HIV/AIDS Information on East African Websites: A Comparative Analysis

Abstract

According to the UNAIDS Global Report of 2010, Sub-Saharan Africa has about 22.5 million people living with HIV/AIDS. In a textual analysis of government-sponsored and private websites originating in East Africa, we analyze how the Internet and social media tools are used to disseminate information about HIV/AIDS and promote social change among targeted audiences. Our analysis found that content available on selected government and private websites, with minor exceptions, is generally not updated frequently nor systematically targeted specifically to those who can benefit most from the information. The government-initiated websites were populated with information that highlighted national strategic plans and focused on evaluation reports, while the private organizations provided information that in some instances was customized for specific audiences, but overall encouraged grassroots collaborations.

Keywords

HIV AIDS Africa East Africa Internet

Introduction

The spread of the HIV/AIDS epidemic globally continues to pose specific challenges for Sub-Saharan African countries. According to the UNAIDS Global Report of 2010, Sub-Saharan Africa has about 22.5 million people living with HIV/AIDS. Studies have shown that there are unique factors in individual African countries that influence the prevalence and spread of HIV/AIDS. For instance, paid sex is a significant factor in Kenya and Uganda, while injected drug abuse is the main mode of HIV transmission in Tanzania. The UNAIDS Report (2010) also concludes that HIV prevention knowledge varies, with Kenyans having the greatest level of understanding, followed by residents of Tanzania. The differences in knowledge and understanding highlight the need for improved and continuous message development and selection of methods for the dissemination of these messages that will be accepted by media practitioners, health care professionals, the general population, caregivers, as well as for people living with HIV/AIDS.

From the earliest reports of HIV until today, messages for the world’s population have changed primarily due to increased documented knowledge about the transmission of the disease and breakthroughs in alternative treatment. Yet populations’ attention to understanding preventative measures remains a major need, as current messages have not precipitated behavior and social change to the degree the epidemic requires. In Sub-Saharan African countries, there are certainly multiple contributing factors that are limiting the reach of information about HIV/AIDS, particularly to rural areas. Epidemiological and sociocultural variables appear to have a greater impact on the epidemic than do socioeconomic factors (Temah, 2009), and how these variables impact prevalence is yet another area that requires distinct investigation in terms of messages and behavior change. Another complicating factor is that individual countries tend to develop e-health policies that are narrow and only meet their needs and thus do not take full advantage of global policy initiatives and experience (Mars and Scott, 2010).

Messages must also assist in overcoming what is perhaps a leading impediment to marked prevention behavior change, and that is the social stigma associated with HIV/AIDS, which is apparent to those living with HIV/AIDS and reinforced by the lack of tolerance for sufferers demonstrated by the general population. Self-stigmatization is of particular concern, as individuals who are hiding their diagnosis may in fact be contributing to the spread of the disease (Allen et al., 2003; Mahajan et al., 2008; Sengupta et al., 2011). To a degree, those hiding their status are also an indication of whether current messages are understood or even if they are being received at all. Addressing cultural norms in terms of increased couples testing and counseling may also have a positive impact on reducing stigmatization and increasing positive prevention behavior (Grabbe and Bunnell, 2010).

Studies on Internet browsing behavior in Africa have shown that those able to access health information online find the information useful, and these individuals tend to display high levels of its application in their lives. Availability of health information on the Internet has the effect of empowering both producers of the content and consumers. Anonymity offered by the Internet provides both privacy and convenience to consume crucial health information and request assistance independent of time or space. However, for those limited by the lack of technology infrastructures and resources needed to access the Internet, information on the websites can serve to increase the existing social divisions, with the odds stacked against those without adequate resources (Korp, 2006).

