HIV Prevention Knowledge Base
Behavioral Interventions: Mass Media and HIV Prevention
The Effectiveness of Mass Communication to Change Public Behavior
Mass media campaigns have traditionally targeted individual behaviors and evaluated campaign effectiveness by assessing whether people changed their behavior. Data suggest that while mass media can indeed influence behavior change, changes are usually modest. As evidence accumulates about the need for using structural approaches to modify risk behaviors, communication campaigns too must target more than just individual behaviors. The authors discuss the need for adopting an ecological approach to public health communication campaigns—that is, one that considers not only the individual, but the context within which the individual lives. Between this new approach and rapid changes in technology that have redefined what mass media is and how it reaches people, public health communication efforts must adjust accordingly. The authors recommend that in addition to targeting individuals, behavior change messages must target social networks and communities that influence the individuals whose behavior the campaigns want to change.
Using Mass Media Campaigns to Promote Voluntary Counseling and HIV-Testing Services in Kenya
Mass media campaigns can increase the use of HIV testing and counseling (HTC) services, and mass media messages explicitly addressing HIV have greater impact. In Kenya, a professionally designed mass media campaign was developed to increase public demand for HTC. The campaign included radio, television, posters, flyers, outdoor advertising, and a recognizable logo that was used on all materials and on signboards at registered HTC sites. Campaign implementation was divided into four phases: phases one and four more overtly mentioned the possibility of testing HIV-positive, whereas phases two and three used a more understated “lifestyle’’ approach (for example, the phase two message was to “get in control of your life” by knowing your HIV status). Phase one increased attendance by 28.5 percent and phase four by 42.5 percent. There was also a significant increase in HTC uptake among young people under age 25, particularly in urban areas. Phases two and three did not have a significant effect on HTC uptake. The authors note that the timing of phases one and two overlapped, making it difficult to differentiate a negative effect of phase two from a lack of sustained response to phase one.
Radio Role Models for the PMTCT of HIV and HIV Testing among Pregnant Women in Botswana
Role models—both fictional and real-life—can facilitate behavior change. The Makgabaneng radio drama in Botswana was developed to help listeners protect themselves from HIV and support people with HIV through modeling and reinforcement. It included two major storylines about HIV during pregnancy which informed listeners about preventing mother to child transmission (PMTCT). About 250 episodes of Makgabaneng had been broadcast prior to surveying 500 pregnant and postpartum women. Exposure to this drama was high among these women, with 79% of respondents reporting ever listening to the program, and 53% reporting listening at least once a week. Although many women could recall a character in a PMTCT storyline, this recollection was not significantly associated with seeking HIV testing during pregnancy. Women who identified with characters in the drama, however, were more likely to be tested for HIV while pregnant. The authors conclude that such serial dramas can contribute to HIV prevention, treatment, and care when concurrent with widespread access to such services.
One Day I Might Find Myself HIV-Positive Like Her: Audience Involvement and Identification with Role Models in an Entertainment-Education Radio Drama in Botswana
Researchers used 31 in-depth interviews with regular listeners of the Makgabaneng radio drama in Botswana (see Radio Role Models for the Prevention of Mother-To-Child Transmission of HIV and HIV Testing among Pregnant Women in Botswana) to understand why people identified with the positive, negative, and transitional role models in the series. This radio drama included characters dealing with pregnancy and HIV testing. Many listeners aspired to be like the positive role model, who was uniformly admired. The negative role model was not looked upon favorably, and no one aspired to act as she did. Most respondents wanted to discuss the transitional character, with some seeing her in a negative light and others aspiring to be like her. The audience showed evidence of differential modeling: that is, being able to compare and contrast the behaviors among the three characters and seeing the consequences of each characters’ actions. The authors conclude that including more than one transitional character in a series can be beneficial, particularly one who is portrayed as adopting positive behavior behaviors at a later time, after discarding previous risky behaviors.
The Reach and Impact of Social Marketing and Reproductive Health Communication Campaigns in Zambia
This study used the nationally representative 2001–2002 Zambia Demographic and Health Survey to assess the effect of mass media campaigns on condom use. Statistical methods were used to ensure against the possibility that the same factors that influence media exposure also influence condom use, or that condom users may seek out the health communication programs in question. Men were more likely to recall media messages than women, with fully 75% of men reporting exposure to condom messages. Although there was no correlation between exposure to these campaigns and other sexual risk behaviors, men and women with such exposure were more likely to have ever used condoms. For women, the difference was small but statistically significant; however, men exposed to messages were 50% more likely to have ever used condoms. Generally, the more exposure to the campaign, the greater the likelihood of these positive health behaviors—for example, men with the most exposure to messages were twice as likely to have ever used condoms than those with the least exposure. While the study cannot identify what specific content or messages affect condom use or the pathways of exposure, it nevertheless shows an overall positive effect of media exposure to condom use.
