Can video do more than attract lots of people to a meeting? Today, this seems to be video's main role in health education about HIV/AIDS. Realizing that a film's content may not have much impact on the community, the AIDS Committee at Bukumbi Hospital in Tanzania produced its own experimental interactive video, focusing on the sensitive issues of sexual attitudes and behaviour.

Many people in Tanzania are not accustomed to television because the Government does not broadcast its own TV programmes. However, for many years films and videos have been used by priests to reach thousands of village people. Often the films are dubbed in the local language or a commentator explains the scenes.

When health education on HIV/AIDS began in the late 1980s, some audiovisual materials were available. In those years, the Ministry of Health made a film about AIDS, showing many severely affected patients and scenes of people crying at a graveyard. This shocking film for the general public was distributed throughout the country by regional medical officers. In subsequent films, made in the early 1990s, more attention was paid to the means of HIV transmission, prevention and how patients and relatives cope with the disease. 

Programme development

In 1990, when Bukumbi Hospital established its AIDS Committee, it used the available films to educate its own personnel. The Hospital then took its health education sessions to villages and nearby institutions. Sometimes the villages would request the sessions, but mostly the AIDS Committee organized the meetings. The meetings attracted few people until a local choir joined the committee's sessions.

The choir was discovered at a wedding where it sang songs to the bridegroom, telling him not to deceive his wife because it would bring him AIDS. In the following months, the choir produced more songs on AIDS, stressing the routes of transmission and risky behaviour. For religious reasons it was not possible to sing about condoms. When the AIDS Committee had access to video, it was usually used during the second visit to a community, after the Committee had already held a health education session with the choir.

Video can serve goals besides attracting many people. It can show an AIDS patient and his or her feelings and those of the relatives. Video can also directly instruct the viewer on how to use a condom. It can show and create identification with positive roles and thereby teach social skills.

Only a little research has investigated the effects of health education and the use of video on AIDS in Africa. A pilot research project in rural Zimbabwe observed that small-scale health education leads to better knowledge and attitudes on AIDS, but no measurable changes in behaviour (such as condom use). However, American research found that a video showing local culture has more impact on the public and makes identification easier than a video showing a different culture.

Local applications

In 1994 the Bukumbi Hospital AIDS Committee concluded that the films were indeed attracting many people, but the questions afterwards were still very general and not directly related to the films' specific content. Also, the films showed people in quite different circumstances from those of the local people: the office clerk in Uganda or the modern city girl in Nairobi had little in common with the villagers living in remote areas. The Committee also realized that large groups inhibited discussion and that some of the films took so long that people were already tired before the discussion even started.

The Committee therefore made its own 30-minute video, set in an environment the villagers would recognize. Committee members and others in the community volunteered to play different roles. The video was made with a camcorder and edited directly on a VHS recorder. Sound was mixed afterwards. The film, Tufanye nini ("What shall we do?"), showed six problems in six short scenes.

The audiences were small and included homogeneous groups, such as students from institutes and schools. After every scene, a Committee member stopped the video and asked the audience questions about the problem just illustrated. As with the "starter" method with posters, where a scene presents a topic for discussion, every video scene had the same function.

Generating participation

Subjects for the six scenes included the more sensitive problems and questions that people have but are often afraid to ask. Each scene showed a person asking advice about a certain behavioural choice. For example, a woman is shown visiting a health promoter and saying, "I have a problem. I know what AIDS is and how to prevent it, but my husband sleeps around. What can I do?". At this point the video is stopped and the audience is invited to give advice.

During the first sessions, it became apparent that the facilitator's role was much more important than just handling the remote control. He or she could stimulate discussion by redirecting questions back to the audience and asking whether their suggestions were realistic. The facilitator could then lead the discussion on to motives and the background for certain behaviours, eventually bringing the generalizations about the problem to the local situation.

After the discussion, scenes of street interviews with a village chairman, a village girl, a village boy, a hospital worker, a teacher and a priest were shown. Some of their reactions were contradictory and intended to provoke discussion. Their comments also showed that the film does not pretend to have all the right answers or solutions.

Generally, the audiences responded to the questions with spontaneity and excitement because they shared the problems in their own lives. This method seems quite successful when organizing "to the point" discussions. Direct attention can be given to attitudes and behaviours with regard to sexuality; the general questions for which everyone already knows the answers can be shifted to the background.

Interactive health promotion

The role of video in health education on HIV/AIDS, with regard to message contents, is still modest. Yet video is used increasingly in health projects. It attracts many people who might have had little exposure to television and it can bring a group of people together, motivating them to pay attention to AIDS and join in discussions. By using video interactively, details of the contents become subjects for discussion. Of the different methods of health education, video in combination with group discussions seems to be the most effective. However, whether it really leads to behavioural change is still an unanswered question. More research is needed for answer.