In this paper, we explore how the Internet and websites are used to communicate information about HIV by analyzing information presented by government-sponsored and private websites in East Africa. Of particular interest are the types of content provided by the selected websites and the incorporation of interactive online features, which may combine to shape how the perceived target audience accesses and interacts with health information. The six websites selected for analysis include three official government-sponsored web resources established to provide information about the epidemic crisis. The other three websites selected for analysis are owned by non-governmental organizations (NGOs) founded by grassroots advocate groups and various experts (health and media) to provide support and resources in order to increase capacity building in their respective countries and bring about social change. Due to the high-ranking positions of these selected websites on search engines, and supporting funding from many international government and private organizations, these organizations have the potential to reach a wide audience.

This paper, which is divided into five sections, begins with a review of current challenges facing the three Sub-Saharan countries in East Africa and measures taken to address the epidemic. In the second section, we draw on existing scholarship on web content analyses to examine how the six websites presented information about HIV/AIDS, and any interaction with their target audiences, and present our research questions. The methodology used to guide our analysis is presented in the third section. Next, we present the results of our analysis and describe major themes observed across all six websites. We conclude the paper with a summary of our findings and recommendations for future studies.

Review of HIV/AIDS Epidemic in East Africa

Sub-Saharan Africa remains the region most heavily affected by HIV/AIDS in the world. It is estimated that 68% of all people living with HIV infections reside in these countries, and this group represents 12% of the global population (UNAIDS, 2011). Specific estimates using 2009 data published in 2010 indicate that the number of people living with HIV in Kenya totals 1.5 million, Tanzania 1.4 million and Uganda 1.2 million. The United Nations’ goals for these countries remains getting to zero new HIV infections, zero discrimination towards those living with HIV, and zero AIDS-related deaths, that require innovative African solutions that respond to the needs of the African people (UNAIDS Issues Brief, 2012). Further, an examination of the United Nations’ goals that have been set to achieve by 2015 reveals that over 60 percent of them speak directly to prevention and the remainder address access to treatment and gender-based violence (United Nations, 2011).

These goals are reinforced with a mandate of the importance of adapting services to client needs and bringing these services closer to communities and individuals (World Health Organization, 2011). Of particular concern is how countries currently address the HIV-specific information needs of women and children, including how antiretroviral therapy impacts the pregnancy rate of HIV-infected women (Myer et al., 2010). The prevalence of HIV/AIDS in Sub-Saharan Africa has many social influences, behavior shortcomings and associated information needs.

As suggested in a basic communications model (Schramm, 1971), the method of message development from a source must include a means of encoding the message, carefully selecting words, images and other forms of communication that will have meaning when decoded by the receiver. Recognizing that the “language” of young people is unique in any society, encoding messages keeping this language in mind will enhance the possibility of effective communications (Gakahu, 2011). The population of Sub-Saharan Africa requires that prudent attention be given to encoding messages and how these messages are communicated and interpreted by certain population segments. It is not enough to talk about negative outcomes and directive actions, but in addition, messages must provide the motivation to responsibly alter long-standing detrimental behaviors.

Message processing is also impacted by the intensity of the processing (elaboration) undertaken by those receiving the message and the repetition of the message (Cacioppo and Petty, 1989). Repositories of HIV/AIDS statistics, whether government, private, or other NGOs, become message source references that are endlessly reported by the media. The question requiring further investigation is whether the target audience for behavior change is listening (elaborating), and do these statistical messages indeed persuade those to undertake changes in their personal behavior, or are properly encoded messages the outstanding need, regardless of the channel of delivery?

Health Information and the Internet

The introduction of the Internet in Africa in the early 1990s resulted in many utopian claims about the web’s ability to transform societies and bring about social change. Fürsich and Robins (2002) argue that technological developments in African countries are “marked by familiar historical and political-economic patterns that have situated the continent’s people among the world’s most poor and disfranchised” (p. 193). Furthermore, it is usually a select group of stakeholders who play an important role in guiding the expansion of the telecommunication industry, thus favoring a private for-profit model. For instance, in their analysis of web pages focusing on African nations, Fürsich and Robins (2002) found four types of websites dominating the cyberspace in 2001: sites owned by tourism industries, NGOs, diaspora communities and those promoting international investments. Furthermore, many of these sites originated from and were controlled by Western-based institutions. In a follow-up study examining tourism websites in Africa, Fürsich and Robins (2004) found that while many of the websites were more professionally presented and were easier to locate, many of the sites were not functioning owing to outdated or broken links, and content was not updated frequently.

