Impact Examples: HIV/AIDS Communication Programming

Experimental Evaluation of MTV Shuga: Changing Social Norms and Behaviours with Entertainment Education

This study was designed to causally evaluate the effects of the MTV Shuga television drama on knowledge, attitudes, and behaviours related to HIV/AIDS and gender-based violence in Nigeria. In treatment locations, individuals were shown MTV Shuga in two screenings that compressed the third season of the Shuga series. Control communities were shown a placebo movie lacking messages of sexual risky behaviour and having a similar length.

Selected results from the study, published in 2016:

• Knowledge of HIV transmission and testing - Seeing Shuga led to improved knowledge of ways of HIV transmission and of antiretrovirals, including a decrease in myths related to HIV transmission like eating from the same pot, sharing toilets, and shaking hands. It also led to improved knowledge of HIV testing: Respondents in the treatment group were 43% more likely to know about the three-month waiting period (10.1% in the control vs. 14.5% in the treatment group).
• Stigma and discrimination - Individuals in the treatment group were 35% less likely to think that HIV is a punishment for sleeping around (13.7% vs. 8.9%) and 8% more likely to think an HIV-positive boy should be allowed to play football (62% vs. 67.2%).
• Attitudes around risky sexual behaviour - Viewers were less likely to think that it's okay for a young girl to date an older married man or a sugar daddy if he offered money for the family, financed her education, or took her out.
• HIV testing - Individuals who watched MTV Shuga were 35% more likely to report getting tested in the last 6 months (9.3% versus 6.9% in the control group). To obtain an objective measure of testing, during the 6-month follow-up survey, the research team gave study respondents information about the nearest HIV testing centres and verified whether they visited them. The treatment group was twice as likely to get tested as the control group (4% vs. 2%).
• Multiple partners - Individuals in the treatment group were 14% less likely to report having had concurrent sexual partners in the 6 months prior to the follow-up survey (18% vs. 22% in the control group), and they reported having fewer partners at the time of the follow-up survey.
• Sexually transmitted infections (STIs) - The prevalence of chlamydia among females in the treatment group was significantly lower than in the control group (1.3% vs. 3.1%, a reduction of 58%).

Impact of Peer Education and On-Site Clinical Services for Female Sex Workers in Bangladesh Brothels

Carried out as part of the global consortium Link Up, this is an evaluation of a brothel-based HIV and sexual and reproductive health and rights (SRHR) intervention that combined peer outreach with the provision of on-site clinical services in 3 Bangladesh brothels. After approximately one year of Link Up activities, in August-September 2015, the research team conducted interviewer-administered surveys of 531 female sex workers who resided in the 3 brothels.

Selected findings include:

• Not only did women with more programme exposure have increased testing self-efficacy, but they were more likely to have received an HIV test. They also were more likely to know where to receive a test, among those who had not yet been tested.
• Among those who received both peer education and satellite clinic services, more than 98% expressed confidence to make good decisions about sexual behaviours and to talk to a partner about sexual health issues, compared to less than 85% who reported such confidence among women who received neither Link Up intervention.
• Among those who received both peer education as well as satellite clinic services, 21% had high HIV transmission knowledge, compared to 13% among those who only received peer education and 4% among those who had no Link Up exposure. Likewise, HIV testing was more common among those who received higher levels of exposure to Link Up activities, with 76% ever tested among women who received both interventions, compared to 54% and 44% among those who just received peer education or no exposure. Knowledge of testing location and confidence to get tested also were significantly higher among those who received higher levels of exposure to Link Up interventions.
• Among women who received both peer education and satellite clinic services, a larger proportion reported high knowledge of female STI symptoms: More than one-third of those who got this most intense level of Link Up exposure had high knowledge, compared to less than 10% in the 2 lower exposure categories.

Reducing Provider-Held Stigma and Improving Young Client Satisfaction in Bangladesh

Citing research indicating that stigma can inhibit uptake of critical HIV and SRHR services, the Population Council designed and evaluated a training programme for service providers in Bangladesh as part of Link Up. The initial 2-day "integration training" featured participatory activities; a 1-day supplemental training highlighted messages on social stigma and encouraged reflection on personal values around key populations and youth sexuality.

In brief, the results (published in 2016) indicate:

There was a shift in provider attitudes about people who live with HIV. For example, the percentage of providers who reported that people living with HIV should feel ashamed dropped from 35% at baseline to 20% after the initial integration training, yet after the supplemental stigma training, the change was less pronounced (from 20% to 16%). Similarly, after the integration training, the percentage of providers who agreed with the statement that people living with HIV have had many sexual partners dropped from baseline (57%) to midterm (46%), with a less dramatic reduction after the supplemental stigma training (46% to 43%). And, after the initial integration training, the percentage of providers who said people living with HIV should be allowed to have babies if they choose rose to 53% from 40% at baseline, but only increased slightly (to 56%) after the supplemental stigma training.

Tchova Tchova, Juntos Vamos Mudar "Together Will Change", Mozambique, 2007-2010

This evaluation explores an HIV/AIDS prevention gender tool - Tchova-Tchova Histórias de Vida Diálogos Comunitários (TTHV) - developed as part of Tchova Tchova [TT], Juntos Vamos Mudar (Push, Push, Together We Are Going to Change), the Social and Behavioral Change Communication project for HIV/AIDS Prevention, Treatment and Capacity Building. It features 10 video and written profiles of Mozambican "positive deviant" men, women and couples telling their stories of how they overcame gender, cultural, and social barriers with a specific focus on HIV treatment and prevention. It also includes: facilitator's and reference guides, a field implementation model, 15 champions' stories/mini posters, cue-to-action cards, TTHV advocacy, and a TT radio magazine. A post-only survey with a non-equivalent control group - 462 TTHV participants (men and women) and a group of 453 men and women who had not participated in TTHV but accepted to participate - was conducted July 19-29 2010.

