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Youth have a new attitude on AIDS, but are they talking about it? Alison Zisser & Dennis Francis Published online: 11 Nov 2009.
To cite this article: Alison Zisser & Dennis Francis (2006) Youth have a new attitude on AIDS, but are they talking about it?, African Journal of AIDS Research, 5:2, 189-196, DOI: 10.2989/16085900609490379 To link to this article: http://dx.doi.org/10.2989/16085900609490379
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African Journal of AIDS Research 2006, 5(2): 189–196 Printed in South Africa — All rights reserved
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Youth have a new attitude on AIDS, but are they talking about it? Alison Zisser and Dennis Francis*
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School of Education and Development, University of KwaZulu-Natal, Private Bag X03, Ashwood 3605, Durban, South Africa * Corresponding author, e-mail: [email protected]
In advocating HIV prevention, organisations such as loveLife in South Africa have increasingly used the media to encourage communication and influence behaviour change in youth. Our study examined youths’ understanding and communication habits surrounding loveLife’s extensive ‘Get Attitude’ print campaign. Intrigued by the ambiguous campaign message, we implemented a questionnaire-based study in three urban KwaZulu-Natal schools to investigate how youth are interpreting the images and to determine whether they would connect the personalityaimed message with HIV prevention. As communication is a focal point of loveLife’s strategy, we looked at whether the campaign was successful in fostering discussion and examined what factors contributed to or impeded dialogue. One-hundred-and-eighty-seven Grade 11 students completed the questionnaire, responding to both multiple-choice and free-response questions about the ‘Get Attitude’ campaign images. Our study was largely exploratory, with the data revealing that the youth did interpret the images as intended by loveLife. While the campaign failed to stimulate discussion for many of the youth, those who did talk about the campaign were more likely to speak to their teachers than to parents or friends. Keywords: Africa, communication, knowledge/attitude/behaviour, loveLife, media, prevention campaigns, sexual behaviour
Introduction South African youth know about AIDS. They understand how HIV is transmitted. Most can explain what safe sex means and will tell you why abstinence is the most effective prevention mechanism (Harrison, Smith & Myer, 2000). However, with the peak incidence of HIV occurring in youth aged 15 to 24 (Reproductive Health and Research Unit, 2004), knowledge clearly does not always translate into action. Youth represent the most critical target population for HIV prevention strategies, as over 95% of South African 15–16-year-olds are HIV-negative. If these youth successfully internalised HIV prevention, the pandemic would collapse within the next decade (loveLife, 2005a). With no known cure for AIDS, recent literature on the prevention of HIV recognises behaviour change as the only means of preventing its spread. While South African efforts have been very effective in raising awareness of HIV/AIDS, Harrison et al. (2000, p. 289) believe past prevention campaigns lacked qualities necessary to effect lasting behaviour change: “While much has been done, the impact on the epidemic has been slight and much greater commitment, resources and effort will be needed if we are to make any impact on the course of the epidemic. Currently there is a substantial gap between high levels of knowledge and low levels of preventive practice.” Harrison et al. (2000) offer several suggestions for improving prevention campaigns, such as aiming interventions at high-risk populations, promoting culturally relevant messages, extending links to other health services, such as family planning and antenatal care centres, and continuously evaluating a programme’s effectiveness.
While many researchers (e.g. Kuhn, Steinberg & Mathews, 1994; Harrison, 2002; Kelly, 2002; Morrel, Moletsane, Abdool-Karim, Epstein & Unterhalter, 2002; Rugalema & Khanye, 2002) have focused on schools as the main vehicle of HIV/AIDS education, it is critical to acknowledge other ‘non-formal’ sources of information — namely the media and interpersonal communication. Outside of school, South African youth access HIV/AIDSrelated information from a multitude of sources including television, radio, billboards, posters, newspapers, magazines and conversations with family and friends (Africa Strategic Research Corporation/The Kaiser Family Foundation, 2002; Francis & Rimmensberger, 2005). Organisations focused on prevention (such as loveLife, the largest HIV/AIDS awareness movement in South Africa to date) continuously seek innovative means to instil HIV prevention skills, using the media to stimulate and complement prevention-related communication in schools and at home. At its inception, loveLife identified communication as the key factor in effecting behaviour change and expressed its importance through the loveLife slogan “Talk about it” (Reproductive Health and Research Unit, 2004). Through their advertisements and events, loveLife continuously encourages openness about sexuality and AIDS: “This is based on the premise that more open communication about these issues will challenge social norms and lead to positive behaviour change such as delaying age of first sex and increasing safer behaviour” (Pettifor, Rees, Steffenson, Hongwa-Madikizela, MacPhail, Vermaak & Kleinschmidt,
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2004, p. 53). LoveLife recognises that only through open communication in confronting misconceptions of gender roles, challenging power differentials, teaching healthy habits, and instilling life skills will South Africans begin to demonstrate the behavioural modifications necessary to successfully stem this epidemic. Even so, societal tensions over gender identity and sexuality complicate and confuse this communication. Thomas (2004), for example, argues that the loveLife campaign obscures rather than addresses the social factors that shape gender identities. She critiques the campaign’s failure to deal with crucial issues such as the vulnerability of young women, sexual violence and transactional sex. In the same way, Reddy (2004) suggests that in “talking about it”, youth must talk about much more than safer sex. In her article ‘Safe sex or safe love’ she proposes that before youth can change their notions of sex, they must shift their views of the opposite sex. She explains that the gendered language of sex undermines gender identity and creates an environment where women surrender power over their sexuality. Communication on HIV/AIDS must address the social pressures young people experience as they manage their own sexuality. Confronting culturally taboo aspects of sexuality and encouraging discussions on one’s role as a man or woman may positively impact a young person’s sexual identity and behaviour. While reviewing recent research on HIV/AIDS communication we noticed a discrepancy between identified successes and failures in terms of increasing discourse about HIV/AIDS and sexuality among youth. The loveLifesponsored National Survey of HIV and Sexual Behaviour among 15–24-year-olds reported that 44% of youth had spoken to parents or guardians about HIV/AIDS and a vast majority of the 56% who did not communicate with parents or a guardian, said they had spoken to friends (Pettifor et al., 2004). Yet, research by Narismulu (2004) presents a youth far less willing to talk about HIV/AIDS. When youth were asked what peers are discussing about HIV/AIDS, many replied, “nothing” or “very little”. When the youth were asked why, they often replied that the subject was “too personal” or they feared rejection from friends for raising the issue (Narismulu, 2004, p. 458). Thus, while one study presents a youth actively communicating about HIV/AIDS, the other depicts youth as fearful to broach the subject. In 2005, loveLife launched its “Get Attitude” campaign (see Figure 1), a year-long stage of their multi-year and multi-message campaign. LoveLife publicised the “Get
Attitude” message on billboards, bus placards, magazine pages and newspaper inserts across South Africa. While one image dominantly features the organisation’s name, loveLife, and the slogan “Get Attitude”, the second presents the motto “Born Free”. The 2005 campaign differed greatly from past promotions by focusing on an individual’s personality rather than on overt behaviour. But evaluating these images, we wondered, what does “get attitude” even mean? The ambiguity is perhaps the most interesting (and troubling) quality of the campaign, as the advertisement does not deliver a concrete message to viewers. Singer (2005, p. 25), a critic of loveLife, characterised the campaign as “stylish but often cryptic” and Thomas (2004, p. 29) described the campaign as featuring “abstract and seemingly nonsensical images and text”. As the AIDS pandemic reaches catastrophic proportions, it seems dangerous and foolhardy to rely upon the chance understanding of such an influential and far-reaching campaign. Thus, we set out to investigate how youth, as the target population for loveLife campaigns, conceptualise and understand the “Get Attitude” and “Born Free” slogans. Is the campaign communicating the intended preventive message to the South African youth? In examining how youth are processing the “Get Attitude” and “Born Free” messages, we also wondered whether these advertisements stimulated discussion, a key objective of loveLife’s work. If the youth are communicating about these advertisements, to whom are they speaking? Are they showing a preference in talking to friends versus parents or teachers? Why are they choosing to talk to these individuals? And more importantly, why are they perhaps not choosing to talk?
