How to run prevention and education programmes and campaigns

This guide teaches basic principles of campaigning and public education and applies them to the main tasks that should be done at local level. It has the following sections:

1. Overall approach
2. Targeting and message
3. Public education
4. Condom distribution
5. Promoting openness
6. Counselling and testing  
7. Focus on young people

1. Overall approach

About 80% of sexually active South Africans are not yet HIV positive. It is vital that we do everything we can to prevent new infections. Education and awareness campaigns, condom distribution and testing are important ways to prevent the spread of HIV and AIDS.

Although there are many education programmes in South Africa, research shows that the majority of men still do not always use condoms. In countries like Uganda, where infection rates have gone down, prevention campaigns became successful when two things happened:

• National and local leaders spoke openly about HIV and AIDS and led the prevention campaign
• About 30% of adults were HIV positive and so many people were dying that it was impossible for anyone to be untouched by HIV and AIDS.

We cannot afford to wait to take action because there are already about 950 Aids related deaths in South Africa every day.  We have to talk openly about HIV and AIDS and make sure that everyone understands the danger of unprotected sex, and the responsibility they have to protect themselves and their partners. The silence and stigma surrounding HIV and AIDS must be broken and replaced by openness, good communication and compassion.

In this section, we look at how to run an effective prevention campaign. The aims of any prevention campaign should be to reduce the infection rate. Remember to also make a special effort to target the 10% of South Africans who are disabled. Here are the key things that should be done:

• Educating everyone to understand how HIV and AIDS is spread and what we can do to protect ourselves. We must encourage people to change sexual behaviour and to practice safe sex at all times.
• Making condoms freely and easily available and educating people on how to use them.
• Promoting openness so we can break down the stigma and silence surrounding HIV and AIDS.
• Making everyone aware of the plight of people living with AIDS and the problems faced by their families, and mobilising communities to help care for people who are affected.
• Encouraging testing for all people who are sexually active and making sure there is proper counselling that goes with the testing.
• Ensuring people understand their rights and the treatment options once they have been diagnosed.

There are many organisations that do prevention and education work and they use many different methods like pamphlets, billboards, radio, workshops, drama, talks and so on. We have tried to learn from examples from all over the world. It is clear that some programmes are good and make a real difference while others are just a waste of money. Organisations often spend a lot of money on media and activities without planning their campaigns properly.

 Public education and awareness programmes are most effective when you plan and prepare well and have the following:

• A clear target group that you want to reach and a good understanding of the target group’s culture, language and attitudes
• The right slogans and messages to really influence and change the target group
• The right methods to reach your target group
• The people and resources to implement the programmes

In this section, we will share good ideas and experiences about these things. The next section of this guide deals with target groups and message and section 3 describes good ways of doing education, condom distribution, awareness and testing.

2. Targeting and message

Your campaigns and projects should reach the right people and get your message across clearly and strongly.

Targets

An HIV and AIDS prevention campaign should reach every person in our community in some way.  In the previous section, we listed the things that should be done – education, changing behaviour, condom distribution, promoting openness and testing. Although we must try to reach everyone, we often do not have the resources to do so. Some groups are more likely to get HIV and AIDS and it is important to target the groups that will benefit most from each activity.

The part of the campaign that focuses on educating people about HIV and AIDS and changing sexual behaviour should first target specific groups of people who are most vulnerable. Condoms should be directly distributed or made available to these target groups. They should be encouraged to go for counselling and testing. We must ask: “Who is most vulnerable to getting HIV and AIDS?”

The same people are most likely to spread the virus to other less vulnerable groups. It is for example more sensible to target young sexually active women than widows.

