In most parts of the world, young adults are exposed to media that refer to sex and romance, often with little or no mention of responsible sexual behavior. Casual sex is depicted, but without references to sexually transmitted disease or unintended pregnancy.
Nevertheless, television, radio, music, magazines and other media can also become powerful tools for giving young adults perspective on the consequences of sexual activity. HIV prevention media campaigns in Uganda, for example, have played a major role in encouraging safer behavior. During the 1990s, HIV prevalence among young women has declined in Uganda.1 Some experts attribute the decline to a rise in monogamy, condom use in risky sexual relationships, and later age of sexual debut -- behavior messages that were often emphasized in the HIV prevention media campaigns.
"Every study [in Uganda] shows the same trend of people reporting fewer casual partners, more condom use, and young girls delaying being sexually active," says Elizabeth Marum, HIV/AIDS prevention technical advisor for the U.S. Agency for International Development in Kampala, Uganda, who cautions that the specific role played by media is not clear. "What to attribute these new behaviors to is the question of the hour."
Better research is needed to understand how media campaigns influence behavior, although observers agree that media used effectively can make an important contribution. One such example is a nationwide media campaign promoting safer sexual behavior among Ugandan adolescents, including abstinence, partner reduction and condom use. Beginning in 1995, the campaign by the Delivery of Improved Services for Health (DISH) Project, implemented by Pathfinder International and Johns Hopkins University, promoted HIV prevention messages through songs and soap operas, rap music contests, drama, a newsletter and posters.
The "Hits for Hope" portion of the campaign invited music groups to compose and perform songs about HIV prevention. Eighty groups performed for audiences in 10 different districts. The winning song, "Ray of Hope," by House Lane B, a Kampala-based group, was selected by judges representing the target audience, men and women ages 15 to 19.
The song was then recorded on cassettes, distributed to taxi drivers and youth centers, and sold commercially.2 In surveys of 1,681 adolescents, many of them out of school, the percent who reported using condoms increased from 46 percent before the campaign to 69 percent afterwards, and the percentage who reported they did not know where to get condoms declined, from 42 to 31 percent.3
While a definitive relationship between the campaign and condom use has not been established, the behavior change "definitely coincides with the time of the campaign," says Cheryl Lettenmaier, DISH communication advisor in Kampala. "The consumption of condoms has gone way up. There has been a change in attitudes."
Other media campaigns were used in Uganda. The AIDS Information Center, for example, used radio announcements to attract clients to anonymous and voluntary HIV testing services over several years. When the program advertised special days for young adults to receive free testing, young people turned up in large numbers.
Family planning
Research in Nigeria suggests that media campaigns can help influence family planning behavior. A 1993 survey of Nigerian reproductive age women correlated current use of contraception with whether the women had watched television music videos three years earlier.
The videos featured two songs, "Choices" and "Wait for Me," by popular Nigerian musicians King Sunny Adé and Onyeka Onwenu that conveyed family planning messages and encouraged clinic visits.4 Of 6,879 women surveyed, about 13 percent of those who reported having heard or seen the videos were using contraception, compared to 4 percent of those who had not.
Women who were exposed to pro-family planning messages seemed to be more likely to use contraception and desire fewer children, even when other variables such as education and urban residence were taken into account. The Nigerian study is not conclusive, however, because it is possible that women who heard the songs were more likely to be contraceptive users for other reasons. For example, 12 percent of those who remembered hearing or seeing the videos said they had used contraception in the past and intended to use it again, compared to only 3 percent of those who did not recall the videos.
Many experts believe that media campaigns are an effective way to inform people about where to obtain contraceptive services or other reproductive health care. Clinic locations, hotline phone numbers and referral networks can be included in media campaigns. In 1988, a popular music campaign in 12 Latin American countries, using the singers Tatiana and Johnny, generated high audience approval ratings, but the campaign did not include any messages telling listeners where to go for services. The omission made it difficult to assess the campaign's impact, according to an evaluation.5
Mass media may be especially useful for teaching young adults because media can use elements of popular culture to articulate a message in young people's own terms. Campaigns seem to be more effective if messages appear in different media simultaneously -- music, television, radio, movies and posters. For example, a 1992 AIDS prevention campaign by the National Youth Union and CARE International in Vietnam combined leaflets, television, radio, posters, newspaper articles, booths, discussion groups, and a parade on World AIDS Day.6
A mass media campaign can use celebrities, such as musicians, as role models to demonstrate healthy behavior. However, role models who do not practice what they preach or who behave irresponsibly can have a negative impact on the public's acceptance of campaign messages.
Before any campaign begins, the message and objectives of the campaign must be tailored to fit both the audience and the setting.7 This process should begin with a careful review of the audience, an assessment of current policies and programs that affect the reproductive health services available, and an evaluation of communication resources. Focus group research and pre-testing materials can reveal specific audience needs and help gauge the effectiveness of new materials before they are reproduced and widely distributed.
-- Sarah Keller
References
- The Status and Trends of the Global HIV/AIDS Pandemic Final Report. (Arlington, VA: AIDSCAP/Family Health International, Harvard School of Public Health and UNAIDS, 1996)17.
- Lettenmaier C, Gamurorwa A, Sengendo J. Report on the "Hits for Hope" music competition in 10 DISH districts, May-June 1995. Unpublished paper. Johns Hopkins University, 1995.
- Lewicky N, Lettenmaier C, Sengendo J, et al. The Uganda HIV/AIDS youth communication campaign: preliminary evaluation results. Presented at the 124th Annual Meeting of the American Public Health Association, New York, Nov. 17-21, 1996.
- Bankole A, Rodriguez G, Westoff C. Mass media messages and reproductive behavior in Nigeria. In Westoff C, Rodriguez G, Bankole A, eds. Mass Media and Reproductive Behavior. Chapel Hill: The EVALUATION Project, 1995.
- Kincaid DL, Valente TW, Merritt P, et al. Sex and contraceptive use among adolescents in Lima and Mexico City. Presented at the 120th Annual Meeting of the American Public Health Association, Washington, Nov. 8-12, 1992.
- Franklin B. Targeting young men: audience-centered communication for AIDS prevention in Vietnam, monograph series no. 4. Hanoi: CARE International in Vietnam, 1994.
- DeJong W, Winsten JA. The use of the mass media to communicate public service messages: lessons learned from past campaigns. Unpublished paper. Harvard School of Public Health, 1996.
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