Image 1
Image 2
Methodology Current research on HIV/AIDS in South Africa emphasises a qualitative, micro-level approach to studying the epidemic (Muthukrishna & Mitchell, 2006). However, larger-scale or macro-level findings on population habits and sentiments, while shallow in personal value, are still quite necessary in measuring the societal effects of HIV/AIDS or in evaluating prevention methods. In studying the extensive loveLife campaign, we sought insight into how youth were processing the campaign messages as well as a quantified account of whether adolescents were talking about these images. Acknowledging the merits of both methodologies, we incorporated a qualitative and quantitative approach to balance each method’s limitations.
Figure 1: Media images used by South Africa’s loveLife 2005 ‘Get Attitude’ campaign
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We chose a questionnaire format as the most effective means of accessing the desired information. A questionnaire is an easily distributed, structured instrument, through which researchers may access important information while maintaining the privacy of their respondents (Cohen, Manion & Morrison, 2000; Babbie & Mouton, 2001; Terre Blanche & Durrheim, 2002). After reviewing present literature on data collection and consulting with loveLife’s own media analyst,1 we designed a 41-item questionnaire. The authors employed multiple-choice questions and rating scales to acquire quantifiable information about the youth’s impressions of the loveLife campaign, as well as free-response questions to help explain and elaborate on how the campaign’s images influenced their communication about HIV/AIDS. Since the loveLife media campaign reaches a large number of South African youth, the research goals necessitated a sizable number of respondents. We used a sample of roughly 180 students as a significant but manageable number for gathering information on behavioural habits and personal impressions of the campaign. We targeted Grade 11 students, as this age group falls within the high-risk population of 12- to 17-year-olds targeted by loveLife, had completed a course on life orientation and sexual health, and are at an age where many of their peers are becoming sexually active (loveLife, 2005b). To provide an adequate sample size, we selected three schools: an ex-DET, ex-HOD, and ex-Model C school.2 Thus, the three schools provided a student sample that varied by race and socio-economic status but with a fairly equal distribution of males and females. The study was approved by the Ethics Committee at the College of Humanities, University of KwaZulu-Natal. Permission was obtained from the provincial Department of Education and Culture and from the three school principals. Confidentiality and anonymity were stressed and maintained throughout the study. Twelve Grade 11 16-year-olds from two urban schools piloted the questionnaire for its length, language and clarity. Using feedback from the pilot, we revised the questionnaire as needed. A total of 187 (80 male, 107 female) students completed the questionnaire during a free period in school. The participants were evenly distributed across the three Durban schools: 62 from an ex-DET, 63 from an ex-HOD, and 62 from an ex-Model C school. The sample included students from the four main racial groups in South Africa: black, white, coloured and Indian. Participants completed the questionnaire in an auditorium-like room or lecture hall, under the supervision of one of the researchers and school staff. Instructions were given to the students orally as well as on the questionnaire’s cover, to respond to the questionnaire items based on their experience with the ‘Get Attitude’ and ‘Born Free’ billboard images (also depicted in the questionnaire). Respondents were informed on the questionnaire and by the study’s administrator that their participation was voluntary and that their answers would be kept confidential. If they felt uncomfortable, they could discontinue with the questionnaire at any time. Each group of participants received the same instructions. The questionnaire began with five demographic questions (age, sex, race, first language, and household
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economic level). Respondents were then asked to view the two loveLife images (Figure 1) and to briefly write about what the images meant to them. Next, multiple-choice questions inquired if the participant had seen the images before, and to whom the participant may have spoken about the images. The students were then asked a series of multiplechoice and open-ended questions about their communication habits related to the images: Have you discussed these images with friends? If no, why didn’t you discuss these images with friends? If yes, why did you discuss these images with friends? If yes, did you discuss these images with mostly female or male friends? If you discussed these images with friends, how did your friends respond? Why do you think your friends responded in this way? Two sets of questions followed, substituting ‘parent/adult guardian’ and ‘teacher’ for ‘friends’. Participants were then asked to give their definition of “get attitude” and “born free”. Finally, the students responded to questions about how the “Get Attitude” campaign related to HIV prevention and to information learned at school. They rated the success of the campaign and were asked to offer suggestions on how the prevention campaign images could be improved. Data showing the campaign’s rating by the students are not presented in this paper. Data processing was conducted using SPSS statistical software. For the free-response questions, each author reviewed twenty questionnaires and formulated categories for each question based on common responses. A third, outside researcher reviewed twenty questionnaires to confirm the reliability of the categories. The free-response questions were then categorised by the third researcher based on these groupings. For example, respondents’ answers to the question, “What does ‘Get Attitude’ mean to you?” fell into one of four categories: 1) Improve your attitude; 2) Act independently; 3) Live a healthy life; or 4) Get informed about HIV/AIDS. The category ‘Other’ was always included to accommodate responses that did not fit into the established categories.3 Results In this section we present findings on how youth interpreted the ‘Get Attitude’ images and on how successful the campaign was in stimulating discussion. The data reveal critical information on the communication habits of the youth and the factors that contributed to and impeded open dialogue. Although 187 students participated, not all students responded to every question. A weakness of questionnairebased methodology is that it is difficult to ensure that participants all commit equal effort to a study. The lack of responses to some questions can bias the interpretation of results. However, we believe the absence of information is as telling as the actual responses when considering the feelings of youth towards HIV prevention efforts. This matter is considered in the discussion section. Data analysis revealed that the youth did in fact interpret the images in line with loveLife’s design. Seventy-four percent (128 respondents) indicated that the images communicated that they should adopt a different, more positive outlook on life. Twenty-one percent (36) connected
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the simple messages “get attitude” and “born free” with HIV prevention. This suggests a pre-existing understanding of loveLife’s organisational goals, as neither advertisement explicitly addresses contraction of the virus. The authors were interested in how participants unfamiliar with loveLife interpreted the images, since understanding the campaign message depends largely on one’s familiarity with the loveLife organisation. Consistent with loveLife’s finding that most South African youth are familiar with the loveLife brand (loveLife, 2005b), 94% (176) of our participants reported familiarity with the loveLife organisation. A chi-square test demonstrated no significant difference according to participants’ familiarity with loveLife with how participants interpreted the campaign images (p > 0.18). Participants also addressed each image independently, first interpreting “get attitude” and then “born free”. Participants’ explanation of “get attitude” corresponded with loveLife’s definition of the phrase, with 88% indicating that it meant they should either adopt a new outlook on life or act independently (70 and 81, respectively). Students varied more with the expression “born free”, with responses ranging from “all opportunities are open” (37%; 63), “the freedom to act alone” (37%; 62), “freedom from disease” (12%; 20), to “the end of apartheid rule in South Africa” (12%; 20). In rating their impressions of the loveLife images, the youth responded very favourably. Seventy-seven percent (138) either agreed or very much agreed (46 and 92, respectively) with the message communicated by the ‘Get Attitude’ images. Ninety percent (160) either agreed or very much agreed (39 and 121, respectively) that it is important to talk about personal attitude in facing dangers and challenges. LoveLife states as a principal goal that their prevention campaigns should foster communication about HIV and prevention measures. Thus, we were especially interested in the conversation habits of the loveLife audience. The results indicate that while some participants communicated with friends, parents and teachers, many other participants did not discuss the campaign images. Only 19% (35) said they had discussed the images with friends, 28% (51) had discussed the images with parents, and 30% (54) had discussed the images with teachers. It is particularly interesting to us that more of the youth talked about these images with their teachers and parents than with their friends. The participants who did not discuss these images with teachers, parents or friends varied in their responses as to why not. When considering communication with friends, many of the participants (44%; 64) answered that the images simply did not seem important enough to discuss. Others indicated that they already understand HIV prevention (18%; 26); that the topic was not appropriate to their conversation (18%; 27); or that their friends simply do not care (12%; 17). Of the youth who did not speak to parents, some participants responded that they did not feel comfortable (39%; 49), while others did not feel the need to discuss the images with their parents (39%; 48). Participants offered similar reasons as to why they did not speak with teachers, such as they did not feel comfortable (26%; 31) or did not feel it was important to discuss (19%; 23). Some respondents (38%; 46) wrote that the campaign was not addressed in school.
