# Voice For Humanity's

# Africa AIDS Orality Initiative

**12/15/03**

**Introduction: Challenges to Changing Behavior through Information,
Education and Communication**

The centrality of behavior change in combating HIV/AIDS has been
recognized since the beginning of the epidemic. One of the most
widespread approaches to behavior change used in the battle against
HIV/AIDS has been information, education and communication (IEC)
campaigns focused on raising awareness about the virus and the syndrome,
avoiding behaviors associated with increased risk, and providing
behavioral strategies for the caregivers of people with AIDS. 

Many HIV prevention and education communications campaigns have been
implemented in developing countries. However, many of these campaigns
have fallen short of the intended purposes of wide-spread distribution
of information resulting in behavior change. Often the information does
not reach the intended audience in a way that enables a person to
internalize it to the point where behavior change occurs.

Voice For Humanity has identified two barriers to IEC campaigns that
need to be overcome, as well as five accelerators that are more likely
to result in lasting change in behavior. Some of these accelerators have
been identified by the Center for Disease Control in Atlanta as best
practices for behavioral change communication strategies.

**Barrier 1:** **Illiteracy**

There are more non-literate people in the world today than at any time
in history. According to UNESCO, there are 73 million illiterate adults
(over 15 years old) in the 12 HIV/AIDS priority Africa countries. When
broadened to include illiterates, functional illiterates and
semi-literates, the number is closer to 150 million. That means that
about 42% of the adults in the Africa priority countries are cut off
from the information highway as we know it in the literate-based West.

Even though many non-literates (oral communicators) can read some words,
they all prefer to take in information orally and visually.
Literate-based information is seldom "heard", let alone understood and
retained. Oral communicators receive, process, and retain information in
totally different ways than do literates. Therefore, information about
HIV/AIDS must be presented in a way that overcomes the illiteracy
barrier.

## Barrier 2: Poverty 

There is a high correlation between illiteracy and poverty. The lack of
access to information caused by illiteracy also leads to a lack of
economic opportunity. Poverty, then, also becomes a barrier to
information access. It is a vicious cycle. In those areas of the world
where illiteracy is high, poverty is also high. They are linked.

Most tools that are designed to access information are cost prohibitive
to most non-literates or oral communicators. Computers, TVs, DVD/VCR
players, cell phones, CD players, MP3 players, etc. are all too
expensive. They are all 1^st^ World products designed primarily for 1st
World literates. Half the world has never made one phone call, let alone
watched a video or listened to a CD player.

**Accelerator 1: Orality-based Information**

Oral communicators, find it very difficult to understand, internalize
and recall messages that do not come through proverbs, prose, or
carefully constructed stories compatible with their cultural
presentation style. Their preferred learning and communication style, or
format, is the oral narrative. Oral communicators do not readily
understand information when it is presented to them by means of
outlines, principles, precepts, lists, steps, and logically developed
discourses. Even if they do manage to understand, they find it very
difficult to remember the information. Most literates cannot remember
the information either, but the literate can look it up in notes as
needed. An oral communicator's patterns of learning are the exact
opposite of literate, word-culture patterns.

**Accelerator 2: Embedded in social and cultural norms and
expectations**

For information to make sense and be useful to members of the target
population, it must be easily integrated into their social expectations,
norms, and values as well as their political and economic culture. It
must be applicable to everyday life, and presented in a narrative form
(i.e., story-telling) that is familiar to the target audience.

**Accelerator 3: Personalized Information**

Successful public health projects, even when applied on a large scale
(and perhaps especially so), work best when the public message is
reinforced interpersonally and in concert with other services and
sectors. Members of target populations will almost always require
individualized attention when trying to adapt general information to
their unique situations and concerns.

**Accelerator 4: Emotionally compelling**

Communication campaigns are sometimes hobbled by a tacit belief that
conveying information will, in itself, induce change. Such efforts rely
upon a purely cognitive approach rather than an approach combining both
informational as well as emotional appeals. Programs that succeed in
modifying behaviors appear to do so because they create an emotional
stake that motivates the population to act. 

**Accelerator 5: Reliance on role models**

The use of role models is at the heart of many interpersonal
communication and community mobilization activities. From testimonials
by persons living with AIDS to peer education strategies, real life role
models in the form of peers, friends, family members and opinion
leaders, are extremely powerful. This is even more the case with oral
communicating people who rely on others for information. Role models are
a particularly effective way to motivate individuals to change behavior
by increasing their confidence in their ability to change their
behavior, by persuading them of the positive benefits of change, and by
showing them how to change. Thus, the use of role models not only
contributes to creating the sort of emotional commitment that can lead
to change, but provides concrete examples of behavior that can be
emulated.

**Accelerator 6: Reliance on trusted networks**

Similarly, information that is passed through trusted networks is more
likely to be heard and acted upon than through generic or impersonal
methods. Most people, particularly oral communicators, prefer to get
their information from people they know and trust. Faith-based
organizations (both Christian and Muslim) are trusted by the majority of
Africans in the priority countries. They have great influence over their
constituencies as well as the stability over time to continually
reinforce the required behavior changes.

**Voice For Humanity's AIDS Orality Initiative**

**Project Objective:** Lower the prevalence rate of HIV/AIDS among
non-literate populations through a more effective IEC campaign that
ensures HIV/AIDS awareness, prevention and treatment information is
understood, internalized and results in positive behavior change.

**Goals:**

1.  Provide HIV/AIDS awareness and prevention information to
    non-literate populations in a user friendly and cost effective
    format, using "last mile" compressed digital audio technology.

2.  Develop or adapt HIV/AIDS awareness and prevention information
    content that is culturally suitable, easy to retain for non-literate
    populations and likely to result in positive behavior change.

