Officially launched on December 1 2009, Break the Chain is a national social and behaviour change communications (SBCC) campaign that addresses one of the key drivers of the HIV epidemic in Namibia, the practice of multiple and concurrent sexual partnerships (MCP). The ultimate goal of the initiative, which is being implemented by a wide range of civil society and Government of Namibia (GRN) partners, is to contribute to the reduction of HIV transmission in the country.
This campaign is multi-level and multi-channel. The tone is meant to come from a public health perspective, with no moral judgment about MCP, and to provide options rather than prescriptions. The messaging is intended to be concise and unambiguous, cutting across age, income, and ethnic group boundaries. The SBCC strategy that guides the campaign outlines a two-step approach: First: to 1) introduce concepts of MCP and sexual networks in order to raise risk awareness among those actively or passively (through an unfaithful partner) connected to a network; and 2) introduce risk reduction strategies (partner reduction, condom use). Second: to 1) address the more complex factors driving MCP and build skills necessary to implement risk reduction strategies (cultural issues, communication skills, ending of harmful relationships...); and 2) reduce social acceptability of MCP.
In both phases of the campaign, interpersonal communication (IPC) and mass media activities characterise the strategy - reinforcing each other. With regard to the former (IPC), the campaign has a presence at activities such as taxi ranks during holiday periods and events where the intended audience might be drawn. Also, new IPC materials have been designed for use by civil society and other partners in communities and workplaces to create discussion around MCP and its related topics, including transactional sex, cross-generational sex, and couples communication. All campaign materials were developed with the involvement of the Break the Chain thematic working group (TWG) and harmonised to be in line with the national SBCC strategy and its key messages and intended audiences. New IPC materials include:
- MCP Picture Code Flip Chart [PDF]: a flipchart developed for Namibia that features photographs of "everyday situations", a set of questions on the back of each picture to stimulate discussion, specific messaging on transactional and intergenerational sex, and strategies for better relationships;
- MCP Campaign Fact Sheet [PDF]: a 2-sided sheet of HIV prevention and transmission facts on MCP and the Break the Chain campaign (in PDF format) with diagrams and images of campaign materials and objectives of the campaign.
- MCP flannelgram kit: a set of Namibianised drawings of people, a flannel board, and a facilitation guide to be used with 15-20 participants that explains sexual networks and how to step off such networks in a participatory manner; and
- "3 1/2 Lives of Philip Wetu": an interactive movie, the viewers of which can discuss and decide on the decisions of the main character - and, thus, determine the course of the narrative.
The TWG has conducted widespread training of civil society and public sector implementing partners on MCP as a driver, on the MCP campaign, and on the use of the new MCP IPC materials. The new MCP materials have been reproduced and distributed to trained partners. Organisers hope to expand involvement further to additional civil society and all key line ministries working in the prevention of HIV throughout the country.
With regard to the latter component (mass media), messaging has included: television spots, radio spots and dramas, billboards, posters, full-page newspaper articles, and flyers.
To further reach out to young people in and out of school settings, local Namibian artists recorded a Break the Chain campaign anthem, a text messaging (SMS) line was set up, radio talks were held with disk jockeys (DJs) on popular stations, and a year planner calendar was distributed to Namibia College of Open Learning (NAMCOL) students. School competitions and designing of a board game on MCP have also been initiated. (For additional details about the specifics on the young people’s messaging, contact Rushnan Murtaza at the address below.)
Advocacy and social mobilisation work is also part of Break the Chain. Consultations with traditional authorities in key regions took place before launch of the campaign. Consultation with regional offices of GRN and with PLWH groups continues.
For more information about Break the Chain, visit C-Hub.
According to the regional MCP Task Force draft document "Technical Guidance on Addressing Multiple and Concurrent Partnerships within HIV Prevention in Southern Africa" (February, 2009), concurrent partnerships can broadly be described as relationships where an individual has two or more sexual relationships that overlap in time. It has been shown that having long-term concurrent sexual partners increases HIV transmission compared to sequential or serial partnerships because of the increased viral load in acute infection that facilitates transmission, and also because new infections can spread more rapidly through the sexual network when its members are concurrently connected.
Campaign organisers describe high tolerance of MCP in Namibian society (it is a norm), especially among cohabiting couples. They point to "experimenting" and sexual thrill-seeking and inter-generational sex as being at the core of most MCP among younger audiences. There is also some cultural practice of MCP, and a lack of relationship skills to make main relationships mutually satisfying.
The campaign was named first runner-up in the category "Multi-Channel Communication Strategy" for excellence in HIV and AIDS communication by the African Network for Strategic Communication in Health and Development (AfriComNet) in Johannesburg, South Africa, in August 2010. In a series of focus group discussions (FGDs) conducted three months into the campaign across Namibia, respondents describe the campaign as "new" and "different". They also say that it made them re-evaluate their personal risk of HIV. The MCP TWG is currently in the process of developing a more formal first-phase evaluation to determine what impact has been made on knowledge so far.
Break the Chain was developed by the Ministry of Information and Communication Technology's Take Control partnership and supported by the United States (US) President's Emergency Plan for AIDS Relief/United States Agency for International Development (USAID) through NawaLife Trust, C-Change, IntraHealth, and the Global Fund against AIDS, Malaria and TB through the National Social Marketing Programme Namibia (NaSoMa), the United Nations Children's Fund (UNICEF), the Joint United Nations Programme on HIV/AIDS (UNAIDS), Desert Soul, and the German Development Service (DED)/GTZ (Deutsche Gesellschaft für technische Zusammenarbeit). This group forms the national MCP technical working group within the National Prevention Technical Advisory Committee of the Ministry of Health and Social Services/Directorate for Special Programs, which is the Secretariat to the National AIDS Executive Committee.
Partners implementing HIV prevention programmes that are participating in the campaign include: Chamber of Mines, Namibian Association of Community Based Natural Resource Management (CBNRM) Support Organisations (NACSO), Sam Nujoma Multipurpose Center, Walvis Bay Multi Purpose Centre Trust (WBMPC Trust), Catholic Aids Action (CAA), Caprivi Hope for Life (CHFL), Development Aid from People to People (DAPP), Church Alliance for Orphans (CAFO), Lifeline-Childline (LL/CL), NawaLife Trust (NLT), Intrahealth, and Society for Family Health (SFH).
Emails from Elizabeth Burleigh to The Communication Initiative on September 16 2010 and September 27 2010; emails from Bastian Schwarz to The Communication Initiative on September 17 2010 and September 25 2010; emails from Rushnan Murtazaand and from Sandra Kalscheur to The Communication Initiative on September 29 2010, respectively, and Break the Chain blog, accessed on September 24 2010.