 Our actions should first target the following vulnerable groups:

• Sexually active youth – male and female
• Migrant workers, mine workers and transport workers
• People with more than one sexual partner – especially men
• Sex workers
• Women who are in unequal relationships with HIV positive men and who are powerless to negotiate on the use of condoms.
• Men and women who are already HIV positive and may spread it to others

For the parts of our campaign that creates awareness and openness, we should ask: “Who can most influence people’s attitudes?” People who are in leadership positions in our communities are already in touch with many people and can use their positions to influence others. When you want to change attitudes it is best to use people who are already respected – people will follow the example they set and will listen to their opinions.We should try to involve people like:

• The local mayor
• Ward councillors
• MPs and MPLs
• Religious leaders
• Traditional leaders
• Traditional healers
• Sport and cultural stars
• Popular business people
• Community organisation leaders
• Shop stewards
• Teachers and school principals
• Clinic and hospital administrators
• Community radio DJs and reporters

This does not mean we should ignore ordinary people – in the end we have to change attitudes everywhere. If you have the resources, target the community as a whole. If you do not have resources, work with the targets listed above because they can reach and influence other people.

Message

A very important part of your campaign planning is the broad message you want to communicate and the slogan that sums it up. “Message ” is the ideas we try to get across in everything we say and do. A campaign message is usually only a few sentences long, but it is used as the basis for all speeches, pamphlets, radio interviews, etc. The slogan you use is just a short way of summing up the message so you can put it on a poster or a T-shirt to make it popular.

A campaign will have much more impact if the message is clear and if everyone involved keeps saying the same things. If a campaign is both national and local, it is important to create a campaign identity by using the same slogan and message.

Here are some examples of slogans:

• The Treatment Action Campaign encourages people to wear T-shirts with the slogan “HIV positive”. This helps to bring HIV and AIDS awareness to the public and shows that people with HIV and AIDS are not ashamed.
• The Love Life campaign has many different slogans that appeal to young people. A common slogan is “Talk about sex”. This encourages teenagers as well as their parents to talk openly about sex.
• The Department of Health encourages testing with the slogan: “I have been tested. I know.”

Earlier slogans like “HIV and AIDS kills” were used on posters and billboards. It was used to scare people, but also had some negative effects and was abandoned. People living with HIV and AIDS found it very upsetting to see such a slogan everywhere. They also felt it made people scared of them and lead to discrimination. Be very careful and sensitive when you develop a slogan.

Examples of slogans and messages

On the importance of the struggle against HIV and AIDS:
Slogan: HIV and AIDS affects all of us

Message:

• All of us are affected when half the children in this country may never grow up, when a quarter of our workforce may die in the next decade, when millions of children without parents, basic care and education have to look after themselves. HIV and AIDS is our problem.

On prevention:
Slogan: ABCD – Abstain, Be faithful, or Condomise, Disclose

Message:

• Young people should try to postpone having sex with penetration as long as possible. If you do have sex, use a condom every single time.
• Be faithful to one partner – that is the only 100% guaranteed way of having safe sex.
• It is your responsibility to be tested, and if you are HIV positive, not to pass on the disease to your partners. Tell those who are close to you if you are HIV positive – it will help you to get support and will also protect those you love.
• Real men can make a difference – Stop abuse and respect your partner enough to only have safe sex.
• There is no cure yet for AIDS but it can be prevented by using a condom.
• You can only get HIV and AIDS from unsafe sex or from mixing your blood with the blood of someone who is HIV positive (open sores, blood transfusion, using same needles for injections, mother to child transmission during birth process)

On openness, support, care and an end to discrimination
Slogan: Together we can

Message:

• While we are hiding this disease, we will not be able to fight it. We must break the silence and shame that surrounds HIV and AIDS and deal with it openly and honestly
• HIV and AIDS is not an individual problem – it is so widespread that it affects all of us. All of us have a duty to join the struggle against HIV and AIDS.
• Let’s start talking and bring HIV and AIDS into the open so we can deal with it. Talk to your children. Speak out if you or your loved ones are affected. Let’s break the silence and stand by those who are suffering.
• People living with HIV and AIDS need our support and care – they are no different from people with any other illness, why treat them differently?
• No one should be blamed if they get the disease. It can happen to any of us.
• You cannot get HIV and AIDS from someone by sharing cups, plates, facilities or toilets with them. You can touch, hug or kiss someone with HIV and AIDS without fear.

