Download Let’s Talk About Sex… and Gender: Examining the

Let’s Talk About Sex… and Gender: Examining the
Role of Gender Mainstreaming in HIV/AIDS
Communications Campaigns in South Africa
Submitted to
THE FACULTY OF THE PUBLIC COMMUNICATION GRADUATE
PROGRAM
SCHOOL OF COMMUNICATION
AMERICAN UNIVERSITY
WASHINGTON, D.C.
In Candidacy for the Degree of
Master of Arts
by Leisha McParland
August 2015
© Copyright 2015 Leisha McParland
Table of Contents
Abstract
4
Chapter 1: Introduction
5
Chapter 2: Literature Review
8
Chapter 3: Methodology
19
Chapter 4: Results/Case Studies
21
Chapter 5: Analysis & Discussion
26
Chapter 6: Conclusion
32
References
34
Appendix: Coding Tables
39
Abstract
This study examines prominent HIV/AIDS prevention campaigns in South Africa to determine
how gender mainstreaming informs content design for media campaigns using entertainmenteducation to reach target audiences. The case study provides a profile and analysis of three
modern campaigns — Scrutinize, loveLife, and Soul City — to provide a snapshot of the types
of HIV/AIDS prevention activities in South Africa. The campaigns were selected to ensure
diversity among types audiences targeted by these communication interventions and to reflect
activities implemented by local non-governmental organizations as well as international groups.
Results showed significant effort to incorporate men and boys into safe-sex dialogue and
to promote key behavior change needed to stop new infections. Content across the board is
grounded in behavior change theory and uses culturally specific content. However, it was also
discovered that messages related to female sexuality, promoting gender-based equality and
female empowerment were inconsistent among content intended for male audiences.
4
GENDER MAINSTREAMING IN E-E HIV CAMPAIGNS
Chapter 1: Introduction
HIV/AIDS is killing women. In 2013, roughly 35 million people were living with HIV
(UNAIDS, 2015). Since the start of the epidemic, an estimated 78 million people have become
infected with HIV and 39 million people have died of AIDS-related illnesses (UNAIDS, 2015).
While worldwide AIDS-related deaths have declined since a peak in 2005, and new infections
overall have dropped by 38 percent since 2001, in the world’s most vulnerable regions, HIV/
AIDS continues to spread (Center for Disease Control and Prevention, 2015). For women and
girls in these regions, the threat of new infection is highest of all.
In North America and Western Europe, new infections have decreased largely due to
preventative measures, such as condom use. The same has not been the case in the
developing world. Countries in South and Southeast Asia, Eastern Europe and Central Asia, and
those in Latin America continue to battle with the disease, and Sub-Saharan Africa bears the
biggest burden of all (UNAIDS, 2015). Knowing that preventive measures have been effective in
some parts of the world, we must ask ourselves why similar interventions have not been as
successful in countries the hardest hit by the disease.
Understanding the role of gender in HIV/AIDS-affected communities is integral for
combating the proliferation of this disease. Gender inequalities are widely accepted among
public health professionals and social anthropologists as central to the epidemic (FaIola &
Heaton, 2007). Gender inequality describes the socially constructed relationship between men
and women, which restricts certain conduct and roles within a community (Gupta, Ogden &
Warner, 2011). According to Olinyk, Gibbs and Campbell (2014), such disparities are linked to
power imbalances. A lack of power limits women’s access to resources, makes them vulnerable
to gender-based and intimate partner violence, deters them from negotiating condom use, and
more broadly, from taking control of their sexual health. These factors combine to increase
women’s risk of contracting HIV (Jewkes& Morrell, 2010; Gupta, 2000).
5
GENDER MAINSTREAMING IN E-E HIV CAMPAIGNS
In 2013, 64 percent of new adolescent infections globally were among young women. In
Sub-Saharan Africa, young women aged 15 to 24 are almost twice as likely to become infected
with HIV as their male counterparts (UNAIDS, 2015). Socio-cultural barriers to practicing safe
sex include a woman's lack of sexual decision-making power, men's dislike of condoms, a
denial of HIV/ AIDS’ existence, the importance placed on family, and the fear that the suggestion
to use condoms will elicit suspicion from one's partner and result in social rejection and
stigmatization (Scott, 2009; Meursing, 2009). These barriers disproportionately put women at
risk for contracting HIV by limiting their sexual agency and tying their social status to sexual
passivity. Accordingly, programming geared toward thwarting the disease focuses increasingly
on “mainstreaming” gender, with varying degrees of success (Olinyk, S., Gibbs, A., & Campbell,
C., 2014).