Today, most African governments and official stakeholders maintain a web presence; however, current status of content and services available on e-government sites has not been extensively documented (Rorissa and Demissie, 2010). In their comprehensive analysis of 582 e-government service websites, Rorissa and Demissie (2010) found that while there are many federal/national government and departmental websites, local government departments maintain a minimal web presence. Most of the websites were found to provide the most basic services in the form of access to documents and report downloading, and the focus was on establishing web presence and publishing content online, rather than providing interactive services for the public (Kaaya, 2004). Further, because of widespread lack of Internet access, information for the public does not appear to be a priority in developing countries (Cash, 2002).

This paper attempts to contribute to existing literature on use of websites for health information in Africa by analyzing how websites are constructed, maintained and used for influencing social change in East Africa, as even the limited information found on government website can be useful for those seeking health information online. Smith et al. (2007), in their study of medical students in West and East African countries, found that respondents relied on the Internet to access medical knowledge.

The elaboration likelihood model of persuasion advocates that persuasion can occur even when the individual is not actively engaged in processing information, and that the degree of the outcomes are different with each situation (Petty and Cacioppo, 1986). The differences in message processing characteristics provide a basis for examining message content against “matching” of the message to a recipient characteristic. The HIV/AIDS message(s) and persuasive outcomes are thus related to favorable or unfavorable thoughts associated with the messages, and potentially the manner in which the message is delivered. For the individual who has unfavorable thoughts and seeks further information and clarification about prevention, for example, the persuasive outcome may ultimately turn positive. Although information about HIV/AIDS, its transmission and the significant pharmacological treatments that have been developed and made widely available has improved, the target audiences for preventative measures remain the same. Young adults, pregnant women, people who inject drugs, men who have sex with men, migrant workers, displaced and migrant workers, and those engaged in sex as a profession still need access to accurate information. It is also important to note that across cultures there are common themes followed by those living with HIV/AIDS, including finding information, making social connections, advocating and escaping (Reeves, 2001). However, the question remains: how can these needs be most efficiently met?

One of the major barriers limiting behavioral and social change in many developing countries is access to current information in a timely manner, increasing the urban–rural divide. Health workers, who represent primary agents responsible for addressing community needs and affecting social change, are unable to take advantage of information available via computers (online or in electronic format) due to lack of infrastructure (Pakenham-Walsh and Bukachi, 2009). In order to examine the current status of information presented on HIV/AIDS-related websites and explore the utility of available content, we used the following questions to guide our analysis:

R1: What types of information are presented?

R2: What observable goals are apparent from website content?

R3: Do the websites incorporate social media and other forms of communication as feedback mechanisms between the websites and the perceived target audiences?

Methodology

Populations in developing countries in East Africa provide an excellent opportunity for analysis of web content, because they are usually late adopters of technology, due to lack of infrastructure, literacy and economic development (Rorissa and Demissie, 2010), and therefore site design and content is not updated frequently. We focused our analysis on three East African countries which are not only neighbors geographically, but also share similar challenges in providing accurate and timely information about HIV/AIDS to their respective citizens. In order to establish a baseline understanding of existing Internet sites originating in Sub-Saharan African countries and their effectiveness in communicating HIV/AIDS information to several critical publics, we employed a qualitative content analysis method to analyze and compare content published on the official government and major NGOs’ websites dedicated to information about HIV/AIDS.

Drawing from previous studies of web content in Africa (Kaaya, 2004; Rorissa and Demissie, 2010; Smith et al., 2007), we first conducted a preliminary open-ended coding to identify major themes across our selected sample, which was then used to design categories for systematic coding. The analysis was conducted in October 2011, over a 30-day time period in order to take into account any changes that may have occurred during that time that in any way may have markedly affected the results. The government websites assessed included the Tanzania Commission for AIDS (TACAIDS), the National AIDS Control Council (NACC) in Kenya, and the Uganda AIDS Commission (UAC). The private websites were Chezasalama (Tanzania), the Kenya AIDS Watch Institute (KAWI), and The AIDS Support Organization (TASO) in Uganda.