On testing
Slogan: I have been tested. I Know.
Message:

• Get tested so that you can be sure – if you are still negative, you can then protect yourself.
• If you are positive, you can get access to treatment and support and learn ways to keep yourself healthy. HIV and AIDS is not a death sentence and the sooner you know, the better you can look after yourself.
• We are all responsible to stop this disease from spreading. Get tested so you can protect those you love.

Each organisation could add their own message themes, but it is important that we all try to reinforce the ones above. We should avoid situations where the public gets confused because organisations have totally conflicting messages.

Download toolkit

3. Public education

Public education programmes should aim to get to as many people as possible and to educate them about prevention and safe sex. Remember that we have to try to change behaviour and that we have to challenge sexist attitudes that lead to women abuse. It is also important to change attitudes about people living with HIV and AIDS and encourage non-discrimination and support. Always remember to select your target groups carefully and to stick to the message.

Most people in our society find it hard to openly talk about sex. Educators have to be trained to deal with issues simply and openly and to handle difficult audiences. All over the world “peer education” is the most popular method for HIV and AIDS education. This means using members of a target group to reach others in that group. For example, sex workers are trained to do education for their colleagues and truck drivers are trained to educate other truck drivers. When you use “peer educators” it is easy for them to understand the group’s culture and to gain the trust of their peers. Disabled people face many prejudices about their sex lives and are also vulnerable to abuse. Disabled peer educators should be recruited to deal with this target group.

Try to also involve people living with HIV and AIDS as speakers and trainers in all public education work. This will help to break the silence. Be prepared to face some prejudice and ignorance and try to deal with it constructively and calmly. Always send at least two people to any event so that they can help each other to deal with difficult questions or hostile people.

Here are some of the methods you can use to do public education:

• Talks

Ask schools, churches, organisations and workplaces in your area if you can send a speaker to talk about HIV and AIDS. Speeches/talks should be about 30 minutes long and you should leave lots of time for questions. Click here for information to form the basis for a speech. Also, tell people what their rights are and where they can go for help. Make sure to train all your speakers so that they understand the issues, the message themes and can answer difficult questions.

• Workshops

A workshop can be a few hours long and is a good way to educate people. Workshops give people a chance to discuss issues in more detail. Try to make the workshop exciting and participatory – no one wants to sit and listen to a long lecture. (See workshop outline). Workshops are more difficult to handle and your trainers or facilitators should be trained to run them. Always send inexperienced people with experienced people until they build confidence.

• Plays, songs and music

Culture can be a very effective way of getting your message across to people who do not want to sit in meetings or workshops. Involve local cultural groups in developing education programmes. You can also organise cultural or talent competitions for schools and youth groups.

• Community meetings

Use meetings of interested people from your community or from a specific target group, where people come together to discuss HIV and AIDS or a specific issue related to HIV and AIDS.  Try to involve sympathetic community leaders like politicians, councillors, religious leaders and health workers. For example, ward councillors can call ward meetings and church leaders can organise an interfaith event.  Meetings work best if people have a chance to give their views, ask questions and discuss problems and solutions. The leaders should be there to listen and to give some information and direction. Speakers should make only a very short introductory speech that covers the main issues/problems and then ask the participants to give their experiences and their views about what should be done. Leaders can sum up the way forward at the end of a forum.

• Door-to-door

Do house visits to talk to people about HIV and AIDS.  Get many volunteers, train them and then go from door-to-door in an area.  You can use this method to get to people who never attend events. Try to take a pamphlet with you so that you can leave something behind even if people do not want to talk. Train volunteers in the best way to get people to talk. For example, when someone opens the door you can say: “ Hello, I am Themba. I work for the Youth AIDS Project. We are visiting everyone in this street so that people can ask us questions about AIDS and the things that worry you.  We also want to tell you what we are doing to help young people to stay safe. Do you have a few minutes to talk?”

• Pamphlets

Pamphlets are a good way of spreading information about HIV and AIDS and services offered by organisations. The Department of Health has many simple pamphlets you can use. If you write your own, keep pamphlets short and simple. Translate them into the most common languages used in your area. Make sure you distribute them properly and to the right target groups – otherwise you can waste a lot of money.