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Responses by participants who did engage in discussion about the images with friends, parents, and/or teachers reveal that certain factors encouraged communication. Of the participants who spoke to friends, 70% (21) wrote that they feel the subject is important to discuss, and 17% (5) wrote that their friends are interested. Forty-three percent (20) who had spoken to their parents responded that the subject is important to talk about; 21% (10) wrote that the parents care about the child; and 17% (8) indicated that they share an open relationship with their parents. Teachers were the most popular choice with whom to engage in conversation. Forty percent (21) explained that it was the teacher’s job to discuss HIV prevention, while 23% (12) attributed the discussion to their teacher’s concern for students. Only 12% (6) wrote that their relationship with their teacher made it comfortable for discussion. Nineteen percent (10) wrote that discussion with a teacher occurred simply because they wanted to know more about the campaign and message. Interestingly, when participants did discuss these images, they claimed that friends, parents and teachers generally responded in an interested and positive way (76%, 35; 90%, 72; and 96%, 54, respectively). This demonstrates that although many of the respondents did not feel comfortable or thought that others did not care, when conversation did occur the results were usually positive and beneficial. However, there were several cases where a young person did attempt to talk about the campaign to friends, parents or teachers, and the other party rebuffed them or acted uninterested. While only 3 of the 187 participants had spoken to their friends, parental figures, and teachers about the loveLife campaign, it appears that many of those having communicated did speak to more than one target: 21 of 35 students who had spoken to friends, also spoke to a parent or teacher; 26 of 51 participants who communicated to parents also spoke with friends or a teacher; and 25 of 54 participants who had spoken to a teacher also spoke to friends or a parent. Chi-square analysis demonstrated no significant difference by gender in communication habits with friends, parents and teachers (p > 0.41; p > 0.22; and p > 0.27, respectively). Discussion This study was largely exploratory, with the data revealing that while the youth did successfully interpret the loveLife images, they preferred to discuss the campaign with teachers and parents rather than with peers. Through the “Get Attitude” message, loveLife intended to market personality and attitude — to stimulate discussion on HIV/AIDS and to encourage lasting behaviour change. At the onset of the campaign, loveLife received strong criticism for the images’ ambiguous and cryptic nature. However, in the present study, the respondents’ interpretations of the campaign suggest that the ambiguity of “get attitude” (get attitude about what?) and “born free” (born free of what?) allows students to personalise the message to their individual lives and circumstances. Moreover, most responses corresponded well with loveLife’s own interpreta-
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tion of “attitude” as a positive force that will enable youth to achieve their goals (loveLife, 2005a). One participant wrote that the images meant, ‘Enjoy your youth. Love yourself. Live to the fullest. Be careful of the choices you make in life. And RESPECT yourself!’ [participant’s emphasis] For these youth, the ‘Get Attitude’ campaign was about gaining confidence, setting goals, and fulfilling their aspirations. Considering the social tensions that surround HIV/AIDS and sexual identity, we wondered how gender identity may impact interpretation of the loveLife campaign. Particularly encouraging was the number of female respondents who wrote about the need to set high goals and establish control over their sexuality. As argued by Reddy (2004), one of the greatest obstacles to effective dialogue between males and females is the power discrepancy between genders and traditional notions of male and female roles. Young women’s dependence on their boyfriends for security, their fear of rejection, and men’s belief that sex with multiple partners will prove their masculinity all directly challenge certain HIV prevention measures, such as demanding condom use and reducing the number of one’s sexual partners (Morrel, Unterhalter, Moletsane & Epstein, 2001; Moletsane, Morrel, Unterhalter & Epstein, 2002; Morrel, Moletsane, Abdool-Karim, Epstein & Unterhalter, 2002; Reddy, 2004). Responses by both male and female participants reflect the power dichotomy proposed by Reddy (2004) and demonstrate how attitude and confidence may challenge traditional gender roles. A female participant wrote that ‘get attitude means that I must not be passive and must not just sleep with people because they want to’. By internalising attitude as a source of confidence and independence, youth become better equipped in making decisions to benefit themselves rather than their partners or friends. While condom use and faithfulness to one partner are direct means to safer sex and preventing HIV infection, a sense of independence and a confident attitude represent indirect means of protecting oneself, through which the direct preventive actions are more likely to take place. Despite the audience’s successful interpretation of this new brand of prevention message, the media images failed to stimulate discussion for many of the study’s participants. If the study participants had understood the campaign message, what prevented so many of them from carrying the message forward? When asked why they did not talk to their friends about the images, participants frequently responded that their friends do not care, the subject did not seem important, or they already understand HIV prevention: ‘I didn’t think they [the images] concerned me. Or had to do with me. And my friends wouldn’t like the subject of discussion.’ Frequent answers of this nature reflect the disturbing finding that 44% of 15–19-year-old South Africans believe that they are not at risk of contracting HIV (Pettifor et al., 2004). However, participants in the present study overwhelmingly agreed that it is important to discuss attitude when facing dangers such as HIV/AIDS. These contradictory findings demonstrate that youth understand the critical nature of HIV/AIDS, but deflect feelings of personal vulnerability. Some respondents reported that despite the issue’s importance, they avoided the topic because they feel none of their peers share their concern.
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This contradiction in beliefs supports Narismulu’s (2004) concept of social isolation — the phenomenon in which individuals reject supportive social networks due to irrational fears of rejection. In order for youth to overcome these fears when raising subjects such as HIV/AIDS and sexuality, they must be given safe spaces for open dialogue and must be constantly encouraged to communicate about the societal dangers they face. It is likely that they would find common understanding in each other’s fears and concerns. While many organisations, such as loveLife, have developed discussion-based youth programmes, young people may not take advantage until they internalise their vulnerability to the condition and their role in its prevention. Youth must be reminded that their peers are experiencing similar fears and challenges. Perhaps loveLife should modify their well-known “Talk about it” slogan to include “because your friends want to talk about it too”. The hesitance to speak with friends and the participants’ common response that the topic did not seem important reflects another formidable challenge in HIV prevention education — AIDS fatigue. As educators and activists have integrated HIV/AIDS education into nearly every feasible outlet, the audience has tired of the issue, ironically before much discussion among young people has even taken place. South African youth have become so inundated with HIV prevention messages that they report a general apathy or fatigue towards AIDS-related information. This fatigue usually takes one of two forms: “Either ‘Other people are going to get AIDS’ or ‘We are going to get AIDS anyway, so why bother?’” (Mitchell & Smith, 2001, p. 513). Despite this, the need for HIV prevention remains until South African youth display lasting behaviour change. The challenge, however, is for advocacy groups to explore ways of engaging youth meaningfully by situating them as active participants in HIV prevention. Empowering youth as agents in their own prevention education and as dispensers of this information to others will provide an engaging and cooperative environment for effective communication on the complex issues surrounding HIV/AIDS (Walsh, Mitchell & Smith, 2002). The close association of sexuality with HIV/AIDS typically causes tension in dialogue, especially between youth and parental figures. Some students wrote that their parents hold old-fashioned beliefs about sexuality and do not understand the pressures facing today’s youth. Research on the dynamics of HIV/AIDS communication reveals this perceived generation gap and the taboo status of sexuality within familial dialogue. Both parents and children may evade the topic, preferring silence to the temporary discomfort that often accompanies critical dialogue even though it can lead to new understanding (Campbell & MacPhail, 2003). Whereas, until now, parents have been responsible for instilling life skills and promoting healthy habits, many adults have skirted this responsibility when dealing with HIV/AIDS. Even parents who do discuss these subjects with their children may thwart future communications by using an authoritarian tone: ‘Thou shallt [sic] not engage in sex’, as one participant put it. Not only do parents have tremendous influence on their children’s confidence and identity development, but it is often their attitude and openness towards communication that encourages dialogue on critical issues such as HIV/AIDS.