3.  Equip rural clinic workers with digital audio tools to help in
    diagnosis, treatment and health education for patients.

4.  Train a network of volunteer trainers to conduct HIV/AIDS awareness
    and prevention listening groups.

5.  Provide awareness and prevention information for other infectious
    diseases such as TB and malaria in addition to HIV/AIDS, as well as
    general health nutrition, sanitation and maintenance information to
    oral communicating and illiterate populations.

# Methodology 

**1. Low-cost technology.** Voice For Humanity utilizes low cost digital
audio technology designed specifically for non-literate populations to
deliver life-saving and life-changing prevention and intervention
information. Each solar-powered portable audio device can reach up 350
people at a cost of 10 cents per person. This technology can reach
remote rural areas isolated from normal information channels.

**2. Orality-based Information.** Voice For Humanity combines culturally
relevant prevention and treatment protocols using orality-based methods
such as story telling, drama, dialogs, music, parables, proverbs and
folk tales shared in small listening groups of 5 to 10 people. When
information is presented this way to oral communicating peoples, there
is a much higher comprehension and retention rate, making behavioral
change more assured.

**3. Indigenous Faith-based Organizations.** Voice For Humanity is
partnering with several indigenous faith-based organizations in each
country for assistance in developing the audio content, as well as
deploying the audio devices. Local faith-based organizations have
existing networks of churches, mosques, schools, health clinics and
outreach centers for rapid dissemination. These organizations have great
influence within their constituents and have the necessary stability
over time to continually reinforce the required behavioral changes.
Faith-based groups can also provide the compassionate care and
acceptance for those living with HIV/AIDS. This approach deploys
information without creating a new network and reinforces the principle
of Africans helping Africans.

**4. Job creation.** Voice For Humanity will establish assembly,
testing, packaging and distribution operations in each country where the
digital audio devices will be deployed. These operations will provide
jobs as well as have a synergistic impact on the local technology
sector. Priority will be given to hiring people living with HIV/AIDS in
these operations.

**5. Phased Approach based on Effectiveness.** While this project is
highly scalable and can be rolled out rapidly in all 12 countries, Voice
For Humanity will phase in the project based on the results of early
interventions. Researchers from Emory University School of Medicine,
Division of Infectious Diseases, will establish baseline and
longitudinal benchmarks to quantify the effectiveness of the technology
in delivering AIDS prevention and treatment information to illiterate
and oral communicating populations. Voice For Humanity will begin the
project in Nigeria. Effectiveness will be measured at 6 month intervals
to provide the basis for "go/no go" decisions for additional phases of
the project.

**Voice For Humanity's Nigeria Pilot Project**

Voice For Humanity will begin the Africa AIDS Orality Initiative in
Nigeria. Voice For Humanity will partner with the following indigenous
partners: Evangelical Church of West Africa (ECWA), Christian Health
Association of Nigeria (CHAN) and the Federation of Muslim Women
Associations of Nigeria (FOMWAN). Voice For Humanity has a signed MOU
with ECWA as the lead Nigerian partner. ECWA has identified CHAN and
FOMWAN as additional partners in this project.

**Nigeria Pilot Project Scope:**

-   Train a network of up to 3,000 volunteer trainers in ECWA, CHAN and
    FOMWAN to conduct HIV/AIDS awareness and prevention small and large
    group seminars in two Nigerian states (Plateau and Kaduna).

-   Introduce an inexpensive digital audio player for listening to
    training materials and messages to accelerate the spread of useful
    information in a format more conducive to the oral communicating
    culture in Nigeria. 9,000 handheld units will be distributed: 3,000
    for ECWA, 3,000 for CHAN and 3,000 for FOMWAN.

-   Convert existing written-based ECWA materials to oral-based
    materials. Create new audio only content. Translate the audio
    materials to the three major languages (in addition to English):
    Hausa, Yoruba, and Igbo. Audio content will include different
    modules: training, awareness and prevention messages, counseling
    messages, treatment/care instructions, etc. Most modules will be the
    same that are used by all three groups (ECWA, CHAN and FOMWAN).
    However, one or two modules may vary to reflect the differences in
    approach of the faith-based groups.

-   Training modules include: HIV/AIDS awareness/prevention; counseling
    (pre and post testing); reproductive health; peer group education;
    involvement of the local church/mosque and schools; treatment/care
    for people living with HIV/AIDS, including home-base care; and
    orphan care.

-   Expand some of the awareness/prevention and treatment/care training
    and messages to include other infectious diseases, in addition to
    HIV/AIDS, such as TB and malaria, as well as general health
    nutrition, sanitation and maintenance information. Instructions for
    food washing, preserving and storing will also be included.

-   Develop some visual materials (pictures and video) to accompany and
    supplement audio materials in both awareness and prevention training
    as well as in diagnosis, treatment and care applications.

# Nigeria Pilot Project Monitoring and Evaluation

Dr. Igho Ofotokun, a Nigerian and an Assistant Professor at Emory
University School Medicine, Division of Infectious Diseases, has agreed
to manage the monitoring and evaluation of the effectiveness of this
pilot project. Dr. Ofotokun also works with the Infectious Disease
Program's comprehensive HIV treatment facility in Atlanta which is part
of a collaborative effort with Grady Health System and Emory University.
Dr. Ofotokun will conduct pre and post intervention surveys to assess
the impact and effectiveness of the project.

# Nigeria Pilot Project Public/Private Funding

Voice For Humanity is seeking \$730,000 in funding from public and
private sources to cover the costs of this pilot project. Voice For
humanity's goal is to obtain one-third funding from the US Government,
one-third from private foundations, and one-third from individuals,
churches and mosques.