Index

Corresponding Author:
Philip Massey, UCLA School of Public Health, 948 15th St. Apt 2, Santa Monica, CA 90403. Email: masseypm@gmail.com

Suggested citation: Massey P; Morawski BM; Rideau A; Glik D. Health Communication via New Media: An Internet-Based Peer Community Dedicated to Health Information Created by Youth in Dakar, Senegal. Cases in Public Health Communication & Marketing. 2009; 3:13-37.
Available from: www.casesjournal.org/volume3.

Abstract

Réseau Africain de l'Éducation pour la Santé (RAES) developed and implemented a health communications pilot project targeting secondary school students throughout Dakar, Senegal, in the summer of 2008. The program focused on the development of a scholastic, Internet-based community dedicated to health information, education, and dissemination, created by and for Senegalese youth. This article focuses on the summer pilot aspect of this program. Forty-five students from three local high schools in Dakar were recruited during their summer break to participate in a 10-week pilot project conducted at RAES. This summer project developed students' communication and technical skills; youth leaders formulated health messages communicating HIV/AIDS issues to their peers by producing their own digital content. Youth designed, wrote, and produced content using web-based applications, audio/visual equipment, and traditional journalistic approaches. The program was designed to positively impact health behaviors and attitudes among Senegalese youth in the domains of HIV/AIDS stigmatization and discrimination. This included emphasizing the importance of voluntary counseling and testing (VCT) for HIV, as well as the role of peer support in reducing health risks. This program can help usher in a new and effective health communications method that may be implemented in high schools throughout Dakar, as well as be scaled up to serve the interest of the greater African community.

Introduction

The HIV/AIDS pandemic has had an extensively documented, disproportionate impact on Sub-Saharan Africa. Of the 33 million people living with HIV in the world today, over 22 million reside in sub-Saharan Africa, accounting for 67 percent of total cases. ¹ In 2005, the region received over one billion dollars from the President's Emergency Plan for AIDS Relief (PEPFAR) alone for prevention and treatment efforts, addressing issues from transmission prevention to palliative care to care for children orphaned by the pandemic. In Senegal, nearly $18 million was spent on the fight against HIV in 2007, an almost 50 percent increase from the previous year. ² For all of these efforts, however, the battle against HIV/AIDS still presents many challenges.

The number of people living with HIV/AIDS continues to increase, because of both new infections and increased life expectancy of people living with HIV/AIDS due to antiretroviral therapy.¹ The incidence of HIV has decreased globally since 2000, but the number of new cases remains high. There were three million annual incident cases in 2000 and 2.7 million in 2007. Of the 2.7 million new cases in 2007, 1.9 million occurred in Sub-Saharan Africa. ³ While HIV/AIDS is less prevalent in Senegal than in other African nations (approximately 1 percent prevalence among 15-49 year olds), the social and economic burdens of the disease remain significant. ⁴

Early prevention and treatment efforts in Senegal have helped keep the overall prevalence of HIV relatively low; however, there is still an enormous need for prevention programs that target key populations in innovative ways. This need can be characterized by a 2005 national survey, which demonstrated that only 22 percent of youth aged 15-24 were able to correctly identify means of preventing HIV transmission and reject major misconceptions about transmission. ³ Another disconcerting HIV trend among Senegalese youth is an increase in prevalence from 2005 to 2007; these estimates indicate that among youth aged 15-24 years, HIV prevalence has increased from 0.1 percent to 0.3 percent in males and 0.5 percent to 0.8 percent in females. ⁴

There are many health education programs in Senegal surrounding the AIDS epidemic, but these programs rarely address the issues of stigma and discrimination that were instrumental in allowing the pandemic to occur. ⁵HIV/AIDS prevention education must move beyond lectures on biological transmission and include vehicles for dialogue surrounding the discriminatory and stigmatizing attitudes towards those living with the disease. ⁵ Progressive attempts to curtail transmission and eradicate the virus must remove the mystery and stigma surrounding HIV/AIDS to create a supportive environment. Such an environment would encourage voluntary counseling and testing (VCT), transfer accurate knowledge regarding methods of transmission and foster the compassion necessary to create the will to treat those living with the disease. ⁵