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Contrary to recent research showing that youth are most likely to speak to their friends about HIV/AIDS, followed by parents and then teachers (Pettifor et al., 2004), our results show the opposite — that respondents more often spoke to teachers, less often to parents, and least often to their friends. While, Pettifor et al. (2004) report on communication habits concerning HIV/AIDS, this study looks at communication habits concerning loveLife’s 2005 campaign. Even so, as the loveLife campaign is designed to stimulate dialogue on HIV/AIDS, we expected communication habits to mirror past findings. While teachers were the most popular to speak to, analysis of participants’ responses revealed a critical difference as to why. Participants reported talking to friends and parents because of a supportive relationship or the importance of the subject matter. They spoke to teachers because they felt that it is the teacher’s job to discuss HIV prevention. This suggests that some youth may view HIV/AIDS education as an obligatory lesson given by teachers, at the teachers’ rather than the students’ initiative. It is also possible that the utilisation of loveLife materials in the classroom prompted discussion on these images. Perhaps the ambiguous nature of the advertisement also influenced the youth’s decision to speak with adults over their peers. Nonetheless, the results suggest that since many parents are not communicating about HIV/AIDS with their children, the ‘job’ of initiating discussion has passed from parental figures to teachers. Dependence on teachers to instil these lessons may be problematic, as teachers are already overburdened with full curriculums and often over-crowded classrooms (Coetzee & Kok, 2001; Theron, 2005). Past research on AIDS education has demonstrated the challenges of preparing teachers to address such a culturally sensitive topic. In many cases, a teacher’s erroneous notions of the virus and its transmission have biased classroom discussions (Coetzee & Kok, 2001; Rugalema & Khanye, 2002; Baxen & Breidlid, 2004). This demonstrates the limitations of an approach that relies strongly on teachers to impart this information. There remains the need to explore how families, for example, can be an effective vehicle for HIV/ AIDS education. It is impossible to design a prevention campaign that will appeal to every consumer, and as the leading HIV prevention organisation in South Africa, loveLife assumed certain risks in establishing the ‘Get Attitude’ campaign. First, understanding the message depends upon the viewer’s familiarity with the loveLife organisation. Although our results show that the participants unfamiliar with loveLife still demonstrated a ‘change your attitude’ understanding consistent with that of participants familiar with the organisation, very few explicitly linked the campaign with HIV prevention. We believe this connection would be lost on most young men and women unfamiliar with loveLife. The 2005 loveLife campaign also fails to specify to whom it is speaking. LoveLife likely intended this particular ambiguity, because HIV/AIDS affects everyone regardless of race and class, and prevention campaigns are often criticised for ‘racialising’ or blaming one sub-population for the epidemic. However, without a concrete target, it is much
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easier to deflect ownership and responsibility for the problem, as demonstrated by the participant who wrote, ‘I didn’t think they [the images] concerned me. Or had to do with me.’ That participant’s words support the theory of Harrison et al. (2000) which states that behavioural interventions are most successful when they target specific groups at risk. However, the pervasive nature of epidemic should caution prevention campaign planners to avoid stigmatising one sub-population and in turn neclecting the risk to another societal group (Coulson, 2002). Media campaigns, especially billboard images, rely on momentary viewing to spread the intended message. Just as specifying the target could lead to more effective understanding, so could specifying the underlying communication goal, namely “talk about it with someone”. We believe that the phrase ‘talk about it’ has been so well marketed by loveLife that it has lost some of its potency. Just as explicit societal tensions such as gender identity must be addressed through prevention campaigns, so must more implicit problems, such as social isolation. Messages in public spaces, such as, “Speak to your friends. They want to talk about it” or “Speak to your parents. They’re interested” would not only remind youth that support networks do exist, but would also communicate to parents that they play a critical role in encouraging prevention. As our research demonstrated, when open dialogue about these images and HIV/AIDS did occur, the participants found the experience positive and beneficial. In evaluating our results, the reader should be mindful of several possible limitations to the study. While we chose to use a questionnaire involving both multiplechoice and free-response questions, it was impossible to guarantee that every participant would dedicate equal care and effort in completing the questionnaire. The length and completeness of responses varied across the subject pool. Whereas incomplete questionnaires could be attributed to participant laziness, we interpret it as another indication of AIDS fatigue: some participants may have viewed the questionnaire as yet another reminder of HIV prevention and so conducted a silent protest by exerting less effort. There are also several qualitative questions left unanswered. For example, did the youth communicate about the loveLife images with boyfriends or girlfriends? And if the youth had communicated about these images with peers, parents, or teachers, who instigated the discussion? Finally, our study offers insight into the communication habits of a fairly small, urban sample of youths. As interpretation and implementation of the campaign likely vary between urban and rural communities, similar research should be conducted among rural youth. Conclusions LoveLife has succeeded in presenting a new brand of HIV prevention message and in gaining the attention of South Africa’s media-savvy youth. While the campaign may be criticised for its ambiguous nature, the youth surveyed in this study understood the underlying message of “get attitude” as intended by loveLife. The message is direct
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enough to imply the necessary choices youth should make to remain free of the virus, but ambiguous enough to allow viewers to apply the “Get Attitude” message to their individual lives. While the campaign was not overwhelmingly successful in stimulating discussion, those who did communicate about the images demonstrated a strong preference for speaking to teachers or parents over their peers. As the HIV/AIDS pandemic continues, prevention organisations must maintain their commitment to designing and implementing effective prevention campaigns to reach a population already bored of prevention messages. LoveLife designed their ‘Get Attitude’ campaign as a fresh, positive, personality-based approach, and the youth have understood the message. However, to effectively curtail the epidemic, youth must do more than understand. They must internalise the attitude of prevention and talk about it with their friends, significant others, family and teachers. Only with such openness and mutual support will youth realise that they hold the behavioural tools necessary to drastically reduce HIV incidence. Notes 1
2
3
The loveLife media analyst provided statistical information about loveLife’s campaign distribution across South Africa as well as the sample images used in the questionnaire. Under apartheid, all schools were operated by racially-divided education departments. DET schools were for black African students only and were operated by a specific national department. HOD schools were operated by the Indian House of Delegates. Model-C schools were provincially operated schools for White students and were permitted to take in pupils of colour after a certain date. Although these categories have been formally eliminated, schools often retain an ethos from the period, and are thus referred to as ‘ex’ one category or another. The authors recognise that each individual will approach the phrase with a unique perspective. The categories were not intended to reduce the value of the information, but to establish a pattern of response. The number of categories per free-response question varied based on the number of common responses. If at least two students indicted a similar response, a new category was established.
The authors — Alison Zisser is a graduate student in clinical and health psychology. She conducted this research as an international affiliate at the University of KwaZulu-Natal. Her research interests include child psychology and parent-child interactions. Dennis Francis teaches in the area of social justice education in the Faculty of Education at the University of KwaZulu-Natal. His research interest include narrative inquiry, youth and HIV/AIDS.
References Africa Strategic Research Corporation/The Kaiser Family Foundation (2002) The 2001 National Survey of South African Youth. Johannesburg, March 2002. Babbie, E. & Mouton, J. (2001) The Practice of Social Research. Cape Town, Oxford University Press. Baxen, J. & Breidlid, A. (2004) Researching HIV/AIDS and education in sub-Saharan Africa: examining the gaps and challenges. Journal of Education 34, pp. 9–29. Campbell, C. & MacPhail, C. (2003) ‘Condoms are good but I hate those things’: sexuality and HIV-transmission among
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young people. In: Campbell, C. (ed.) ‘Letting them Die’: Why HIV/AIDS Prevention Programmes Often Fail. Cape Town, Double Storey. Coetzee, A. & Kok, J.C. (2001) What prohibits the successful implementation of HIV/AIDS, sexuality and life-skills education programmes in schools. South African Journal of Education 21(1), pp. 6–10. Cohen, L., Manion, L. & Morrison, K. (2000) Research Methods in Education, 5th edition. London, Routledge Falmer. Coulson, N. (2002) Developments in the use of the mass media at the national level for HIV/AIDS prevention in South Africa. Available at: http://www.eldis.org/static/DOC10659.htm [Accessed 30 June 2005]. Francis, D. & Rimmensberger, N. (2005) Selling HIV/AIDS: a case of mixed messages. Acta Academica 37(3), pp. 88–107. Harrison, A. (2002) The social dynamics of adolescent risk for HIV: using research findings to design a school-based intervention. Agenda 53, pp. 43–52. Harrison, A., Smith, J.A. & Myer, L. (2000) Prevention of HIV/AIDS in South Africa: a review of behaviour-change interventions, evidence and options for the future. South African Journal of Science 96(6), pp. 285–290. Kelly, M. (2002) Preventing HIV through education. Perspectives in Education 20(2), pp. 1–12. Kuhn, L., Steinberg, M. & Mathews, C. (1994) Participation of the school community in AIDS education: an evaluation of a highschool programme in South Africa. AIDS Care 6(2), pp. 161–171. LoveLife (2005a) LoveLife’s Communication Strategy. Available at: http://www.lovelife.org.za/corporate/news/article [Accessed 19 June, 2005]. LoveLife (2005b) LoveLife 2004 Report on Activities and Progress. Available at: http://www.lovelife.org.za/corporate/research/ research.html. Mitchell, C. & Smith, A. (2001) Changing the picture: youth, gender and HIV/AIDS prevention campaigns. Canadian Woman Studies Journal 21(2), pp. 56–63. Moletsane, L., Morrel, R., Unterhalter, E. & Epstein, D. (2002) Instituting gender equality in schools: working in an HIV/AIDS environment. Perspectives in Education 20(2), pp. 37–54. Morrel, R., Moletsane, R., Abdool-Karim, Q., Epstein, D. & Unterhalter, E. (2002) The school setting: opportunities for integrating gender equality and HIV-risk-reduction interventions. Agenda 53, pp. 11–21. Morrel, R., Unterhalter, E., Moletsane, L. & Epstein, D. (2001) Missing the message: HIV/AIDS interventions and learners in South African schools. Canadian Woman Studies Journal 21(2), pp. 90–96. Muthukrishna, N. & Mitchell, C. (2006) Editorial. Journal of Education 37 (forthcoming). Narisamulu, P. (2004) ‘It’s a matter of trust’: Young people in South Africa and the discourse of HIV/AIDS prevention. Alternation 11, pp. 454–473. Pettifor, A.E., Rees, H.V., Steffenson, A., Hongwa-Madikizela, L., MacPhail, C., Vermaak, K. & Kleinschmidt, I. (2004) HIV and Sexual Behaviour among Young South Africans: A National Survey of 15–24-year-olds. Reproductive Health Research Unit, University of the Witwatersrand, Johannesburg. Reddy, S. (2004) Safe sex or safe love? Competing discourses within the context of HIV/AIDS. Alternation 11, pp. 440–453. Reproductive Health and Research Unit (2004) Talk about it: loveLife. Available at: http://www.rhru.co.za/site/publications. asp. Rugalema, G. & Khanye, V. (2002) Mainstreaming HIV/AIDS in the education systems in sub-Saharan Africa: some preliminary insights. Perspectives in Education 20(2), pp. 20–36. Singer, R. (2005) Is loveLife making them love life? The Mail & Guardian, 19 August, p. 25.