• Radio/newspapers

Talk to local community and regional radio as well as newspapers about doing stories that will educate people about prevention, non-discrimination and care. Ask for space to run a talk show or advice column on HIV and AIDS. Ask them to interview people living with HIV and AIDS and their families.

Remember that anyone who gets interviewed should be clear about the messages we want to get across. Click here to talk through some of the key things you should get across.

PUBLIC EDUCATION WORKSHOP OUTLINE – 2 hours
1. Do you know anyone?	Questions to audience	5 minutes
Ask the audience to put up their hands if they know anyone they think died of AIDS. Most people will put up their hands. Then ask them whether it was publicly admitted at the funeral, that the person had AIDS. Few will put up their hands. Use this to lead to the next question.
2. Why is there a silence around HIV and AIDS?	Groups of three	15 minutes
Ask people to discuss this question with two people next to them for five minutes. Then get each group to make one point only until all points are out. Add your own from the manual.
3. Facts about HIV and AIDS and local services	Input	20 minutes
	Questions	10 minutes
Use ‘Important facts on HIV and AIDS’ guide to do an input on HIV and AIDS. Add any local information on services that you can find. Allow for questions
4. What can we do?	Group discussion	30 minutes
	Report back + discussion	20 minutes
Break people into groups of 5-10 and ask them to discuss these two questions: 1. What can we do to protect ourselves against infection? 2. What can we do to help people living with HIV and AIDS and orphans in our community? After 30 minutes let each group make a brief report. Add in ideas from chapter 1 and some of the things that are being done locally and ask people to join existing projects.
5. Personal pledges	Individual task	15 minutes
Ask people to each think of a pledge (promise) they can make about what they will change in their attitudes or behaviour after this workshop. Give them a few minutes, then go around the room, and let each person speak. If you are recruiting volunteers – have forms for people to sign up.
6. Close and thank people. Briefly sum up the workshop with an emphasis on what the workshop agreed should be done.

Download pamphlets and posters

4. Condom distribution

Also see section on correct condom use (click here).

Condoms are the best way to prevent the spread of AIDS, but people need easy access to them. Millions of free condoms are distributed every year and many of those end up being wasted. Condom distribution works best when people are also taught why to use them, how to use them properly, how to store them and how to throw them away safely. Distribute condoms at all your events and workshops.

There is resistance to condom use in many cultures. It is very important to make sure that you also change attitudes. In Britain and France, the government ran very effective TV and billboard advertisements for condoms in the late 80's and early 90's. They made it look "cool" and fashionable to use condoms and very stupid to not use them. The campaigns were very successful with young people and now most people who are not faithful to one partner, use condoms. Their infection rates have stayed very low.

On the one hand, condom distribution should be very well-targeted. Make sure that vulnerable groups can get them easily and conveniently and distribute directly to them. On the other hand, we must make condoms accessible for anyone in the community – do not only distribute to the most vulnerable. Remember that many people are shy and will not ask for condoms so we have to also use places where people have some privacy. Place pamphlets on how to best use a condom wherever you are distributing condoms.

Here are some ideas for distributing to vulnerable groups:

• For truck drivers - put free condom dispensing machines in public toilets at all truck stops and garages. Ask petrol attendants to keep condoms and hand them out to people who ask for them.
• For migrant workers – Place condom dispensers in toilets at hostels, display free condoms dispensers at tuck shops and workplace clinics.
• For sex workers – encourage sex workers to come for check-ups for sexually transmitted infections at clinics and to collect a month’s supplies of condoms. Distribute condoms through one sex worker who is trained to educate others.

Distributing to the general public does not have to be so targeted – but make sure that people can get condoms easily when they need them. Here are some ideas:

• Make free condoms available at spaza shops, shebeens and 24–hour garages
• Condom dispensers in all public toilets and workplace toilets
• Allow people to collect a few dozen condoms at a time at clinics and workplaces
• Find a way of getting condoms to youth – use clubs or other young people. It is not easy for young people to ask at a spaza shop or clinic in their area - the adults who work there may know their parents.