The spread of HIV/AIDS can be slowed and eventually halted as evidenced by progress
made in North America and Western Europe, by successfully reaching target audiences with
health messages that are both informational and empowering. Although the first generation of
this disease predominately affected male, homosexual communities, today women are in
greatest danger of contracting HIV/AIDS. This is true for low-income communities in the United
States as well as for women in Sub-Saharan Africa, where the highest numbers of new
infections are currently on record. More focus must be applied to identifying communication
interventions able to overcome barriers that prevent women from making safer sexual choices
and accessing health resources available to them.
HIV prevention efforts have included communications campaigns since the early 1980s
when the world began to fully grasp the magnitude of this disease. Although today we see a
wide variety of campaign styles and tactics, the early initiatives largely used mass media
interventions and endeavored to raise awareness about HIV among the general public about
how the disease is spread and the importance of getting tested. Later interventions adopted
6
GENDER MAINSTREAMING IN E-E HIV CAMPAIGNS
well-established campaign features including audience segmentation and conducting formative
research, using theory as a conceptual framework and message design tailored to target
audiences (Noar et al., 2009). This development also marked a shift aware from awareness
building campaigns toward behavior change communications.
Entertainment-education (E-E) using narrative message-design theory and grounded in
Social Cognitive Theory is increasingly popular for behavior change campaigns, to include those
directed at HIV/AIDS prevention (Storey & Sood, 2013; Connolly, Elmore & Ryerson, 2008).
Entertainment-education is the purposeful infusion of prosocial messages in entertainment
programming (Singhal & Rogers, 1999) and has be heralded by some as the “magic bullet.”
This study will conduct an in-depth analysis of three case studies HIV/AIDS prevention
campaigns launched in South Africa over the last ten years and that employ some version of
entertainment-education. Using a multi-theory approach: health belief model, social cognitive
theory and extended-elaborated likelihood model, this project will attempt to answer the
following research questions: How effectively have modern E-E HIV/AIDS prevention
campaigns integrated gender into programming; and, what are best practices in educationentertainment for changing attitudes regarding gender roles in HIV/AIDS prevention? These
findings will highlight best practices and inform recommendations for future campaign design
aimed at persuading men and women in HIV/AIDS-affected areas to make safe sexual
decisions.
7
GENDER MAINSTREAMING IN E-E HIV CAMPAIGNS
Chapter 2: Literature Review
GENDER AND HIV/AIDS
Understanding the role of gender in HIV/AIDS-affected communities is integral for
combating the proliferation of this disease. Gender inequalities are widely accepted among
public health professionals and social anthropologists as central to the epidemic. Gender
inequality describes the socially constructed relationship between men and women, which
restricts certain conduct and roles with in a community (Gupta, Ogden & Warner, 2011).
According to Olinyk, Gibbs and Campbell (2014), such disparities are linked to power
imbalances. A lack of power limits women’s access to resources, makes them vulnerable to
gender-based and intimate partner violence, deters them from negotiating condom use, and
more broadly, from taking control of their sexual health. These factors combine to increase
women’s risk of contracting HIV (Jewkes& Morrell, 2010; Gupta, 2000).
The current literature establishes general trends in the relationship between genderbased inequality and the spread of HIV/AIDS, but the complexities of the phenomenon are
deeply rooted in specific cultural, political, and even geographic realities. Worldwide, gender
inequality disproportionately privileges men, but the particularities with which this dynamic
manifests, and relatedly affects HIV transmission, fluctuates from country to country and
community to community. As noted by Scott (2009), in order to understand HIV/AIDS in the
developing countries where it continues to spread, researchers must look to political, economic,
ecological, social, and cultural factors that influence how HIV/AIDS is understood and
represented, and the ways in which people perceive their health outlooks.
