Knock Knock Knock: Zimbabwe’s Soundtrack to Understanding HIV

There’s something new spreading through Zimbabwe—and it’s a good thing.

“Knock Knock Knock” is a catchy and up-tempo song, with sunny Afro-jazz beats and a hard-to-forget jingle. More than a hit song on the airwaves of Zimbabwe, it is also an essential tool for public health promotion. (Watch the video, below.)

In Zimbabwe and most African countries, creative arts and music play an important role in promoting public health programs, according to Rosemary Muchengeti, ICAP Communications Officer for the Zimbabwe Population-based HIV Impact Assessment (ZIMPHIA) survey. Zimbabwe is the first country to roll out surveys for the PHIA Project, a five-year, multi-country initiative led by ICAP at Columbia University and supported by the President’s Emergency Plan for AIDS Relief (PEPFAR) through the U.S. Centers for Disease Control and Prevention.

The PHIA Project is measuring the reach and impact of HIV programs in PEPFAR-supported countries by estimating HIV prevalence, incidence, and population viral load in each country. Conducted in close collaboration with ministries of health, the CDC, and local stakeholders, each national survey of about 30,000 adults and children offers household-based HIV counseling and testing with return of results, and asks household members questions about access to preventive care and treatment services. The results of these surveys will guide policy and funding priorities.

Participation in the survey is voluntary, so getting public buy-in is vital for data collection—and “Knock Knock Knock” is one way ZIMPHIA hopes to spread the word.

“We saw the song as tool to communicate about ZIMPHIA through national and community radio stations,” said Muchengeti, who proposed the idea of the song after past success using interactive arts and music for health promotion.

The first step of any health communications campaign is to gauge community interests and preferences, Muchengeti said, to get a sense of public attitudes and beliefs about a particular issue before coming up with a strategy to achieve desired outcomes.

The ICAP team in Zimbabwe worked with project partners including the Ministry of Health and the CDC, as well as community members to develop the lyrics of “Knock Knock Knock,” which conveys its message in English and eight of Zimbabwe’s languages, with the goal of spreading the word far and wide, among old and young.  

To lead musical production, ICAP approached Albert Nyathi, a leading Zimbabwean poet, musician and activist. Nyathi then recruited fellow artists who are all well-known in Zimbabwe for their performances in support of various human rights campaigns. Together, these musicians are the voices and faces of “Knock Knock Knock,” communicating the importance of the ZIMPHIA survey to communities. In the dramatic introduction to the song, Nyathi says:

“After a decade of successful scaling up of HIV prevention and treatment efforts in Zimbabwe

Now is the time to assess the effects of HIV in our nation

Now is the right moment to take stock of what has been achieved in confronting the HIV epidemic

In Zimbabwe and define the way forward…”

Played almost daily on the radio in Zimbabwe, the song reaches rural areas as easily as it does city centers. The “Knock Knock Knock” music video is broadcast as a public service announcement on television, and a one-minute jingle version of the song was adapted to be played on ZTV, the country’s one and only national TV channel.

“The ZIMPHIA song is a great example of the creative, collaborative approaches to public health promotion that CDC likes to support,” said Beth Tippett Barr, CDC Country Director, Zimbabwe. “It reflects a strong engagement with our national partners.”

“Knock Knock Knock” has been key to letting the Zimbabwean public know that surveyors would soon come knocking on their doors for the ZIMPHIA survey, according to Muchengeti. But beyond awareness, the song also helps to dispel discomfort and change negative perceptions.

“Many people are understandably reluctant to allow someone to come into their home and draw their blood,” said Jessica Justman, principal investigator for the PHIA Project and ICAP’s senior technical director. “The song makes it easier for people to understand why it’s important for them to take part in ZIMPHIA.”

Unlike other hit songs, the success of “Knock Knock Knock” is not measured by record sales, number of downloads, or YouTube views. In this case, its success is reflected in the nearly 12,000 people who have participated in the ZIMPHIA survey since its launch in October 2015.

“The response has been overwhelming. All age groups are singing along and they love the artists,” Muchengeti said. “The way the song is framed with creativity and with an emphasis on the community is very appealing to the public.”

Zimbabwe’s history of success in responding to the HIV epidemic over the past decade makes it a role model for the other sub-Saharan African countries included in the PHIA Project. Wide participation in the survey will enhance the ability to measure the status of the HIV epidemic and inform the next phase of the global HIV response. And that’s something to sing about.

Watch the video: