August 8, 2019 — Each year in Zambia, 60,000 people are infected with HIV, and more than 20,000 die of AIDs. In all, it’s estimated that more than 1.2 million people in the country are living with HIV. Research shows that over 90% of Zambians have heard of HIV but less than 40% have a thorough knowledge of the virus or how to protect themselves. In this week’s episode, we’re talking to the people behind a collaborative project working to fill that knowledge by harnessing the influence of some of Zambia’s most popular musicians.
The goal is to produce songs and music videos that can reach youth across Zambia with important messages about HIV prevention. We spoke to three of the people making this possible. Katy Weinberg recently graduated with an MPH from Harvard T.H. Chan School of Public Health and works in the Global Health Program at Boston Children’s Hospital. She has partnered on the project with her colleague, David Bickham, a research scientist at the Hospital’s Center on Media and Child Health. And we were also lucky to be joined by one of the musicians collaborating with Katy and David—Ephraim “Son of Africa.”
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Watch the video for “Worth More”
NOAH LEAVITT: Coming up on a special episode of Harvard Chan: This Week in Health…
Using music to combat HIV in Zambia.
KATY WEINBERG: What we want to do is we want to inspire youth and say wake up, HIV is still here. Wake up, there’s stigma. Wake up, use a condom. Wake up, be abstinent, be faithful. And so I think that was where the idea of Ukani Manje came from.
NOAH LEAVITT: In this week’s episode, how a Harvard Chan alum is partnering with musicians to raise awareness about HIV prevention.
NOAH LEAVITT: Hello and welcome to Harvard Chan: This Week in Health. I’m Noah Leavitt.
Each year in Zambia, 60,000 people are infected with HIV, and more than 20,000 die of AIDs.
In all, it’s estimated that more than 1.2 million people in the country are living with HIV.
And while research shows that over 90% of Zambians have heard of HIV, less than 40% have a thorough knowledge of the virus or how to protect themselves.
A new collaborative project is aiming to fill that knowledge by harnessing the influence of some of Zambia’s most popular musicians.
The goal is to produce songs and music videos that can reach youth across Zambia with important messages about HIV prevention.
That song you just heard is called “Worth More”—and since its release in February 2018 the video for the song has been viewed more than 50,000 times and it has been played extensively on the radio in Zambia.
And that single song is just the first step in a larger musical campaign.
In this week’s episode, we’re speaking to three of the people who are making this possible.
Katy Weinberg recently graduated with an MPH from the Harvard Chan School and works in the Global Health Program at Boston Children’s Hospital.
She’s partnered on the project with her colleague, David Bickham, a research scientist at the Hospital’s Center on Media and Child Health.
And we were also lucky to be joined by one of the musicians collaborating with Katy and David—Ephraim “Son of Africa”—who is an immensely popular singer in Zambia.
KATY WEINBERG: I just want to tell you how big Ephraim is…
NOAH LEAVITT: That’s Katy Weinberg.
KATY WEINBERG: A British lady and myself were driving around and we got pulled over for breaking the law somehow, some traffic issue. And we were told the car might be impounded, we might be jailed for life, and we didn’t know what to do so we called Ephraim. And the lady spoke to him on the phone and said, ‘I don’t care who we’re talking to.’ And I said, ‘Ephraim, I don’t know what to do.’ And then Ephraim showed up, signed a CD and we were on our way.
NOAH LEAVITT: So Ephraim is popular—and he’s managed to corral a group of Zambia’s most popular singers for this project.
While the project only started a couple of years ago, the friendship between Ephraim and Katy dates back to 2006, when she was a Peace Corps volunteer in Zambia.
KATY WEINBERG: Well, I was going for a walk with a Peace Corps volunteer friend of mine, and we were looking for a Fanta. So we had walked probably about 10 miles looking for a Fanta and stumbled across Emphraim who was making a music video. And my–
EPHRAIM “SON OF AFRICA”: That’s right.
