R U Positive?

South Africa tries a novel method to promote HIV testing.

By Jesse Ellison

South Africans are no strangers to AIDS-awareness campaigns. Billboards urging testing and posters promoting condoms and abstinence line the roadsides. They're there for good reason: the country has the highest incidence of HIV-positive citizens of anywhere in the world. In some areas, 40 percent of people are infected. But despite those numbers, and despite the campaigns, only about 2 percent of South Africans have ever even been tested. "There are a lot of campaigns out there, and a lot of different messages. But the messages are so generic," says digital media consultant Gustav Praekelt. "It's like, 'You must get tested.' Well, then what?" Praekelt's organization, the Praekelt Foundation, a South Africa-based nonprofit that uses mobile technology to combat the impacts of poverty, is now trying an unlikely medium to make the message stand out: text messaging.

Beginning last month, the Praekelt Foundation, as part of a larger program called Project Masiluleke, has been sending short messages embedded in the "Please Call Me" SMS messages sent regularly throughout South Africa. For now, the messages are general, asking people to call the national AIDS hotline if they want information about testing or have questions about virus transmission. But in this first trial period, calls almost immediately quadrupled to 4,000 per day. The results suggest something pretty simple: direct messages received on a personal mobile device are proving more effective than countless giant billboards. "Our maximum response time is 8pm," Praekelt says. "We'll send the messages throughout the day, but at 8 in the evening is when people call back. People are basically sitting with these messages all day, and then deciding to do something about it."


The biggest hurdle so far has been in the capacity of the hotlines to handle the volume of phone calls. Project Masiluleke's organizers are hoping to supplement staff at the local call centers, but they also plan to implement "virtual call centers," which will be staffed off-site by trained counselors who are themselves HIV positive. According to organizers, these call centers could not only create jobs and increase the capacity of the health response, but also pave the way for the final, most important phase of the project: free at-home testing kits supplemented with a widespread, easy-to-reach network of counselors who can talk people through their results.

For now, though, organizers are focused on phase one. The project's long-term efficacy remains to be seen, and South Africa has certainly seen its share of educational efforts try and fail. Still, according to project organizers, if just 1 percent of those reached by the 365 million messages that will be sent out in the next year actually get tested, that number will exceed the number of South Africans tested in the whole of the country's history. That's a pretty big impact for such a short message.