For the purpose of our study, individual websites were the units of analysis. To provide consistency in the analysis of both the private and government websites in each country, data coding included gathering information about intended audience, relative timeliness of overall information provided, services and programs audiences, HIV/AIDS-specific information, resources offered, visitor feedback mechanism(s) via the website and categorization of content by country. Each of the aforementioned categories was tabulated in a spreadsheet where information from each of the websites was documented. We began the analysis by reading information in each of the categories multiple times in order to identify the salient themes across our data. Detailed notes were taken during each reading of the data.

Results

In the following sections we describe the main components and strategies used by six websites, both government and private, to communicate information about HIV/AIDS. We explore three main elements which play an important role in defining the utility of a website: content value, interactive features and appropriate target audiences.

Description of Website Content

Among the six websites, there was a distinct difference between content published by government versus private organizations. While all the websites analyzed provided information about the prevalence of HIV/AIDS in their respective countries, the rest of the content varied significantly in scope, timeliness and relevance. The three government-owned websites were populated with information that highlighted national strategic plans and focused on evaluation reports, while the private organizations provided information relevant to their target audiences.

Overall, the government websites reflected a top-down approach, where the goal is not to inform and interact with audiences; rather, the focus is on providing directives and goals for others to implement. For instance, the NACC site in Kenya focused on policy and a strategic framework for mobilizing resources for prevention of HIV transmission and provision of care and support to the infected and affected in Kenya. Together with the information being dated, the content was designed to provide top-down directives on how various regional and local agencies should address the epidemic. Likewise, while the Ugandan UAC website mirrors the strategic focus visible on the Kenyan NACC site, there are some notable differences. For one, the content was up to date and separated by links to specific programs that provide purpose, history, progress and reports on ongoing campaigns, including: The Young Empowered and Healthy Campaign (YEAH) Campaign (partnership between stakeholders, youth and the media); National Strategic Plan; universal access to HIV/AIDS services; and Uganda Think Tank on AIDS (UTTA). Similarly, the TACAIDS website reflects a top-down approach, reflecting patterns visible in the other two government websites, by providing a combination of information the Tanzanian government’s efforts to respond to HIV/AIDS and guidelines for implementation of national strategic plans.

In contrast to the government websites’ top-down approach to content publication, information on the private websites was tailored to specific audiences, encouraging grassroots collaborations. While the quality and organization of web content could benefit from professional editing, the Kenyan KAWI website focused on information that might be relevant to medical practitioners. Though ample space was devoted to laying out the organization’s strategic plans and expertise of its members, probably with the goal of appeasing and attracting funding sources, there was also useful information about antiretroviral drugs and instructions on how to access a hotline for questions about HIV/AIDS. In the case of TASO in Uganda, an indigenous organization founded by members who were personally affected by HIV/AIDS epidemic, the website focuses on educational information, including lists of counseling and medical centers and opportunities for attending advocacy and networking opportunities.

Likewise, Chezasalama, which is a collaborative effort funded and supported by three NGOs working in Tanzania to promote open talk and healthy lifestyles (Deutsche Gesellschaft für Internationale Zusammenarbeit, Restless Development and Femina HIP, a multimedia, civil society initiative), has content tailored specially for the youth, starting from basic questions about safe sex to tips to avoid sexually transmitted diseases. In fact, Chezasalama could be used a standard model to present information to a young demographic who are increasingly becoming known as digital native, and who prefer to seek out information from multiple sources, instead of waiting for information to be delivered to them.