As already noted, nowhere is the HIV/AIDS epidemic spreading more consistently than
Sub-Saharan Africa. Political instability, stalled economic growth and undeveloped infrastructure
8
GENDER MAINSTREAMING IN E-E HIV CAMPAIGNS
no doubt are contributing factors to this health crisis. However, research now points to cultural
beliefs and attitudes as the largest obstacles to preventive strategies (Scott, 2009).
Extensive anthropological research on sexual behaviors and sexual decision making has
illuminated some of the pervasive cultural and attitudinal challenges in HIV/AIDS prevention. For
instance, in Malawi, condoms are regarded as an “intruder” in the context of marriage, seen as
an affront to the intimacy of monogamy. Condom use is regarded appropriate only for casual,
extra-marital affairs. The condom serves as a symbol of the type of relationship two people
engage in, thus making it very difficult to promote its use within committed relationships, despite
fears of HIV status (Chimbiri, 2007). In South Africa, condom use is condoned in commercial
sex because this type of coupling is seen as dirty and impersonal, and therefore in need of
protection. Personal partners, alternatively, should be clean and trustworthy, thus to suggest
condom use reflects a woman’s status as dirty, promiscuous and a possible carrier of HIV/AIDS
(Scott, 2009).
Considerable misinformation about the efficacy, purpose and risks of condom use render
the technology severely underused throughout Sub-Saharan Africa (Scott, 2009). Due to gender
roles that place high value on sexual inexperience, fertility and naiveté, adolescent girls are not
likely to feel comfortable seeking out condoms nor information about safe sex and family
planning. Likewise, value placed on male sexual authority and prowess hinders men’s safe,
confidential access to safe-sex information (Gupta, 2000).
GENDER MAINSTREAMING
The concept of “gender mainstreaming” was introduced during the 1995 Beijing Platform
for Action at the UN Conference on Women to reflect lessons learned during the previous 20
years of international development focused on the needs of women worldwide. The premise
was this: efforts that targeted women and so-called women’s issues as independent of other
development challenges failed to address gender-based inequality that fueled women’s
9
GENDER MAINSTREAMING IN E-E HIV CAMPAIGNS
marginalization in development (Elsy, Tolhurst & Theobald, 2005). Most definitions of gender
mainstreaming adhere closely to those set out by the UN Economic and Social Council (1997:
28):
Mainstreaming a gender perspective is the process of assessing the implications for
women and men of any planned action, including legislation, policies or programs, in all
areas and at all levels. It is a strategy for making women’s as well as men’s concerns
and experiences an integral dimension of the design, implementation, monitoring and
evaluation of policies and programs in all political, economic and societal spheres so that
women and men benefit equally and inequality is not perpetuated. The ultimate goal is to
achieve gender equality.
Over the past two decades, most international development agencies and the majority of
international NGOs have adopted some version of the gender mainstreaming terminology
(Moser, 2005). Although there is general consensus on the importance of this agenda,
practitioners and researchers alike are beginning to question the efficacy of the international
development field to successfully operationalize it. One of the criticisms of gender and sexuality
analysis in the public health prism is the utilization of a disease framework (Gupta, 2000),
meaning these concepts are social determinants of ill health, rather than legitimate identity
facets worthy of examination and respect. As a result, public health interventions frame the
discussion around safe sex, rather than sexual health or rights. In other words, rather than take
an inclusive, “sex positive” approach, standard interventions tend to pathologize sex and
sexuality, which may restrict open dialogue and reinforce conservative attitudes toward sex. This
tendency to ignore opportunities to promote empowerment among both men and women leaves
room to question the efficacy of interventions seeking to affect behavior change without
10
GENDER MAINSTREAMING IN E-E HIV CAMPAIGNS
addressing these prevailing social conditions and cultural attitudes. More broadly, significant
concern has been raised about the conflation of the idea of gender with woman-ness. This
tendency focuses on the roles and experiences of women to the exclusion of men. This last
concern is of particular interest to this study.