KATY WEINBERG: Yeah. –and my friend, who is an Asian-American Peace Corps volunteer, and I, who am a white woman, walked by Emphraim who was singing a song called “We Are All Children of God,” and we really upped the diversity level quite a bit. So he stopped the video production and stuck us in the video. And that’s how it all began.
EPHRAIM “SON OF AFRICA”: So, I looked at them, I said, perfect. You’re doing a video, and you’re trying to send out a message, and boom, God just brings people together–
KATY WEINBERG: Yeah, brings over the [INAUDIBLE].
EPHRAIM “SON OF AFRICA”: –from Asia. So it was pretty interesting. And just the humility and how they adjusted from living in America and then coming as missionaries, and how they just loved us. And for me, I think that’s what drew me closer to them, yeah.
KATY WEINBERG: Two years into my program, I called Emphraim up, and I said, would you possibly consider coming up to Mpika, Zambia, which is about, what, seven hours north of the capital city and doing a song to promote HIV awareness. Or at that time what we wanted him to do was sing his own songs, which were quite popular, to draw a crowd. And then we would talk to them about getting tested, and we opened up a community center up there.
So we stuck Emphraim on a bus, and we got him up there because I, again, was a Peace Corps volunteer with limited funds. So he came out, and that was in 2008. And he was talking about HIV then.
EPHRAIM “SON OF AFRICA”: Yeah, I think it was payback time because they were featured in my video, so–
KATY WEINBERG: Yeah. So we–
EPHRAIM “SON OF AFRICA”: –I have to sacrifice and just go and do the right cause because they were doing something that is so dear to my heart. I’ve lost uncles, I’ve lost cousins, I’ve lost friends who were HIV positive. And the moment she said that, I said, you know what, with the influence that God has given me, I needed to just positively touch life someway.
NOAH LEAVITT: At that time, prevention messaging was everywhere, but over the years Katy has seen a shift in how people think and talk about HIV.
KATY WEINBERG: And then I’ve gone back to Zambia to see my family there every year since then. And one of the things we’re seeing is we’re seeing a lot of emphasis on testing and treatment, which is great. And, for example, mother-to-child transmission has gone way, way down.
But one of the things that they’re neglecting to do is prevention. And so what you have is you have young people who are now having multiple partners. And this is all coming at the same time that cell phones are coming in, and so people are all of a sudden having access to internet, and seeing Rihanna videos, and their cultural standards and beliefs have shifted. And now people who used to– their thighs used to be private parts are now wearing shorts, or short dresses, or things like that.
EPHRAIM “SON OF AFRICA”: Yeah.
NOAH LEAVITT: It was also during these visits that Katy began to see the effects of climate change on Zambia’s agriculture and economy—leading to a rise in so-called “transactional sex”—where women have sex in exchange for certain items.
KATY WEINBERG: People can’t plant their crops in the same way that they were doing before, so you don’t have pocket cash. So one of the things that we saw, and that I saw in the village, was young girls who wanted to buy talk time for their phones and also saw more promiscuous behavior on these videos or whatever it was. And so what they were doing was they were having transactional sex which they see as different than prostitution. But essentially, they were having sex for hair extensions, or talk time, or things like that.
NOAH LEAVITT: Katy says that public awareness of HIV and AIDS had shifted. People were aware of the virus—but not necessarily the risks. She says that’s because people in Zambia are not dying of AIDS as often.
KATY WEINBERG: And what I mean by that is you don’t see people wasting away really very sick, skin and bones, dying of AIDS. What they die of is an opportunistic infection. But it’s not this dramatic wasting away in front of you, which is great on the one hand, but on the other hand, it’s an “out of sight, out of mind” scenario. And a lot of people don’t realize how much of an impact HIV can have on you because they don’t see the impact every day. So that’s one of the issues.
And then I think another one of the issues is that the World Health Organization has listed the 90-90-90 goals to be the way forward in HIV. So I think it’s by 2020 that 90% of the populations would be HIV– who would be tested for HIV, 90% of those people would be on ARVs. And then 90% of those people would be in virus submission. So they put a lot of time and money into that.