Interactive Features

One of the major advantages of websites today is the ability to cross-promote information across multiple platforms to not only reach a wider audience, but also receive instant feedback that can contribute to improved health messages. The websites in our sample represent two distinctive categories: one which still relies on traditional forms of feedback option—telephone, email or letters—and another that recognizes the potential of social media to reach a wider audience, especially with Facebook, Twitter, blogs, YouTube and even live feeds via short message service (SMS) (See Tables 1 and 2 for breakdowns). We found that even though government-owned websites in Kenya and Uganda have embedded links to their Facebook and Twitter pages, there is little social media activity from the audiences. This may partially be due to the content not being updated regularly, and also because the posts and tweets tend to focus on academic or strategic information.

Table 1.

Comparison of Content on Government Websites.

GOV’T WEBSITES	AUDIENCE	INFORMATION	SERVICES & PROGRAMS	HIV/AIDS INFORMATION	RESOURCES	FEEDBACK OPTIONS	TYPE OF CONTENT
TANZANIA (TACAIDS)	General	Current	General	Current	Strategic focus	Email; phone	Strategic plan
KENYA (NACC)	General	Dated	General	Current	Strategic focus	Email; phone; Facebook Twitter	Strategic plan; evaluation reports
UGANDA (UAC)	General	Current	General	Current	Strategic focus	Email; phone; Facebook; Twitter	Strategic plan; forum; reports

Table 2.

Comparison of Content on Private Organizations’ Websites.

PRIVATE WEBSITES	AUDIENCE	INFORMATION	SERVICES & PROGRAMS	HIV/AIDS INFORMATION	RESOURCES	FEEDBACK OPTIONS	TYPE OF CONTENT
TANZANIA	Targeted: youth	Current	Targeted	Current	Forum; talk shows; advice columns; SMS Q & A	Email; phone; Facebook; Twitter; SMS; blog	Social
KENYA	General; medical professionals	Dated	Targeted	Dated	Hotline	Email; phone	Medical
UGANDA	Living with HIV/AIDS; Community workers	Current	Targeted	Current	Training sessions; hospice care	Email; phone	Academic

In the case of private websites, only the Tanzanian-based Chezasalama seems to have mastered the power of cross-communication across multiple platforms. Webmasters for this website seem to invest extensive resources and hours to produce a diverse range of content, suitable for each medium. For YouTube, there are relevant videos/skits educating audiences about HIV/AIDS. On Facebook, there are humorous posts and cartoons (replicated in some cases from content available on the website) posted to engage audiences in a dialogue about the dangers associated with risky sexual behavior. The blog posts written by youth leaders from various Tanzanian communities focus on issues relevant to youth and provide an option for reader comments. Furthermore, audiences have the option of using SMS to ask the webmaster questions about the health information posted on the website, or anything else related to sex, health and safe lifestyle which are then streamed on the website for other readers to vote on, or respond to, in the comments sections or via SMS.

Website Audiences and Goals

Non-commercial websites usually have two main purposes—one to publicize activities of the owner and raise funds, and two, provide specific services to target audiences. In the context of health communication, language and relevance of the content to the target audience plays an important role in defining and establishing the website’s role as an important and credible source of information. In our analysis, we found that all websites used English language to communicate information about HIV/AIDS to their perceived target audiences, with the exception of Chezasalama website which offered dual language options—English and Swahili. Although English is the language of commerce in many Sub-Saharan countries, it is mostly spoken in urban areas where there is access to health information from multiple sources. Furthermore, we found that the content of government websites was targeted to a general audience, providing information about the organization’s structure, with a possible goal of attracting donors and the media’s attention, and limiting its appeal and utility for the general public looking for resources at the communal level (see Figure 1 below).

Figure 1.

Perceived Target Audience: Audience Orientation of HIV/AIDS Websites in Sub-Saharan Africa.

Even though government websites in general are intended to be primary sources for important information, when the content focuses predominately on strategic goals and reports its value and relevance to the public is decreased substantially. Fortunately for those people with access to the Internet in East Africa, they have the option of visiting private websites for information about HIV/AIDS and available resources. For instance, media organizations, health professionals or even people living with HIV/AIDS visiting the Kenyan website owned by KAWI would find information relevant to their interest or need.

