As South Africa continues to battle one of the largest HIV/AIDS epidemics in the world, a group of health care workers and innovators is deploying what it hopes will be a powerful new weapon in the formidable fight: the cell phone.
By blasting approximately 1 million HIV/AIDS and tuberculosis text messages each day to the personal cell phones of the general public, the initiative aims to overcome the widespread stigma that prevents millions of South Africans from seeking testing and treatment.
Calling it the "largest ever" use of mobile devices for the delivery of HIV/AIDS and TB care, organizers launched Project Masiluleke (or simply "Project M") last week at the annual Pop! Tech technology conference in Camden, Maine.
The name of the initiative means "to give wise counsel" and "lend a helping hand" in Zulu.
The project grew out of the Pop! Tech Accelerator -– a social innovation incubator designed to support cutting edge, inter-disciplinary solutions to global problems -– and brings together an international coalition of partners, including design firm frog design and communications services giant Nokia Siemens Network.
"Because cell phone penetration in Africa and in South Africa is almost 100 percent ... this is the absolute perfect medium available to do this," said Dr. Krista Dong, an HIV and TB specialist and director of the South African HIV and TB outreach organization iTeach. Her organization is one of the key local partners on the initiative.
Project M also focuses on tuberculosis because it is one of the most common killers of HIV-positive patients in sub-Saharan Africa. As HIV weakens a person's immune system, it makes it more vulnerable to opportunistic infections like TB. Recognizing this fatal relationship, Dong's nonprofit iTeach stands for "Integration of TB in Education and Care for HIV/AIDS."
Overcoming the Stigma
According to the United Nations, South Africa has one of the highest AIDS/HIV rates in the world. The disease kills 1,000 people in the country every day. Yet, according to Project M's organizers, just 5 percent of the population has been tested for it.
Stigma, they say, is one of the most serious obstacles to increased HIV/AIDS testing. Reluctant to be seen standing in line at local clinics and hospitals, many in South Africa don't get tested or receive treatment until it is too late, the project organizers say.
Zinny Thabethe, an HIV campaigner with iTeach, is particularly familiar with the stigma surrounding AIDS. When she was diagnosed with the illness seven years ago she made the conscious decision to spark the difficult conversations others in her community wanted to avoid.
"The story of HIV always has a negative connotation, [it's] always related to death," she told ABNews.com. "My message has always been about, how do you look at HIV as a person? ... Have people look at it in a different, positive light."
Crafted by Thabethe and iTeach, the Project M messages, which are broadcast in three languages -- English, Zulu and Sesotho -- reflect this more hopeful and encouraging tone.
One message says: "HIV+ & being mistreated your family or friends? For confidential counseling call AIDS Helpline on 0800012322." Another message asks if the user frequently feels sick and is scared that he might be HIV positive. All of the 120-character messages direct people to call the national AIDS Helpline.
'Please Call Me'
The mechanism that makes this project possible is unique to countries where most cell phone owners use prepaid cell phone plans as opposed to long-term contracts. In South Africa, 95 percent of cell phone owners use pay-as-you-go service plans. When those customers run out of air-time, and want to tell a friend to call them, their plans allow them to send free "please call me" text messages.
With technology created by another local Project M partner -- the Praekelt Foundation -- those messages embed the text directing users to the national AIDS help line.
Robin Miller, a co-founder of the Praekelt Foundation, emphasizes that these messages are not spam.
"It's a user initiated interaction," she said. "If I don't have air time on my phone, I'm sending a request to a friend to phone me."
Before the "please call me" system, prepaid customers without air-time would call a friend and then hang up when they wanted their friends to call them. Realizing that traffic was being jammed by all the hang-ups, telecommunications companies developed this solution, Miller said.
In the country of 48 million people, 30 million of these messages are sent per day, she continued. South African telecommunications company MTN has donated 5 percent of its inventory of these messages -- 1 million per day -- to Project M for one year.
Assuming the project is successful this year, Miller said they hope to extend the initiative across Africa.
Future plans also include targeting those South Africans with AIDS who are currently receiving therapy and reminding them of scheduled clinic visits.
A New Direction in Health Care
Although the technology is only being used in pilot programs, some experts say cell phones could play an increasingly significant role in delivering health care in the United States as well.
This summer, for example, the University of North Carolina at Charlotte School of Nursing launched a text message-based AIDS education program for teenagers. Students who agreed to participate receive brief phone messages, such as "U can get HIV with unprotected sex," and then respond to indicate that they have read the text. Supported by the National Institutes of Health, the project targets African-American youth and will last for two years.
"We're using the medium with which they are most familiar with and attune to," said Patricia Grady, director of the National Institute of Nursing Research with the National Institutes of Health, about the teenagers. "It seems that if they were that comfortable with a technology that is a second nature, then they may pay more attention to the messages that came that way.
"We're tapping into a very new use of the technology," she said, adding that, to her knowledge, this study was one of the first of its kind supported by the NIH. "Our studies are focused on the youth group –- the teens –- but I don't think there's any reason it couldn't be used for others."
Indeed, Baltimore-based WellDoc Communications Inc., a technology-based health care company, is already using mobile technology to support older diabetes patients.
The company's cell phone-based diabetes management software lets patients provide data and receive real-time feedback on how to manage their condition.
Dr. Suzanne Clough, an endocrinologist and chief medical officer of WellDoc, said that in a three-month pilot study that they conducted, she saw better results with that patient population than she ever did in her own clinic.
She helped found WellDoc when she noticed that regardless of socioeconomic background, nearly all of the people who walked into her clinic owned cell phones.
"We wanted something to provide diabetes coaching in real-time to patients," she said. "We used that technology to deliver just-in-time, relevant, personal health care information."
But she concedes that several obstacles need to be overcome.
One of the biggest hurdles for health care practitioners is inadequate compensation, she said.
"If we're going to ask nurses and doctors to use mobile technology ... we need to reimburse them more," she said.
Another significant barrier is that many Americans use contractual, post-paid cell phone plans. South Africa's "please call me" system doesn't have a parallel in the United States.
Customers would need to opt-in to a personalized program or a cell phone carrier would need to co-brand an embedded message, WellDoc president Anand Iyer told ABCNews.com.
When cell phone companies broadcast service messages to their customers, they could agree to include a pro-social message encouraging people to get tested or seek treatment for a specific illness, he continued.
In the next 18 to 24 months, Iyer said, these kinds of partnerships might begin to surface.
"We definitely aren't there yet," Clough said. "But is this the direction in health care? My answer is yes."