Project Masiluleke: Texting and Testing to Fight HIV/AIDS in South Africa

Series: Yale-Design Observer Design and Social Enterprise
Format: Raw, online case
Topics: Organizational Behavior, Marketing, Public Policy, Design, Innovation, Healthcare, Technology, Social Enterprise, Economic Development, Nonprofit
Initial date of publication: September 2011
Geographic setting of case: South Africa, United States
Access:  Available free online at http://nexus.som.yale.edu/design-project-m.

Overview: When Krista Dong and Zinhle Thabethe came to the 2006 PopTech conference in Camden, Maine, they hoped to expand their fight against HIV/AIDS, one of South Africa’s greatest problems. They were the founders of iTEACH, an HIV/AIDS and TB prevention and treatment program in KwaZulu-Natal, South Africa. Impressed by their story, conference organizers and participants vowed to help the organization.

The PopTech group developed a model for engaging the broader community at every stage in the HIV lifecycle from awareness to testing and follow-up. This model centered on a few key principles:

  • leveraging mobile technologies to dramatically increase access to information and services.
  • creating a set of services that can be overlaid on top of the healthcare system with minimal integration.
  • adopting an outside-in model from the community perspective, rather than augmenting existing healthcare services.

With this model in place, the partnership targeted two approaches. The first effort harnessed mobile phones to deliver a series of messages designed to raise awareness and connect users to information. The second approach was the development of a self-test kit with mobile support, so that individuals could determine their HIV status in the privacy of their own homes.

These efforts were outside mainstream approaches. The focus on testing was novel in itself. A “know your status” campaign was neither a direct deterrent to new infections nor a treatment for individuals already infected. Indeed, success of the campaign could potentially add to the already overburdened medical facilities. The specific approaches were also out of the box. With the first effort, no one knew whether a text message on a mobile phone would reach the right individuals or influence behavior in a way that would help with the problem.

The second effort was an even larger leap. No agency or government had approved self-testing for HIV/AIDS. It was not clear that untrained individuals, particularly those with low literacy, could perform tests well enough to get accurate results. Furthermore, even if the results were accurate, it was not certain that receiving a life-threatening diagnosis over a cellphone rather than in the presence of a professional counselor would lead to appropriate understanding and follow-up behavior.

The traditional Zulu greeting, "Sawubona," literally translates as "I see you." The major challenge faced by Project Masiluleke could be captured in this local greeting—could Project M see the lives of the individuals they hoped to help? Could they find ways to understand each other and the individuals threatened by this disease well enough to design effective solutions to a major health crisis?