The African Network for Health Education (Réseau Africain de l'Éducation pour la Santé, or RAES), a Dakar-based Senegalese non-governmental organization, attempts to address these issues by training Senegalese adolescents to become the next generation of peer-to-peer educators through the use of Information and Communication Technology (ICT). While many types of media have been used in the fight against AIDS, it is rare for programs targeting the youth population to allow youth to design the intervention campaign. RAES' approach builds on research indicating that peer-to-peer education programs yield more fruitful results than other methods. ⁶ RAES entrusted selected youth from Dakar with engaging their peers in the fight against HIV/AIDS via media campaigns designed by lycéens, for lyceéns (high school students). These youth were nominated by their teachers because they were identified to have both an interest in the summer program as well as possess leadership skills needed to become peer leaders. In order to train the selected student leaders, RAES recruited 45 youth from two public schools and one private school for a ten-week summer training; this program equipped students with the technical skills and content knowledge needed to train fellow students upon re-entry to school. The goals of the summer training pilot program were to train these students and educators to become proficient in digital health communication methods, so that they would be able to 1) impart this knowledge to their peers through the creation of thematic clubs, and 2) create a student-designed media campaign to raise awareness about HIV/AIDS.

Successfully targeting youth for HIV/AIDS-related behavior change is highly advantageous. Teaching healthy behaviors before sexual debut, while attitudes and ideas are more malleable, can protect youth in the higher risk period of their lives and lead to long-term healthful behavior. This in turn may result in fewer incident HIV infections. A 2005 Demographic and Health Survey (DHS) estimate showed that only 12% of men and 9% of women have had sexual intercourse before the age of 15 in Senegal. ⁴ This means that the RAES program targets Senegalese youth just as they are reaching the age of sexual debut, and likely have yet to engage in behaviors that put them at risk for contracting HIV.

The RAES summer training program endeavored to combat the HIV/AIDS pandemic by teaching youth to engage their peers in the fight against HIV through ICT. Partners during the summer program included SIDA SERVICE, specializing in HIV/AIDS education and testing services, as well as ASPROCIDE, a human rights organization that focuses on issues surrounding stigma and discrimination against people living with HIV/AIDS.

In partnership with SIDA SERVICE and ASPROCIDE, the program trained students and teachers to develop digital HIV/AIDS-education related content for websites and other media for a national HIV/AIDS campaign. This technological component was the backbone of the program, providing the technical competence for these youth leaders and educators to raise awareness about discrimination, stigmatization and human rights as related to HIV/AIDS through new media. By developing technological skills over the summer, youth leaders would be prepared to share their knowledge and skills with fellow students and to actively engage them upon reentry to school. By extension, the summer component provided important support to the voluntary HIV/AIDS testing component of the program. The RAES program is a new and potentially effective step forward in the continued fight against HIV/AIDS.

Background

Information and Communication Technology (ICT) is not a stand-alone solution to the HIV pandemic; research has shown that technology is most effective when integrated into existing programs. ⁶ To keep the fight against HIV at pace with larger changes in society, there is a need - and a niche - for innovative components that complement more traditional approaches in the battle against HIV. A growing body of evidence shows that ICT - especially via the Internet - is effective in broadcasting health messages. ⁷ By working with ASPROCIDE and SIDA SERVICE, RAES was able to examine the effectiveness of this approach in sub-Saharan Africa as part of a program that encourages voluntary counseling and testing, fights stigma and promotes human rights.

The difficulty of successfully incorporating ICT into this program relates to the issues of access to technology and technological savvy among program participants and the target group. In an effort to create effective youth leaders who were comfortable with the technological tools that they were asked to use, the summer training session developed participants' technical skills (computer, radio, video and journalism), and applied these methods to social marketing ideas. This issue of bridging the "digital divide" - the gap between the average level of technological literacy seen in the developed world versus the developing world - is one of the major innovations of this program. Furthermore, it is an issue that has been prioritized by the current Senegalese administration, headed by President Abdoulaye Wade (first elected in 2000).

It is important to understand the current place of ICT amongst Senegalese youth. The majority of the 45 high school students interviewed in this pilot program used the Internet approximately once a week (about 40 percent), although students attending the participating private high school may have inflated this figure. Approximately 19% used the Internet once a day and almost 17% used it more than once a day. About a quarter of high school students used it once a month or not at all. Students' online activities varied, but the majority used the Internet to download files (for non-scholastic purposes) or to search for information ("Research"). These activities are described in more detail in Figure 1, next page.

