Magazine article Communication World

Njoo Tuzungumze! Come, Let's Talk! A Comprehensive Program Seeks to Change Behavior and Promote HIV Counseling and Testing in Tanzania

Magazine article Communication World

Njoo Tuzungumze! Come, Let's Talk! A Comprehensive Program Seeks to Change Behavior and Promote HIV Counseling and Testing in Tanzania

Article excerpt

Project manager Anatory Didi held up a newspaper cartoon at a recent staff meeting for Angaza, an organization that promotes HIV testing and counseling in Tanzania. "Angaza is truly a household word, and people understand our mission!" he said excitedly. The cartoon depicted a woman in the market bargaining with the butcher about the quality of a chicken for sale. The butcher held up his hands in exasperation and said, "If you don't believe this chicken is healthy, take it to Angaza!"

The cartoon proved that after an intensive four-year communication campaign, Angaza had become a recognized, trusted and accessible resource for Tanzanians seeking quality counseling and testing.

In the age of HIV/AIDS, health communications tread upon layered fields of sexual behavior, stigma and morality. Perhaps like no other health issue, HIV/AIDS has forced development professionals to push cultural and clinical boundaries to reach the public with effective prevention, care and treatment messages. Voluntary counseling and testing (VCT) has increasingly been recognized as an HIV prevention tool. In 2001, the African Medical and Research Foundation (AMREF)/Tanzania was awarded a grant from the U.S. Agency for International Development to enhance counseling and testing services across Tanzania. The program, dubbed Angaza (meaning "shed light" in Swahili), now supports 65 voluntary counseling and testing sites and has seen almost 365,000 clients.

From the program's inception, Angaza's communication strategy has challenged the notion that knowledge of HIV status equals a loss of hope. The strategy aims to influence (1) knowledge about VCT availability, (2) attitudes toward knowing one's HIV serostatus, and (3) HIV prevention behaviors, including participation in VCT.

In a country with an HIV prevalence rate of 8.8 percent, communications must captivate the public and encourage behavior change. While 75 percent of Angaza baseline survey respondents in 2001 reported wanting to be tested at one time or another, and more than 90 percent expressed the attitude that knowing one's serostatus has benefit, only 12 percent reported having ever taken an HIV test. This gap between attitudes and practices proved to be an enormous challenge.

Different angles and media

Angaza provides individuals and communities with information about HIV prevention, local support for HIV-positive clients and treatment options. Strategic communication for behavior change can include many streams, including the use of mass media through advertisements or entertainment education, community mobilization, advocacy, and social marketing. Angaza uses precisely this formula to change behavior in Tanzania.

Angaza also works within health care settings to stimulate referrals for service. For example, Anna Yoeza, a 36-year-old mother of six, tested HIV-positive while at the hospital for prenatal care. "After the results, I was worried what would become of my baby when it [was] born," she says. "How would I break the sad news to my husband?" Though she told him that same day, he never revealed his own HIV status. He died the following year. "As I cleared his stuff after the funeral, I found ARVs [anti-retroviral medication] in his briefcase. This was the first and last indicator to me that he knew he was HIV-positive but never told me. I had never suspected anything."

Yoeza is now a leader of Angaza's post-test club operated at Selian Lutheran Hospital in Arusha. Her youngest child was recently tested at the center. "He was found to be HIV-negative, which reduced a lot of burden from my mind," she says. The club has 72 members and holds weekly meetings. "I get my strength for continued living from the support of Angaza's post-test club. Some of us give testimonials at church and in this way educate our fellow Tanzanians about HIV/AIDS," she says. Angaza is working to build client demand for service, to provide quality counseling and testing, and to follow up with psychosocial support for clients. …

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