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Terre Blanche, M. & Durrheim, K. (2002) Research in Practice. Cape Town, University of Cape Town Press. Theron, L.C. (2005) Educator perceptions of educators’ and learners’ HIV status with a view to wellness promotion. South African Journal of Education 25(1), pp. 56–60.
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Thomas, K. (2004) A better life for some: the loveLife campaign and HIV/AIDS in South Africa. Agenda 62, pp. 29–35. Walsh, S., Mitchell, C. & Smith, A. (2002) The Soft Cover Project: youth participation in HIV/AIDS interventions. Agenda 53, pp. 106–113.
African Journal of AIDS Research Publication details, including instructions for authors and subscription information: http://www.tandfonline.com/loi/raar20
Youth have a new attitude on AIDS, but are they talking about it? Alison Zisser & Dennis Francis Published online: 11 Nov 2009.
To cite this article: Alison Zisser & Dennis Francis (2006) Youth have a new attitude on AIDS, but are they talking about it?, African Journal of AIDS Research, 5:2, 189-196, DOI: 10.2989/16085900609490379 To link to this article: http://dx.doi.org/10.2989/16085900609490379
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African Journal of AIDS Research 2006, 5(2): 189–196 Printed in South Africa — All rights reserved
Copyright © NISC Pty Ltd
AJAR EISSN 1727–9445
Youth have a new attitude on AIDS, but are they talking about it? Alison Zisser and Dennis Francis*
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School of Education and Development, University of KwaZulu-Natal, Private Bag X03, Ashwood 3605, Durban, South Africa * Corresponding author, e-mail: [email protected]
In advocating HIV prevention, organisations such as loveLife in South Africa have increasingly used the media to encourage communication and influence behaviour change in youth. Our study examined youths’ understanding and communication habits surrounding loveLife’s extensive ‘Get Attitude’ print campaign. Intrigued by the ambiguous campaign message, we implemented a questionnaire-based study in three urban KwaZulu-Natal schools to investigate how youth are interpreting the images and to determine whether they would connect the personalityaimed message with HIV prevention. As communication is a focal point of loveLife’s strategy, we looked at whether the campaign was successful in fostering discussion and examined what factors contributed to or impeded dialogue. One-hundred-and-eighty-seven Grade 11 students completed the questionnaire, responding to both multiple-choice and free-response questions about the ‘Get Attitude’ campaign images. Our study was largely exploratory, with the data revealing that the youth did interpret the images as intended by loveLife. While the campaign failed to stimulate discussion for many of the youth, those who did talk about the campaign were more likely to speak to their teachers than to parents or friends. Keywords: Africa, communication, knowledge/attitude/behaviour, loveLife, media, prevention campaigns, sexual behaviour
Introduction South African youth know about AIDS. They understand how HIV is transmitted. Most can explain what safe sex means and will tell you why abstinence is the most effective prevention mechanism (Harrison, Smith & Myer, 2000). However, with the peak incidence of HIV occurring in youth aged 15 to 24 (Reproductive Health and Research Unit, 2004), knowledge clearly does not always translate into action. Youth represent the most critical target population for HIV prevention strategies, as over 95% of South African 15–16-year-olds are HIV-negative. If these youth successfully internalised HIV prevention, the pandemic would collapse within the next decade (loveLife, 2005a). With no known cure for AIDS, recent literature on the prevention of HIV recognises behaviour change as the only means of preventing its spread. While South African efforts have been very effective in raising awareness of HIV/AIDS, Harrison et al. (2000, p. 289) believe past prevention campaigns lacked qualities necessary to effect lasting behaviour change: “While much has been done, the impact on the epidemic has been slight and much greater commitment, resources and effort will be needed if we are to make any impact on the course of the epidemic. Currently there is a substantial gap between high levels of knowledge and low levels of preventive practice.” Harrison et al. (2000) offer several suggestions for improving prevention campaigns, such as aiming interventions at high-risk populations, promoting culturally relevant messages, extending links to other health services, such as family planning and antenatal care centres, and continuously evaluating a programme’s effectiveness.
While many researchers (e.g. Kuhn, Steinberg & Mathews, 1994; Harrison, 2002; Kelly, 2002; Morrel, Moletsane, Abdool-Karim, Epstein & Unterhalter, 2002; Rugalema & Khanye, 2002) have focused on schools as the main vehicle of HIV/AIDS education, it is critical to acknowledge other ‘non-formal’ sources of information — namely the media and interpersonal communication. Outside of school, South African youth access HIV/AIDSrelated information from a multitude of sources including television, radio, billboards, posters, newspapers, magazines and conversations with family and friends (Africa Strategic Research Corporation/The Kaiser Family Foundation, 2002; Francis & Rimmensberger, 2005). Organisations focused on prevention (such as loveLife, the largest HIV/AIDS awareness movement in South Africa to date) continuously seek innovative means to instil HIV prevention skills, using the media to stimulate and complement prevention-related communication in schools and at home. At its inception, loveLife identified communication as the key factor in effecting behaviour change and expressed its importance through the loveLife slogan “Talk about it” (Reproductive Health and Research Unit, 2004). Through their advertisements and events, loveLife continuously encourages openness about sexuality and AIDS: “This is based on the premise that more open communication about these issues will challenge social norms and lead to positive behaviour change such as delaying age of first sex and increasing safer behaviour” (Pettifor, Rees, Steffenson, Hongwa-Madikizela, MacPhail, Vermaak & Kleinschmidt,
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2004, p. 53). LoveLife recognises that only through open communication in confronting misconceptions of gender roles, challenging power differentials, teaching healthy habits, and instilling life skills will South Africans begin to demonstrate the behavioural modifications necessary to successfully stem this epidemic. Even so, societal tensions over gender identity and sexuality complicate and confuse this communication. Thomas (2004), for example, argues that the loveLife campaign obscures rather than addresses the social factors that shape gender identities. She critiques the campaign’s failure to deal with crucial issues such as the vulnerability of young women, sexual violence and transactional sex. In the same way, Reddy (2004) suggests that in “talking about it”, youth must talk about much more than safer sex. In her article ‘Safe sex or safe love’ she proposes that before youth can change their notions of sex, they must shift their views of the opposite sex. She explains that the gendered language of sex undermines gender identity and creates an environment where women surrender power over their sexuality. Communication on HIV/AIDS must address the social pressures young people experience as they manage their own sexuality. Confronting culturally taboo aspects of sexuality and encouraging discussions on one’s role as a man or woman may positively impact a young person’s sexual identity and behaviour. While reviewing recent research on HIV/AIDS communication we noticed a discrepancy between identified successes and failures in terms of increasing discourse about HIV/AIDS and sexuality among youth. The loveLifesponsored National Survey of HIV and Sexual Behaviour among 15–24-year-olds reported that 44% of youth had spoken to parents or guardians about HIV/AIDS and a vast majority of the 56% who did not communicate with parents or a guardian, said they had spoken to friends (Pettifor et al., 2004). Yet, research by Narismulu (2004) presents a youth far less willing to talk about HIV/AIDS. When youth were asked what peers are discussing about HIV/AIDS, many replied, “nothing” or “very little”. When the youth were asked why, they often replied that the subject was “too personal” or they feared rejection from friends for raising the issue (Narismulu, 2004, p. 458). Thus, while one study presents a youth actively communicating about HIV/AIDS, the other depicts youth as fearful to broach the subject. In 2005, loveLife launched its “Get Attitude” campaign (see Figure 1), a year-long stage of their multi-year and multi-message campaign. LoveLife publicised the “Get
Attitude” message on billboards, bus placards, magazine pages and newspaper inserts across South Africa. While one image dominantly features the organisation’s name, loveLife, and the slogan “Get Attitude”, the second presents the motto “Born Free”. The 2005 campaign differed greatly from past promotions by focusing on an individual’s personality rather than on overt behaviour. But evaluating these images, we wondered, what does “get attitude” even mean? The ambiguity is perhaps the most interesting (and troubling) quality of the campaign, as the advertisement does not deliver a concrete message to viewers. Singer (2005, p. 25), a critic of loveLife, characterised the campaign as “stylish but often cryptic” and Thomas (2004, p. 29) described the campaign as featuring “abstract and seemingly nonsensical images and text”. As the AIDS pandemic reaches catastrophic proportions, it seems dangerous and foolhardy to rely upon the chance understanding of such an influential and far-reaching campaign. Thus, we set out to investigate how youth, as the target population for loveLife campaigns, conceptualise and understand the “Get Attitude” and “Born Free” slogans. Is the campaign communicating the intended preventive message to the South African youth? In examining how youth are processing the “Get Attitude” and “Born Free” messages, we also wondered whether these advertisements stimulated discussion, a key objective of loveLife’s work. If the youth are communicating about these advertisements, to whom are they speaking? Are they showing a preference in talking to friends versus parents or teachers? Why are they choosing to talk to these individuals? And more importantly, why are they perhaps not choosing to talk?