Figure 1. Preferred Activity Using the Internet in Target Population of Three Dakar High Schools, Dakar, Senegal, 2008

Giving youth the tools to create their own digital media can help them become engaged, committed and confident peer educators in the fight against the pandemic. Additionally, these innovative technologies help tailor messages and reinforce awareness-raising programs concerning stigma, discrimination, and human rights relating to HIV/AIDS.

Methods

Digital Media Strategy
RAES developed a health communications pilot project targeting three secondary schools in Dakar. The program focused on the development of a school-based, community dedicated to digital health information, education, and dissemination, created by and for Senegalese youth. Original digital health communications content will be created by school clubs based at each participating high school incorporated expressly for this purpose; student leaders trained during the summer pilot session at RAES will recruit peers to these clubs in the school year immediately following the summer.

Specific content will include messages combating HIV/AIDS stigma and discrimination, the importance of testing and ways to be tested (voluntary counseling and testing, or VCT), the role of peer support, and other topics related to sexual health education. RAES believes that one of the most effective ways to fight the HIV/AIDS pandemic is through the use of stimulating and attractive learning tools, such as ICT. Students attending the school clubs will be provided an opportunity to work with media and materials that they would perhaps not otherwise have, creating a higher level of interest and retention in the program.

To visually depict the theories and assumptions underlying the program, and link short- and long-term outcomes with program activities and processes, program administrators developed a logic model. ⁹ The logic model for this program can be seen in Appendix 1.

Targets
Three Dakar high schools participated in the pilot program: Blaise Diagne, Parcelles Assainies and Sacré-Coeur. Sacré-Coeur was the sole private high school targeted in this intervention. The Open Society Initiative of West Africa (OSIWA), the principal funder, selected the participating high schools on the basis of faculty enthusiasm for the project. Direct targets for the pilot project included the recruited students attending one of the three participating high schools. Secondary targets include other students at the participating high schools, as well as youth, teachers, and parents in the larger Dakar community who could benefit from the health content created in the program. According to data collected during the formative research phase, approximately 92 percent (n=1841) of students from four Dakar high schools use the Internet. These high schools were the three participating in the project - two public and one private - and one public comparison school. The formative research showed a varied amount of Internet usage across the establishments, indicating that one could consider these high schools representative of the larger Dakar high school population. Similar levels of Internet use were found in the two participating public high schools, a slightly higher rate of use in the private establishment, and a slightly lower rate in the control high school. However, in all schools, the proportion of students who had ever used the Internet was greater than or equal to 82 percent. The high percentage of Internet users in local high schools justified the use of this program in targeting other high school aged youth as indirect beneficiaries. Table 1 (next page), provides further data on Internet usage in these high schools.

Table 1. Internet Usage (%) in Four Dakar High Schools (Collége Sacré-Cceur, Lycée Parcelles Assainies, Lycée Blaise Diagne, and Lycée Moderne de Rufisque) in Target Populationa versus Control High School, Dakar, Senegal, 2008

Partners
RAES, ASPROCIDE and SIDA SERVICE partnered to implement this program. Each Dakar-based organization brought a different specialty to the project; RAES specializes in digital media creation; ASPROCIDE, an association of Dakar middle and high school teachers, has expertise in human rights issues pertaining to HIV/AIDS; and SIDA SERVICE focuses on HIV/AIDS knowledge and voluntary testing. Together, these organizations provided a multifaceted approach to combating the progression of the AIDS epidemic, hinging on youth-developed digital content pertaining to HIV/AIDS education.

Materials
Equipment utilized for this project included field and studio microphones, mini disk recorders, video cameras, digital cameras and a computer laboratory for uploading and editing. After the summer pilot project, this digital equipment was kept available at each of the three schools, for student clubs to use to create communications material as per program guidelines.

Personnel
A video editor, sound engineer, online journalist, and webmaster were recruited from Dakar to help participating students learn skills needed to effectively create original digital content. Each professional was an expert in his respective field and received compensation for their participation; combined, these Senegalese consultants had over 40 years of experience working with digital equipment and creating digital content.