THE THEORY BEHIND MEDIA CAMPAIGNS
A range of communications theories have been applied toward affecting health-related
behavior change. The health belief model and the social cognitive theory are among the most
commonly cited in the literature. Applying the two theories together provides an important,
complementary approach to understanding change. As discussed in greater detail below, the
health belief model is particularly important for understanding health prevention behaviors like
condom use at the individual level; in contrast, the social cognitive theory is particularly
important for understanding how to change not just individual behavior, but social and cultural
norms, as well.
HEALTH BELIEF MODEL
Health outcomes are affected by myriad factors, including personal attitudes and
community-level realities. Whereas “stimulus response” theories point to consequences alone
as driving individual behavior, both the health belief model and social cognitive theory subscribe
to the “value expectancy” school of thought, which emphasizes the role of subjective
hypotheses or expectations held by the individual viewer as a predictor of behavior
(Rosenstock, Strecher, & Becker, 1988). In other words, behavior is a function of the value an
individual ascribes to a particular outcome and, importantly, one’s confidence in being able to
achieve it. Using this guiding principle, in the 1950s a group of social psychologists at the U.S.
Public Health Services developed the health belief model (HBM) based on social and
psychological theories as a framework to understand individuals’ health behavior change
11
GENDER MAINSTREAMING IN E-E HIV CAMPAIGNS
(Janz, Champion & Strecher, 2002). The HBM constructs are perceived susceptibility, perceived
severity, perceived benefits, perceived barriers, cues to action, and self-efficacy (Asare &
Sharma, 2012). This theory contextualizes health-behavior in terms of individual belief and selfperception, meaning facts alone are insufficient to explain behavior. Rather, this theory
anticipates a person’s likelihood to take specific preventative health-related action by analyzing
three factors: how serious a person perceives a given health risk to be, their sense of personal
vulnerability, and how confident they are in their own ability to successfully avoid negative health
outcomes by taking the proscribed action (Hochbaum, Rosenstock & Kegels, 1952).
SOCIAL COGNITIVE THEORY
In some ways, social cognitive theory (SCT) picks up where the health belief model
leaves off, with some overlap in key conceptual areas. Adapted from the social learning theory,
social cognitive theory was first posited by Canadian psychologist Albert Bandura in 1986,
renamed to signify the importance of cognition in shaping and encoding behaviors. Put simply,
social cognitive theory explains how and why people learn to adopt new behavior. This theory is
founded in an agentic perspective, meaning that individuals are active participants in shaping
their experiences as opposed to passive recipients of stimuli (Bandura, 2001).
What distinguishes social cognitive theory from its predecessors is its effort to explain
why humans adopt new behaviors (Pajares, Prestin, Chen & Nabi, 2009). According to Bandura
(2001), early psychological theorizing was founded on “behavioristic principles that embraced
an input-output model linked by an internal conduit that makes behavior possible but exerts no
influence of its own on behavior. In this view, human behavior was shaped and controlled
automatically and mechanically by environmental stimuli.” Social cognitive theory, alternatively,
suggests that the process is not so simple. Rather, cognition, or the human ability to process
new information, generates a complex process of assessment, which in turn informs human
behavior. While complex, this theory can best be explained by distilling it down to its four key
12
GENDER MAINSTREAMING IN E-E HIV CAMPAIGNS
concepts: human agency, human capability, vicarious learning and self-efficacy. As Pajares,
Prestin, Chen and Nabi (2009) point out, the former two, human agency and capability, can be
framed as the foundation on which social learning is cultivated; vicarious learning is the process
through which new information is obtained; and self-efficacy determines if the new behavior will
ultimately be adopted.
