1. APHA
Boston, MA
Monday, November 4, 2013
Opportunities for technology-based HIV prevention among
secondary students in Cape Town, South Africa
Michele L. Ybarra MPH PhD, Center for Innovative Public Health Research, San
Clemente, CA
Kelvin Mwaba PhD, University of Western Cape, Cape Town, South Africa
Nicolette Roman PhD, University of Western Cape, South Africa
Bronwyn Rooi BA, University of Western Cape, South Africa
Tonya Prescott BA, Center for Innovative Public Health Research. , San
Clemente, California
Sheana Bull PhD, University of Colorado, Denver, Colorado, USA

2. Disclosure
The authors have no conflicts to declare.

3. Acknowledgements
The project described was supported by Grant
Number R03MH094238 from the National Institute
of Mental Health. The content is solely the
responsibility of the authors and does not necessarily
represent the official views of the National Institute of
Mental Health or the National Institutes of Health.
We would like to thank our collaborators at CiPHR
and University Western Cape, as well as Dr.
Leickness Simbayi, our consultant. We’d also like to
thank the schools for their support of the research
and the participants for their time taking the survey.

4. Study motivation
Estimates suggest that if the current HIV
infection rates remain stable in South
Africa, 50% of 15-year-olds alive today will
die from AIDS.
 Effective programs exist in South Africa, but
they are not having the intended impact.
 Programs that are easily scaled up and that
address structural and fidelity
challenges, are urgently needed.

Joint United Nations Programme On HIV/AIDS (UNAIDS) (2000). AIDS epidemic update:
December 2000. Geneva: Joint United Nations Programme on HIV/AIDS (UNAIDS) and World
Health Organization (WHO). Available on the world wide web at:
http://www.unaids.org/en/media/unaids/contentassets/dataimport/publications/ircpub05/aidsepidemicreport2000_en.pdf

5. Study motivation

Programs are only as impactful as they are
interesting and engaging to youth, however.

Needs assessments are critical in this
regard so that researchers can understand
the acceptability of program delivery across
modes.
Image from: http://www.nspreview.org/wpcontent/uploads/2013/06/youth.jpg

6. Cape Town Adolescent Health
Survey



In 2012, 1,107 10th – 11th graders completed a
paper-and-pencil survey.
Respondents were enrolled in one of three
public high schools located in predominantly
black, lower income neighborhoods in Cape
Town.
Youth answered questions about experiences
and exposures related to sex and HIV; and
about opportunities for HIV prevention
programming that might be particularly salient
and interesting for youth.

7. Survey sample
characteristics
Respondents were on average, 17.6 years
of age (SD: 1.3, Range: 16-24).
 59% percent were female
 96% were Black.
 44% percent of respondents’ fathers had
completed secondary school or less
(equivalent to a high school education in
the U.S.).

Image from:
http://conceptovihsida.blogspot.com.es/p/metodos-deprevencion-y-enalces.html

8. Access to technology
No
Yes
Don't Know
Text messaging 1%
Internet
Decline to answer
81%
15%
0%
10%
10% 8%
4%
81%
20%
30%
40%
50%
60%
70%
80%
90%
100%

9. Likelihood of accessing an HIV prevention
program if it were available via…
Internet
15%
Text messaging
15%
Email
14%
Decline to answer
Somewhat unlikely
23%
12%
32%
17%
12% 10% 5%
0%
10%
26%
16%
Relgious organization
School
20%
20%
32%
24%
15%
11%
19%
36%
30%
40%
23%
19%
22%
44%
60%
80%
Not at all likely
Somewhat likely
100%

10. Interest by mode and biological
sex
90%
80%
70%
Male
77%
68%
Female
62%
60%
52%
52%
56%
55%
50%
41%
40%
38%
32%
30%
20%
10%
0%
School**
** p<0.01
*** p<0.001
Relgious
organization**
Email **
Text messaging
***
Internet

11. Interest by mode and selfappraised likelihood of getting
HIV
90%
80%
Less than average chance
74%
71%
Above average chance to get hIV
70%
60%
58%
54%
47%
46%
50%
40%
30%
20%
10%
0%
38%
31%
56%
51%

12. Interest by mode and selfappraised HIV programming
fatigue
90%
80%
70%
76%
69%
60%
50%
40%
30%
20%
10%
0%
* p<0.05
All other
Somewhat/very extremely tired of HIV
prevention messages
58%
58%
57%
51%
47%
47%
38%
37%

13. Limitations
Data are from three purposefully selected
high schools in Cape Town, South Africa.
The generalizability of these data to greater
South Africa, and youth not enrolled in high
school is unknown.
 Given the sensitivity of the topic and the
stigma related to both HIV/AIDS and sexual
behavior among adolescents in South
Africa, it is possible that some youth did not
answer honestly.


14. Conclusions
Access to the Internet and SMS is high
among low income adolescents attending
high school in Cape Town.
 Internet programs may be more
acceptable, and therefore have the
potential to reach more youth than SMS.
 Given the preference for school-based
programming, embedding the intervention
within a school
setting is
recommended.
