The participants’ responses were coded and three broad themes were generated from the data namely; Awareness of mass media HIV campaigns, influence Mass media campaigns on ART uptake, and Adolescents’ media preference.
Awareness of Mass Media Campaigns Promoting ART Uptake among Adolescents
Many respondents stated that they are aware of the mass media HIV campaigns like Obulamu which was being aired on different media mainly Televisions, radios, magazines, and posters as well as phone SMS. One participant expressed awareness of these messages and was quoted saying,
“I have heard about Obulamu health campaigns on TV and radios telling people on ARVS to stop drinking alcohol and that HIV kills.”
We found that majority of the participants were aware of Obulamu news reporter campaigns for example one participant reported that,
“I have also heard about Isaac and Sarah advert where Sarah was reminding the husband Isaac to take his drugs”.
Other than Obulamu messages respondents were aware of messages by Rock point 256, HIV awareness drama played on Radio. To this regard one respondent said,
“I recently heard a message on the radio saying that now that corona has come don`t think that HIV has ended it`s still there and kills so keep taking the medication, because the disease kills and we should stop spreading it”.
Conversely we found that some respondents reported that they were not aware of any HIV media campaigns in their settings. Interestingly almost a third of the respondents reported that they had gotten information about these campaigns from health workers but they hadn’t seen or heard the campaigns by themselves. Results from the Key informants confirmed that most of adolescents receiving care at MRRH had been exposed to HIV media campaigns and they (adolescents) were indeed aware of them as expressed in this verbatim:
“There is a TV set at the triage and usually displays some of the recorded videos so as to air out the messages about ART up take. The message is in both English and Runyankole”.
We also found that most of the respondents had seen/heard mass media HIV campaigns about adherence to ART, Stigma, family planning, condom use, circumcision, abstinence, counseling and testing, positive living as well as Antenatal care. Such messages were aired out in the print, broadcast and folk media. Majority of the participants pointed out that they found these HIV mass media campaigns at the health facilities they attended. For example a participant reported that,
“In hospitals like at our clinic they be saying that we should keep taking our drugs well because if we don’t then the virus will make us powerless (destroy our immunity). They usually put for us suchmessages on the TV here at the hospital” and “ in hospital like here, sometimes you go to the clinic you find posters or you hear someone saying that I saw an advert”.
In deed data from key informants was in agreement with these results where they (KIs) expressed use of media campaigns in their adolescent HIV clinic,
“We also run messages on TV at the hospital and these messages are often telling us about HIV and other diseases that can come up if one does not take their medications very well. We also have clip videos of Rock Point 256 and Obulamu that we put for our adolescents like we usually call them when it’s not their clinic day and are not busy then we put for them these videos to watch and we evaluate what they have learnt from the videos at the end”.
Influence of Mass Media Campaigns on ART Uptake among HIV Positive Adolescents
Under this section participants identified countless ways through which the HIV mass media campaigns influenced their uptake of ART. Among others, participants underscored these messages for offering them with inspiration. In other words participants became encouraged, motivated, hopeful, educated, and determined to take their medications. For instance one of the participants in the FGD appreciated the messages in this verbatim:
“. . . They encourage me to take my dugs so as to have a healthy life and look like other healthy people and I prevent myself from getting the severe signs and symptoms of HIV and even getting infected with other illnesses because if you don’t take drugs then you become wasted and look bad”.
Indeed data showed that these campaigns inspired participants to adherence to treatment, fight off enacted stigma and rejection as well as increased their awareness of the likely consequences of non-uptake of ART. These results were alluded to still by almost all the Key Informants, for instance one of them commented that,
“They have helped the adolescents to avoid early pregnancy and infecting others as well as avoiding reinfection”.
