Student: Meredith G. Morrow Course: Behavioral and Social Sciences Applied to Public Health Exercise: “Utilize a social construct to create a public health campaign that involves altering behavior” Guest Instructor from Johns Hopkins University: Vanya C. Jones, PhD, MPH The audience that the behavior change program will ultimately target is all South African citizens (children and adults of both genders). By teaching the disease transmission process and giving accurate knowledge about protected sexual behaviors, South African society can learn the difference between myth and fact when it comes to HIV/AIDS. The state of the world population report (released in 2004) suggests that life expectancy at birth for South African males was 45.1 years, while the life expectancy for females is reported as 50.7 years (Lehohla, 2004). The population of South Africa is estimated to decline from 45.2 million in 2004 to 40.2 million in 2050 as a direct result of HIV mortality (Lehohla, 2004). Therefore, it is important for this audience to address the safe-sex behavior as early as possible in order to delay this trend. In addition, the younger the child that is first introduced to positive condom use, the more likely they are to use a condom as they age. Since many South Africans grow up as orphans and have no strong ties to familial referents of support, the association of positive condom use with popular role models (famous celebrities, for example) may serve to alter their normative beliefs, and in turn, change their behavior thereby utilizing a condom during sexual practices. In order to increase condom use to reduce the public health threat of HIV/AIDS, I have utilized the Social Cognitive Theory. This intervention will take place in schools located in Johannesburg, South Africa. Eventually, the goal is have this behavior adopted throughout South Africa by disseminating into smaller, rural villages after changing the behavior of citizens of Johannesburg. In addition, multiple media events will take place utilizing dialogue of famous celebrities and their positive association with condom use. I
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will emphasize that each person is an agent in control of his or her own life and acts in accordance to certain cognitive factors, environmental factors, and behavioral factors. By the end of this intervention, each person will be in control over whether or not they become infected through approved sexual contact. One of the constructs that I utilized in analyzing this issue was Observational Learning (Acting how you see others around you behave). As mentioned earlier, South African orphans usually lack positive role models in their lives. Instead, many of them choose to admire celebrities that are often associated with charitable donations and medical help for the AIDS crisis in South Africa (Oprah Winfrey, Beyoncé Knowles, and Bono of U2, to name a few). Through my intervention, these role models will add to their cause the discussion of the importance and necessity of using condoms during sexual practice. These sentiments will be conveyed to the public through personal dialogue, posters, videos, free concerts, and by the celebrities visiting public health clinics that provide free condoms. Not only will South Africans learn how to use a condom from these very important teachers, but they will also see that it is more than socially acceptable…Through observational learning by viewing these celebrities as role models, society will change their mentality to: ”If Beyoncé practices safe sex, I should too.” The next construct that was used was SelfEfficacy. Although free condoms are often given out for free at local health clinics, often the stigma of walking inside the health clinic proves too great and condoms are never even taken. For that reason, it is important that South Africans have the confidence to walk into these buildings in the first place and know that they will not be harmed after leaving the building. This can be done by setting up more security around the clinic. In addition, the fact that the aforementioned celebrities will be visiting these sites (showing
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that it is “okay” to walk inside the building), will only increase ones belief that they have the ability to safely take action. Expectations are another construct that plays a role in this setting. For instance, a behavior will only be adopted if one believes that they will be rewarded in some way. Through the use of the media, celebrities will have a chance to personally speak to each citizen, explaining that using condoms will save your life (the expectation of using a condom will prevent HIV infection). Lastly, the fourth construct that was utilized was Reciprocal determinism. Since the environment in South Africa is not currently suitable for widespread use of condoms, it is important to change the setting in which most people live so they, in turn, change their attitude toward condom use. The use of celebrities will undoubtedly change the social aura when it comes to speaking about safe sex, however, it is the South African society that will inevitably need to feel comfortable performing these acts within their community and around their peers. If enough people are inspired by these celebrities to change their behavior of obtaining and using free condoms, then the rest of society will be inspired to change by witnessing the change in their peers’ attitude toward safe sex. In the end, the entire safe sex campaign once spurred by famous role models, will eventually be transferred down the cascade to other cities and villages within South Africa. The Observational Learning construct was particularly helpful in this intervention as I was able to recognize that most orphans lack a positive role model to look up to. When asking children who they want to be like when they grow up, many of them answered with names of famous, American celebrities. It was this thought that prompted the intervention using celebrities as peers: if celebrities discuss their own personal use of condoms, then it will show South Africans that condom use is safe, and
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socially acceptable. Self Efficacy was helpful because it is important for the person at risk to realize that they have the ability to change their destiny. Some citizens may be so immune to the trauma associated with an HIV diagnosis that they come to believe this will ultimately be their fate as well. If this is the case, self-efficacy is probably the most important construct. Women in South Africa often lack power and a voice, so if they have the courage to walk in a health clinic, ask for a free condom, and ask their partner (who is receptive after hearing Bono discuss using a condom) to use a condom during sexual intercourse, this will only further the safe sex behavior in the future. The Reciprocal determinism construct was helpful in this intervention since it deals with how people interact within a society. As mentioned previously, there first needs to be a change in an environment to create a permanent behavior change. This is specifically true for South Africa since violent crimes are often committed against anyone who goes against the social norm of discussing HIV in public. Therefore, if enough South African citizens are inspired by the celebrities, it will eventually create a new environment: one that is friendly and receptive toward condom use. Finally, as South African society begins to realize that the HIV rates of infection are declining due to condom use, they will come to expect (Expectations) that being diagnosed as HIV negative is positively correlated with condom use and will only continue their adopted behavior. Safe sexual practices are often viewed as an identifying behavior of an HIVinfected person, and are therefore highly stigmatized. Discussion of being tested, and the myth of various ways to “cure” HIV often lead to violent crimes based on gender, age, race, and socio-economic factors. Therefore, my intervention will radically address culture based on all of the aforementioned factors. For instance, earlier I mentioned that
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each person is an agent in control of his or her own life. Currently, this is not the case for many women, which is why it is important to have both powerful female and male celebrities influence women in South Africa. In addition, race plays a role in the culture of South Africa since more than half of the population of South Africa is of the African race (Study, 2007). Caucasians make up just 9% of the population, however, the postapartheid culture is still being felt in South Africa, since caucasians are also the wealthiest in the country and least affected by HIV/AIDS (Study, 2007). Consequently, it is important to choose celebrities that will motivate and encourage the larger population of Africans often influenced by the American experience.
Me visiting an Othandweni orphanage outside of Johanessburg, S.A. (2004)
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Helping a thirsty orphan get a drink of water (2004)
References Cited
Lehohla, P. (2004) State of the World Population: 2004. The Statistician General (States SA). Avail from: http://www.statssa.gov.za. Accessed 08.01.07. Study. (2007) Study South Africa: The Guide to South African Higher Education. International Education Association of South Africa. Avail at: http://www.studysa.co.za. Accessed 08.01.07.
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