The critical, and complementary, difference between the health belief model and social
cognitive theory is the scale at which they examine behavior. Whereas the HBM is concerned
with individual-level behavior, SCT examines both individual and community-level change,
overlapping at the key issue of self-efficacy. While learning does indeed occur on the individual
level, social change is a collective phenomenon and all four components of SCT can be applied
to collective-level experiences. This community-level application underpins the theory’s utility in
shaping behavior-change media campaigns. Bandura (1995) explores two of the four
components of SCT particularly within the context of collective change: human agency and selfefficacy. Teasing out the notion of agency, SCT recognizes personal agency exercised
individually; proxy agency in which individuals pursue particular goals by influencing people
around them to act on their behalf; and collective agency in which people come together
collaboratively to shape their futures (Bandura, 2002; Moyer-Guse, 2008). Likewise, extending
from self-efficacy, collective efficacy is “the degree to which individuals in a system believe that
they can organize and execute courses of action required to achieve collective goals” (Papa et
al, 2000, pg. 36). Change related to health outcomes require action at both the individual and
community level. As noted in the previous section, the proliferation of HIV/AIDS is driven by
social attitudes toward gender. Overcoming gender-based inequality, and the associated health
consequences, cannot be achieved by the individual alone, but rather demands a collective
change. Bandura (1995) argues that “People who have a sense of collective efficacy will
mobilize their efforts and resources to cope with … obstacles they seek to change” (p. 38). In
13
GENDER MAINSTREAMING IN E-E HIV CAMPAIGNS
fact, self-efficacy is cited as a better predictor of human behavior and achievement than
previously attained goals (Pajares, Prestin, Chen & Nabi, 2009; Bandura, 2002) because
individual motivation tends to be based on what people believe, rather than what is objectively
true.
Social cognitive theory is uniquely suited to media campaigns because of its central
proposition that humans learn vicariously from observing the people around them and in turn,
they model observed behavior (Moyer-Guse, 2008; Bandura 2002; Bandura 1986). Bandura
argues this phenomena holds true for observations made in both live settings or transmitted
through mass media channels. Importantly, according to this theory, not all observed behaviors
are adopted and imitated by viewers. Much like agency, vicarious learning is comprised of four
sub-processes, which, in this case, govern learning: attention, retention, production, and
motivation (Moyer-Guse, 2008). This last part is really key; not only must people learn about
new behaviors, but they must be compelled to adopt them. Accordingly, as in the case of the
health belief model, motivation is related to expected outcomes. When viewers connect positive
reactions to a given behavior, the theory holds that they will have increased motivation to
imitate. The inverse is proposed for behaviors with perceived negative consequences.
These theories are applied to education-entertainment (E-E) based on the crucial
assumption that self-efficacy, and thus likelihood of change, can be increased when E-E
programming models specific skills people can use to overcome perceived and real barriers. For
example, if women have a difficult time discussing condom use with partners due to culturallybased norms, an entertainment-education approach would be to model those conversations
using fictional characters to provide viewers with potential conversation starters and content. In
parallel, the program must model positive outcomes when successful conversations take place,
using locally relevant, realistic scenarios, to promote social, cultural, and relationship changes
over time.
14
GENDER MAINSTREAMING IN E-E HIV CAMPAIGNS
Modern mass-media interventions aimed at affecting HIV/AIDS-related behavior change
have relied heavily on social cognitive theory and the health belief model over the last two
decades, but some have questioned their efficacy on the basis of culture and even logic.
Airhihenbuwa and Obregon (2000) challenge the use of HBM to guide HIV/AIDS prevention,
arguing that it falsely assumes individuals are rational actors. The two authors claim instead that
sexual choices are often driven by emotion rather than logic. Freimuth (1992, p. 101) agrees,
stating “the HBM is a rational-cognitive model and assumes a ‘rational’ decision-maker. Most
adolescents, and many adults, do not seem to approach the AIDS issue from such a logical
perspective, but seem quite capable of discounting risks and optimistically perceiving
themselves as invulnerable to harm.” Questions have also been raised about the narrow range
of influences that HBM recognizes as relevant to health-related decision making, claiming the
theory ignores social, cultural and economic factors which may constrain individual choices.