In fact some Key Informants confessed to have used these HIV media campaigns in their daily work as they attended to these adolescents as expressed in this verbatim:
“Whenever I see something on TV through these campaigns and it catches my attention then am like okay I can do this for my adolescents at work or I will implement and improve this or that in my care for my children at work as I call them. When I see these campaigns I pick some few words which can help me to at least talk to my adolescents and at times it impacts on their lives”.
Though the study focused on mass media HIV campaigns, some participants pointed out that teachers were a major source of encouragement to their uptake of ART. For example one participant was quoted,
“. . . You see teachers in class tell us that most people long ago used to die of HIV because of not taking their drugs and that if you keep taking your drugs then you can live long. They have made me aware and encouraged to take my drugs”.
Participants revealed that due to these campaigns, their immunity had improved, had suppressed viral load. On the contrary, some participants expressed being irritated by these HIV media campaigns. For instance a participant commented that,
“. . .like on TV you find they show these drugs that we take and everyone is seeing them so when we are at school and maybe you misplace your tablet and the other students see it, you hear them saying that we have HIV positive students here, I always feel so bad and peaceless” Such sentiments were also expressed in other FGDs for instance another participant reechoed such feelings in a verbatim:
“I hate it when the massage is directed to me even in front of my enemies .I love it when the massages is given to me in secret. You find the person delivering the message says it when there is an enemy seated next to you or they even send those messages on your phone when your enemy is seeing and that person always pinpoints you making you uncomfortable”.
It would appear that these HIV media campaigns elicited both externalized and internalized stigmatization tendencies among some of our study participants. A case of internalized stigma due to these campaigns can be observed in the one of the FGD submissions where a participant said “Me it disturbs me a lot because you might be seated watching TV or listening to radio as a family and they put the messages/campaigns yet you know that you are the only victim so you feel bad that’s what I don`t like about them. There is no way the family members harass me but myself I feel touched”.
On the whole approximately over three quotas of the FGD participants appreciated the influence of these campaigns on their ART uptake. Although most of the participants appreciated, trusted, liked these HIV media campaigns and would even recommend them to their friends, it’s imperative to note that some participants reported that they were not comfortable with the languages in which these campaigns were communicated out. The use of English Kiswahili and Luganda campaigns was considered not appropriate for instance a participant observed that,
“. . . they are languages they use we don’t understand because they usually use English or Luganda and me I don’t understand them”.
Instead participants preferred Runyakole-Rukiga messages since this is the commonly spoken and understood language by the people of southwestern Uganda. Indeed even Key informants pointed out language barrier as one of the limitations of these campaigns,
“A number of our adolescents are illiterate, yet most of these media messages are in English thus leaving them out”.
The study found that some of the participants wouldn’t recommend these messages to their friends for fear of being stigmatized. In fact one participant said,
“I keep the massage to myself because I don’t know who is sick and I hate it when someone suspects me to be positive” another participant in another FGD said “I can’t share the information. I’m the only one who is infected in the family so there is no one I can share with. I also I assume that where I get the information the friend can also get that information there”.
However most of the participants were free with these messages and were also ready to recommend them to their friends as one them said,
“I would like to share with the colleagues but it is not possible because most people hide their status and sometimes end up missing the information and sometimes dying” another participant commented that “Me at school there is a child and he also gets his drugs from here so when I saw him I tried to advise him to always listen to those messages. I always advise my friends to listen to them. Me I be wanting that even if I meet a person and I know that he or she is HIV positive, I always want to tell that person so that even if I die at least I know that he has remained with good health”.
Participants gave their opinion about what they thought would make these HIV media campaigns to be more effective to them and the wide community of the adolescents living with HIV in southwestern Uganda. Their recommendations hinged around privacy and confidentiality since these would deal with stigmatization. In this regard one of the participants commented that,
“I like that these messages be put in hospitals because it’s the health workers that keep our medical records and we trust them a lot more than people in the village who will know our status and start discriminating us from others”.