And it’s very easy to count how many people you’re putting on ARVs. You can get a number for that. You can’t get a number for how many people you’re preventing from getting HIV, and so nobody is putting money into it because you’re not performing up to a standard.
NOAH LEAVITT: The danger is that HIV could balloon out of control in Zambia. And Katy says there are already discouraging signs.
KATY WEINBERG: When I went back to the village where I was a Peace Corps volunteer, it was surprising, shocking, I don’t know, I would even use the word devastating to see young people who I’ve lived and worked with for the past 15 years who are now HIV positive. So if they’re in my village, and I’m an HIV educator, and that’s what’s happening now, I can’t imagine what it’s like in places where people aren’t even getting the message.
EPHRAIM “SON OF AFRICA”: That’s right.
KATY WEINBERG: It’s real. HIV is real in Zambia.
NOAH LEAVITT: Katy realized that it was time, in a sense, for a return to back to basics messaging about prevention. So, in 2017, with a grant funded by the band Aerosmith, she and colleagues at Boston Children’s Hospital started developing a plan to combat this transactional sex by promoting prevention. This would eventually become the song “Worth More.”
KATY WEINBERG: So I called Emphraim up, and I said, this is a pattern that’s continuing. And HIV is– the prevention message needs to get out there again. And it needs to get out there in a big way. I said, if I was able to find a small amount of funding, would you be willing to do a song that focused on HIV prevention? And then one of the other things that we did at the same time was we went to the Center for Media and Child Health and we said, not only do we want to do a song, but we want to put in public health communication techniques to make sure that the song is something that youth can pick up on and understand.
DAVID BICKHAM: Communicating through media health messages is something that we’ve done for a while at the Center of Media and Child Health.
NOAH LEAVITT: That’s David Bickham.
DAVID BICKHAM: The concepts are really about one doing some work to understand in your audience what the key issues are. And so Katy did focus groups among young people, and they supported and reinforced this idea of transactional sex. And so that’s where the song “Worth More” that Emphraim did came from.
NOAH LEAVITT: Bickham says the key to developing a message that people will engage with and respond to is moving beyond simple scare tactics. He says that simply instilling fear will leave people frozen—what’s needed is a call to action with a positive message. And that was the idea behind “Worth More”—to teach young people that they are “worth more” than material things—and that they can take action—whether it’s something as simple as using a condom or starting an HIV peer support group.
DAVID BICKHAM: And the idea is if we can shift beliefs about this, if we can make it normal to not have this transactional sex, or make it normal to get tested for HIV, then that helps people really– their belief system starts to agree with that, line up with those cultural beliefs. And there’s this pretty tight connection between beliefs and behaviors. What our beliefs are lead to our intended behaviors. What our intended behaviors lead to our actual behaviors. So as long as there’s no obstacles there, and they have both the ability and the means to follow through, then you can have really impactful public health messaging through that.
NOAH LEAVITT: For his part, Ephraim recruited other popular Zambian musicians. And he says the approach was similar to writing any other song—find a way to write something with mass appeal.
EPHRAIM “SON OF AFRICA”: The same influence that we use to attract masses we can use it to actually write good songs. And we wrote that one song. And just the next thing it became a big song.
Actually, we were surprised because it was not just in our country where this song became big. I started getting calls from different countries about the same song, like, oh, we love what you’re doing. And we want to be a part of that big message that you’re sending out because that is exactly what is happening even in different countries.
NOAH LEAVITT: The next step in this musical campaign is a song called Ukani Manje—which literally means “wake up.” To prepare, Katy and David hosted a workshop with Ephraim and the other musicians.
[CLIP FROM DOCUMENTARY]
NOAH LEAVITT: The public health experts worked with musicians to teach them about proven public health communication techniques to work into their songs.
EPHRAIM “SON OF AFRICA”: And you know they came in to help us because sometimes you can do a song, but then you’re misguided. You want to make sure you get the right information and package it in a way that, like Dr. Bickham was saying, packaged in a way that does not scaring people, but in a nice way that people can dance to and say, you know what, this is actually making sense. I need to do this. I need to act upon it.