Image 1
Image 2
Methodology Current research on HIV/AIDS in South Africa emphasises a qualitative, micro-level approach to studying the epidemic (Muthukrishna & Mitchell, 2006). However, larger-scale or macro-level findings on population habits and sentiments, while shallow in personal value, are still quite necessary in measuring the societal effects of HIV/AIDS or in evaluating prevention methods. In studying the extensive loveLife campaign, we sought insight into how youth were processing the campaign messages as well as a quantified account of whether adolescents were talking about these images. Acknowledging the merits of both methodologies, we incorporated a qualitative and quantitative approach to balance each method’s limitations.
Figure 1: Media images used by South Africa’s loveLife 2005 ‘Get Attitude’ campaign
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We chose a questionnaire format as the most effective means of accessing the desired information. A questionnaire is an easily distributed, structured instrument, through which researchers may access important information while maintaining the privacy of their respondents (Cohen, Manion & Morrison, 2000; Babbie & Mouton, 2001; Terre Blanche & Durrheim, 2002). After reviewing present literature on data collection and consulting with loveLife’s own media analyst,1 we designed a 41-item questionnaire. The authors employed multiple-choice questions and rating scales to acquire quantifiable information about the youth’s impressions of the loveLife campaign, as well as free-response questions to help explain and elaborate on how the campaign’s images influenced their communication about HIV/AIDS. Since the loveLife media campaign reaches a large number of South African youth, the research goals necessitated a sizable number of respondents. We used a sample of roughly 180 students as a significant but manageable number for gathering information on behavioural habits and personal impressions of the campaign. We targeted Grade 11 students, as this age group falls within the high-risk population of 12- to 17-year-olds targeted by loveLife, had completed a course on life orientation and sexual health, and are at an age where many of their peers are becoming sexually active (loveLife, 2005b). To provide an adequate sample size, we selected three schools: an ex-DET, ex-HOD, and ex-Model C school.2 Thus, the three schools provided a student sample that varied by race and socio-economic status but with a fairly equal distribution of males and females. The study was approved by the Ethics Committee at the College of Humanities, University of KwaZulu-Natal. Permission was obtained from the provincial Department of Education and Culture and from the three school principals. Confidentiality and anonymity were stressed and maintained throughout the study. Twelve Grade 11 16-year-olds from two urban schools piloted the questionnaire for its length, language and clarity. Using feedback from the pilot, we revised the questionnaire as needed. A total of 187 (80 male, 107 female) students completed the questionnaire during a free period in school. The participants were evenly distributed across the three Durban schools: 62 from an ex-DET, 63 from an ex-HOD, and 62 from an ex-Model C school. The sample included students from the four main racial groups in South Africa: black, white, coloured and Indian. Participants completed the questionnaire in an auditorium-like room or lecture hall, under the supervision of one of the researchers and school staff. Instructions were given to the students orally as well as on the questionnaire’s cover, to respond to the questionnaire items based on their experience with the ‘Get Attitude’ and ‘Born Free’ billboard images (also depicted in the questionnaire). Respondents were informed on the questionnaire and by the study’s administrator that their participation was voluntary and that their answers would be kept confidential. If they felt uncomfortable, they could discontinue with the questionnaire at any time. Each group of participants received the same instructions. The questionnaire began with five demographic questions (age, sex, race, first language, and household
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economic level). Respondents were then asked to view the two loveLife images (Figure 1) and to briefly write about what the images meant to them. Next, multiple-choice questions inquired if the participant had seen the images before, and to whom the participant may have spoken about the images. The students were then asked a series of multiplechoice and open-ended questions about their communication habits related to the images: Have you discussed these images with friends? If no, why didn’t you discuss these images with friends? If yes, why did you discuss these images with friends? If yes, did you discuss these images with mostly female or male friends? If you discussed these images with friends, how did your friends respond? Why do you think your friends responded in this way? Two sets of questions followed, substituting ‘parent/adult guardian’ and ‘teacher’ for ‘friends’. Participants were then asked to give their definition of “get attitude” and “born free”. Finally, the students responded to questions about how the “Get Attitude” campaign related to HIV prevention and to information learned at school. They rated the success of the campaign and were asked to offer suggestions on how the prevention campaign images could be improved. Data showing the campaign’s rating by the students are not presented in this paper. Data processing was conducted using SPSS statistical software. For the free-response questions, each author reviewed twenty questionnaires and formulated categories for each question based on common responses. A third, outside researcher reviewed twenty questionnaires to confirm the reliability of the categories. The free-response questions were then categorised by the third researcher based on these groupings. For example, respondents’ answers to the question, “What does ‘Get Attitude’ mean to you?” fell into one of four categories: 1) Improve your attitude; 2) Act independently; 3) Live a healthy life; or 4) Get informed about HIV/AIDS. The category ‘Other’ was always included to accommodate responses that did not fit into the established categories.3 Results In this section we present findings on how youth interpreted the ‘Get Attitude’ images and on how successful the campaign was in stimulating discussion. The data reveal critical information on the communication habits of the youth and the factors that contributed to and impeded open dialogue. Although 187 students participated, not all students responded to every question. A weakness of questionnairebased methodology is that it is difficult to ensure that participants all commit equal effort to a study. The lack of responses to some questions can bias the interpretation of results. However, we believe the absence of information is as telling as the actual responses when considering the feelings of youth towards HIV prevention efforts. This matter is considered in the discussion section. Data analysis revealed that the youth did in fact interpret the images in line with loveLife’s design. Seventy-four percent (128 respondents) indicated that the images communicated that they should adopt a different, more positive outlook on life. Twenty-one percent (36) connected
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the simple messages “get attitude” and “born free” with HIV prevention. This suggests a pre-existing understanding of loveLife’s organisational goals, as neither advertisement explicitly addresses contraction of the virus. The authors were interested in how participants unfamiliar with loveLife interpreted the images, since understanding the campaign message depends largely on one’s familiarity with the loveLife organisation. Consistent with loveLife’s finding that most South African youth are familiar with the loveLife brand (loveLife, 2005b), 94% (176) of our participants reported familiarity with the loveLife organisation. A chi-square test demonstrated no significant difference according to participants’ familiarity with loveLife with how participants interpreted the campaign images (p > 0.18). Participants also addressed each image independently, first interpreting “get attitude” and then “born free”. Participants’ explanation of “get attitude” corresponded with loveLife’s definition of the phrase, with 88% indicating that it meant they should either adopt a new outlook on life or act independently (70 and 81, respectively). Students varied more with the expression “born free”, with responses ranging from “all opportunities are open” (37%; 63), “the freedom to act alone” (37%; 62), “freedom from disease” (12%; 20), to “the end of apartheid rule in South Africa” (12%; 20). In rating their impressions of the loveLife images, the youth responded very favourably. Seventy-seven percent (138) either agreed or very much agreed (46 and 92, respectively) with the message communicated by the ‘Get Attitude’ images. Ninety percent (160) either agreed or very much agreed (39 and 121, respectively) that it is important to talk about personal attitude in facing dangers and challenges. LoveLife states as a principal goal that their prevention campaigns should foster communication about HIV and prevention measures. Thus, we were especially interested in the conversation habits of the loveLife audience. The results indicate that while some participants communicated with friends, parents and teachers, many other participants did not discuss the campaign images. Only 19% (35) said they had discussed the images with friends, 28% (51) had discussed the images with parents, and 30% (54) had discussed the images with teachers. It is particularly interesting to us that more of the youth talked about these images with their teachers and parents than with their friends. The participants who did not discuss these images with teachers, parents or friends varied in their responses as to why not. When considering communication with friends, many of the participants (44%; 64) answered that the images simply did not seem important enough to discuss. Others indicated that they already understand HIV prevention (18%; 26); that the topic was not appropriate to their conversation (18%; 27); or that their friends simply do not care (12%; 17). Of the youth who did not speak to parents, some participants responded that they did not feel comfortable (39%; 49), while others did not feel the need to discuss the images with their parents (39%; 48). Participants offered similar reasons as to why they did not speak with teachers, such as they did not feel comfortable (26%; 31) or did not feel it was important to discuss (19%; 23). Some respondents (38%; 46) wrote that the campaign was not addressed in school.