Try to monitor distribution and use. Keep a list of how many you have distributed to each place and how soon it was used up. Make sure you have a good system in place to find out when a distribution place has run out, and to send them new supplies.

5. Promoting openness and awareness

We have to actively promote openness about HIV and AIDS and create a more supportive environment for people living with HIV and AIDS. Unless we bring the disease into the open, we cannot deal with it effectively. If we cannot break the silence ourselves, we cannot expect the rest of society to do so.

As organisations we can:

• Encourage and support people living with HIV and AIDS to go public about their status
• Ask people living with HIV and AIDS to sit on platforms and speak at meetings with our leaders
• Encourage testing by organising testing drives and asking those leaders who are willing to, to go public about their results
• Create role models for how to cope with HIV and AIDS, by encouraging our leaders and other influential people who are HIV positive to reveal their status and to help campaign and raise awareness.

Awareness campaigns are used to make issues visible and to change public attitudes. They should aim to get publicity and to directly reach thousands of people. Be sensitive in the way you campaign. People are easily turned away by campaigns that are too aggressive or negative. Here are some methods you could use:

• AIDS ribbons - everyone should wear the red AIDS ribbon to show their support – especially local leaders.
• Banners – make a striking banner and hang it in a prominent place. Take it to places where many people gather – like soccer matches. The banner should have a clear message with a slogan and a picture if possible.
• Posters/pamphlets/graffiti – use posters and pamphlets to raise the issues or give people information. Get them from other organisations or make your own. Get permission from the council to paint an educational mural in a public place.
• Marches, events and culture –  use marches, cultural events and parties to mobilise community support. “Breaking the silence” events - where people living with HIV and AIDS come to talk about their experiences, or plays and songs that show the reality of HIV and AIDS.
• Protests – support the campaign against drug companies that do not make medicines available cheaply to developing countries. Protest against any employer or body that discriminates against people living with HIV and AIDS.
• Prayer meetings, funerals and other community events – Call special prayer meetings around HIV and AIDS. Get traditional leaders to call their subjects together to discuss HIV and AIDS. Use funerals of people who died of AIDS as an opportunity to raise awareness – be sensitive to the family’s wishes.
• Loudhailers, information tables, etc – use loudhailers to talk at taxi ranks or in train carriages, set up information tables at busy places.
• Radio/newspapers – ask local media to raise awareness through phone-ins on radio, and interviewing people living with HIV and AIDS and your organisations.

6. Counselling and testing

Most people who are HIV positive do not know it. This means that they will unknowingly spread the disease to their partners while they are in the early stages.

There are few, if any, symptoms in the early stages of the disease. The flu-like symptoms that often occur shortly after infection usually pass quickly so most people   do not know that they have become HIV-positive (seroconverted is the medical term)). This underlines the importance of people being tested even if they have no symptoms. Testing should not be a once-off activity. Encourage people to be tested every couple of years (click here to view available VCT sites).

The Department of Health is promoting voluntary counselling and testing (VCT) at clinics and hospitals. People who want to be tested are counselled before the test and if they are positive, get further counselling and support afterwards. The counselling is very important since people need good advice and emotional support if they are positive. They also need counselling on how to protect their partners.

The major problem with VCT is that it is mostly pregnant women who come for tests. They do this so that they can get medicine like Nevirapine to prevent infection of their babies. A very small percentage of the men who are positive come for tests. Many people say they would rather not know if they have HIV and AIDS since they see it as a death sentence and as an end to their sex lives. They also fear that their families and friends will reject them.

Unless people who are HIV positive know it and practice safe sex, we will not stop the spreading of the disease. We have to find ways to overcome resistance to testing. People must feel that it is in their interest to be tested.  Linking testing with treatment is the most effective - if people know they may stay healthy for longer, they will come for tests.

We should stress four main things as good reasons for testing:

1. If you know you are still negative, you can make sure that you protect yourself and stay negative.
2. If you know that you are positive, you can do the right things to stay healthy.
3. If you are positive, the clinic will help you to get treatment for infections and other support from services that will help you to look after yourself and your family.
4. If you know that you are positive, you can protect your partner by practicing safe sex.