Similarly, in the case of Ugandans, especially media and health workers interested in training and research would find adequate information to answer their questions. The case of Chezasalama in Tanzania is unique, because even though the information is relevant to many demographics, including health professionals and the media, the health information is structured as a mix of education and entertainment appealing to a younger demographic, especially school-age children, and the website layout is designed towards Tanzanian youth who are immersed in social media and comfortable with mobile communication. In other words, private websites have been designed to create awareness about HIV/AIDS, provide information about available resources for the targeted audiences and solicit feedback and questions about community needs.

Discussion

The goal of our study was to conduct a comparative analysis of government and private websites in order to examine the relevance and importance of the information presented and differences in how website owners and their respective target audiences interacted. Our analysis showed that there are distinct differences between government and private websites in each country, with the perceived target audiences being the ultimate judges of the appropriateness of content. Government websites focus on strategic plans and program evaluation reports, whereas the private websites provide more diverse content including social, medical and academic information. However, for a patient living with HIV/AIDS, content is generally lacking that could contribute favorably to education and improved treatment outcomes. Furthermore, even in cases where social media platforms such as Facebook and Twitter are linked to websites, minimal sustained activity has occurred, illustrating that interaction between content producers and consumers is limited. Furthermore, most of the websites were found to provide the most basic services in the form of access to documents and downloading services, and the focus was on establishing web presence and publishing content online, rather than providing interactive services for the public. Our findings confirm observations made by Rorissa and Demissie (2010), who had found in their analysis that most government organizations maintain a minimal web presence, limited to information about policy goals.

While there are encouraging signs that government and private stakeholders concerned with global health issues have adopted information and communication technology to provide alternative forms of access to information, in this case computers and the Internet, our analysis found that content available on these websites is generally not targeted specifically to those who can benefit most from the information. The exception is www.chezasalama.com in Tanzania, which is partially sponsored by a media organization. Our findings highlight the need for developing targeted messages across age groups and the innovative use of communication technologies to disseminate these messages while encouraging interaction with media practitioners, healthcare professionals, people living with HIV/AIDS and their support groups.

What requires further diligence is whether additional investment and development of Internet-based information meeting audience needs in Sub-Saharan Africa, particularly when widespread access to the Internet is limited, can be justified in the near term (O’Grady, 2006). Consideration of audience needs and behaviors must take precedence. Disseminating information to the varied audiences is difficult, but improved understanding through communications recognizes that prevention is the key to the future in confronting the epidemic. How information is communicated and the desired targeted response by specific audiences will be driven by the messages, and assuming that knowledge sharing will produce desired outcomes may be too simplistic in its orientation. Knowledge can be augmented if it is shared, but information sharing may also be detrimental to knowledge if inadequate representations of knowledge are transferred between people (Hendricks, 1999).

Whatever communication methods are in use today, the messages themselves may be barriers that must be overcome in order to facilitate social change in communities struggling to address the HIV/AIDS epidemic. For example, reaching the younger population through school-based education has been shown to have minimal effect on sexual behavior in these countries (Bennell et al, 2002). There is also some controversy about providing young adolescents with HIV and pregnancy information, which has led to considerable policy and political debates (Bhana, 2006). The need to carry out more research to better understand how to best utilize the potential of contemporary information and communication technologies (ICT) solutions for targeting teenagers in developing countries is evident (Bada and Suhonen, 2011)

The method by which prevention information is delivered requires greater emphasis as well as greater usage of the infrastructure available in individual countries (Institute of Medicine, 2010; Tiruneh, 2009). One question that must be considered about the affected HIV/AIDS populations is whether preventative messages have become stale (lack of attention), meaning repetition of messages is not providing the intended influential outcome. When government websites are not updated frequently or campaigns are limited to a few target groups, the information starts to lose its relevance. When an issue takes on a degree of attention it cycles to a point of reduced interest (Downs, 1972), and it has been shown how maintenance of interest presents a challenge in healthcare in particular. This concept was demonstrated clearly in recent years in the USA when the potential of a swine flu pandemic reported repeatedly in the media was reduced to something far less by the public indicating that it was hearing too much about the illness (Pew Research Center, 2009). Messages must shift from simply raising awareness about HIV/AIDS to attempting to impact safer sexual behaviors (Peltzer et al., 2012). While websites are clearly the most effective medium for dynamic message transmission, whereby information can be uploaded and revised frequently, the websites included in our analysis were unable to utilize the potential of the Internet effectively.

