Let’s SMS about sex, baby
shyly describing night-time ejaculations (wet dreams) that can be common during adolescence and early adulthood. “I sent a message to SMS BIZ and learnt that it is normal.”
Globally, about 80% of countries are using mobile and wireless technologies to support the achievement of health objectives (mHealth), according to a 2011 World Health Organisation (WHO) survey. The huge growth in cellular network coverage has helped mHealth’s rise. The WHO report notes that the bulk of the world’s more than five billion cellphone users are in low- and middle-income countries.
Many countries are using the technology to tackle culturally sensitive matters such as sexual and reproductive health.
“We have seen that young people are shy to talk about issues of sexual and reproductive health. This is worse in rural areas where they have limited access to information,” says Francelino Murela, from the United Nations Children’s Fund (Unicef), which supports the programme that now reaches about 36 000 young people.
“SMS BIZ does not require a smart phone with access to the internet [so] anyone who has a mobile phone can use the service. All they have to do is register, then they can send their texts to our counsellors for free.”
The programme targets people between the ages of 10 and 24 and “especially girls, because they are most affected by HIV”.
Mozambique has an HIV prevalence rate of 11% among adults aged 15 to 49, according to UNAids. This rate is higher in women (13%) than in men, who only have a 9% prevalence rate.
Women also typically get infected earlier than men do. HIV prevalence among young women aged 15 to 24 is almost three times higher (11.1%) than among men in the same age group (3.7%).
Unicef supports similar SMS programmes in other countries, including Swaziland, Zimbabwe and Nigeria, where the platform shares information about diseases such as Ebola and polio.
The direct effect of SMS programmes is unclear. Unicef’s 2015 annual report notes that an evaluation found that Zambian SMS-based campaigns have had no “significant impact” on the uptake of medical male circumcision. Medical male circumcision can reduce a man’s risk of contracting HIV through vaginal sex by about 60%, according to UNAids.
A 2014 article in the journal Global Health Action, which reviewed studies of several mHealth programmes in low- and middle-income countries, calls for more detailed studies on the effect of mobile technologies on health outcomes.
The review finds that, for mHealth, “evidence of effectiveness is both mixed and scant”. For example, the article describes an SMS-based support group in South Africa for women with diabetes. It notes that although women were linked with buddies to support their treatment and care through SMS, the project was unable to demonstrate significant changes in the women’s health after six months.
Researchers also argue t hat, although some SMS systems help HIV patients to stay on treatment, textbased messages have failed to curb HIV risk behaviours such as unsafe sex. The Global Health Action article also shows that gender disparities in mobile phone ownership can restrict access to SMS mHealth programmes. In Uganda, for example, “women were less likely to own a mobile phone, so were less likely to directly benefit from SMS education”.
Data collected since the SMS BIZ programme was launched in Mozambique in October last year show low levels of HIV knowledge among users.
These levels are similar to UNAids figures that show only 48% of women and 63% of men aged 15 to 49 had accurate knowledge about how HIV was spread.
In cases where data showed SMS BIZ users had accurate HIV knowledge, this did not translate into behaviour change, says Murela. “Although they knew that HIV can be transmitted through sexual intercourse, some of the users indicated that they still engaged in unprotected sex.”
Mu r e l a is hopeful. Judging by the high rate of engagement with users on the programme, he believes that, in time, the service will lead more young people to make informed choices about their sexual health.