We should also stress that it is the right thing to do and that it is our moral responsibility to not spread the disease. This should not be the main reason we use. The four listed above may be more effective since they appeal to people’s self-interest. It is also important to set up counselling and testing in places where it is comfortable and where people can go without others finding out. The facilities should be open at times when working people can get there. There should also be a referral system in place so that when someone tests positive they can be offered other forms of support. (See Medical Treatment, Clinics and Hospitals).

We must use all our public education and awareness methods to promote testing.

Here are some ideas:

• Organise a testing drive led by key local leaders and role models – publicise the drive and mobilise people to go on specific days to be tested.
• Encourage people to take five friends with them so they can all be tested.
• Get local leaders to talk publicly about being tested and why they did it.
• Organise health workers to come to workplaces to take blood – do a talk or workshop first to motivate people.

7. Special youth focus

The behaviour of young people now will determine the future of the HIV and AIDS epidemic. If we cannot change the behaviour of people who do not have HIV and AIDS, the disease will only spread even more widely. There are many different kinds of projects that can be used to reach young people. The most successful ones all over the world, have used the principle of “peer education”. This means that young people are trained to be the educators of other young people. They are much better at communicating with other young people and are not treated with the suspicion that young people might have for older people who come and tell them what to do with their lives.

Young people need to be educated and learn how to deal with things like:

• Preventing HIV and AIDS through healthy and safe sexual practices
• Preventing sexually-transmitted infections
• Understanding drug-use and the spread of HIV and AIDS
• Understanding sex, reproduction and safe-sex
• Learning about care and support of people with HIV and AIDS and their families
• Learning how to deal with peer-pressure
• Learning some communication and negotiation skills – especially around sexual issues

The kinds of projects that have been used to get these messages across differ all over the world. It is not enough to simply have an education project that goes to schools, although this can make a big difference. One of the most important things to do is to make sure that young people feel free to talk about sex and can deal with it honestly and openly in their relationships with each other. They must be able to get support and information and get easy access to prevention measures like condoms, treatment of sexually transmitted infections, testing, and counselling.

Here are some examples of projects that have been used successfully used:

• Peer education on HIV and AIDS that targets youth organisations or youth sectors within churches and communities.
• School programmes that deal with both the health as well as the emotional side of sex and give young people some of the life skills they need to negotiate safe sex.
• Youth groups that talk about sex or offer support to young people with problems.
• Youth-friendly health services, where young people can talk to other young people about the kind of problems they experience and get the help, information and condoms that they need.

Examples of Peer Education Projects

In Thailand, where HIV and AIDS is mostly spread through prostitution, young girls who may enter the sex trade, have been targeted for special work. The Education Ministry, together with the private sector have set up bursary and loan schemes and social workers and teachers identify young girls who may be vulnerable to becoming sex workers.

These young girls are people who come from poor families, who drop out of schools, or who already behave in socially unacceptable ways. The teachers and social workers provide counselling to these girls and try and get them onto a bursary or loan scheme to help them stay in schools. In some areas, they get special after-school support or extra training to make sure that they do not miss their education.

The loveLife Project in South Africa has also been very successful in setting up youth centres and facilities in townships where young people can meet, socialise and get involved in activities. The loveLife centres are also places where people can talk openly about sex and get counselling and advice (click here for loveLife website.

In Kenya, the Mathare Youth Sports’ Association was set up to form soccer clubs where young people could come to play, talk about their problems, as well as get some basic sex education.  Based in a desperately poor region where HIV and AIDS is widespread it is now the largest soccer club in Africa and has 410 boys’ teams and 170 girls’ teams. Peer education is the main method that is used within the soccer club and all the members become resources for their communities or in their schools.

The Shosholoza project in Pietermaritzburg trains peer educators from local soccer clubs to work with other soccer players. They promote condom use and responsible sexual behaviour.

The Khayelitsha-based Mothers’ Programmes trains HIV-positive women who are pregnant or who have young babies to become peer educators and support persons. These peer educators assist other woman by running support groups, visiting them at home, meeting with family members and teaching them skills to make them economically self-sufficient.

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