Here are just a few examples of findings:

• With regard to HIV partner communication: talking with partner about HIV/sexual behaviour in last 3 months - the number was 88% among intervention group vs. 72% among control group); intervention group respondents talked about significantly more HIV topics than did controls, and controls exposed to TT radio also talked about significantly more HIV topics than controls that were not exposed to TT radio.
• Intervention group respondents were significantly more likely to correctly identify ways to prevent HIV infection.
• Three times as many controls as intervention respondents reported having more than 1 sexual partner.

Youth Radio for Better Adolescent Reproductive Health

This 2-year project, carried out by the Straight Talk Foundation, incorporated a local language youth radio show with complementary information, education, and communication (IEC) materials and face-to-face activities - a package of interventions meant to facilitate sustained and informed conversations amongst adolescents and the adults in their lives about adolescent sexual and reproductive health (ASRH).

The August 2009 study found:

There have been significant improvements in the knowledge and attitudes of young people towards condoms compared to the 2005 baseline: 65.6% of young people in 2009 compared to 35.2% in 2005 agreed that condoms are an effective way of protecting against STIs (P= 0.0000). Similarly, there has been a significant increase in the proportion of young people who disagree that buying condoms is males' responsibility - from 23.2% in 2005 to 58.3% in 2009 (p=0.000). In addition, those who disagree that using a condom is a sign of mistrust rose from 15.3% in 2005 to 32.7% in 2009 (p=0.02). An insignificant difference was observed in the proportion of young people who disagree that girls carry who carry condoms are "loose" (sexually promiscuous) - from 12% in 2005 to 26.5% in 2009. There was a significant increase (p=0.003) - from 27% in 2005 to 45.8% in 2009 - in the proportion of young people who disagree with the statement that the man who should have the final word on sex.

Condom, Condom! Campaign - India

The British Broadcasting Corporation (BBC) World Service Trust (WST) developed this campaign to promote condom use among young men in India through television, radio, and online public service advertisements (PSAs). Carried out in 4 phases, the campaign is designed to normalise the use of condoms via a coloured animated parrot designed to come across as smart, pesky, opinionated, and humorous.

2009 evaluation results:

• The proportion of men exposed to the campaign who were not embarrassed to carry a condom increased by 21% from baseline to endline. The increase among unexposed men was less than half that, at 7%.
• Men who agreed with the statement "I can buy a condom from any shop without any fear or embarrassment" increased by 21% from baseline to endline among those exposed. In contrast, this increase was only 7% for the unexposed.
• Fear of being judged by friends when buying condoms decreased by 9% for those exposed compared to 2% among the unexposed.
• There was a 7% increase in the men who thought the use of condoms reflects smart and responsible behaviour. This number was only 3% for men unexposed to the campaign.

Wan Smolbag Theatre created this television soap opera in an effort to raise the profile of HIV and foster understanding of related issues in the Pacific.

2009 evaluation results:

Surveys conducted in Vanuatu and Fiji illustrate that the reach of Love Patrol was excellent and was notably high amongst youth and young women in particular, which are both identified as vulnerable groups to HIV and sexually transmitted infections (STIs).

Knowledge change example: Just over 1 in 5 of the participants in the Vanuatu workshops were able to identify the difference between HIV and AIDS prior to viewing the series. Once having viewed it, the proportion of participants who answered the question correctly increased to almost one-third (31.3%).

Attitude change example: After viewing Love Patrol, there was a notable increase in the proportion of participants who conveyed that they would treat HIV-positive family members "equally" (12.5% increase) and "care for them/give them support" (12.5% increase).

Behaviour change example: There was an increase (of 8.3%) in the proportion of participants who indicated they would "seek medical advice from a health professional and/or medical treatment" if diagnosed with HIV. There was also an increase (of 4.2%) in the proportion of participants conveying that they would "avoid spreading the virus".

Text Me! Flash Me! Helpline - Ghana

This project uses cell phone technology to provide most-at-risk populations (MARP) with friendly and accessible HIV and AIDS information, referrals, and counseling services from qualified providers. The Helpline was launched in September 2008 through a pilot focusing on men who have sex with men (MSM) exclusively, and then was expanded in February 2009 to include female sex workers (FSW).

Text Me! relies on a database of cell phone numbers collected by peer educators and social networks. Outgoing SMS texts are sent with educational and promotional messages, either through a "phased communication" strategy or in response to trends noticed through ongoing quality assurance and monitoring and evaluation (M&E). Automatic SMS text responses are sent to clients' SMS text inquiries that refer clients who text "HELP" to live Helpline counselors, who call back within 24 hours.

The Flash Me! component of the project refers to the fact that, in order to encourage clients to call and use a Helpline, it is important that the call is free to the client. However, in Ghana, there is currently no way to procure a phone number that will be free for all callers from all networks. The solution was that potential clients may "flash" the cell phone number of a Helpline counselor on duty, who returns the client's call within 24 hours. Helpline counselors' cell phone numbers and duty hours are disseminated both through social networks, discrete fliers, and by peer educators.