Although information dissemination in the digital age has far-reaching potential when interactive media are used to facilitate understanding and garner receiver feedback, based on our analysis we argue that this technology has not been harnessed effectively to enhance dissemination of health information in African countries and promote social change. Understanding communication processes among young people, in particular, is crucial in order to design and implement preventative strategies (Gakahu, 2011). Future studies need to examine how social media can be used more effectively to engage with specific target audiences. The information needs of healthcare professionals is one area that needs further examination to take full advantage of communication technologies (Ajuwon, 2008). A global comparative analysis of the websites should be conducted to see if other countries have mastered the art of using the Internet for health information transmission effectively. Furthermore, the widespread use of cellular technology by consumers in East Africa raises the distinct opportunity for delivery of meaningful and actionable public health messages to large portions of the population via text messages.

Footnotes

Funding

This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

Author biographies

Ammina Kothari is an Assistant Professor in the School of Communication at Rochester Institute of Technology. Her research focuses on issues related to health, gender, technology and religion that are situated within the contexts of global communication, journalism and media studies. She has presented work at national and international conferences and her work has been published in peer-reviewed journals.

Dennis Elliott is an independent researcher and a retired lecturer from Indiana University. His research interests originate from a professional career focused on medicine, new drug development and continuing medical education programs for physicians in areas of central nervous system disorders, cardiovascular medicine, cancer and auto-immune deficiencies. The HIV/AIDS epidemic is his current focus and specifically the potential for incorporating communications technology to positively impact prevention and treatment.

References

(http://www.nacc.or.ke) National AIDS Control Council

(http://www.aidsuganda.org) Uganda AIDS Commission

(http://www.tacaids.go.tz) Tanzania Commission For AIDS

(www.kenyaaidsinstitute.org) Kenya AIDS Institute

(http://www.tasouganda.org/) The AIDS Support Organization

(www.chezasalama.com) Cheza Salama

Ajuwon Gand Rhine

(2008) The level of internet access and ICT training for health information professionals in sub-Saharan Africa. Health Information and Libraries Journal 25(17): 175–185.

Allen

Meinzen-Derr

Kautzman

. (2003) Sexual behavior of HIV discordant couples after HIV counseling and testing. AIDS 17: 733–740.

Bada

Suhonen

(2011) Survey on ICT for HIV/AIDS preventive education: Are the teenagers forgotten in developing countries? Journal of Emerging Trends in Computing and Information Sciences 2(6): 263–275.

10.

Bennell

Hyde

Swanson

(2002) The Impact of the HIV/AIDS Epidemic on the Education Sector in Sub-Saharan Africa: A Synthesis of the Findings and Recommendations of Three Country Studies. Brighton, UK: Centre for International Education, University of Sussex Institute of Education.

11.

Bhana

(2006) The (im)possibility of child sexual rights in South Africa. IDS Bulletin 37: 64–68.

12.

Cacioppo

Petty

(1989) Effects of message repetition on argument processing, recall and persuasion. Basic and Applied Social Psychology 10: 3–12.

13.

Cash

(2002) HIV/AIDS information on government health websites in developing countries. Doctoral dissertation, University of North Carolina at Chapel Hill, USA.

14.

Downs

(1972) Up and down with ecology. The Public Interest 29: 38–50.

15.

Fürsich

Robins

(2002) Africa.com: The self-representation of sub-Saharan nations on the World Wide Web. Critical Studies in Media Communications 19(2): 190–211.

16.

Fürsich

Robins

(2004) Visiting Africa: Constructions of nation and identity on travel websites. Journal of Asian and African Studies 39(1–2): 133–152.

17.

