Go Together, Know Together Couples HIV Counseling and Testing Campaign

The campaign development process began with a literature review on the current context of HIV Counselling and Testing (HCT) in Uganda; the major barriers and facilitators to uptake of HCT, and emerging issues in the HCT arena, including couples HCT, discordance, and disclosure. Literature was also reviewed on HCT campaigns implemented in other African countries, challenges, lessons learned, and major achievements. Based on the literature reviews and various meetings with HCT stakeholders, the Health Communication Partnership developed the communication strategy.

The resulting communication campaign, designed particularly for married and cohabiting couples of unknown HIV status, is being implemented in the 8 districts with AIDS Information Centre (AIC) branches, Kampala, Jinja, Mbale, Arua, Lira, Soroti, Mbarara, and Kabale. After testing, these couples then transition into one of three categories: HIV positive concordant couples, HIV negative concordant couples, and HIV discordant couples. Secondary intended audiences for the campaign include HIV counselling and testing service providers and religious and opinion leaders.

Launched with a highly publicised event that included a live concert, games, and prizes for couples, the campaign uses mass media such as outdoor and print media, radio spots, interactive radio programmes, and video testimonials to motivate couples to utilise couples HCT services. Interpersonal communication and community mobilisation approaches complement the mass media. Working through local leaders, health workers, community volunteers, people living with HIV, post-test clubs, couple clubs, and community and faith-based organisations, the campaign strategy includes community dramas, community couple dialogue sessions, health talks, and community video shows.

According to the organisers, the meaningful involvement of HCT service providers, people living with HIV/AIDS, community members, those implementing HIV prevention activities in the districts and/or communities, those engaged in treatment, care and support services, as well as those dealing in commodities and supplies are very important to the campaign’s success. Personal testimonies and examples of real couples are often used. In order to help build service provider's ability to support couple's post-testing, counsellor trainings, provider support materials, and client education materials (to help ensure quality service provision) supplement the campaign. Service delivery sites were branded with the campaign logo to help improve visibility and enhance access to services.

The organisers recognised a need for a strong and active coordinating body for the communication campaign and testing events. Communication and advocacy, service delivery, and monitoring and evaluation committees were established within the national campaign coordination committee. HCP led the communication team, AIC led the service delivery team, and MOH led the monitoring and evaluation and coordination committees. District Coordination Committees were formed in the 8 implementation districts. In May and June 2010, central-level teams conducted 2-day support supervision visits to 36 of the 105 health facilities carrying out CHCT (34%) in the 8 implementing districts. The response on campaign materials was overwhelmingly positive, with health workers consistently reporting that the materials were well designed, that they "always" used them in their work and that they found them "very useful". Challenges included the mobilisation of men for CHCT services and the understanding of discordance by clients and providers alike. The implementers plan to introduce new strategies and materials to address these challenges.

HIV/AIDS

The 2004/2005 Uganda HIV Sero Behavioural Survey revealed a high incidence of HIV among married couples. Married persons account for an estimated 65% of new HIV infections, and discordant couples comprise up to 50% of these transmissions. Despite relatively high levels of knowledge around where to get an HIV test, the job of couple HIV counselling and testing (CHCT) remains complex. Less than 13% of men and women currently married have ever tested for HIV and received the results, and only 3.3% of married women and 4.3% of married men have done so in the last 12 months. Moreover, 90% of married women and 89% of married men do not know the HIV status of any of their partners or spouses.