2009 evaluation results:

• The number of callers disclosing their sexual orientation to a Helpline counselor increased each month. In addition:
  - 86.9% of survey respondents said that after their Helpline call session they shared the information they received with others;
  - 40% of respondents forwarded the texts they received to others, and sent to an average of 8.6 other people;
  - Respondents who forwarded texts said their reason for doing so was either to educate others, or because they wanted them to have the same information;
  - Only 13.1% of clients said they did not share the information with anyone.
• The evaluation findings revealed that the Helpline increased clients' knowledge of and intention to use condoms and lubricants.
• Of the survey respondents who were referred for services by a Helpline counselor; 47% reported that they followed up and went for these services; 77% said they intended to go for counseling and testing (CT) services; 23% said they did not intend to, mainly because they said were "already aware of my HIV status" or had "already taken the HIV test". The sum total of CT service uptake in Oct. 2008 was higher than the uptake numbers in the previous 5 months combined at the MSM drop-in center at one of the project's local NGO implementing partners: 69 clients from May to Sep. 2008, as compared to 76 clients in Oct. 2008.
• CT uptake following referrals increased after the launch of the Helpline:
  - 16% effective referrals over the period of Apr.-Aug. 2008;
  - 39% effective referrals over the period of Sep. 2008-Jan. 2009.
  - Prior to the Helpline, only 1% of MSM referred to the MSM drop-in centre at one of the project's local NGO implementing partners for sexually transmitted infection (STI) services actually went and received STI services. Following the launch of the Helpline Pilot, that number increased to 11%.
  

Intercultural Radio Educativa Project - Peru

This project included a thrice-weekly intercultural educative radio programme and on-the-ground community resource people. These elements were strategically leveraged with a year-round school-based initiative, involving teachers, students, and community members to prevent and reduce domestic violence and HIV/AIDS, empower victims of violence (mostly children and women), and reduce prejudice, stigma, and discrimination associated with being HIV-positive. In addition, several students in each participating rural school were trained as radio correspondents and on the topics of domestic violence and HIV/AIDS, and after these trainings, were in charge of encouraging youth in their respective communities to listen to Bienvenida Salud and then provide feedback, including proposing new subjects for inclusion and treatment on the radio programme.

2008 evaluation showed:

From January 2006 to March 2008, the staff of Bienvenida Salud received a total of 4,860 letters. Of these, 21% of the letters (N=1003) made a direct and explicit reference to issues of violence in the community or domestic sphere, or raised questions or concerns on HIV/AIDS.

Adult women, the primary intended audience of Bienvenida Salud, wrote most of the letters (45%) to the radio programme. Many of the adult women listeners wrote in to share that they have either abused their children or been abused by their partners. Adult men and youth (both male and female) are increasing as an audience segment of Bienvenida Salud and also increasingly writing in to the programme. This finding, evaluators assert, suggests increased involvement of men in the welfare of their families and their partners. The analysis of senders for the same time period shows that 46% were youth radio correspondents: "In focus group interviews, correspondents voiced a sense of 'pride' in that their school and Minga trusted them to receive the training. They take seriously their role in writing letters to Minga informing of cases of violence in their communities, as also their responsibility to search for alternative and local solutions to problems of domestic or community violence."

"In general terms, students emphasized that they now talk about these issues with their friends and family members, especially about domestic violence."

"...[P]rimary and secondary data clearly shows that students have learned about their rights as individuals, about different forms of violence, and about taking preventive measures for not contracting HIV/AIDS."

"Prior to the implementation of the school-based program, students noted that they had several misconceptions about HIV/AIDS. Many thought that it was 'a small animal' that could be transmitted by touching someone. HIV also attributed as being synonymous with having sex with homosexuals or prostitutes. Although some misconceptions still persist, the secondary school students show mindfulness in acknowledging that the person they have sex with may have multiple partners."

"A great majority of the students said that they are 'better informed and less afraid': that after talking to their teachers and listening to Bienvenida Salud, they now know how to prevent the spread of HIV and other sexually-transmitted infections."

"Many teachers acknowledged their own biases, misconceptions, about HIV/AIDS and family violence, and how they now know what they should have known all along. For instance, a teacher in Nauta noted: 'Before, I thought that when somebody was infected with HIV and they did not eat all of their food that another person could get infected through the food, or when somebody kissed an infected person they would become infected. Now I know I was wrong.'"

"In our discussions with students, while acknowledging the difficulties in broaching these topics with their girlfriends or boyfriends, they expressed a desire for change, including delaying of sexual relations, limiting sexual partners, and using condoms in sexual encounters."

Soul City Institute Regional Programme - Botswana, Lesotho, Malawi, Mozambique, Namibia, Swaziland, Zambia, and Zimbabwe

• 8 southern African countries
• The adaptation of local communication materials with a large-scale capacity building programme
• Local partners in each country
• The 8 countries produced a total of 20 titles in the 5-year period from 2002 to 2007
• 20 million copies of these were distributed in the region
• 11 radio drama series and 14 television documentaries/talk shows

2008 evaluation results:

• Clear shift in HIV testing in all countries from 2002 to 2007
• Exposure to Soul City partner interventions associated with testing in all settings
• 15% of the exposed people show positive behavioural change
• Among more educated women in Zambia, 18% of those who had no exposure to Kwatu used condoms with their non-regular partner, compared with 40% of those who had high access to Kwatu.
• In Namibia, 80% of men with low education and high exposure to Desert Soul consistently used condoms with their regular partner, while only 20% of those with no exposure did.

Valvula de Escape [Escape Valve] - Mexico

This was a radio call-in show produced and aired in 2007 by Population Media Center (PMC) in collaboration with CORA (Centro de Orientación para Adolescentes) that provided an outlet for teens to discuss issues relating to sexual/reproductive health directly with health professionals and other teens. It was aired every Thursday on Radio Mexiquense from 4:00 pm to 5:00 pm.

