) do?

From January to December, 2009, 34 tertiary institutions were visited with 4,312 students and 231 staff completing voluntary self-administered surveys. Afterwards, there were focus group discussions where the findings of the interviews were presented and discussed with students.

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Results Obtained Melissa Godwaldt, HIV/AIDS Advisor Since completing her Master’s Degree in Socio-Cultural/Medical Anthropology with a specialization in HIV and Structural Adjustment Reforms in 2001, Melissa has been active in the field in both Canada with the AIDS Committee of London and in Botswana with the Department of Technical and Vocational Education and Training where she created a teacher training program in HIV Basics and Life skills. Photo credit: Sandra Oey, WUSC Ottawa

The results of the surveys were described by Melissa Godwaldt as “the shock of a lifetime”. The statistics were alarming. For example, the surveys revealed approximately 45% of students had already engaged in sex without a condom and only 49.4% knew the status of their partners. The evidence gathered concluded that, despite increased knowledge and experience of AIDS deaths within their own families, the risky sexual practices that gave rise to the current HIV epidemic in Botswana persisted amongst tertiary youth. This left the researchers wondering about the missing link between students’ knowledge and experience of HIV and AIDS and their behaviours and attitudes: “How does that not translate into ‘I never want this disease so I am going to do this, this and this’.” Melissa stated that she had been a firm believer in behaviour prevention going into the study but came out of the research with an understanding that much more prevention and support was necessary. In her opinion, one of the main findings of the research was that the country’s HIV and AIDS

response had let this vulnerable population down at a critical time in their lives. Other interesting findings emerged from the focus group discussions with tertiary students, many of whom indicated that they rarely had opportunities to discuss these topics. Students were shocked to find out that it was not only themselves who were engaging in unprotected sex, but also their peers. The focus groups also unearthed some subtle gender differences in perceptions of women’s dependency on men, lack of voice and lack of decision-making power regarding condom use. Males mostly saw these as things women ‘allow’ to happen whereas women sometimes felt they had no choice. These findings highlighted the need to design life skills programs with gender differences in mind. Many other issues were also explored including: role models, transgenerational relationships, financial dependency, population mobility and alcohol use. This research project was recognized as critical to understanding youth perceptions of HIV and AIDS and TEC promptly shared the findings nationally and internationally in order to shed light on what was happening in a high prevalence country.

TEC Director, Mr Molutsi, signing the BNAPS/teAIDS agreement. Photo credit: Melissa Godwaldt

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the teAIDS project. The new outreach program was officially launched in 2013. Uniterra also supported TEC with a volunteer on advocacy strategies in 2013.

As a result of this study, an official proposal to the Botswana National AIDS Prevention Support Project (BNAPS) was created and submitted and TEC was granted 18 million Botswana pula (approx. $2,155  000 CDN) to strengthen

More Uniterra Volunteer Contributions to TEC Since 2009, WUSC has mobilized three other Canadian volunteers through the Uniterra program: Antoinette Davis through Students Without Borders, Anouk Bissonnette through Leave For Change and David Aimé who recently completed a 14 month posting as an HIV Advocacy Advisor for the teAIDS project. These volunteers have worked with TEC colleagues to build their technical skills, advocacy expertise and offer strategic planning advice. Some of their most significant achievements include: Market Research and Strategic Plan: Anouk Bissonnette developed a strategic plan and a step-by-step guide to strategic planning in collaboration with the teAIDS reference team. A market study guide was developed in collaboration with the University of Botswana’s Centre for the Study of HIV and AIDS and Population Services. HIV Experience and Training Database: Antoinette Davis surveyed 46 tertiary institutions and created a database to track HIV and AIDS expertise among staff/teachers/lecturers.

Photo credit: David Aimé

Advocacy and Educational Work: In 2013, David Aimé worked closely with TEC colleagues and tertiary students. He appreciated working with experienced public health specialists and found his social marketing skills were in high demand. Some of the highlights include:

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An Advocacy Action Plan to advance HIV policies, leverage HIV-services on campus and to foster behavioral change was created with TEC staff. This included an illustrated booklet of advocacy activities for tertiary students.



