Circumcision in South Africa Supporting the Scale Up plan

Richard DelateJohns Hopkins Health and

Education in SA

The Beeg Bang for MMC

Men Ever Counselled and Tested NCS - 2006/2009

Men Counselled and Tested in last 12 Months – 2006/2009

Knowledge Levels of the benefits of MC for HIV risk reduction – NCS 2009

Acceptability Levels of MC amongst Men and Women*

* Data from four community studies in Ethekwini Metro Municipality (KZN), Matjhabeng and Masilonyana Local Municipalities (Lejwelephutswa, FS); Merafong (Gauteng); Madibeng Muncipality (Bojanala, North West)

% of men self reporting to be circumcised – NCS 2009

77 73

46 42 36 34 3318 17

0102030405060708090

Limpopo Eastern Cape Gauteng Western Cape Mpumalanga Free State North West KwaZulu-Natal Northern Cape

A BEEG BANG IS REQUIRED!

WHY IS A BEEG BANG REQUIRED

• TO REACH 16 600 per month until March in the priority to make target of 100 000

• To reach 41 600 circumcisions per month to achieve 500 000 over the next five years.

Without Social and Behavioural communication we will NOT have the

beeg bang

Have laid the foundation for the Beeg Bang

• SANAC Comms Strategy in place – Provincial ACSM strategies being developed – Men’s sector sensitised and provincial strategies

developed

• Radio Talk Shows undertaken – Radio Producers Trained – 8 community radio stations – 1 National Station (Ukhozi FM – Zulu)

Foundations have been laid

• Television – integrated into Mindset in public health centres and on Siyayinqoba-Beat-it.

• Posters Developed in 2 languages • Brochure developed in 2 languages • Integrated into toolkits and Peer Educators trained

- Siyayinqoba – Beat It – 2 300 peer educators trained - Brothers for Life – 500 peer educators trained • Men’s sector and community partners mobilised and

ready– but absence of services for referral is on hold.

Mass Media Outdoor

Radio Talk Shows – Advert.

Television

Drama / Advert.

SERVICESSoc. & Beh

Change

Social Mobilisa

tion

Community

Dialogues

Face to face

Communication

Small Media

Posters Brochur

es

Media Advocacy

/PR

New Media

Telephone

Helpline

Web/ email/ mobile

THE BEEG BANG

ENVIRONMENTAL CONTEXT: SUPPORTS & CONSTRAINTSBurden of disease; level of toxic chemicals in air, water, & food; population density; technology; policy; access to food, safe water & sanitation; access to health care, socio-economic conditions

enabling

SKILLS & KNOWLEDGE reinforcement

Attitudes BEHAVIOR

confirmation

IDEATIONAL FACTORSCOGNITIVE Attitudes (Beliefs & Values) Subjective Norms Self-Efficacy Perceived Risk Self-ImageEMOTIONAL Fear, Sadness, Affection, Happy, Trust, Empathy SOCIAL Mutual Understanding Cohesion & Reciprocity Collective Efficacy

COMMUNICATION

INSTRUCTION

DIRECTIVE Dissemination Promotion Prescription

NONDIRECTIVE Entertainment Counseling Dialogue Social Networks

PUBLIC Advocacy Coalition Formation Regulation

HEALTHPHYSICAL & MENTAL STATUSREDUCED MORBIDITY & MORTALITY from INFECTIOUS & CHRONICDISEASES

INDIVIDUAL Intention & Behavior

COLLECTIVE Leadership Participation Goal Setting Action

META-THEORY OF HEALTH COMMUNICATION

What do we need to make the beeg bang happen

NEED INVESTMENT AND COMMITMENT• Current disconnect between what

Government and Donors want and resources! – National and provinces have cut back on ACSM budgets – but

still want drive people to services. – Donors have cut back on ACSM budgets – but still want to

drive people to service? – Private media owners have given GREAT benefits in the past –

matching investments by donors and government – but in the absence of resources its not possible to fund these efforts.