2007 evaluation results:

• Listeners had significantly higher knowledge than non-listeners of various birth control methods including birth control pills (74% vs. 60%), female condoms (44% vs. 27%), and injections (28% vs. 11%).
• Significantly more listeners (93%) compared to non-listeners (72%) correctly indicated that, without an HIV test "a person can't tell when another person has HIV." Listeners were significantly more likely than non-listeners to know how HIV can be transmitted.
  -Having sex without a condom: listeners (77%) vs. non-listeners (57%).
  -From sharing needles: listeners (58%) vs. non-listeners (24%).
  -Through blood transfusions: listeners (63%) vs. non-listeners (32%).
• Listeners (59%) were significantly more likely than non-listeners (26%) to know that a blood test will not detect HIV infection one week after exposure to the virus.

Straight Talk Campaign - Uganda

Mass media communication campaign to bring sexual and reproductive health information to young people.

• Radio programmes meant for in- and out-of-school youth, which are broadcast to various districts in English and 11 other Ugandan languages
• Newspapers in English and 6 other Ugandan languages, primarily geared toward secondary school students
• English-language newspaper designed for primary school students
• Various school-based activities
• Community activities such as health fairs

2007 evaluation results:

• Exposure to STF activities was associated with getting tested for HIV. Female adolescents were three-and-a-half times more likely to have been tested than those not exposed, and male adolescents were nearly 4 times more likely to have been tested.
• Female adolescents exposed to STF materials were 4 times more likely to abstain from sex if they had a boyfriend, compared to their unexposed counterparts. Males exposed to the materials were less than half as likely to engage in sexual activity and 3 times more likely to resume abstinence if they had previously had sex, compared to those not exposed.
• Exposure to STF products is also associated with some increase in condom use, but the relationship is not statistically significant, largely due to the small sample size limiting statistical analysis.
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Is This Justice? Multi-Media Campaign to Reduce Stigma Against Women Living with HIV/AIDS

Conducted from February to April 2007, "Is This Justice?" was created by the international human rights organisation Breakthrough to demonstrate how an HIV-positive status, compounded by a husband's death, often leads to a loss of rights and consequent eviction of women from marital and natal homes. Focusing on the states of Uttar Pradesh, Karnataka and Maharashtra, the campaign included television, print, radio, and internet and mobile messaging.

Selected findings:

• After the campaign, the community acknowledged that women are not able to negotiate safer sex (a 4% difference), are subject to domestic violence (an 8% increase), and are treated unjustly after their husbands' deaths (an 8% difference). Specifically, 16% more people acknowledged that this statement is true in society: "A women has no right in her husband's home after his death." Also, 12% more acknowledged the following: "If a woman loses her husband at a young age, she is blamed for his death."
• The campaign found statistically significant positive changes in two indicators: There was a 22% decrease in the number of people who feel it is necessary for a woman to stay with her HIV-positive husband. "In the Indian context this decrease is significant, as it is usually considered the duty of the wife to stand by her husband under all circumstances." There was a 10% decrease in the number of people who blame a woman for not satisfying her husband sexually.

Soul Buddyz

A multi-media intervention designed for children aged 8 to 14 in South Africa that focuses on the promotion of children's well-being through the provision of health information and skills, especially those which relate to HIV and AIDS and sexuality. Components include: a television drama, a radio intervention, a "Lifeskills Booklet" for Grade 7, and Soul Buddyz Clubs.

2006 evaluation results:

Cambodia Mass Media Campaign

This was a multifaceted mass media campaign in 2003 that was an effort to help stop the spread of HIV and AIDS, improve care and support for people living with HIV, and improve the health of Cambodia's mothers and children. The co-ordinated campaign consisted of:

• 100 episodes of a soap opera ('Taste of Life') were broadcast.
• 666,000 copies of a photo-strip magazine were produced each month and distributed to the public.
• A youth radio phone-in programme ('Really?') was broadcast weekly.
• A radio discussion programme ('Real Men') was broadcast weekly.
• 99 shows of a radio phone-in programme ('First Steps') were broadcast.
• 23 television and 22 radio public service announcements (PSAs) about child and maternal health. In the space of a year, the radio PSAs were broadcast more than 35,000 times across 11 radio stations.

2006 evaluation results:

• 37% of television and radio audiences said they were discussing HIV and AIDS more often.
• 27% felt they were talking about condoms more often.
• Talking 'sometimes' or 'regularly' about HIV testing rose to 63%.
• The attitude that it was acceptable for women to buy condoms increased from 60% to 80%.

Reducing AIDS-related Stigma and Discrimination in Indian Hospitals

A 4-year effort to ensure the provision of non-stigmatising health services to all patients regardless of HIV status.

• Drew on a participatory approach that encompassed all levels of hospital staff, people living with HIV/AIDS (PLHA), and the various collaborating organisations
• Involved:
  • development and dissemination of printed guidelines for HIV care and management
  • sensitivity training of health workers about the needs and rights of people with HIV
  • expansion and strengthening of HIV testing and counseling services
  • development and dissemination of educational material (posters).

2006 evaluation results:

• "About three or four years back, we had an HIV-positive patient....The ward staff sprayed DDT [a pesticide] all around the patient's bed so that the virus would not spread. Now these things do not happen."
• At endline, more doctors reported wearing gloves for at-risk procedures such as drawing blood (64% vs. 93%; p < .05), as did ward staff for procedures such as carrying patients blood samples (29% vs. 93%; p < .05). Doctors were also more likely to seek informed consent the last time they ordered an HIV test (40% vs. 59%).
• At baseline, health care workers often took it upon themselves to inform peers and other staff in the hospital about a patient's HIV-positive status. At follow-up there was some improvement among doctors, as a smaller proportion reported informing nurses (87% vs. 71%) and ward staff (51% vs. 30%) about a patient's serostatus. Nurses corroborated this trend; compared to baseline, a smaller proportion at follow-up reported being informed by doctors of a patient's positive HIV status (31% vs. 17%). But there was essentially no change among nurses in telling ward staff (97% vs. 99%). In short, "many health care workers continued to feel that they were entitled to know the HIV status of their patients and to share this information with one another even as they expressed increased respect for patient privacy in general. More work is therefore needed to translate changes in attitudes to changes in practices."