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Responses by participants who did engage in discussion about the images with friends, parents, and/or teachers reveal that certain factors encouraged communication. Of the participants who spoke to friends, 70% (21) wrote that they feel the subject is important to discuss, and 17% (5) wrote that their friends are interested. Forty-three percent (20) who had spoken to their parents responded that the subject is important to talk about; 21% (10) wrote that the parents care about the child; and 17% (8) indicated that they share an open relationship with their parents. Teachers were the most popular choice with whom to engage in conversation. Forty percent (21) explained that it was the teacher’s job to discuss HIV prevention, while 23% (12) attributed the discussion to their teacher’s concern for students. Only 12% (6) wrote that their relationship with their teacher made it comfortable for discussion. Nineteen percent (10) wrote that discussion with a teacher occurred simply because they wanted to know more about the campaign and message. Interestingly, when participants did discuss these images, they claimed that friends, parents and teachers generally responded in an interested and positive way (76%, 35; 90%, 72; and 96%, 54, respectively). This demonstrates that although many of the respondents did not feel comfortable or thought that others did not care, when conversation did occur the results were usually positive and beneficial. However, there were several cases where a young person did attempt to talk about the campaign to friends, parents or teachers, and the other party rebuffed them or acted uninterested. While only 3 of the 187 participants had spoken to their friends, parental figures, and teachers about the loveLife campaign, it appears that many of those having communicated did speak to more than one target: 21 of 35 students who had spoken to friends, also spoke to a parent or teacher; 26 of 51 participants who communicated to parents also spoke with friends or a teacher; and 25 of 54 participants who had spoken to a teacher also spoke to friends or a parent. Chi-square analysis demonstrated no significant difference by gender in communication habits with friends, parents and teachers (p > 0.41; p > 0.22; and p > 0.27, respectively). Discussion This study was largely exploratory, with the data revealing that while the youth did successfully interpret the loveLife images, they preferred to discuss the campaign with teachers and parents rather than with peers. Through the “Get Attitude” message, loveLife intended to market personality and attitude — to stimulate discussion on HIV/AIDS and to encourage lasting behaviour change. At the onset of the campaign, loveLife received strong criticism for the images’ ambiguous and cryptic nature. However, in the present study, the respondents’ interpretations of the campaign suggest that the ambiguity of “get attitude” (get attitude about what?) and “born free” (born free of what?) allows students to personalise the message to their individual lives and circumstances. Moreover, most responses corresponded well with loveLife’s own interpreta-
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tion of “attitude” as a positive force that will enable youth to achieve their goals (loveLife, 2005a). One participant wrote that the images meant, ‘Enjoy your youth. Love yourself. Live to the fullest. Be careful of the choices you make in life. And RESPECT yourself!’ [participant’s emphasis] For these youth, the ‘Get Attitude’ campaign was about gaining confidence, setting goals, and fulfilling their aspirations. Considering the social tensions that surround HIV/AIDS and sexual identity, we wondered how gender identity may impact interpretation of the loveLife campaign. Particularly encouraging was the number of female respondents who wrote about the need to set high goals and establish control over their sexuality. As argued by Reddy (2004), one of the greatest obstacles to effective dialogue between males and females is the power discrepancy between genders and traditional notions of male and female roles. Young women’s dependence on their boyfriends for security, their fear of rejection, and men’s belief that sex with multiple partners will prove their masculinity all directly challenge certain HIV prevention measures, such as demanding condom use and reducing the number of one’s sexual partners (Morrel, Unterhalter, Moletsane & Epstein, 2001; Moletsane, Morrel, Unterhalter & Epstein, 2002; Morrel, Moletsane, Abdool-Karim, Epstein & Unterhalter, 2002; Reddy, 2004). Responses by both male and female participants reflect the power dichotomy proposed by Reddy (2004) and demonstrate how attitude and confidence may challenge traditional gender roles. A female participant wrote that ‘get attitude means that I must not be passive and must not just sleep with people because they want to’. By internalising attitude as a source of confidence and independence, youth become better equipped in making decisions to benefit themselves rather than their partners or friends. While condom use and faithfulness to one partner are direct means to safer sex and preventing HIV infection, a sense of independence and a confident attitude represent indirect means of protecting oneself, through which the direct preventive actions are more likely to take place. Despite the audience’s successful interpretation of this new brand of prevention message, the media images failed to stimulate discussion for many of the study’s participants. If the study participants had understood the campaign message, what prevented so many of them from carrying the message forward? When asked why they did not talk to their friends about the images, participants frequently responded that their friends do not care, the subject did not seem important, or they already understand HIV prevention: ‘I didn’t think they [the images] concerned me. Or had to do with me. And my friends wouldn’t like the subject of discussion.’ Frequent answers of this nature reflect the disturbing finding that 44% of 15–19-year-old South Africans believe that they are not at risk of contracting HIV (Pettifor et al., 2004). However, participants in the present study overwhelmingly agreed that it is important to discuss attitude when facing dangers such as HIV/AIDS. These contradictory findings demonstrate that youth understand the critical nature of HIV/AIDS, but deflect feelings of personal vulnerability. Some respondents reported that despite the issue’s importance, they avoided the topic because they feel none of their peers share their concern.
