The winner of the 1st prize in the DNRF’s Photo Competition 2021 is the picture of an antenna radio that has been placed in the ground in front of the fundament to a clay house in Zimbabwe. Using a disposable camera, a young man who calls himself Knowledge took the picture, which was part of a response to potential solution models for the prevention of HIV among young people in Zimbabwe.
A dark red antenna radio placed on just-as-red ground in an undefined place outside. The picture’s raw and blurry expression makes it seem like the radio’s sound waves and frequencies are vibrating in the picture. The winner of the 1st prize in the Danish National Research Foundation’s Photo Competition 2021 shows a picture of a small antenna radio placed in the ground in front of the fundament to a clay house in Zimbabwe. Using a disposable camera, a young man who calls himself Knowledge took the picture, which was part of a large intervention study from the University of Copenhagen, Imperial College London, and the London School of Economics, in response to potential solution models for the prevention of HIV among young people in Zimbabwe.
“Essentially, we now have the technology and knowledge that we need to fight and beat the HIV epidemic, but HIV is still a big problem in Zimbabwe, especially among groups of young people. Even though there are different HIV-contraception and HIV-prevention technologies, they are localized and placed in localities that make it hard for people here to use those technologies now accessible to them. In practice it is a whole other story,” said Morten Skovdal, a social and health psychologist and an associate professor at the Department of Public Health at the University of Copenhagen.
Knowledge is not always enough
In the 1980s and 1990s, the condom was the only prevention technology that was available most places in the world. Since then, a lot of new prevention technologies have been created, yet you see HIV cases going up among young people in the 50 countries worldwide, including African countries South of Sahara, where the prevalence was significantly high among young women.
“Even though it is obviously a sad story, it is still exciting for me to try to get an understanding of how, in spite of all the biomedical solutions we have, something still happens in practice that means the solutions aren’t used as we expected them to be used,” said Skovdal.
One of the reasons many young people in Zimbabwe don’t use the prevention technologies available to them, according to Skovdal, is based on the great social stigma connected to using these technologies in the local societies in general but also among young people themselves.
“There are so many cultural, religious, social, and relational circumstances and barriers that make it almost impossible for young people to use the technologies even though people as individuals have both the knowledge and economic conditions required to access them. And this is where our challenge is,” said Skovdal.
With a grant from the National Institutes of Health in the US, Skovdal and his research colleagues from the UK started the intervention study in Zimbabwe in 2018 with the idea of testing different solution models to promote young people’s use of the prevention technologies.
The study focused on two technologies — male circumcision and the pill PrEP— and they separated the study into two approaches: behavioral economics and community psychology, the second being the one Skovdal is running. The behavioral economics approach was about tackling the lack of information and insight about the young people’s risk behavior, while Skovdal’s intervention was about making young people create solution models to challenge the social barriers through a process called community conversations.
“The whole point with the study is to test if these behavioral economic interventions in themselves can influence young people’s use of the technologies, or if they, in cooperation with community psychology activities, somehow will create a bigger crowd of young people that will use the technologies. In other words, it is a test of different interventions and which ones work the best,” said Skovdal.
A little radio with a big effect
The photograph of the little read antenna radio was taken with a disposable camera in the study’s leading phase, and it was one of the young people’s response to a potential solution model in relation to male circumcision. The photographer, who calls himself Knowledge, was one of ten men who, along with ten women, took pictures of what they believed
influenced their own risk behavior, and what the situation is with HIV in their local network. They offered suggestions for solutions that could help them overcome the challenges they face.
“As soon as young people get a camera in their hands and the possibility to go out and do something locally, they then get a more critical understanding of this problem through some local dynamics and processes. They learn their own context in another way by taking pictures that are so local,” said Skovdal. He continued:
“Knowledge had an aesthetically beautiful picture that at the same time expressed a solution to a problem instead of only being focused on the problem. He had in other words chosen a more solution-oriented approach to his pictures, and I thought that was beautiful in many ways.”
In Zimbabwe, the radio is still the primary tool for communication. At the same time, it also symbolizes the credibility of the health information heard on the radio and influences how people act in terms of their health.
According to Skovdal, the point is not that you should generate more radio campaigns to promote the lack of use of the HIV-prevention technologies. The point is that the local radio has a special impact because this is a platform that listeners trust. Local radio stations are a meeting point for conversation. This means that the messages sent over the radio will be discussed locally and it creates a breeding ground for debate. In this way it can help challenge the social norms that are part of the reason why the prevention technologies aren’t being used.
“The residents of Zimbabwe, and in Africa in general, listen to local radio stations that present information in local languages and that interview local people and role models, all of which creates trust among the listeners. There is a lot of skepticism in many places in Africa, and this is why the local programs are so important. The young people as well as other local residents are able to filter everything that happens. They have more trust in what is being said over the local radio stations, rather than all the other information that comes from some place far away,” said Skovdal.
A very current research field
In the study, Skovdal and the rest of the research team test different behavioral interventions, but according to him, it is not only about reaching individuals. For Skovdal, the study of health communication and individuals has to go hand in hand with interventions that address the social and cultural barriers as well as the structural institutions and look closer at how they influence people’s actions.
“People don’t receive information and are then automatically capable of acting based on this new knowledge. They are part of a very complex, social, political, cultural, and economic environment that makes sure their actions are controlled and limited to what surrounds them. And this is where the study tries to shed light on the importance of showing that if you take note of the social and cultural structures and involve them in specific interventions, then you actually have a bigger impact and effect than if you don’t use them,” said Skovdal.
Even though the study’s research focuses on behavioral interventions and which one of them can be implemented to change behavior in context of the HIV epidemic among young people in Zimbabwe, the study also has a global health aspect that reaches far beyond Zimbabwe’s borders.
“We began in 2018, and we have always worked with HIV and AIDS, and the relevance of this study hasn’t shrunk, especially in light of COVID-19. We might risk that people don’t use their masks, don’t keep socially distanced, or won’t get the vaccine. We might end up in some situations where people won’t comply with the expected behavior and that might have some public health complications. And how do you then communicate with people? It is the same situation we have in Zimbabwe, only with another infectious disease,” said Skovdal.
The study is a collaboration between the research organization Biomedical Research and Training Institute in Zimbabwe, the University of Copenhagen, the London School of Economics, and Imperial College London, and it is still an active study that will run until 2023.