The newest weapon against HIV/AIDS in Africa? MTV

The latest development in the fight against HIV/AIDs in Africa wasn’t conceived in a lab with scores of scientists, but on a TV set with actors, makeup artists, directors and producers. What are we talking about? The MTV Staying Alive Foundation produced the entertainment education program MTV Shuga, a television drama that targets African youth.  Oscar winner Lupita Nyong'o starred in the first two seasons of the show. The show is broadcast in over 70 countries, reaching over 750 million people worldwide.  

While the first two seasons were filmed in Kenya, the third season was shot in Nigeria, a country that has 3.3 million people with HIV/AIDS — 9% of the global total. As in most African countries, the epidemic disproportionally affects young women. 15- to 24-year-old women are almost twice as likely to be infected as their male counterparts. Sex with older men, a.k.a. “sugar daddies,” is a driving factor in why women are infected disproportionally more than men.

Despite investments of millions of dollars in HIV awareness and behavior change campaigns, important knowledge gaps persist.  According to the latest Nigerian Demographic Health Survey, only a third of Nigerian youth properly understand how HIV/AIDS is transmitted. Moreover, just knowing about HIV/AIDS doesn’t necessarily mean behavior change, as other social and psychological factors are at play. Information and behavior change campaigns, often lacking motivating narratives and communicated through traditional outlets such as pamphlets, rarely reduce risky sexual behaviors, especially in the long run.

Enter MTV and development research

Pop culture has a unique advantage over other dissemination vehicles because of its breadth and power to update people’s perceptions of what is “normal” and socially acceptable, as recently highlighted by the Bank’s 2015 World Development Report “Mind, Society and Behavior.” There are a few theories, one of which is that narratives are easier to understand and commit to memory than abstract concepts. The blurred lines between fantasy and reality make the messages easier to digest. The show’s characters can be role models and therefore influence behavior change in their fans. Soap operas can repeat the same message and keep it fresh by changing the storylines and characters. Traditional campaigns, on the other hand, become repetitive too soon. The popularity of soap operas among poorer and less educated households presents a unique opportunity for the show to make a significant dent in bridging socio-economic divides. 

Although it is clear that educational soap operas work in theory, do they work in practice? The World Bank’s Development Impact Evaluation (DIME) unit teamed up with MTV Staying Alive Foundation, the Bill & Melinda Gates Foundation, and academics affiliated with the Abdul Latif Jameel Poverty Action Lab to evaluate MTV Shuga. The study, led by DIME economist Victor Orozco, implemented large cluster randomized controlled trials in southwest Nigeria to study the effects of the third season of the TV series on viewers and their friends. Entertainment screenings were carried out in 80 community centers.

While the final report won’t be ready until this summer, preliminary results of the six-month follow-up survey are promising. Viewers, especially women, liked the show and four out of five people remembered that the show was about HIV. The experimental evaluation shows that MTV Shuga improved knowledge about how HIV is transmitted and debunked myths—for example, that you can get HIV by shaking hands. The show positively changed viewers’ attitudes towards sugar daddies, people living with HIV/AIDS, and gender-based violence.

What about HIV testing and risky sexual behaviors? The evaluation found that viewers were a third more likely to report getting tested (11.1% versus 8.6% in the control group). To obtain an objective measure of testing, during the six-month follow-up survey, the research team gave study respondents information about the nearest HIV testing centers and verified whether they visited the testing centers. The treatment group was twice as likely to go to the centers and get tested after six months of watching the show (6.6% versus 3.3%), an important accomplishment considering that one in ten sexually active Nigerian youth gets tested every year.

The show led to reduced concurrent sexual partnerships and most importantly,  reduced new infections of chlamydia, a common sexually transmitted infection, among female viewers (1.3% versus 3.1% in the control group), a substantial reduction rarely seen in the HIV behavior change literature.

Would educational soap operas work in different countries or in other sectors? The DIME team says maybe, but that much more research is needed to inform the global scale up of effective entertainment education by governments and development partners. And this is how DIME started a new program to expand the research in main entertainment hubs.

However, the study results offer an encouraging message on the potential to use entertainment education as a development tool. Given the popularity of soap operas among poorer and less educated households, entertainment education could be used to positively change hearts, minds, and most importantly, behaviors of millions of individuals at very low marginal costs, not only around stigmatized issues such as HIV/AIDS and gender- based violence, but also around other development issues.

For now, it looks like pop culture and development research are the new besties. The World Bank study was recently covered by the leading showbiz newspaper, “The Hollywood Reporter” (along with other dramatic Hollywood stories). MTV Shuga is now moving to South Africa, with Nigerian singer, songwriter, and actress Tiwa Savage playing a DJ who faces the different challenges that African young women face on TV, in the real world, and everywhere in between.