Soka Uncobe social and behavior change communication (SBCC) is based upon the GKOS Male Circumcision Communication Strategy, 2009–2013. The overall approach is based upon understanding existing perceptions, identifying motivators, and eliminating barriers. Guidance and direction for developing Soka Uncobe SBCC was taken from a number of workshops, PSI and pulse taking research, in-country partner experience and Ministry of Health (MOH), Swaziland National AIDS Program (SNAP) and National Emergency Council for HIV/AIDS (NERCHA) guidance. Soka Uncobe has achieved a number of successes in SBCC. Partners have conducted in-depth advocacy with royalty, traditional leaders, unions, businesses, religious groups, schools and Government to create awareness of and understanding of MC and the ASI.
Swaziland provides a unique context for male circumcision (MC). This is the first time an entire country has undertaken the rapid scale-up of MC for HIV prevention. The country’s social and epidemiological characteristics are also unique, and include a society with a proud and rich heritage of traditions, a relatively low countrywide population, non-circumcising cultural practices, and high HIV prevalence within a hyper-endemic region.
Within the Soka Uncobe program, the communications team worked collaboratively to bring awareness on male circumcision and access to services throughout the country. The Soka Uncobe brand was cultivated by the MOH and partners for a Swazi audience and evaluated by key decisionmakers.
As mentioned, guiding the overall communications campaign was the MC Communications Strategy 2009-2013, the Swaziland National Strategy for Social and Behaviour Change Communication, and the SBCC Field Guide. Led by the MOH, SNAP, NERCHA, PEPFAR and implementing partners collaborated to deliver the campaign.
Soka Uncobe implemented three focused initiatives, as guided by a communications consultation in April 2011 and documented in the SBCC Field Guide. The first was a partnership with the Public Sector HIV/AIDS Coordinating Committee (PSHACC) to develop and implement action plans on MC for each ministry within the GKOS. Ministries implemented their workplans with support from Soka Uncobe.
The second initiative was the Back To School campaign, a partnership with the Ministry of Education in targeting school aged boys for circumcision. In mid-August, 2011, schools in Swaziland went for a Term Two break. With guidance from the MOE, Soka Uncobe launched a sensitization, advocacy and messaging workshop series for all four regions with three target audiences. Workshops in each region started with the 1) Regional Education Officers, followed with 2) Head Teachers and the chairpersons of school committees (parent representatives) and completed with the training of the 3) Career Guidance teachers. The guidance teachers, with the help of head teachers, led the messaging with the students and were responsible for the registration of male students for circumcision for the Soka Uncobe school campaign in July and August. One hundred and thirty six schools were visited and young males at the schools were sensitized. During the campaign, mass media produced targeted information, education and communications (IEC) materials, highlighting the clinics that serviced for this campaign, which were distributed prior and during the period of the school break. Radio spots highlighted teachers and students who were engaged with Soka Uncobe, mothers voicing protection for their sons, and leadership. A press conference between the MOH and MOE was held to further motivate the community to engage in male circumcision services during this campaign.
The third initiative was the regional waves, which followed the endorsement of male circumcision by His Majesty King Mswati III on July 15, 2011. Following the Soka Uncobe launch by King Mswati III, a follow up meeting was held with the Regional Administrators for the four regions. The meeting set forth a process to engage all chiefs in the four regions according to the regional wave implementation. The Regional Administrators directed the Soka Uncobe team to connect with the chiefs directly. Soka Uncobe put together Advocacy Response Teams, consisting of a nurse, counselor, IPC agent and promoter, and driver to meet with chiefs and their chiefdoms in structured community engagements. The Manzini regional wave was implemented in October and November and the Hhohho regional wave was implemented in November and December.
Beyond the three initiatives, the Soka Uncobe team focused on mass media to increase awareness, advocacy to engage different Swaziland sectors and interpersonal communications to provide a platform for individuals to ask questions about and engage personally around MC with knowledgeable individuals. In April 2011, billboards were unveiled and awareness efforts deployed. Radio, television, newspapers and IEC materials created awareness. The previously established 977 emergency line was strengthened to provide clinical and emergency support and provide information on site locations and transportation to the public.
Interpersonal Communication (IPC) agents provided on-the-ground support through door-to-door activities, taxi rank outreach and other events. These teams served as a link between those expressing interest in male circumcision and accessing services. In addition, Change Agents, members of the community identified as champions in advocacy work, were engaged to support specific sites with focused interpersonal communications.
As awareness increased across the country, Soka Uncobe sought to identify and addressbarriers. A triangulation research effort took place, including IPC Agent feedback through a journaling activity, video ethnography on barriers, and a national pulse-taking quantitative household survey. The results complemented each other, in terms of barriers and gaps towards uptake. The triangulation research informed the way forward for activities in the last quarter of the Soka Uncobe campaign.
Over the course of six months, 54 different radio testimonials aired. The variety of those speakers included: police officers, members of parliament, soccer players, poets, fathers, mothers, girlfriends/wives, students, Change Agents, and teachers. From here, the campaign identified ambassadors that would serve as representatives to motivate. For example, Msandi Kababa, King Mswati III’s royal praiser, underwent MC. His experience was videotaped as part of a short documentary and public service announcement. His experiences were also captured in a comic book. Additionally, one of the Mr. Swaziland contestant’s experiences were captured and broadcast nationally.
Collateral and IEC materials developed throughout the campaign included: brandoms, playing cards, 16 different types of brochures, wristbands, t-shirts, rain jackets, golf shirts, coasters, earrings, bottle openers, comic books, and referral cards. There was purpose, intention, and an evidence-base with each material.
Responding to the research, in the last quarter of the campaign, Soka Uncobe engaged in a Door-to-Door activity, whereby former clinical staff, nurses and counselors, went household to household to give further information, answer questions, and book clients.
Throughout the campaign, communications responded to informal and formal research to ensure that messaging remained relevant.