INTRODUCTION
Three randomised control trials in Kenya, Uganda and South Africa have shown that
Voluntary Medical Male Circumcision (VMMC) reduces the risk of heterosexual HIV
transmission to men by up to 60%. This has resulted in a WHO and UNAIDS
recommendation to promote VMMC as part of comprehensive HIV prevention
programming. In order for South Africa to achieve its 80% national coverage target of
VMMC, significant investment needs to be made in demand creation programming. The
Centre for HIV/AIDS Prevention Studies (CHAPS) provides free VMMCs through 28
community based clinics and hospitals in Gauteng, North West and Limpopo Provinces. In
2013, CHAPS demand creation activities have resulted in some increases in demand but
CHAPS have committed to exploring additional demand creation opportunities. In terms of
reach, mobile telephones are highly prevalent in South Africa, with more than 90% of South
African households surveyed in 2011 reporting to have at least one cellular telephone in the
home. The ongoing advancement of mobile phones to allow data transfer and internet
access also means that more ‘Technology-Poor’ or ‘ICT Have-nots’ will be able to access the
ever increasing knowledge content of the internet, participate in digital social-domains and
be reached in shorter times and at lower costs.
MATERIALS AND METHODS
This was a secondary data analysis study of data from a cross-sectional study on
uncircumcised men who chose to access the free VMMC provided at three CHAPS clinics in
Soweto and Orange Farm, Gauteng, South Africa. This study had access to all data collected
and captured for all uncircumcised primary study respondents aged 15 years and older who
were surveyed by CHAPS clinic staff from March to October 2013. Analysis was conducted to
assess associations between socio-demographic factors and mobile phone ownership.
Associations were also assessed between messaging platforms used and mobile phone
usage, networks utilised, and factors that influenced the VMMC seeking behaviours,
knowledge and beliefs about VMMC and reasons to get circumcised.
MPH Research Report: Gareth Coats 511 038
IV
RESULTS
Mobile phone ownership was high (92.7%) amongst study participants (n= 1,207) with the
likelihood of mobile phone ownership, increasing with age (p< 0.001). The vast majority of
participants lived with two or more people, but those living in smaller households or alone
were more likely to own a mobile phone (p= 0.040). Participants who were single or did not
live with their partner were also less likely to own a mobile (p= 0.015). SMS remains the
most used message platform, but more than half the sample uses a combination of
messaging platforms. Information sources that combined mass media and interpersonal
channels were shown to most influential to participants in deciding to access VMMC and the
most significant factor about the CHAPS clinic that lead to participants accessing the VMMC
services was the clinics’ convenient locations (p= 0.009). Nearly three quarters of
participants had an above average knowledge of HIV and VMMC. The study data showed
that uncircumcised men who did not use any mobile phone messaging platforms scored
lower in knowledge while those who used a combination of platforms with SMS had the
highest knowledge (p< 0.001). The opposite was shown for positive beliefs (p= 0.023). The
HIV preventive benefits of VMMC was the most recorded reason for becoming circumcised,
but when reported reasons were tested by messaging platforms used, improved hygiene
was shown to be the most significant reason for getting circumcised.
CONCLUSION
Overall, the study found that the use of mobile phones is feasible for the promotion of
VMMC. The data showed that mobile phone based messaging platforms provide a mix of
demand creation opportunities. However, using platforms as a way to meaningfully
segment target audience content delivery for may not be required, especially as ‘Smart’
phones become more prevalent in the mobile phone market. Smart phones allow multiple
cost effective platforms to be used and it appears that the utilisation of costlier messaging
platforms such as SMS is diminishing.