Driving behavior change for men living with HIV in South Africa

South Africa has one of the world’s highest populations of people living with HIV (PLHIV), an estimated 7.7 million people. Despite considerable gains, South Africa has not yet achieved 90-90-90 targets to achieve HIV epidemic control.

A variety of societal and psychosocial factors that limit men’s uptake of HIV services means the gap between men and women in HIV treatment (-12%) and viral suppression (-8%) has persisted and grown over time. Despite adult men making up only 34% of the PLHIV population, men make up 60% of AIDS deaths.

A men’s health brand

Project Last Mile was engaged by PEPFAR, USAID, and the National Department of Health (NDoH) to apply private sector consumer marketing best practices to increase the uptake of HIV services among men. Historically, there have been limited behaviorally-driven, national-scale communications targeting men in South Africa.

Leveraging best practices from The Coca-Cola Company, Project Last Mile applied an insights-driven strategic marketing process, developing and launching a behavior change campaign for men’s health.

The men’s health campaign was launched in late 2020, encouraging men to see themselves as part of a broader community and aiming to reconstruct their relationship with healthcare and destigmatize HIV.

HIV is not this death sentence

Brand ambassador, Zonwabele is a husband and a father to twins. “Twenty years ago, I was in hospital, and I had TB and pneumonia,” he says. “I wasn’t responding to treatment. So, the doctor said let’s do an HIV test. The results came back positive. I was scared. I didn’t want to die. I chose humor as my vehicle for disclosure.”

Men’s health brand ambassador, Zonwabele.

Zonwabele was anxious to tell his mother about his status. “I told her the results are back, and I’m HIV positive. She left the hospital ward. She came back with a family friend who was a nurse. The first thing she said was, ‘My child, I want to take care of you.’ I knew that if I had my mum next to me, I could conquer anything.”

Zonwabele says his wife has been his pillar. “She’s an integral part of my support system. She understands what it means for our family for me to live. Whenever I’m sad, I’ve got these coping mechanisms. It’s singing; it’s laughing; it’s talking; it’s crying. I talk a lot.”

He says he manages to keep a positive outlook because he wants to see his children grow up. “HIV is not this death sentence everyone has made it to be. You can have families, you can have businesses, you can have a career,” he says. “You need to understand that you are human. You are alive. Don’t fall into a trap where you are suffering in silence.”

My life changed for the better

He says that understanding that having an undetectable viral load means he will not transmit HIV to someone else (U=U) has given him a second lease on life. “My life changed for the better. It’s very easy to reach this new status. You do so by taking one pill a day. Within 3 to 6 months, you are unable to pass the virus to the next person,” he says. “It also gave me confidence and assurance that I’m not going to be infecting my wife, and I’m going to be protecting my unborn children. Knowing that you have protected your partner is what every man should aim for. The goal is that the cycle of infection should end with me. It’s about building an HIV-free generation, and it starts with me. It’s the status that we all need to aim for.”

Zonwabele with his family.

This campaign has been the first effort at developing a national-scale, NDoH endorsed, targeted communications effort for MLHIV using a consumer-marketing approach. Initial results suggest a positive link between men’s exposure to the men’s health campaign campaign and positive HIV health-seeking behaviors.

Accelerating HIV testing and treatment for men living with HIV

Following the launch of the men’s health campaign, men’s HIV testing and treatment saw an accelerated uptake. 73,890 more men started antiretroviral treatment in the first year after the men’s health campaign launch. 49% of the total growth of men on treatment nationally was from facilities with the men’s health campaign active, despite the campaign being active in less than 15% of facilities nationally. Men’s HIV testing also accelerated 8% higher than women’s, shifting historical trends. The growth was highest in the youngest men, who have historically had the largest gaps in HIV testing and treatment uptake. 

“This campaign is about men owning up to their health,” says Zonwabele. “It’s about men being proactive, instead of waiting for something to happen to them. To men in South Africa, this campaign will mean an opportunity to change things.”

As of March 2022, the men’s health campaign has been activated in 501 facilities across 27 districts in South Africa. The media campaign has reached roughly 4.391 million men across South Africa, using radio and television commercials, social media, and out-of-home advertising. 

Based on the initial success, Project Last Mile continues to work with PEPFAR, USAID, and NDoH to identify ways to expand and strengthen behavior change programs to empower men to take control of their health.

This initiative is funded and supported by PEPFAR and USAID. The content and information provided on this website is the responsibility of Project Last Mile and is not official United States government information and does not necessarily represent the views or positions of PEPFAR, USAID or the United States Government.