Gakahu

(2011) Communicating HIV & AIDS among students in Kenya’s institutions of higher learning: A challenge for the 21^st century. Journal of Economics and Sustainable Development 2: 171–175.

18.

Grabbe

Bunnell

(2010) Reframing HIV prevention in Sub-Saharan Africa using couple-centered approaches. JAMA 304: 346–347.

19.

Hendricks

(1999) Why share knowledge? The influence of ICT on the motivation of knowledge sharing. Knowledge and Process Management 6: 91–100.

20.

Institute of Medicine (2010) Preparing for the future of HIV/AIDS in Africa: A shared responsibility [Monograph]. Washington, DC: The National Academies Press. Available at: http://www.nap.edu/catalog/12991.html.

21.

Kaaya

(2004) Implementing e-government services in East Africa: Assessing status through content analysis of government websites. Electronic Journal of e-Government 2(1): 39–54.

22.

Korp

(2006) Health on the Internet: Implications for health promotion. Health Education Research 21(1): 78–86.

23.

Mahajan

Sayles

Patel

. (2008) Stigma in the HIV/AIDS epidemic: A review of the literature and recommendations for the way forward. AIDS 22(Suppl 2): S67–S79.

24.

Mars

Scott

(2010) Global e-health policy: A work in progress. Health Affairs 29(2): 237–243.

25.

Myer

Carter

Katyal

. (2010) Impact of antiretroviral therapy on incidence of pregnancy among HIV-infected women in Sub-Saharan Africa: A cohort study. PLoS Med 7: e1000229.

26.

O’Grady

(2006) Consumer e-health education in HIV/AIDS: A pilot study of a web-based video workshop. BMC Medical Informatics and Decision Making 6: 10.

27.

Pakenham-Walsh

Bukachi

(2009) Information needs of health care workers in developing countries: A literature review with a focus on Africa. Human Resources for Health 7(1): 30.

28.

Peltzer

Parker

Mabso

. (2012) Impact of national HIV and AIDS communication campaigns in South Africa to reduce HIV risk behavior. Scientific World Journal 2012: 1–6.

29.

Petty

Cacioppo

(1986) Communication and persuasion: Central and peripheral routes to attitude change. New York: Springer-Verlag.

30.

Pew Research Center (2009) Health news coverage in the U.S. media. Available at: http://www.journ-alism.org/13770.

31.

Reeves

(2001) How individuals coping with HIV/AIDS use the internet. Health Education Research 16(6): 709–719.

32.

Rorissa

Demissie

(2010) An analysis of African e-Government service websites. Government Information Quarterly 27(2): 161–169.

33.

Sengupta

Banks

Jonas

. (2011) HIV interventions to reduce HIV/AIDS stigma: A systematic review. AIDS and Behavior 15: 1075–1087.

34.

Schramm

(1971) How communication works. In: Schramm

(ed) The Process and Effects of Mass Communication (2nd Ed.). Urbana, IL: The University of Illinois Press, pp. 3–26

35.

Smith

Bukirwa

Mukasa

. (2007) Access to electronic health knowledge in five countries in Africa: A descriptive study. BMC health services Research 7(1): 72.

36.

Temah

(2009) What drives HIV/AIDS epidemic in Sub-Saharan Africa? Revue d’économie du développement 23: 41–70.

37.

Tiruneh

(2009) Determinants of adult HIV/AIDS prevalence in Africa: Do cultural variations matter? Midsouth Political Science Review 10: 103–124.

38.

UNAIDS (2010) Report on the global AIDS epidemic. Available at: http://www.unaids.org/globalreport/global_report.htm.

39.

UNAIDS Issues Brief (2012) AIDS dependency crisis: Sourcing African solutions. Geneva, Switzerland. Available at: http://unaids.org/en/resources/documents/2012.

40.

United Nations (2011) World AIDS day this year is about getting to zero. Available at: http://www.un.org/en/events/aidsday/2011.

41.

World Health Organization (2011) Global HIV/AIDS response: Epidemic update and health sector progress towards universal access. Available at: http://www.who.int/hiv/pub/progress_report2011/summary.