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This contradiction in beliefs supports Narismulu’s (2004) concept of social isolation — the phenomenon in which individuals reject supportive social networks due to irrational fears of rejection. In order for youth to overcome these fears when raising subjects such as HIV/AIDS and sexuality, they must be given safe spaces for open dialogue and must be constantly encouraged to communicate about the societal dangers they face. It is likely that they would find common understanding in each other’s fears and concerns. While many organisations, such as loveLife, have developed discussion-based youth programmes, young people may not take advantage until they internalise their vulnerability to the condition and their role in its prevention. Youth must be reminded that their peers are experiencing similar fears and challenges. Perhaps loveLife should modify their well-known “Talk about it” slogan to include “because your friends want to talk about it too”. The hesitance to speak with friends and the participants’ common response that the topic did not seem important reflects another formidable challenge in HIV prevention education — AIDS fatigue. As educators and activists have integrated HIV/AIDS education into nearly every feasible outlet, the audience has tired of the issue, ironically before much discussion among young people has even taken place. South African youth have become so inundated with HIV prevention messages that they report a general apathy or fatigue towards AIDS-related information. This fatigue usually takes one of two forms: “Either ‘Other people are going to get AIDS’ or ‘We are going to get AIDS anyway, so why bother?’” (Mitchell & Smith, 2001, p. 513). Despite this, the need for HIV prevention remains until South African youth display lasting behaviour change. The challenge, however, is for advocacy groups to explore ways of engaging youth meaningfully by situating them as active participants in HIV prevention. Empowering youth as agents in their own prevention education and as dispensers of this information to others will provide an engaging and cooperative environment for effective communication on the complex issues surrounding HIV/AIDS (Walsh, Mitchell & Smith, 2002). The close association of sexuality with HIV/AIDS typically causes tension in dialogue, especially between youth and parental figures. Some students wrote that their parents hold old-fashioned beliefs about sexuality and do not understand the pressures facing today’s youth. Research on the dynamics of HIV/AIDS communication reveals this perceived generation gap and the taboo status of sexuality within familial dialogue. Both parents and children may evade the topic, preferring silence to the temporary discomfort that often accompanies critical dialogue even though it can lead to new understanding (Campbell & MacPhail, 2003). Whereas, until now, parents have been responsible for instilling life skills and promoting healthy habits, many adults have skirted this responsibility when dealing with HIV/AIDS. Even parents who do discuss these subjects with their children may thwart future communications by using an authoritarian tone: ‘Thou shallt [sic] not engage in sex’, as one participant put it. Not only do parents have tremendous influence on their children’s confidence and identity development, but it is often their attitude and openness towards communication that encourages dialogue on critical issues such as HIV/AIDS.
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Contrary to recent research showing that youth are most likely to speak to their friends about HIV/AIDS, followed by parents and then teachers (Pettifor et al., 2004), our results show the opposite — that respondents more often spoke to teachers, less often to parents, and least often to their friends. While, Pettifor et al. (2004) report on communication habits concerning HIV/AIDS, this study looks at communication habits concerning loveLife’s 2005 campaign. Even so, as the loveLife campaign is designed to stimulate dialogue on HIV/AIDS, we expected communication habits to mirror past findings. While teachers were the most popular to speak to, analysis of participants’ responses revealed a critical difference as to why. Participants reported talking to friends and parents because of a supportive relationship or the importance of the subject matter. They spoke to teachers because they felt that it is the teacher’s job to discuss HIV prevention. This suggests that some youth may view HIV/AIDS education as an obligatory lesson given by teachers, at the teachers’ rather than the students’ initiative. It is also possible that the utilisation of loveLife materials in the classroom prompted discussion on these images. Perhaps the ambiguous nature of the advertisement also influenced the youth’s decision to speak with adults over their peers. Nonetheless, the results suggest that since many parents are not communicating about HIV/AIDS with their children, the ‘job’ of initiating discussion has passed from parental figures to teachers. Dependence on teachers to instil these lessons may be problematic, as teachers are already overburdened with full curriculums and often over-crowded classrooms (Coetzee & Kok, 2001; Theron, 2005). Past research on AIDS education has demonstrated the challenges of preparing teachers to address such a culturally sensitive topic. In many cases, a teacher’s erroneous notions of the virus and its transmission have biased classroom discussions (Coetzee & Kok, 2001; Rugalema & Khanye, 2002; Baxen & Breidlid, 2004). This demonstrates the limitations of an approach that relies strongly on teachers to impart this information. There remains the need to explore how families, for example, can be an effective vehicle for HIV/ AIDS education. It is impossible to design a prevention campaign that will appeal to every consumer, and as the leading HIV prevention organisation in South Africa, loveLife assumed certain risks in establishing the ‘Get Attitude’ campaign. First, understanding the message depends upon the viewer’s familiarity with the loveLife organisation. Although our results show that the participants unfamiliar with loveLife still demonstrated a ‘change your attitude’ understanding consistent with that of participants familiar with the organisation, very few explicitly linked the campaign with HIV prevention. We believe this connection would be lost on most young men and women unfamiliar with loveLife. The 2005 loveLife campaign also fails to specify to whom it is speaking. LoveLife likely intended this particular ambiguity, because HIV/AIDS affects everyone regardless of race and class, and prevention campaigns are often criticised for ‘racialising’ or blaming one sub-population for the epidemic. However, without a concrete target, it is much
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easier to deflect ownership and responsibility for the problem, as demonstrated by the participant who wrote, ‘I didn’t think they [the images] concerned me. Or had to do with me.’ That participant’s words support the theory of Harrison et al. (2000) which states that behavioural interventions are most successful when they target specific groups at risk. However, the pervasive nature of epidemic should caution prevention campaign planners to avoid stigmatising one sub-population and in turn neclecting the risk to another societal group (Coulson, 2002). Media campaigns, especially billboard images, rely on momentary viewing to spread the intended message. Just as specifying the target could lead to more effective understanding, so could specifying the underlying communication goal, namely “talk about it with someone”. We believe that the phrase ‘talk about it’ has been so well marketed by loveLife that it has lost some of its potency. Just as explicit societal tensions such as gender identity must be addressed through prevention campaigns, so must more implicit problems, such as social isolation. Messages in public spaces, such as, “Speak to your friends. They want to talk about it” or “Speak to your parents. They’re interested” would not only remind youth that support networks do exist, but would also communicate to parents that they play a critical role in encouraging prevention. As our research demonstrated, when open dialogue about these images and HIV/AIDS did occur, the participants found the experience positive and beneficial. In evaluating our results, the reader should be mindful of several possible limitations to the study. While we chose to use a questionnaire involving both multiplechoice and free-response questions, it was impossible to guarantee that every participant would dedicate equal care and effort in completing the questionnaire. The length and completeness of responses varied across the subject pool. Whereas incomplete questionnaires could be attributed to participant laziness, we interpret it as another indication of AIDS fatigue: some participants may have viewed the questionnaire as yet another reminder of HIV prevention and so conducted a silent protest by exerting less effort. There are also several qualitative questions left unanswered. For example, did the youth communicate about the loveLife images with boyfriends or girlfriends? And if the youth had communicated about these images with peers, parents, or teachers, who instigated the discussion? Finally, our study offers insight into the communication habits of a fairly small, urban sample of youths. As interpretation and implementation of the campaign likely vary between urban and rural communities, similar research should be conducted among rural youth. Conclusions LoveLife has succeeded in presenting a new brand of HIV prevention message and in gaining the attention of South Africa’s media-savvy youth. While the campaign may be criticised for its ambiguous nature, the youth surveyed in this study understood the underlying message of “get attitude” as intended by loveLife. The message is direct
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enough to imply the necessary choices youth should make to remain free of the virus, but ambiguous enough to allow viewers to apply the “Get Attitude” message to their individual lives. While the campaign was not overwhelmingly successful in stimulating discussion, those who did communicate about the images demonstrated a strong preference for speaking to teachers or parents over their peers. As the HIV/AIDS pandemic continues, prevention organisations must maintain their commitment to designing and implementing effective prevention campaigns to reach a population already bored of prevention messages. LoveLife designed their ‘Get Attitude’ campaign as a fresh, positive, personality-based approach, and the youth have understood the message. However, to effectively curtail the epidemic, youth must do more than understand. They must internalise the attitude of prevention and talk about it with their friends, significant others, family and teachers. Only with such openness and mutual support will youth realise that they hold the behavioural tools necessary to drastically reduce HIV incidence. Notes 1
2
3
The loveLife media analyst provided statistical information about loveLife’s campaign distribution across South Africa as well as the sample images used in the questionnaire. Under apartheid, all schools were operated by racially-divided education departments. DET schools were for black African students only and were operated by a specific national department. HOD schools were operated by the Indian House of Delegates. Model-C schools were provincially operated schools for White students and were permitted to take in pupils of colour after a certain date. Although these categories have been formally eliminated, schools often retain an ethos from the period, and are thus referred to as ‘ex’ one category or another. The authors recognise that each individual will approach the phrase with a unique perspective. The categories were not intended to reduce the value of the information, but to establish a pattern of response. The number of categories per free-response question varied based on the number of common responses. If at least two students indicted a similar response, a new category was established.
The authors — Alison Zisser is a graduate student in clinical and health psychology. She conducted this research as an international affiliate at the University of KwaZulu-Natal. Her research interests include child psychology and parent-child interactions. Dennis Francis teaches in the area of social justice education in the Faculty of Education at the University of KwaZulu-Natal. His research interest include narrative inquiry, youth and HIV/AIDS.
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