Curriculum Development
In lieu of a traditional lecture-based approach, RAES used a participatory method that encouraged students to become active learners. This method, known as problem-based learning, stressed the effectiveness of a participatory learning environment; instruction allowed students to produce knowledge rather than passively receive it. Through the problem-based learning method, students asked questions about the problems they faced, and learned how to apply the solutions to their daily lives. This method allowed the students to identify a problem, generate ideas, organize those ideas, attain learning needs and resources, organize those needs and resources, and test their new knowledge. Throughout the process, the instructor acted as a guide and provided support for students, furnishing necessary resources for learning skills. The summer curriculum combined basic technical instruction with problem-based learning modules for audio production, video production, and journalism (photography and journalistic writing).

Teacher Recruitment and Training
In order to effectively support student clubs when students returned to their schools, 10 teachers participated in a three-day, abbreviated training, one month prior to the student training. The 10 participating teachers learned communication theories behind message development, as well as the basic principles of HIV/AIDS stigmatization, discrimination and human rights. However, the bulk of the training period was devoted to learning how to use digital media tools. An evaluation of this short training showed that teachers felt comfortable with the majority of the material learned, although they requested more training in sound editing and in uploading content to the Internet. This request will be incorporated into the intervention in the form of weekly "Boost" sessions, slated to begin in January 2009.

Student Recruitment and Training
Teachers from participating schools helped identify and recruit a total of 45 students to begin trainings at the RAES office from late July 2008 to mid-September 2008. Each school came to RAES on a different day, with approximately 15 students from each school. Midday meals and transportation to and from RAES were provided for the students. Table 2 describes the gender and age distribution of the participating students as compared to the greater target population. In general, the participating summer students were slightly younger than the greater target population at the three high schools. This younger age distribution can act as a favorable factor with program sustainability, as fewer students will be graduating in the following year. It is also important to note that nearly all age categories were represented in the summer program, replicating the diverse age distribution of the greater target population. Furthermore, more males than females participated in the pilot program, mimicking the distribution in the larger target population.

Table 2. Basic Demographic description, Intervention Population and Target Population, Dakar, Senegal, 2008

During the first week of training, students were introduced to the equipment and provided with a foundation in creating messages and a story. After students became familiar with equipment functions and basic story development, the students split into groups depending on their interests. For example, students interested in writing and producing songs met with the sound engineer for more in-depth training and students interested in journalism worked more with the journalist. The consultants encouraged self-inquiry among students and guided them in developing new skills.

As students became more comfortable using the digital equipment, they entered the community to develop stories pertaining to HIV/AIDS, focusing on how community members react to people living with HIV/AIDS. At the end of the training, the webmaster helped students create a website that could be used as the interface to exchange ideas and content created during the summer pilot project. The website, www.sunukaddu.com, allows students to upload videos, songs, articles, and blogs.

Evaluation
Students completed a web-based Computer-Assisted Self-Interview (CASI) during the first and last training session. The questionnaire was in French, the official language of Senegal. Thirty-six of the 45 students invited to the training completed the pre-test questionnaire, and 27 out of the 45 completed the post-test questionnaire. Nine students had other commitments and were not available for the post-test, but no student left the program because of lack of interest, lack of parent support, lack of transportation, or another similar barrier to access.

The evaluation instrument captured demographic information, knowledge of and attitudes towards HIV/AIDS and human rights, knowledge and comfort level using new technologies, and competence in journalism, video editing and audio editing. The questionnaire also replicated questions from the formative research period of the study, which surveyed over 2,000 students in the three participating high schools about similar issues (although excluding specific questions about technical competencies).

Results

Based on evaluations of changes in knowledge and competency levels in digital media and knowledge and attitudes about HIV/AIDS before and after the training, the summer pilot program was a success. Pre- and post-test results about knowledge and attitudes about HIV/AIDS are described in detail in Table 3.

Table 3. HIV/AIDS Knowledge among High School Participants in Dakar, Senegal, 2008

The primary objective of the evaluation was to measure how comfortable students felt with the methods that they had learned. In order to measure the level of competence, students indicated their skill level using five ordinal categories: none, beginner, novice, intermediate and advanced.