And that’s how come we did the workshop, came together, did a night jam with other musicians and brought in ideas. And it was great. I mean, working with a team, these are big artists influencing masses out there. So we came together. And that’s how come the song came about. And now it’s become a big thing.
NOAH LEAVITT: The goal, says Katy was to turn the singers into “super peers” who can communicate about HIV.
KATY WEINBERG: We’re not doing a workshop to create an HIV song. We’re creating a workshop to enable these artists to be super peers. So what do you need in order to do that? Do you need to have access to information about public health communications?
Do you need to have access to numbers? Do you need to have access to how HIV is spread? What do you need? And how can we as public health people connect you to those things so that you, the Zambian artist, can be the peer influencer to influence the people in their community?
NOAH LEAVITT: The concept of “super peers” not that different from the influencer marketing that is so common now on social media, says David.
DAVID BICKHAM: I think the idea that these artists are the experts in this area is what we were– one of the things that Katy’s been working on a lot is that we don’t know how to do this. These are the people who know how to talk to their audience. And they’re the ones who really have the skills and the talent to do that. And if, we’re lucky, if we can give them a little bit of information about maybe how to make their message a little more targeted or a little bit more impactful because they’re the ones that are going to have the– that are going to reach the people’s heart, that are really going to have the emotional impact by who they are and how talented they are.
NOAH LEAVITT: And Katy says this was an important lesson for her to learn.
KATY WEINBERG: I’d come in with 10 years of experience in the culture of semi-fluency– Emphraim will call me out if I say fluency in the language. But I had come in here, and I thought that I would be able to communicate this idea and get people excited. And then I had one of the artists, not Emphraim, turn around to me and say, I don’t need PhDs from Harvard to tell me how to connect to my audience. And I was like– it was a very profound moment for me because that’s not what I was trying to imply. But this idea of getting across, I’m not here to tell you how to connect to your audience.
EPHRAIM “SON OF AFRICA”: Yeah.
KATY WEINBERG: I’m here to tell you there is a problem. You can do something about the problem.
EPHRAIM “SON OF AFRICA”: Yeah.
KATY WEINBERG: And I’m just– I’m just in the background. I don’t even know why– I don’t know why I’m there. Why am I there?
NOAH LEAVITT: And the project also represents a key to public health communication—understanding the culture you’re trying to reach. Katy and David say there’s a very specific reason why the overarching theme is “wake up.”
KATY WEINBERG: There’s a Zambian expression that’s “you’re sleeping on duty.” So if you’re going down a potholy road, you might say to the– why is that road have so many potholes in it? Why is no one paying attention? And then the answer might be that the government is sleeping on duty, or that person is sleeping on duty, as in you’re not paying attention. And I think what we realized and through this workshop and thinking about what messages we could give to people, because again, as Dr. Bickham said, you want to have a call to action or a message.
And what we want to do is we want to inspire youth and say wake up, HIV is still here. Wake up, there’s stigma. Wake up, use a condom. Wake up, be abstinent, be faithful, whatever it is. And so I think that was where the idea of [? Wukanamangi ?] came from.
What we’d like to do is we’d like to blanket the radio with these songs. And so we don’t want artists to sing about things that don’t fit their brand. So maybe we have the gospel artists singing about being faithful, we have a rapper singing about one partner, condoms, or something like that. But what we want to do is we want people to be able– we want the blanket statement of wake up and then have individual songs that fit the brand. So hopefully these won’t be songs about HIV, these will be songs that have the message of HIV in it but that people want to listen to.
DAVID BICKHAM: That that’s where the pre-work came to play is that you were able to pick something very specific to intervene on. And that’s really different from what– if you’re just like, oh, I want to write a good song, and it’s just going to be HIV is bad, watch out, there doesn’t– there’s nothing you can do on that. And so when you pick something very specific, that helps the– that helps the message have an impact because you’re like, this is exactly what it’s about, and I can understand the small piece of it.
