The O Icheke Campaign, Botswana: A National Multi-level Communication Programme to Reduce Multiple and Concurrent Partnerships

This 14-page case study, published by AIDSTAR-One, looks at Botswana's O Icheke - Break the Chain campaign which is designed to change attitudes and behaviour around multiple concurrent partnerships. The case study looks at the rationale behind the campaign, described how it was developed, and provides a brief evaluation of the programme's first year. It also includes recommendations and information around future programming. According to the case study, O Icheke is seen as key to achieving Botswana’s long-term goal of zero new HIV infections by 2016.

The case study explains that multiple concurrent partnerships (MCP) are deeply rooted in Botswana's society and culture and until recently the topic was not widely discussed. The three-year O Icheke campaign uses the national mass media to stimulate public discussion about MCP. At the same time, interventions at the district level are designed to encourage communities to change norms and individuals to change behaviour. Campaign messages are intended to serve as a wakeup call for the population: they explain why having two or more partners at the same time accelerates the spread of HIV. This report states that new information about acute HIV infection and how the virus spreads quickly in highly linked sexual networks has proven to be eye-opening for individuals during community and interpersonal group activities.

The project was originally planned in six phases, with phases one and two being implemented in the first two years. Mass media interventions for phases one and two included billboards, radio testimonials, television spots, and leaflets. Before the launch of phase one in March 2009, a teaser campaign stimulated dialogue about MCP. Phase two of the campaign began in June 2010 with a focus on personalising risks, highlighting the costs and benefits of MCP and addressing the reasons people give for engaging in it, based on earlier research. According to the report, the campaign team is also exploring innovative ways to reach individuals in rural areas, due to the fact that, according to research, the campaign has been more successful in urban areas.

As stated in the report, the campaign was designed to be different from earlier programmes. Although it is a national campaign with strong mass media support, it is implemented in the districts through numerous community-based organisations. In addition, community interventions are linked to the national mass media by using the same branding, messages, and tools. Community-level activities include one-on-one sessions, group discussions, dramas, testimonials by people living with HIV, community and church events, youth clubs, and schools and poetry/music groups.

According to this case study, the nationwide, multilevel coverage helped make the project a success. Coverage has stimulated discussion and given people an easier way to talk about a difficult topic. The project has also enjoyed strong national leadership. The initiative is driven by the national government, and strongly supported by the President, Parliament, as well as other ministries and traditional leaders. In addition, one of the pillars of the O Icheke campaign is the integration of MCP messaging into HIV-related services housed in the health sector, such as antiretroviral therapy (ART), voluntary counselling and testing (VCT), treatment of sexually transmitted infections, and Preventing Mother-to-Child Transmission (PMTCT) services.

Some of the challenges cited in the report included: coordinating roles and project ownership; rolling out the campaign to districts; insufficient funding; encouraging more support from civil society; monitoring and evaluation; and sustainability.

The report recommends involving key stakeholders from the beginning, suggesting that the overall success of a national programme hinges on active participation, support, and ownership of all partners. Mass media and on-the-ground activities should be scheduled close together and thoughtfully branded. Complementary messages can bridge the gap between mass media and community-based activities. The report also recommends focusing on a smaller number of phased messages addressing individual or community needs. A longer timeline per phase is necessary, especially given the time needed to implement change on social norms and the reality of involving numerous stakeholders in message development.

As the campaign moves forward, organisers say messages will need strengthening as future phases introduce concepts that are more nuanced and complex and as intended audiences begin to more fully understand the risks associated with MCP. In addition, as the campaign rolls out in the districts, new implementation issues will emerge, such as: ensuring message and intervention quality; providing ongoing training, supervision, and oversight; maintaining a balance between standardisation and local adaptation of messages; and ensuring that correct information about MCP is conveyed. The campaign will also need to address the capacity of district-level employees to deal with these issues locally.