For each category, there were significant shifts in students' self-evaluated competence. Students reported a much higher level of comfort with audio equipment by the end of the training; 90 percent reported having an "intermediate" or "advanced" level of competence, compared with the pre-training levels of 28 percent in those two categories. Video equipment was another area where students reported much progress: 67 percent reported an advanced level and 30 percent reported an intermediate level in the post-testing group, as compared with 11 percent and 14 percent in the pre-testing group, respectively. Levels of competence in journalistic methods were reported as 33 percent "advanced" level and 48 percent "intermediate" after training, an overall gain in competence level of 83 percent. Competence in photography shifted from 56 percent of students reporting beginner, novice or no level of competence to 93 percent reporting intermediate and advanced in the post-training group.

Computer competence showed a shift as well, with 17 percent of students moving from a "beginner" or "novice" stage to "intermediate" (59 percent) or "advanced" (30 percent). After the training, 4 percent of students felt that they had an "advanced" level of competence to post content to the Internet, and 63 percent felt that they were at an intermediate level. Seven percent felt that after the training they still had no level of competence in posting information online, 22 percent were still beginners and 4 percent were novices. (See Table 4.)

The least amount of change from the self-reported scores occurred with knowledge and ability to use computers. This finding may be in part due to the digital divide experienced throughout much of sub-Saharan Africa; compared to video cameras and audio recording devices, computers have many more functions to learn and often require many hours of dedicated training to master. An objective of the summer project was to train students in manipulating small, mobile digital technologies as opposed to strengthening computer literacy; for this reason, participants in the summer project were never directly trained in using the computer, but rather on how to upload digital content created using video and audio recording devices. Because RAES did not focus on increasing overall computer literacy, a significant change in students' self-reported computer skills was not expected. Most students reported on the post-test to have mid-level competence with the computer (59 percent).

Table 4. Self-Assessed Level of Digital Equipment Competency among High School Participants in Dakar, Senegal, 2008


* Average score values assigned as follows:
"None"=0; "Beginner"=1; "Novice"=2; "Intermediate"=3; "Advanced"=4.

Equally important measures of program success could be gleaned from students' comfort in educating their peers about health-related issues using the technical methods that they had learned. As shown in Table 5 (next page), a combined 74 percent of students reported an intermediate or advanced level of aptitude in using the Internet to educate their peers about health-related issues - a marked increase from the 28 percent who reported those same levels prior to training. A high percentage of participating students reported "intermediate" or "advanced" aptitude levels to teach peers about health-related issues using journalistic writing and photography. Sound and video editing saw a similar transformation in self-reported ability levels. In the pre-training group, 22 percent of students reported no ability to teach others using these methods, 44 percent were beginners and 11 percent were novices. Post-training, 26 percent reported an intermediate ability and 59 percent an advanced ability. In video editing, 88 percent of the post-training group reported having an "intermediate" level or higher.

Table 5. Self-evaluated aptitude level to educate others about health-related issues using various types of media among High School Participants in Dakar, Senegal, 2008

* Average score values assigned as follows:
"None"=0; "Beginner"=1; "Novice"=2; "Intermediate"=3; "Advanced"=4.

Between the pre-test and the post-test, students involved in the summer program demonstrated a slightly increased frequency in Internet use, with 4.2 percent more students reporting weekly usage and 3.1 percent reporting daily usage.

Most students reported using the Internet for schoolwork and information seeking. Most students did not spend their time on the Internet on social networking sites, or participating in forums. Participating in forums is especially important to attaining the goals of this RAES project, as it attempts to create a digital community among these students. Figure 2 details how students that participated in the summer training spent their time on the Internet.

Figure 2. Internet Activities of Students Participating in the Summer Pilot Program, Dakar, Senegal, July 2008

The majority of students reported that this intervention would lead them to do more research and school work using the Internet. As a result of this training, 44.4 percent of students reported that they would participate in forums more often. Students also reported that they would read and contribute to blogs more often (25.9 percent). Figure 3 (next page) details the types of Internet activities participating students reported that they would do more often as a result of the summer training.