And so this idea of now there’s a hashtag, an overarching hashtag that’s about this topic, but then each individual message is going to be narrow and precise on a specific kind of behavior, or for a specific audience, or something like that where we can have– the artist can have a more direct precise impact.
NOAH LEAVITT: The product of the workshop will ultimately be a ten-song album. And the potential reach is vast. The pop stars who sing on the album have a combined social media following of a million youth across Zambia, making the album not only a powerful, but also cost-effective way to reach young people with an important message. And Katy says that the experience of “Worth More” shows this can be effective.
KATY WEINBERG: One of the things that we did on our second grant through Children’s Hospital was– this was also my practicum project here at the School of Public Health, we went out and we did surveys of 100 youth who we had listen to the song. And these youth– 100% of these youth in rural, peri-urban, and urban areas understood the messaging that we were getting out to them.
So what they do with that, that’s beyond our scope right now of measurement. But the fact that– these people don’t all even speak English, but they still were able to say HIV is a problem. I think we have one person who said I understand that these luxuries and expensive stuff are nothing compared to someone’s life.
EPHRAIM “SON OF AFRICA”: Yeah.
KATY WEINBERG: Girls need to keep their bodies safe. HIV is real. So that was the message that she walked away from the first song “Worth More.”
NOAH LEAVITT: But this is not just a musical or pop culture campaign.
KATY WEINBERG: And one of the nice things is that we’ve paired with the Ministry of Health. And so we have them and we have doctors who are working with us, and UNDP, and different people. So we have the medical people who can also have the information and the resources. So if we say go get tested, then we’ll be able to say here, here, and here is where you can get tested. So the artist as part of the peer influencer workshop are not just singing a song but creating an entry way for people to get connected to more information. And then that information is backed by doctors, medical professionals, et cetera.
NOAH LEAVITT: The partnership between Katy, Ephraim, David and the others has obviously been instrumental in making this program a success. But another key is that Ephraim and the other musicians are so personally invested in the project.
Ephraim, like so many in Zambia, has been personally affected by HIV and AIDS. And he ended our interview by singing a song written for a friend who died from AIDS.
EPHRAIM “SON OF AFRICA”: I did a song for my friend who died many years ago. And here’s a guy who had a dream. He believed in himself and always told me, you know what, we’re going to make it. I remember that time we just started. But guess what, he died, and we were deprived of this great guy who had this big vision.
So I did a song just last year and it says [SINGING] they say the time will heal, but I’m still hurting. So many years have gone, but it feels like yesterday. I remember how we used to pray and believe God for a breakthrough, those precious moments spent together.
[NORMAL VOICE)]And we keep losing special lives. But it’s about time, like we were saying, Ukani Manje isabout time. We just wake up and protect people that we love.
[SINGING] How I wish you were here to hold me when I cry. How I wish you were not so far away.
KATY WEINBERG: I think when we work in public health, and we’re here in America, and we’re thinking about lives in Africa, it’s hard to remember that that person who passed away is someone’s mother, is someone’s wife, is someone’s daughter, whatever it is. And each person who has left– people grieve very deeply–
EPHRAIM “SON OF AFRICA”: Yeah.
KATY WEINBERG: –in other parts of the world. And we think that that doesn’t happen. And it can be devastating to people who are left behind. And we need to keep that in mind that even though, when we think about things on a population level, these are people, and these are deeply loved people.
EPHRAIM “SON OF AFRICA”: Yeah.
[SINGING] These tears will never dry. I have memories of you. You touched my life in ways no one else could.
NOAH LEAVITT: Thank you to Katy Weinberg, Ephraim “Son of Africa,” and David Bickham for taking the time to speak with us.
If you want to learn more about this project and to hear more of the songs written in Zambia, we’ll have much more information on our website: hsph.me/multimedia
And before we go a personal note: I am leaving the Harvard Chan School, so this will be my last episode hosting this podcast. We started this three years ago not quite sure where it would go, and we’ve now produced almost 150 episodes. I want to thank you all for listening—and I hope you were able to learn something along the way.
The podcast will likely go on a short hiatus, but it should return soon, and I hope you’ll keep listening!