South African National HIV and AIDS Communication Survey 2006

Survey carried out in South Africa that looked in detail at the effects of national HIV/AIDS communication interventions and aimed to show the separate and combined effects of all the interventions.

2006: overall impact of 14 HIV/AIDS communication programmes:

• After controlling for the effects of 17 socio-demographic control variables related to AIDS related behaviour, the joint effects of all 14 AIDS media programmes was found to have a substantial impact on seven important attitudes and behaviours related to HIV/AIDS;
• The cumulative effect of 14 television and radio programmes on using condom with one’s most recent partner to prevent HIV is as strong as the standard social-demographic and socio-economic factors and;
• Mass media AIDS programmes create an environment conducive to discussion and social capital in local communities that in turn have direct effects on AIDS-related behaviour.

Puntos de Encuentro's Somos Diferentes, Somos Iguales (We're Different, We're Equal) - Nicaragua

Featured:

• a weekly national edutainment telenovela called "Sexto Sentido" with a particular focus on HIV risk
• a daily call-in radio show
• community-based activities (coordination across organisational networks, cast visits to schools, youth training camps, and IEC materials).

2005 evaluation results:

• After controlling for age, sex, region, and education, evaluators found that individuals exposed to the intervention were more likely to have talked to someone about HIV in the previous 6 months (OR = 1.4). Those exposed also had: a 32% greater probability (in longitudinal analysis) of having talked with their partner about condom use; a 41% greater probability (in last survey) of interpersonal communication about Somos Diferentes, Somos Iguales (SDSI)-related issues (57% in men and 27% in women); and increased interpersonal and intimate partner communication that resulted in greater probability of consistent condom use with both steady and casual partners. Interpersonal communication with a casual partner resulted in a 63% greater probability of consistent condom use.
  
• Those exposed to the intervention were more likely to know where to find information and services on HIV and violence (OR = 2.2). Participants with greater exposure to SDSI demonstrated: a 21% greater probability of knowing that it is possible to live with HIV for many years; a 30% greater probability of saying that condom use can prevent HIV; a 31% greater probability of knowing of a centre that provides attention for sexually transmitted infections (STIs)/HIV; and a 17% greater probability of knowing where to take an HIV test.
  
• Evaluators identify the following changes between 2003 and 2005: more support for gender equity, and a decrease in stigmatising attitudes toward (and decreased support for discrimination against) people living with HIV/AIDS (PLHA). For example, after controlling for age, sex, region, and education, they found that individuals exposed to the intervention were more likely to say that they would be willing to be friends with PLHA (OR = 2.0).
• Evaluators found that there was an increase in those who had ever had an HIV test. Participants with greater exposure to SDSI demonstrated: 44% greater probability of having used a condom during the last sexual relation with a casual partner; 42% greater probability of having consistently used a condom with casual partners in the last 6 months; and 56% greater probability among men of condom use with casual partners during the last 6 months.
  

"100% Jeune" Social Marketing Program in Cameroon

Social marketing programme that promoted adolescent reproductive health.

• Empowered youth to practice safe sex
• Promoted dialogue about adolescent reproductive health in the community
• Increased accessibility of condoms to youth.

2005 evaluation results:

• The percentage of youth who used a condom in last sex with their regular partner increased from 32% to 45% for females (p < .05) and from 44% to 61% for males (p < .01). By controlling for demographic variables and other endogenous and exogenous variables, the findings suggested that exposure to the "100% Jeune" campaign had contributed to these trends.

Population Media Center Radio Soap Operas in Ethiopia

• 2 social-content radio serial dramas designed to change reproductive health behaviours were broadcast from 2002 to 2004.
• Yeken Kignit (or, Looking Over One's Daily Life) was broadcast in the Amharic language (257 episodes)
• Dhimbibba (or, Getting the Best Out of Life), was broadcast in the Oromiffa language (140 episodes)
• Both programmes addressed issues of reproductive health and women's status, including HIV/AIDS, family planning, marriage by abduction, education of daughters, spousal communication, and related issues.

2004 evaluation results:

• Among married women in the Amhara region who were listeners, there was a 55.1 percentage point increase in those who had ever used family planning methods, while among non-listeners, family planning use increased by only 23.5 percentage points. Among married men in the Amhara region who were listeners, there was a 41.3 percentage point increase in those who had ever used family planning methods, while among non-listeners, family planning use increased by only 16.1 percentage points.
• Female listeners of Yeken Kignit sought HIV tests at 3 times the rate of non-listeners; male listeners of this drama sought tests at 4 times the rate of non-listeners.
• There were also substantial increases in adoption of HIV avoidance measures among listeners.
• Increased use of condoms - The proportions of sexually experienced youth at the intervention site reporting ever use of condoms rose significantly between baseline and follow-up, overall (74 to 97%) as well as among males (76 to 98%), and females (71 to 97%). In the comparison site, condom use among sexually experienced youth also rose, but not significantly (71 to 81%), primarily due to increased use among females (68 to 85%), a rise that was not statistically significant.

Journey of Life Radio Show - Ethiopia

Journey of Life was a family planning (FP) and HIV/AIDS prevention-focused radio drama. The drama addressed perceived risk and self-efficacy as it relates to FP and HIV/AIDS and dual protection offered by condoms.