The Effectiveness of Mass Media in Changing HIV/AIDS-Related Behaviour among Young People in Developing Countries
This systematic review evaluated mass media interventions addressing HIV-related behaviors among young people from 1990 to 2004 to analyze whether evidence exists for their effectiveness. Fifteen studies from Africa, Latin America, Asia, and one multi-country study met the authors’ inclusion criteria. Study quality varied, and different definitions of variables made it impossible to pool and analyze the data. When radio was combined with other media, or when radio was combined with both television and other media, youth showed improvements in knowledge, skills, awareness, use of health services, use of condoms, and interpersonal communication. These media also had a positive impact on changing social norms. However, not every campaign was successful in influencing every variable. The authors provide recommendations for policy makers, program managers, and researchers about funding, developing, and evaluating mass media programs.
Systematic Review of the Effectiveness of Mass Communication Programs to Change HIV/AIDS-Related Behaviors in Developing Countries
This review examines the effectiveness of 24 mass media interventions on changing HIV-related knowledge, attitudes, and behaviors in developing countries from 1990 through 2004. Media interventions included radio, television, small media, and interpersonal communication, sometimes alone, sometimes mixed. Because the outcome indicators of these studies were so diverse, the researchers evaluated seven key variables, including self-efficacy for condom use, abstinence, perceived risk of HIV, condom use, and discussing HIV or condom use with others. Half of the studies demonstrated a positive impact on knowledge of HIV transmission and reduction in high-risk sexual behavior. For the other five variables, however, the studies showed mixed results or no effect. The authors discuss the difficulties inherent in evaluating mass media campaigns. Their efforts were limited by studies that did not represent the state of the art in mass media communication and were not well designed and evaluated. The authors conclude that “communication campaigns are at the heart of the HIV/AIDS response, yet much work remains…in building the evidence base for their effectiveness.”
Assessing Effects of a Media Campaign on HIV/AIDS Awareness and Prevention in Nigeria: Results from the VISION Project
Using data from household surveys conducted in 2002 and 2004, the authors assessed the impact of the program VISION media campaign on the: 1) discussion of HIV and AIDS with a partner; 2) awareness that consistent condom use reduces HIV risk; and 3) condom use at last intercourse. Although exposure to the campaign was high, its impact on outcome variables was small. Yet, respondents with high program exposure were almost one and a half times more likely than those with no exposure to have discussed HIV and AIDS with a partner, and more than twice as likely as those with low exposure to know condom use could reduce the risk of HIV infection. Program exposure had no significant impact on condom use. While overall differences in the outcome variables were small, effects for some subgroups suggest the potential of media activities.
Comparative Cost-Effectiveness of the Components of a Behavior Change Communication Campaign on HIV/AIDS in North India
This article used data from nearly 1,700 surveyed sexually active adults in North India to understand the effect of mediating factors on behavior changes and changes in condom use, extrapolating the findings to estimate costs of increasing condom use. The researchers evaluated the television components of a comprehensive HIV prevention communication campaign, including a TV drama, a youth-focused reality show, and TV spots. Mediating variables included gender attitudes, HIV/AIDS knowledge, perceived risk of HIV, and interpersonal communication skills. Better recall of the TV components was positively associated with positive mediating variables and higher levels of any condom use (though levels were low overall, at 10% among those with good recall and 4% among those with poorer recall). Furthermore, significant associations were found between the mediating variables and frequency and level of condom use. The TV program with the greatest increases in condom use cost $2.49 per additional person using condoms. Costs of mediating factors ranged from $1.23 per person for increases in HIV knowledge to $4.54 per person for reduced perceived risk of HIV.
The Impact of a Mass Media Campaign on Personal Risk Perception, Perceived Self-Efficacy and on Other Behavioural Predictors
This study of over 2,000 sexually experienced men and women ages 15-39 throughout Kenya assessed the impact of mass media exposure on predictors of behavior change. Branded messages about Trust condoms were compared to generic messages about HIV and condoms as a means of preventing HIV transmission. Trust messages were developed to destigmatize condoms by presenting condom use as a positive lifestyle choice. Respondents exposed to the branded messages were significantly more likely to report positive health behavior beliefs and behavior change predictors than those exposed to generic messages. Predictors included the belief that one could convince their spouse to use condoms; that condoms are effective for HIV prevention; and that HIV prevention is the reason for one’s condom use. Furthermore, there was a positive correlation between exposure and predictors of behavior change. The author concludes that “constructing the image of healthy lifestyle choices can exert a significant influence on risk awareness, self-efficacy and other behavioural predictors” through mass media. While the author used statistical techniques to control bias and confounding, the potential for reverse causality exists in this study.
Behavior Change Communication Strategies
This paper broadly reviews behavior change communication strategies implemented over the first 15 years of the HIV epidemic, showing the changes in sophistication and understanding of health communication needs over time. Key principles behind successful communication efforts are taken from health communication, social marketing, and structural intervention theories. The author then provides lessons learned from vulnerable populations, including women, youth, men who have sex with men, and injecting drug users. He closes the paper with a discussion of research and intervention priorities for the future, including communicating with disenfranchised populations and policymakers, addressing stigma and discrimination, and linking HIV prevention activities within existing health programs.