Figure 3. Types of Internet Activities Students Will Engage in More Frequently As a Result of OSIWA Summer Training, Dakar, Senegal, September, 2008

Finally, students reported that the summer training program had prepared them to create and lead clubs centered on the skills that they had learned that are thematically linked to HIV/AIDS awareness. Ninety-three percent of students agreed or strongly agreed with the statement "At the beginning of the school year, I am prepared to create and lead youth clubs dealing with HIV/AIDS and human rights themes in my school."

The summer training briefly recapped previous training sessions that the youth leaders had received from SIDA SERVICE and ASPROCIDE, and centered its problem-based learning approach on HIV/AIDS themes. Students who completed the program displayed a high level of accurate knowledge about HIV/AIDS and a good understanding of human rights; both of these areas are key to spreading accurate knowledge about the disease to peers. Ninety-three percent of students reported that the risk of acquiring HIV/AIDS is reduced by correctly using a condom during intercourse. Ninety-three percent replied "yes" to a question asking if they could reduce the risk of contracting HIV by having only one partner who was not infected with the virus that causes AIDS and who had no other sexual partners. To this same question, 3.5 percent responded "no" and 3.5 percent were not sure.

All of the students responded that it is possible for someone who appears to be in good health to have HIV, and that antiretroviral drugs exist that will fight the virus. They correctly responded that there was no cure for HIV: 96 percent of students said that there was not, and 4 percent were not sure. Ninety-six percent of students reported that they knew a place where they could go to get tested for HIV.

Regarding the students' understanding of human rights concepts, all students reported believing that a student with AIDS should be allowed to attend school. When asked to respond to the statement, "A teacher who has the AIDS virus, but who appears to be in good health, should not be allowed to continue to teach in a school" using the Likert scale, 93 percent of students disagreed or strongly disagreed. Four percent of students reported "No opinion" and 4 percent said that they agreed with the statement.

Students were also surveyed about their opinions of the usefulness of the Internet in the fight against HIV/AIDS. Almost all participants found that the Internet could be a useful way to share ideas about HIV/AIDS (93 percent) and other health issues (100 percent). After the training, ninety-six percent thought that the Internet could be a useful addition to current methods employed to fight the HIV/AIDS pandemic.

Discussion of Project and Lessons Learned

Results obtained from the summer pilot project indicate that the media strategy of incorporating ICT used in this program was an effective way of teaching youth the skills necessary to create digital health content. Upon re-entry to school, with proper guidance, the "club" structure scale-up of this intervention is expected to engage students in creating digital media communicating youth-focused messages about HIV and other sexually transmitted infections. Of equal importance is that the summer pilot program created a base of students who can spread the knowledge they have acquired to their peers. Students gained basic knowledge of HIV/AIDS and of the relationship between human rights and HIV/AIDS, which they learned while participating in the program. This indicates that the use of innovative digital media strategies can reinforce the fundamental purpose of the intervention – decreasing stigma and discrimination associated with HIV/AIDS, and encouraging the transfer of accurate information regarding the disease.

One limitation of the study was that some students failed to complete the training. Students who dropped out could not be identified and consequently could not be paired with pre-program data. Additionally, students failed to complete the training in a decidedly non-random fashion. As a consequence, the sample size was small and only descriptive statistics are presented, which must be evaluated with awareness of the limitations of the results. Despite these limitations, the descriptive statistics clearly indicate an overall shift towards increased knowledge, attitudes, and competence levels of participating students that is, logically, not explained by "chance" and likely attributable to the program.

Upon re-entry to schools, participating students created school and community-based clubs that are expected to continue to create original digital content concerning issues surrounding HIV/AIDS. The necessity of timely and sufficient funding when working with schools became apparent during this intervention. Students who participated in the summer project were energized and excited to create digital media clubs at the start of the school year. Unfortunately, as funding was delayed, teachers reported that students became disengaged and restless. Youth in particular are quite vulnerable to delayed or modified protocols, illustrating the importance of well-timed and executed interventions.

Another strength of the RAES approach was its flexibility. While the authors of this paper witnessed the organization change the timeline and structure of its projected program substantially due to events outside of its control, RAES used these moments as opportunities to learn. The changes allowed RAES to pay more attention to the pilot phases of the project, and to make the program as a whole more effective. For example, when teachers told RAES they needed more technological training to be effective club mentors during the school year, RAES was able to incorporate additional trainings into the program.