2003 evaluation showed:

• Over sixty percent of respondents reported talking with their friends about JOL episodes; 40.5% talked with their family about JOL episodes; 32.3% talked with a romantic partner about JOL episodes.
• Personal risk perception rose to 66.2% after listening to JOL. While almost all listeners (97.6%) believe that HIV/AIDS is a serious health threat in Ethiopia, they also believe strongly (96%) that they have the power to avoid HIV infection. Most respondents (86.6%) agreed or strongly agreed that after listening to JOL they wanted to change their lives for the better. Specifically, the vast majority of urban youth listeners (95.9%) said that JOL influenced them to protect themselves against HIV/AIDS. Females reported a stronger behavioural impact from JOL than males.
• Most listeners (91%) reported that JOL positively influenced them to use family planning methods. 66.2% of urban youth surveyed in the final evaluation agreed that they were susceptible to HIV infection. Most listeners (95.1%) agreed that JOL made them believe there were effective ways to avoid HIV infection. Over 95% of the listeners said that JOL made them feel hopeful about avoiding HIV infection. Almost all of the listeners (97%) agreed that JOL made them believe that having children when they weren't ready was harmful. Females felt greater perceived severity than males from having children when they weren't ready. Female perceptions that they might have unwanted children if they didn't use family planning were more strongly influenced than male perceptions by JOL. About a quarter of the males (28%) felt increased susceptibility to having unwanted children due to JOL, while nearly double the percentage of females (51%) felt the same. JOL strongly influenced perceptions of self-efficacy with 97.6% of listeners saying the show made them believe they were able to use family planning. Most listeners (90.1%) said that JOL made them believe that family planning prevented one from having children unless one really wanted them.

Kenya Adolescent Reproductive Health Programme (KARHP)

Implemented over 3 years (October 1999- March 2003) in 2 rural districts in Western Kenya.

• Focused on in- and out-of-school youth aged 10-19 years, in an effort to delay the onset of sexual activity, decrease and/or prevent high-risk sexual behaviours, and increase young people's knowledge of reproductive health and uptake of services.
• Included:
  • peer education
  • guidance and counselling in schools
  • introduction of youth-friendly services in participating health facilities

2003 evaluation results:

• Project activities may have reduced sexual activity among adolescents. Overall, the proportion of youths who had ever had sex reduced in the project areas. While 5.9% and 1% of 10-year-old boys and girls, respectively, reported being sexually active at the beginning of the project, none at this age were sexually active during the evaluation survey. Over half of boys and girls are still virgins at 16 years and among those who ever had sex, activity is irregular and infrequent. During the study period, pregnancy among unmarried girls decreased in both the experimental and control sites.
• Among those young people who were sexually active, there was a general improvement in the reported use of protection at first and last sexual activity by both boys and girls. Twenty-one percent of the boys, and an equal proportion of girls, who had taken part in KARHP activities had used protection the last time they had sex. Also noted was a significant reduction in the number of boys reporting having had symptoms of STIs.

PRISM Youth Campaign - Guinea

This community-based campaign addressed Guineans aged 15 to 24 with messages about abstinence and condom use in an effort to reduce unintended pregnancy, sexually transmitted infections (STI), and HIV/AIDS. The year-long campaign combined youth-driven community-based interventions with mass media.

2002 evaluation results:

• 60.4% of young men (and 41.0% of young women) in the intervention group reported more community
• openness in discussing youth sexuality issues, as compared to 32.7% of males and 13.3% of females in the control group.
• Among young men in the intervention group (p < 0.01), 85.5% (versus 57.1% in the control group) knew where to get condoms; 70.0% (versus 37.7% in the control group) knew how to use condoms.
• Among young men in the intervention group (p < 0.01), 77.5% (versus 53.0% in the control group) were willing to use condoms; 69.5% (versus 30.6% in the intervention group) advocated for condoms.
• As compared to data collected one year prior to this survey, young women had higher odds (1.27) of contemplating abstinence when they perceived their community to be more open to discussing reproductive health issues.
• The campaign was effective in improving preventive behaviour such as condom use at last sex, which was higher (p < 0.01) in the intervention area than the control (47.6% versus 24.1% for men and 27.0% versus 2.7% for women, respectively). Young men who participated in a larger number of campaign activities showed significantly higher odds (1.24) of using a condom at last sex as compared to one year prior to the survey.

Among Youth - Cameroon

• A research project conducted between July 2000 and February 2002 to encourage abstinence, increase contraceptive use, and reduce sexually transmitted infection (STI) rates among sexually active youth.
• Peer education to address youth through one-on-one counseling
• Use of media and events (theatrical performances, youth magazines, and sporting events)

2002 evaluation results:

• Knowledge about HIV/AIDS prevention methods improved during the intervention, but increases were observed in both the intervention and control groups. 53% of those surveyed in the control site during 2000 knew condoms were a prevention method against the disease, compared to 70% in the intervention site. By 2002 75% in the control site and 79% in the intervention zone were familiar with the method. In both sites abstinence was cited second to condoms as the most effective method of prevention against HIV/AIDS. In 2000 it was cited by 19% of youth in both the control and intervention areas. In 2002 the proportion rose to 30% in the control site and 35% in the intervention site.
• In 2000, very few youth were able to cite all 3 methods of prevention (i.e., abstinence, mutual fidelity, and condoms); by 2002, the numbers rose 11% (from 5%) in the control site and to 13% (from 4%) in the intervention site.
• Abstinence increased in the intervention site and decreased in the control site. After the campaign, 62% of intervention site youth reported abstaining, compared to 50% before. In the control site, 56% reported abstaining after the project, down from 60% before. Fidelity also increased, with fewer youth reporting multiple sexual partners. Prior to the intervention, 37% of youth surveyed in Mokolo had more than one sexual partner per year. After the intervention, the percentage fell to 30%. Boys continued to have more sexual partners than girls (38% of boys reported more than one sexual partner per year, compared to 21% of girls).
• Condom use during last intercourse with a regular partner increased in the intervention site from 42% to 62% among boys and from 31% to 42% among girls. Condom use with the last occasional partner remained the same among control group girls (about 61%), but increased significantly among girls exposed to the intervention from 44% to 79%. Similar changes occurred among youth with regular partners in the control group.

