The Government of South Africa, in collaboration with CDC (Centers for Disease Control) South Africa, has just finished training national and provincial teams to enable them to facilitate the development of PMTCT (Prevention of Mother to Child Transmission of HIV/AIDS) communication strategies in every province of South Africa. The government is using the Communication for Development approach, combined with the ACADA Communication Planning System (click here for more info on ACADA [1]), both originally developed by UNICEF, and now adapted for specific use in South Africa with technical assistance provided by CDC South Africa.

The Government of South Africa first field tested the approach last year in one province. After the success of that field test, the national PMTCT/HIV/AIDS team, in consultation with other related units including VCT, maternal health, IMCI, nutrition, etc., determined that the approach was the best alternative for South Africa, in its attempt to increase acceptance and use of PMTCT services throughout the country. The approach creates the opportunity to build province-specific communication strategies that address the unique needs of each province, while at the same time, ensuring that a uniform and consistent approach is used throughout the country, ensuring quality communication interventions that meet the needs of provincial and national programming. Each provincial strategy addresses local issues related to advocacy, social mobilization, and behavioral development. Community involvement is a key to the success of these strategies and community participation is well-represented in each workshop, with the initial workshop having 41% of its participants coming from community-based organizations.

In addition to training the 9 provincial and 1 national facilitation teams in this approach, the national PMTCT team also held a one week workshop to develop a draft communication strategy that incorporates all PMTCT-related issues including staff representation from the following national and provincial units: VCT, maternal health, integrated childhood management of illnesses (IMCI), nutrition, traditional healers, gender, NGO partnerships, etc. In addition, key community members from last year's original provincial workshop also attended to lend a community perspective to the national level strategy. The new national PMTCT communication strategy will aim to address the following key issues, defined by recent social research:

1. Address issues related to increasing HIV prevalence rates among men and women of reproductive health age by increasing access to condoms in non-traditional sites including border posts, shabeens, bars and discos, etc.
2. Decrease stigma in communities by empowering traditional healers to lead Community Dialogue meetings within their communities, helping the community to identify why stigma exists towards HIV-affected families, and enabling communities to overcome the issues related to stigma so that communty-based care and support systems can begin.
3. Increase access to VCT in non-traditional sites by investigating how certified traditional healers can assist in the VCT process, both within the clinic setting as well as outside the clinic setting.
4. Reduce the incidence of mixed feeding and increase the incidence of exclusive infant feeding methods - among all new mothers by increasing the participation of immediate family care-givers (in-laws, grandparents, fathers, aunts) in infant feeding counseling during ANC visits, and home visits. This aspect of the strategy will focus on establishing new community norms where immediate family care givers, including fathers, will accompany pregnant women to at least one or two ANC visits so that they can also receive infant feeding counseling with the pregnant woman.
5. Address issues related to high maternal mortality rates by encouraging all pregnant women to seek ANC services early in their pregnancy at least by week 16 and throughout the pregnancy, with a target of at least 7 ANC visits. This will also enable health care workers to establish closer bonds and relationships with mothers-to-be.
6. Perhaps most exciting is the focus and commitment to bring traditional healers to the forefront, in mobilizing communities to support PMTCT and VCT services, and also to begin addressing issues related to stigma and discrimination at the community level. The national HIV/AIDS/STI programme in South Africa has two fulltime traditional healer advisors on staff, one of which is both a traditional healer and a nurse. Already a training for traditonal healers has been scheduled and with the development of the new draft communication strategy for PMTCT, issues related to PMTCT will now be included in this new training initiative. Traditional healers will also be playing a lead role in beginning to actively address stigma and discrimination by using the Community Dialogue approach.

For more information on the communication tools and approaches used, and/or the Community Dialogue approach, please contact Shari Cohen, PMTCT Communication Specialist, at scohen@cts.com [2]

For more information on the South Africa Departement of Health national PMTCT communication strategy, please contact Ms. Sesupo Makakole-Nene, Deputy Director PMTCT, at NeneS@health.gov.za [3] or by phone at +027 12 312 0131.