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Text Messages Are New Tool for AIDS Education in South Africa

Project Masiluleke, part of the burgeoning field of mobile health technology, delivers about 1 million HIV/AIDS and tuberculosis texts each day to personal cell phones providing the number for the national AIDS helpline along with messages like: “Frequently sick, tired, losing weight and scared that you might be HIV positive? Please call AIDS Helpline.”

Since the program began in fall of 2008, the messages have increased calls to the center from about 1,000 a day to between 3,000 and 4,000 a day, according to Gustav Praekelt of the Praekelt Foundation, which designed the technology behind the project.

“Increasingly in Africa we find that the mobile phone is the prime resource for finding information,” Praekelt said. “I think people often underestimate the penetration of these devices in Africa and what a difference it makes to a lot of people’s lives.”

Callers to the national helpline can ask questions about HIV, get information about where to get tested and receive counseling.

The project takes advantage of a popular form of texting across Africa, called a “please call me” message, that can be sent for free from a phone even if it is out of pre-paid minutes. The empty characters on the free text are used to convey the health message.

Future phases of the project will allow users to text health questions, if they prefer not to call the line, and will provide an internet portal of information accessible by cell phone for people to learn about HIV. The ultimate goal, says the group, would be to provide free home HIV testing kits that would be supported by mobile counseling, so that people who aren’t willing to visit a clinic can find out their status.

Zinny Thabethe, an HIV positive South African and co-founder of the HIV/AIDS education organization iTeach, helped create the program for Project Masiluleke. She said opening a dialogue about HIV/AIDS is so important because the stigma surrounding HIV/AIDS in South Africa is still very strong.

An estimated 18 percent of South Africans between the ages of 15 and 49 are HIV positive, according to the World Health Organization.

When the South African government announced it would increase access to AIDS medications in 2003, there was new hope for the infected, but the stigma did not go away said Thabethe.

“In the community people don’t want to talk about it,” she said. “If you go to funerals … nobody is talking about it, they are making excuses as to why people are dying.”

In the feedback the program has received, Thabethe said some callers have reacted defensively, asking why they received the message and who knew their HIV status. But most expressed the need for a confidential way to ask their questions about HIV and AIDS.

“They felt uncomfortable because in the clinics there are people from the community,” Thabethe said. “But because [the helpline] is confidential and anonymous they can phone in and talk to someone who doesn’t know them, who is in another province, who can help them with their questions and they can be able to be honest.”

South Africa has 13 official languages, and the project sends messages in the major vernaculars. The team has observed a higher yield of callers from messages sent out in Zulu than in English. While all calls are confidential, anecdotal evidence from the project has shown that the majority of the callers are male and many are from rural areas, two populations that are traditionally very hard to reach with health information, Thabethe said.

The project is a case study for a new area of mobile technology based health efforts, termed “mhealth.” The United Nations Foundation released a report on the topic in February, citing its potential to cast a wider net for health programs and health training.

Aside from initiatives for health outreach and education like Project Masiluleke, there are also pilot programs around the world working on monitoring patients and reminding them to take medications, using mobile technology to quickly collect data about outbreaks so that proper medical response can be deployed faster, and using mobile technology to connect health workers with the training and support they need.

Claire Thwaites, who heads the U.N. Foundation’s work on mHealth, said the mobile phone technology is already in the hands of 64 percent of people in the developing world, and that number continues to grow.

Networks for cell phone service are relatively easy to expand into rural areas, whereas computers are often limited to urban areas that have reliable access to electricity and Internet. By 2012, 50 percent of all individuals in remote areas of the world are expected to have mobile phones.

But, said Thwaites, the field of mhealth technology needs to be strengthened by rigorous data collection about results before programs can be expanded.

“To be very frank, it is very early days in terms of proper monitoring and evaluation of the technology,” said Thwaites.

The two indicators that will be crucial to the success of smaller programs will be finding ways to scale the project up, and sustain the project through government interest and business collaborations.

Thwaites is optimistic that applications can be developed into business models that will provide investors the incentive they need to get involved.

The penetration of cell phones into the developing world “happened without government intervention and without regulation, it’s happened because of market forces,” Thwaites said.

“There is no reason why market forces shouldn’t bring around mhealth next.”