Sunday, November 4, 2012

Using technology to talk to Ethiopian university students about HIV

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This article originally appeared on The ONE Blog on Oct. 26, 2012.

ADDIS ABABA, Ethiopia — The most dramatic demographic divergence in Ethiopia in recent years has been an explosion in the number of young adults enrolled in post-secondary education. Ten years ago, there were 15,000. In 2012, that has risen to 380,000 students attending state universities — a 25-fold increase. Most of them moved out of their family homes and also from the protective shields of their parents, with all the implications that has for their sexual and reproductive health.

To reach them in the most effective way with information about protecting themselves from HIV and other sexually-transmitted infections, health programs in Africa are increasingly turning to technology — digital, mobile and social. In Ethiopia, for example, DKT Ethiopia, an affiliate of the non-profit organization DKT International, launched the Higher Education Initiative in 2009 in an effort to get on top of this demographic trend and the potential negative health consequences it portends.

Ethiopia is increasing university enrollment much faster than the sub-Saharan African average of 15 percent annually. Today’s students will like be tomorrow’s leaders. Many will join the highest wealth quintile, which currently has the highest HIV prevalence, according to Jamie Uhrig, an expert on HIV prevention and care in Africa and Asia who has been working in Ethiopia.

“I have never seen such rapid growth in postsecondary education enrollment,” said Uhrig. “Hundreds of thousands of young people are leaving rural areas to study in urban ones. They are no longer under the direct influence of their parents and are just beginning to become sexually active. This is a massive demographic change and HIV risk is just one of the many challenges they face.” The 2011 Ethiopia Demographic and Health Survey (DHS) found HIV prevalence to be 1.5% of the population age 15-49.

DKT’s Higher Education Initiative — funded by the British Department for International Development, Irish Aid and the Embassy of the Kingdom of the Netherlands — works in behavior change communication, advocacy (with university authorities), health service delivery, capacity-building and monitoring and evaluation.

The goal of the initiative is to help students develop healthier behavior by improving the quality of information and service delivery to students, thus reducing risky sexual behavior, unwanted pregnancies and sexually transmitted infections (STIs), including HIV. The project now reaches 140,000 (37 percent) out of the 380,000 students at 34 state universities with a goal of reaching 200,000 (53 percent) by the end of 2012.
But DKT felt it had to go beyond traditional person-to-person communication to really connect with students: One year ago, it launched the social network called — the first of its kind in Ethiopia — in an attempt to influence digitally health behavior.

The website has a variety of tools to engage students. They can post questions, comments, photos, videos, classified ads, blogs, etc. and DKT Ethiopia staff answers their questions. The site does not focus only on HIV/AIDS issues but on whatever subjects engage students. Recent posts were on technology, obesity, love, foreign relations and Ethiopian national pride.

A year later, almost 34,000 students have signed up and the website has received 7.3 million page views, with 6,000 questions and 13,000 answers posted.

“I was really surprised by the number of students who signed up to,” said Mayet Hailu, the DKT manager who supervises the program. “At the beginning, I was a bit skeptical about Internet access in cities outside Addis and the acceptability of the media as a means to reach them, especially by students from rural areas. Later I found out that young people and students will do anything to get better info and use modern technology. They use their cell phone, wifi and exhaust all possible connections to sign up and get info.”

Uhrig says there is a paucity of information on this demographic group, their sexual behavior and their HIV prevalence. However, the information that does exist prompts concern:
  • The 2011 DHS reported that only 23.6 percent of women aged 20 to 24 and 37.4 percent of men aged 20 to 24 had “comprehensive knowledge of AIDS”.
  • A 2009 study in Dire Dawa found 2.5 percent HIV prevalence among university students, much higher than prevalence of 20- 24-year-olds in the general population, reported as 0.6 percent in the DHS.
  • A study at Addis Ababa University in 2010 demonstrated that 34.2 percent of the students interviewed had already initiated sexual activity.
DKT is conducting a baseline survey of sexual behavior among university students and will have the results in late 2012.

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