Sophie has just had unprotected sex with her “Sugar Daddy” (a person who exchanges large amounts of money or gifts for sexual favours). While he goes to freshen up in the bathroom, she innocently snoops around the bedside drawer to reveal a box of pills—little does she know that they are antiretrovirals. She has unknowingly put herself at risk of HIV infection.
The scenario described above is from the new series of the MTV show Shuga, which has now landed in Nigeria. Condensed into this 60-second scene are issues related to transactional sex, negotiation of safer sex, HIV treatment, and HIV disclosure. But this depiction is just the tip of a gargantuan, mass-media behavior-change iceberg.
Produced by the MTV Staying Alive Foundation in partnership with the Bill & Melinda Gates Foundation, US President’s Emergency Plan for AIDS Relief (PEPFAR), and the Nigerian National Agency for the Control of AIDS (NACA), the award-winning Shuga TV show has already had two hit seasons in Kenya. But Georgia Arnold, the Executive Director of the MTV Staying Alive Foundation and Executive Producer of Shuga, has a vision for the Shuga campaign in Nigeria that far exceeds anything attempted previously in Kenya.
“Shuga is a ground-breaking TV show that portrays the lives and loves of a group of young people. Seamlessly interwoven into the storylines are vital messages related to HIV and a wide range of other sexual health messages,” explains Arnold. “Alongside the TV series is a substantial mass-media campaign, which reaches our audience at all the points where they interact, improving their access to vital sexual and reproductive health messaging and directing them to the health services they need.”
As well as the TV show, the points of interaction that Arnold alludes to include a radio series, a mobile service (SMS), a comic book (focused on the domestic violence story line in the TV drama, aimed specifically at girls with low literacy levels), digital and social media, and a Skype service through which users can “call a character” from the show and share their thoughts.
“The particular nature of stories and dramas not only deliver informational content but create emotional connections to characters and role models, which promote a better context for learning and behavior change than do factual presentations,” observes Victor Orozco, an economist at the World Bank and coordinator of their Africa HIV/AIDS Impact Evaluation Program. “TV could play an important role in introducing ideas to large segments of a society, especially segments where literacy is low and social norms discourage discussion of stigmatized issues such as HIV/AIDS and teen pregnancy.”
Shuga series 3 aired for the first time on World AIDS Day, 2013, on more than 70 channels, with a potential audience of a half billion people.By keeping messages from the TV show at the forefront of people’s minds, the introduction of multimedia elements may have the potential to reinforce and promote positive behavior change. For example, sending weekly text messages can significantly increase adherence to antiretroviral treatment for people living with HIV. The Shuga campaign in Nigeria will aim to reinforce the messages of the Shuga TV show with a 360-degree campaign, including several social media and mobile components, such as text messaging and interactive voice recordings. Orozco is working with MTV to evaluate the behavior-change effects of the show and the additional impact of mobile messages through a randomized study.
Shuga has made the journey from Kenya to Nigeria for several reasons. While some might argue that on the basis of prevalence, the need for a campaign like Shuga is greater in Kenya than in Nigeria—HIV prevalence in Kenya (6 percent) is double that of Nigeria (3 percent). However, Nigeria has thesecond highestnumber of people living with the disease, and while maternal mortality has significantly fallen since 1990 in the country,one in 13 womenstill die during childbirth. Additionally, of Nigeria’s burgeoning population of over 150 million, nearly a third are young people aged 10 to 24 years—a population that falls neatly into the MTV demographic and who will relate more closely with stories portrayed in Shuga.
These public health concerns are compounded by a severe lack of knowledge about HIV among young men and young women. “Comprehensive knowledge about HIV is defined as knowing that condom use and having just one HIV negative and faithful partner can reduce the chances of contracting HIV; knowing that a healthy-looking person can have HIV; rejecting the two most common misconceptions about HIV transmission—that HIV can be transmitted by mosquito bites and that HIV can be transmitted by supernatural means," explains Dr Emmanuel Alhassan, Director, Resource Mobilization at NACA. “However, only 22 percent of young women and 33 percent of young men [in Nigeria] have comprehensive knowledge about HIV.”
Shuga has the potential to displace the silence that has engulfed serious issues like HIV in Nigeria and beyond, and to fill the knowledge vacuum that such silence has created. Shuga series 3 aired for the first time on World AIDS Day, 2013, on more than 70 channels, with a potential audience of half billion people. With this kind of reach, the ability for this so-called entertainment education to inform, change attitudes, and even change behavior is undeniable.
However, Orozco notes that policy makers and funders might be seriously under-investing in such mass-media approaches due to lack of rigorous evidence. But with the support of the Gates Foundation and MTV Staying Alive, he and other researchers are remedying this by evaluating Shuga and creating a knowledge base of what methods works and what is worth scaling up in Nigeria and elsewhere.
“Our vision for Shuga is to see a transformation in attitudes about the way the world talks about sex, not as a dirty topic, or something that should be hidden, but something that is openly discussed: parent to child, peer to peer,” envisions Arnold. “Only by doing this will we see a real change in people’s attitudes about HIV and their knowledge about it. Only through open and honest dialogue can we can hope to save lives.”
Find links to the episodes that have aired so far here.