Stop AIDS Love Life Campaign - Ghana

This campaign included a song and video produced by Ghanaian artists and producers who donated their time and talent to the project. The song and video frequently aired on television, on radio stations, and on M-NET, an Africa-wide satellite TV station.

Television and radio spots also focused on the ABCs of prevention: sexual Abstinence, Be faithful, and Condom use.

2001 evaluation showed:

• Among sexually active men, condom use at last sex increased from 13% in 1998 to 24% in 2001. Among sexually active women, condom use at last sex increased from 4% to 12% during that period. Further, even after controlling for a number of socio-economic characteristics, those sexually active men and women exposed to the campaign were more likely than unexposed men and women to have used a condom at last sex. While only 10% of male non-viewers used a condom at last sex, 34% of men with high campaign exposure had behaviour had done so.
• The number of condoms sold during the two years following the campaign (34.8 million) was almost double that sold during the two years prior to the campaign (18.8 million).
• Although condom use increased, age at first sex and multiple partnerships were largely unchanged by the campaign among the population at large. Reported faithfulness, however, did increase among married men with high exposure to the campaign as compared to those with no exposure.

loveLife Campaign - South Africa

Launched in September 1999, loveLife is a brand-driven, comprehensive national programme designed for young people in South Africa. It focuses on reducing the negative consequences of premature and adolescent sex by promoting sexual health and healthy lifestyles for young people. The programme combines various forms of media – television, radio, and print - with outreach and support programmes and a nationwide drive to develop adolescent-friendly health services.

2001 evaluation showed:

• A majority (58%) of the youth who had heard of loveLife reported that as a result of loveLife they had talked to their friends, family, or others about loveLife and/or lifestyle issues in general and that they are thinking about and discussing relationships. 67% say it has caused them to talk to their friends about sex, sexuality, and relationships between men and women, and 57% agree that it has caused them to think more about the openness and honesty of their romantic relationships. Among those who have heard of loveLife, 64% say it has provided them the opportunity to talk to their parents about HIV/AIDS, and nearly half say it has provided them the opportunity to talk with their parents about relationships between men and women (48%), sex (46%), and other difficult issues (48%). Among the 41% of parents of 12-17 year olds who have heard of loveLife, 61% say they have talked with their child about it.
• 39% percent of youth who had heard of loveLife looked for more information on sex, sexuality and relationships between men and women; 20% had visited a clinic or private doctor. Some who have heard of loveLife report making behavioral changes as a result of loveLife, including delaying or abstaining from sex (65%) and exploring other forms of sexual activity, like masturbation or oral sex (21%).
• Among the 20% of all youth who are both sexually experienced (defined as youth who report ever having had sexual intercourse) and who have heard of loveLife, almost eight out of 10 (78%) report that as a result of loveLife they have used condoms when having sex. Almost seven out of 10 (69%) sexually experienced youth who have heard of loveLife report it has caused them to limit or reduce their number of sexual partners, and 63% say it has caused them to be more assertive in insisting on the use of a condom. This means that in terms of sexually experienced South African youth overall, more than half (53%) report that as a result of loveLife they have used condoms when having sex, and almost half say that it has caused them to limit or reduce their number of sexual partners (47%).

Soul City 4 - South Africa

Highlighted the issue of violence against women in Southern Africa, as well as HIV/AIDS issues, including condom use and voluntary testing.

Included:

• A television series
• A daily radio drama
• Full-colour booklets
• An advertising/publicity campaign
• An advocacy and social mobilisation campaign

2000 evaluation results:

• HIV/AIDS: the likelihood of positive HIV/AIDS behaviour is 3.9 times higher (p< 0.01) amongst respondents with high exposure to SC TV than amongst respondents with no exposure to SC TV. (This includes using a condom, asking one's partner to use a condom, asking one's partner to go for an HIV test, going for an HIV test oneself, and helping someone who is HIV positive.)
• Respondents exposed to more than one source of SC were significantly more likely to say they had asked a partner to use a condom to prevent getting HIV/AIDS during the broadcast period, with a difference of 28 percentage-points (57% vs 85%) between those with no exposure to SC and those with exposure to 2 sources of SC (p< 0.05).
• Exposure to SC 4 radio was associated with HIV testing: 34% of respondents (valid responses) with no exposure to SC radio had asked their partner to go for an HIV test over the broadcast period compared to 77% of respondents (valid responses) with medium exposure to SC radio; 33% (valid responses) of respondents with no exposure to SC radio had gone for an HIV test themselves, compared to 72% (valid responses) of respondents with medium exposure to SC radio (p< 0.05).
• Reports of “always” using condoms increased with increased exposure to SC: 6% of respondents with no exposure to SC reported “always” using condoms, whereas 16%, 30% and 38% of respondents with exposure to 1, 2 and 3 sources of SC respectively reported that they “always” used condoms (p< 0.05). Respondents aged 16 to 24 with high exposure to Soul City TV were more likely to report that they always use a condom than respondents with no exposure to SC TV (38% vs 26%, p< 0.05), a difference of 12 percentage-points.