In resource-scarce environments such as Senegal, it can be difficult to convince others of the utility and importance of incorporating high-tech components to health communication interventions. Proposals are often met with questions about the availability of materials and sustainability of the project; answering these questions with a simple "yes" or "no" ignores the complexity of the public health and development mission. While RAES was able to provide all program-essential digital equipment to the three participating high schools through OSIWA funding, this type of equipment is not readily available in Dakar.

The youth-targeted digital media strategy, however, is an innovative approach to encourage peer leadership among high school students and give youth the opportunity to participate more fully in the digital age. High school clubs created by motivated and involved students can serve as a platform to reinforce positive behavior change and awareness surrounding HIV/AIDS. As of March 2009, more than 100 students have joined each of the three clubs for a one-dollar membership fee that will help foster ownership, fund club projects, and engender sustainability. ASPROCIDE monitors the quality and accuracy of the content produced by youth, and RAES consultants travel to each high school to meet with each club once a month. In addition to the work they do at school, participating students come to RAES on weekends to use digital equipment for their projects.

As digital technologies become more accessible to communities in sub-Saharan Africa, their targeted and appropriate use can help create a participatory environment for communities in general, and specifically youth, to communicate HIV/AIDS issues. In resource-scarce environments such as Senegal and much of Africa, digital - especially wireless - technologies are more practical and sustainable than land based technology because they bypass costly and often limited infrastructure requirements. ¹⁰ This can be evidenced by the success of the movement to include mobile phones into health promotion programs. ¹¹

The greatest strength of the RAES approach is found in the nature of the intervention; digital content created for and by youth through innovative media produces a competent, tailored and attractive message. As improved technologies, particularly digital technologies, become more available throughout the continent of Africa, it is imperative that youth and young adults be trained in the appropriate use of such innovations.

RAES, along with ASPROCIDE and SIDA SERVICE, can help usher in a new and effective health communications method that will serve the people of Senegal. Bridging the digital divide between West Africa and the developed world is just as important as preventing the transmission of HIV/AIDS, as it paves the way for self-sufficient development in fields and skill sets that are traditionally associated with more economically developed regions. Programs of this nature build on existing technological infrastructure to develop local capacity, thus increasing use and knowledge of these technologies and closing the digital divide. In Dakar, according to data collected during the formative research phase, 87 percent (n=2089) of students know how to use a computer and 96 percent indicated that they have access to a computer. These data indicate that technology is accessible and familiar to the new generation of urban Senegalese. Allowing for content adjustment to accommodate local health and education needs, this intervention is appropriate to be scaled up to the urban African community with similar technological infrastructure.

Acknowledgements

The authors would like to acknowledge the support and guidance of the following parties:

Mr. Alexandre Rideau, M.A. in Communications, Director General of The Réseau Africain de l'Éducation pour la Santé;

Deborah Gilk, Sc.D., Professor, Department of Community Health Sciences, School of Public Health, University of California, Los Angeles;

Michael Prelip, D.P.A., M.P.H., C.H.E.S., Adjunct Associate Professor and Field Program Supervisor, Department of Community Health Sciences, School of Public Health, University of California, Los Angeles;

All the members of the Senegal Task Force Team at the UCLA School of Public Health

The excellent staff of The Réseau Africain de l'Éducation pour la Santé; and

The students of Collége Sacré-Cceur, Lycée Parcelles Assainies, and Lycée Blaise Diagne in Dakar, Senegal.

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Author Information

Philip Massey is a second-year graduate student at the University of California, Los Angeles School of Public Health, Department of Community Health Sciences.

Bozena M. Morawski is a second-year graduate student at the University of California, Los Angeles School of Public Health, Department of Epidemiology.

Alexandre Rideau, MA in Communications, Director General of The Réseau Africain de l'Éducation pour la Santé, Dakar, Senegal.

Deborah Glik, ScD, Professor, Department of Community Health Sciences, School of Public Health, University of California, Los Angeles.

Appendix

Appendix A. Logic Model: OSIWA Program: Creating a scholastic, Internet-based community dedicated to health information, education, and dissemination, created by and for Senegalese youth

*Goal: To improve the response to HIV/AIDS in secondary schools in Dakar, Senegal, specifically concerning stigmatization, discrimination and human rights.