Another area of improvement suggested by the participants was about the frequency of messages on Radio and TVs. Participants noted that the HIV media campaigns had reduced and more adverts were concentrating on COVID-19 yet HIV was still killing people. For instance a participant commented that,
“Like when am watching like some TV station e.g. UBC, sometimes they spend long like a week without putting those campaigns and someone can forget if he/she sees a week go by without any message/advert so there they don’t help. Therefore they should always pass those messages during program breaks so that we keep alert and informed”. Respondents also observed that the posters were scattered and they needed to be spread throughout their locations. This is evidenced by a verbatim from one of the participants who commented that, “they should increase on the number of posters now they should start putting posters everywhere and even on radio they should put other messages more than what they have been putting”.
The study found that although these messages were highly recommendable to others and good, some participants noted that they were not age specific which in turn would embarrass viewers as expressed by one the Key Informants,
“They are good to a certain extent but they don’t have age specifications like they put them on TV not knowing there are some young children watching like messages about sex and yet children have a high cognitive so whatever they see or hear tends to sink deep inside their brains so that is the problem with these campaigns. They would be good if they were targeted to a certain age like if they specified that like people of 15 and above should be the ones to watch the messages”.
Most Mass Media channels preferred by HIV Positive Adolescents
Under this section respondents identified the different media channels that they preferred in the transmission of HIV campaigns. Majority of the respondents preferred broadcast media which involved use of Televisions, radios and public address drives because of their easy accessibility. For example a respondent in one of the FGDs stated,
“….On radios (e.g. radio west, Maria) because most people have radios and TVs like TV west. But radios work better.” And another respondent started “….. Public address vehicles because I want many people to know.”
Print media was the other type of media that was identified print media but especially posters. Magazines and newspapers were also mentioned but with little emphasis. This is evidenced by one of the assertions of a participant who commented that,
“Putting posters just like people put posters on houses for sale or commercial adverts, they can do the same for HIV messages so that when someone comes and reads on that poster they can get the message”.
Some of the respondents in the FGDs showed preference of the social media. Social media was also mentioned by a few participants in the FGDs though even one of the key informants underscored its applicability as a channel through which HIV campaigns would be communicated out as expressed in this verbatim,
“At least a certain percentage of adolescent have phones and they are usually in access of social media and they have shown much interest in message on social media than these posters we have in hospital”.
Also a few other participants identified their preference as being mobile phone SMS. Their argument was premised on the assumption that they are always with their phones and they can receive messages anytime yet this is not always the same with print or broadcast media channels. One of the participants gave a view about that Mobile phone SMS that,
“SMS on phone like for people who are always on trips and they have no time for radios so an SMS can also act as a reminder to take Tabs because the person can easily see that message and be helped better than having to wait till they listen to radio or watch TV.”
In addition to their preferred media, respondents also expressed their interests in different kinds of messages they desired to be delivered through the HIV campaigns. Almost all FGD respondents preferred messages about HIV information. These messages included; messages about ART adherence, side effects of ART, prevention of HIV spread, stigma and discrimination. A respondent in an FGD stated,
“….Messages about taking medication and messages teaching those who are HIV positive and those that are negative to stop discriminating us and seeing us as if we are useless because we also didn’t want to be positive but that’s how we were born”.
Respondents also pointed out testimonies and lived experiences of successful HIV positive people in society as one of messages they wanted to be carried out in the campaigns. For example one respondent stated that,
“Messages concerning the experiences and journey of life of those people who have lived with HIV for a long time. I prefer those messages because they encourage us to also live positively like those people who have lived with the disease for long time and they are doing very well”.
Lastly we found that nutrition messages were also other type of messages that our participants wanted to be part of the HIV media campaigns and these massages would involve things like balanced diet, what to eat and what not to eat while taking ART. For emphasis one of the FGD participants For example one stated,
“Messages on feeding while taking medication (the diet to follow) because if you take the drugs without eating the drugs can make you weak. They should talk about what people are supposed to eat and what they should not eat.”