Guidelines for a condom distribution plan were used by most institutions to draft plans.



Brochures on myths and misconceptions about HIV/AIDS, transactional sex, HIV testing, multiple concurrent partnerships and life skills were created.



Concept papers and proposals were developed for a condom-shaped hot air balloon, condom fashion show and a mass media HIV testing campaign.



Communication tools were strengthened (use of logos, templates, email signatures, directory of reliable design companies).



All ten campus health centers were branded with youth-friendly prevention messages. Following a youth led brainstorming session, a Porta-Cabin (health center) providing counseling and information was set up.



A major campaign “It’s all in your hands, gear-up against HIV” was organized.



Interactive and social media outreach was strengthened. A Facebook page (Gear-Up Against HIV) and a Youtube channel (teAIDS) were created.



An innovative condom wall banner forming the letters AIDS was developed to distribute condoms.



An Interview on the Letlabile Show was given to present a flash mob event.



A flash mob involving 400 students and watched by thousands of spectators and

official delegates at the Tertiary Education Fair was organized. •

strategic planning. As a follow-up to the survey findings, numerous awarenessraising initiatives including campaigns, presentations, distribution of promotional materials (brochures, e-cards, posters, etc.) and peer educator training were carried out with volunteer support.

TEC staff was trained in media relations, website creation and in how to implement

In all, 93 management and communication tools have been developed in collaboration with TEC by the four Uniterra volunteers since 2009. TEC is now better able to coordinate and strengthen the teAIDS project across Botswana’s tertiary institutions. There are now approximately 36,000 tertiary students in the country who have increased access to HIV prevention services. Sample of advocacy work. Photo credit: David Aimé

Lessons Learned There have been many lessons learned throughout the partnership between Uniterra and TEC, the main lesson being the value of research in designing effective programs. Without the data generated from thoroughly interviewing over 4,300 students, the teAIDS strategy would not have been able to specifically identify the exact areas where an intervention would be the most effective. For example, the study pinpointed the serious shortage of counselors trained in providing support for trauma, bereavement and illness. Most institutions were only providing services at the level of “awareness”. The study also highlighted the need for further research into social networking, the prevention of mother to child transmission, safe male circumcision, alcohol use on campus and also living conditions at Tertiary residences (lack of extracurricular activities, infrastructures).

Another lesson learned is the importance of engaging youth in decision making. In this case, youth were not only interviewed, but also consistently empowered by including them in all the advocacy campaigns of the teAIDS project. This has made the messages, brochures, photos, flash mobs and other events more innovative, dynamic and enticing to youth. A participatory approach to focus group discussions also ensured richer results. As Melissa Godwaldt noted, the openness of the students to discuss HIV and AIDS during the interview process was a result of “talking with the students, not at them.” The fact that youth were not consulted by many of the national campaigns directed at them over the years may be why many of the messages have missed their mark, as evidenced by the survey.

Conclusion The success of TEC’s model for prevention and support services across tertiary institutions in Botswana is an important example of how research and empirical data can guide and shape policy and planning to produce relevant interventions. While the fight against HIV faces an uncertain future, TEC currently has 39 registered campuses offering strengthened HIV prevention services to tertiary youth. The idea of having a coordinated nation-wide response is now a reality and no longer only a concept.

The partnership between Uniterra and TEC has also helped Botswana respond to HIV and AIDS on tertiary campuses in a more coordinated and comprehensive manner. This is important not only for the health and wellness of individual students and their families, but for the country as a whole. Botswana’s future development requires a healthy and productive population that is able to tackle challenges in the coming decades.

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partner organizations

Tertiary Education Council Gaborone, Botswana www.tec.org.bw WUSC Botswana Plot 545 South Ring Road Gaborone, Botswana

uniterra.ca  |  ceci.ca  |  eumc.ca  |    Uniterra   CECI Canada  | 

  World Uni Service

The Uniterra program is carried out with the financial support of the Government of Canada provided through Foreign Affairs, Trade and Development Canada (DFATD).