Sexual Health Information and Services for Youth - China

• Sexual health programme for unmarried youth (ages 15 to 24) to increase the sexual health information and services available to young people, both in- and out-of-school, living in urban areas of China.
• Included:
  • community-based sexual health counselling and contraceptive services at a youth health counselling centre
  • sex education through youth-focused pamphlets and lectures
  • group activities, including interactive discussion, on sexual health issues
  • contraceptives and condoms made available free of charge to young people
  • sexual health videos, shown at local cinemas prior to popular movies
  • training for family planning providers in provision of youth-friendly services
  • meetings of community leaders and parents.

2000 evaluation results:

• Proportions of youth reporting ever use and/or consistent use of contraception rose significantly among sexually experienced youth in the intervention site between baseline and follow-up.
• At the intervention site, reports of ever use of contraception rose significantly among all youth (from 65 to 99%), among males (68 to 99%), and among females (60 to 99%). Among sexually experienced youth at the comparison site ever contraceptive use rose, but less so (75 to 83%). The rise in ever use of contraception was statistically
  significant for females and for all youth at the intervention site.
• The proportions reporting regular use of contraception rose significantly among sexually experienced youth from the intervention site between baseline and follow-up overall (34 to 89%) as well as among males (33 to 88%) and females (36 to 90%). At the same time among sexually experienced youth at the comparison site regular contraceptive use remained unchanged (44 to 45%).

Twende na Wakati (Let's Go with the Times) - Tanzania

A radio soap opera which promoted HIV/AIDS prevention, family planning, gender equity, and other health issues and was designed to stimulate interpersonal communication about AIDS among the listeners by presenting them with negative, transitional, and positive role models for HIV prevention behaviours.

2000 evaluation results:

• Researchers found positive effects of the radio soap opera on the adoption of HIV/AIDS prevention practices among the listeners. The findings suggested that, after accounting for the potential effects of other national anti-AIDS programmes, 16% of the people in the treatment group had adopted AIDS prevention methods in 1996, and 12% in 1997, as the direct result of listening to the radio soap. The listeners who had adopted an HIV/AIDS prevention method reported reducing the number of their sexual partners (77% in 1995) rather than adopting condom use (15% in 1995) or ceasing to share razors (6% in 1995).

Mass Media Campaign HIV/AIDS - Democratic Republic of the Congo (DRC)

• A mass media campaign in 1998 to promote positive responses to HIV/AIDS through a national multimedia campaign. Youth and urban populations were targeted along with prospective parents.
• Included use of:
  • Television
  • Musicians/music
  • Children's notebooks
  • Radio

1998 evaluation results:

• 85% of the people 6 months after the songs release said that the songs affected their behavior. Of the 85%, one in three were discouraged from multiple partners, one in four began to believe in abstinence, and one in six were encouraged to remain faithful to one partner.
• After two years of the project, 16% more of the people affected by the project said that they had become mutually faithful to their partners (from 28.9 to 45.7%). When asked how their behaviour had changed, 5 times more people responded “by using condoms” (2.6 - 18.8%)
• After the TV drama, nearly 75% of the viewers were encouraged to change their behaviour, and 90% wanted to see another programme.

School Health Education - Uganda

• A sexuality education programme based on social learning theory and intending to change basic attitudes about sexual intercourse and to encourage safer sexual behaviours, delays in the initiation of sexual intercourse and, among sexually experienced youth, reductions in the number of their sex partners.
• Social mobilisation through:
  • a local steering committee
  • a full-time health educator
  • health professionals
  • the involvement and training of local leaders and heads of schools as well as parents, teachers, and senior tutors

1996 evaluation results:

• Between 1994 and 1996, the proportion of students at intervention schools who reported having ever had sex fell significantly from 43% to 11%. At the same time, the proportion of youth from comparison schools who reported ever having had sex remained virtually unchanged (26% in 1994 versus 27% in 1996).
• Among sexually experienced youth in 1994, youth at intervention schools reported an average of 2.2 sex partners; by 1996, this number had fallen to an average of 1.4 sex partners. By contrast, reported numbers of sex partners among sexually experienced youth in comparison schools were 2.1 in 1994 and 2.0 in 1996. The difference was statistically significant. (Note: At baseline, the youth from intervention schools were 3.7 times more likely to be sexually active than those from comparison schools (43% versus 26%, respectively). The youth from rural intervention schools were also 3.7 times more likely to have had sex than youth from comparison schools.)

Family AIDS Education & Prevention through Imams - Uganda

Aims to help Muslim leaders incorporate accurate information about HIV/AIDS prevention into their spiritual teachings by linking the teachings of the Qur'an with recommended risk reduction behaviour. The programme is an effort to provide culturally appropriate HIV/AIDS prevention education to Muslim families living in rural communities and trading centres in Uganda.

1994 evaluation results:

• Between baseline and follow-up, a statistically significant proportion of responding youth from the intervention areas reported a reduced number of sex partners versus responding youth from comparison areas. Among males ages 15 to 24 from the intervention areas, the proportion reporting two or more partners fell from 45% at baseline to 32% at follow-up while rising from 45% to 59% among male youth from the comparison area. Among females ages 15 to 24 from the intervention areas, the proportion reporting two or more partners fell from 13% at baseline to 6% at follow-up while rising from 13% to 16% among female youth from the comparison area.
• Instruction about the importance of using condoms was included in the programme only in the second year, when Imams acknowledged that condoms were an HIV prevention tool that could not be ignored. Reports of ever use rose from 15% at baseline to 25% at follow-up among males from the intervention areas; reports of ever use of condoms also rose among males from the comparison areas (from 15% to 21%). The comparative rise, though slight, was statistically significant for males from the intervention areas.