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Anyone worried about HIV or AIDS in South Africa can now chat directly with a trained counselor using a mobile phone. The service not only uses a form of communication already popular with young people, it is affordable and very private.

By Paromita Pain

South Africa is in the midst of an HIV/AIDS epidemic; the rate of infection is among the highest in the world. Young South Africans have been hit particularly hard by the epidemic, young women especially. Some estimates indicate that as many as one out of three women under age 25 are living with HIV. To offer these youth and young adults support and information about living with HIV, a mobile phone-based counseling service was launched last year called RedChatZone.

There are certain advantages to offering a counseling service via mobile phone. While the South African government operates a national HIV-counseling hotline, the National AIDS Helpline, the expense of calling it from a mobile phone can add up. Users must then resort to public phones which seldom offer much privacy. The rate of mobile phone penetration, compared to landlines, is quite high in South Africa: There are approximately 36 million active cell phone users, and around 80 percent of all youth and adults have a cell phone.

RedChatZone was started by Cell-Life, an organization that uses mobile phone technology to strengthen the response to people living with HIV/AIDS, in partnership with the government’s national hotline. What’s distinctive about RedChatZone is that it provides users with text-based HIV counseling via mobile phone. It relies on a medium of communication – text chatting – with which many young South Africans are already very comfortable.

Not SMS

The service isn’t provided via SMS. As explained by a Cell-Life researcher, SMS text-messaging poses too many obstacles to be a reliable means of communication for the service.

“Each SMS is only 160 characters,” says Katherine de Tolly, a researcher at Cell-Life in Cape Town, South Africa. “SMS counseling would be tough: It’s difficult to maintain a conversation thread, and it would be hard for the counselors to help multiple people at the same time. SMS is also very expensive.”

Clients access RedChatZone via MXit, an application that allows people to send each other messages with a data connection, which is much cheaper than SMS. There are currently 18 million users of MXit in South Africa.

“MXit is an incredibly popular instant message text-chat application in South Africa, and it made sense to see if HIV counseling could be provided through this,” says de Tolly. “MXit is like BBM, the Blackberry chat application, or gtalk on a computer. Users can add contacts and text chat with each other at a very low cost.”

RedChatZone has its predecessors in applications developed by software developer RLabs to address the problem of drug addiction in the Western Cape. Toward the end of 2008, in partnership with MXit, a new service called Angel was launched to provide 24-hour access to counseling and information on drug addiction. Marlon Parker, the RLabs founder, was asked by Cell-Life to apply the same thinking to the HIV problem in South Africa.

An Adjustment for Counselors

The chat service is different from phone-based services where each counselor deals with one person at a time. The staff for RedChatZone required training to get used to the browser-based system that allows them to counsel multiple people at the same time. Eight counselors and two supervisors work from LifeLine's offices in Johannesburg. LifeLine is an established nonprofit organization that provides crisis counseling.

“The shift for the counselors, from phone-based to text-based counseling, was remarkably easy,” says de Tolly. “Despite the fact that they now counsel multiple people at the same time, many of them find providing counseling this way less stressful.”

A typical conversation between counselor and client flows like this:

3:26 PM Client: I was diagnsd hiv+ on the 1st of lst mnth they tld me 2 go bk on the 28th of dat same mnth 4 my cd4count..nd i dd go bt i jst culdn nock on that door i gues i gt cold feet,so i went away..

3:27 PM Counselor: Why? tell me sum more

3:31 PM Client: i havnt tld any1 yet nt even my bf the guy who was suppose 2 luv nd take of me wel i gues that was a lie..sumtymz i fil lyk if i go 2 the doctor every1 wil knw my status ppl wil c me going in that room and sumhow that room scares me

3:36 PM Counselor: Look don't stress abt tellin people now bcos u need 2 deal with it first then disclose whn ready. So r u usin public facilities or u go 2 a private Dr?

3:37 PM Client: Public

3:44 PM Counselor: Look u have an option of goin 2 another clinic were they dont knw u. But u have 2 tell them dat u r frm around dat area, clinic cater 4 a particular area whr de clinic is based.

What They’re Talking About

A study was recently conducted to assess how clients are using the service. The findings were that people mostly use the service for basic HIV information and help (whether or not they're HIV-positive), sexual and reproductive health information and relationship advice. Because of the text-based format, people get to the point really fast. For example: one conversation opened with 'I have genital warts'.

Clients use the service both to get information and to sort out emotional issues. Issues around pregnancy are frequently raised; how to deal with being pregnant and HIV-positive are popular topics.

HIV-positive people use the service to talk about treatment problems and disclosure issues. “The latter is a big question with various aspects to it,” says de Tolly. “Callers ask questions like, ‘Should I tell my boyfriend I have HIV?’, ‘How do I tell my parents?’, ‘How do I deal with rejection since I told them?’ among others. “

Relationships are commonly discussed. When clients don't ask about HIV, some counselors bring up HIV in relation to what the client is saying (for example if the client is talking about sleeping with their partner, the counselor might ask about condoms, or whether they have been tested).

Advantages of Chatting

The counselors believe the chat approach works better in some ways than telephone counseling. They report that they get fewer hoaxers than with telephone counseling. On the phone, they have to follow a particular protocol to get rid of a hoaxer, and it takes time. With MXit they can just ignore the person and counsel other people.

A lot more people can be counselled at the same time than on the phone, partially because of fewer hoaxes and because the technology allows them to counsel multiple people simultaneously. The conversations can be resumed at any point. If the client has to go and do something, the conversation can be carried on later.

The system also allows the counselor to see previous conversations with a client, so there is a history to draw on. This is not possible with phone counseling where clients have to start fresh, recounting their situation each time.

Another important advantage is the privacy the service affords the clients. They don’t have to worry about being overheard, and youth spend a lot of time on their mobiles; no one needs know that they are actually chatting about HIV.

Kinks and Challenges

A few kinks still need to be addressed. Sometimes there is insufficient bandwidth to operate the system. For the system to work well there has to be a stable Internet connection since the system the counselor’s use is browser-based. When the service is over-subscribed users get impatient if counselors take too long to reply.

“On World AIDS Day last year, thanks to some advertising done, there were over 1,000 people waiting. This ended up crashing the system,” says de Tolly.

The main challenge at present is the stability of their funding. The counselors are not volunteers. Right to Care, a South African nonprofit organization, provided RedChatZone with funding for a one-year pilot of the service. The funding ran out in July 2010, leaving them in limbo.

“We got pilot funding from Right to Care, but that has ended and LifeLine are kindly continuing the service until we can secure more funding,” explains de Tolly.

Related Research:

Mobile Communications in Zambia: Demand-Side Survey Analysis of Mobile Phone Access and Use

Zambia: SMS For News and Information in Zambia - Who Gets It, and Who Shares What They Get

The HIV/AIDS Challenge in Mozambique: Who is Most at Risk and How We Can Get More Information to Them

Paromita Pain has been employed with The Hindu Newspaper, Chennai, India since January 2003. She writes for young people on a range of themes, with a special interest in media for young people, health issues, human rights and youth in situations of conflict. She can be reached at paromita.pain@gmail.com.
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