Looking to culture, some have begun to critically analyze the application of academic
theories originating in developed countries to communities within the so-called developing
world. This dynamic is also framed in the literature as occurring between the global south and
north. Dutta (2006) argues that public health interventions based on the above theories and led
by global development actors tend to pathologize culture in low-income countries, claiming
agencies such as the U.S. Agency for International Development and the World Health
Organization seek to change cultural phenomena in low-income countries, without critically
assessing the cultural values they in turn promote. Airhihenbuwa and Obregon (2000) suggest
that the social cognitive theory promotes values of individualistic cultures of the West, which
may not translate effectively in countries which place higher value on the collective. The two
question the relevance of concepts such as agency, imitation of behavior and self-efficacy to
collective societies. Yoder (1997, P.136) further suggests “We should not expect these models
to be productive in explaining behavior in social contexts where commonsense knowledge of
15
GENDER MAINSTREAMING IN E-E HIV CAMPAIGNS
the world takes quite a different form.” While these are important questions to raise, it is
important to note that this argument ignores considerable emphasis Bandura (2001, 2002)
places on the significance of both collective agency and efficacy.
MOVING FROM THEORY TO PRACTICE: MESSAGE DESIGN AND
ENTERTAINMENT-EDUCATION
The behavioral theories discussed in the previous section are helpful in guiding message
content, but they do not specify how to form that content into persuasive messages (Noar,
Palmgreen, Chabot, Dobransky & Zimmerman, 2009; Fishbein & Cappell, 2006). As Noar
(2006), Cappella (2006), and Slater (2006) point out, this process should be guided by theories
of persuasion, message design and/or information processing. Examples of these types of
theories employed in health communications include message framing (gain and loss),
emotional appeals, sensation-seeking targeting, the elaboration likelihood model and the use of
narratives (Cappella, 2006; Salmon & Atkin, 2003). A ten-year review of HIV/AIDS masscommunications campaigns done by Noar, Palmgreen, Chabot, Dobransky and Zimmerman
(2009) indicates that often times, no clear message design theory is in place. However, they did
find that over 30 percent of campaigns between 1998 and 2008 used entertainment education in
such a way that employed narrative message design.
Entertainment-education is the purposeful infusion of prosocial messages in
entertainment programming (Singhal & Rogers, 1999) and is increasingly popular for behaviorchange campaigns (Storey & Sood, 2013; Connolly, Elmore & Ryerson, 2008). E-E strategies
capitalize on the popular appeal of entertainment media to introduce socially significant
concepts to target audiences, seeking to produce changes in audience knowledge, audience
attitudes and audience behavior through entertainment programming on radio, television and
film (Singhal & Brown 1996; Singhal & Rogers 1999). While there are different formats of E-E,
serialized dramas, often in soap opera format, are increasingly dominating the field.
16
GENDER MAINSTREAMING IN E-E HIV CAMPAIGNS
E-E has been referred to as the “magic bullet” (Nyawasha & Chipunza, 2013) of
communications campaigns. However, the magic appears to lie in the narrative message
design. Because of the engaging storyline, audience members have less motivation to criticize
persuasive heath claims made during the program (Slater, 2002; Johnson, Harrison & Quick,
2013). Moyer-Guse (2008) notes that although social cognitive theory is traditionally paired with
E-E, recent theorizing about narrative persuasion in entertainment-education has included the
extended-elaboration likelihood model (E-ELM) to make sense of the technique’s effectiveness
(Slater, 2002b; Slater & Rouner, 2002). This theory focuses on the rare ability of entertainmenteducation to influence beliefs, attitudes, and behavior by limiting message counter-arguing, a
form of message resistance characterized by viewers feeling compelled to dispute the claims
generated by a given campaign. E-ELM suggests that when audience members watch the
dramatic elements of an entertainment program, they are too engaged with the storyline to be
critical of its education messaging (Moyer-Guse, 2008; Johnson, Harrison & Quick, 2013). Thus,
viewers are less likely to counter-argue with the encoded messaging, making it easier to
influence beliefs, attitudes, and behavior.
The success of E-E programming hinges upon the strength of the storyline, the quality of
production, and the ‘‘unobtrusiveness of persuasive subtext’’ (Slater & Rouner, 2002, p. 178).
The theory discusses two main components of engagement, including transportation and
identification. The former describes the viewers’ experience of being cognitively and emotionally
invested in the storyline itself, to the extent that they experience a distance from reality, and
begin to conceptualize within the framework of the program. Identification speaks to viewers’
personal investment in the characters (Moyer-Guse, 2008; Johnson, Harrison & Quick, 2013).
E-E programming typically involves three types of characters from which audience
members can learn vicariously: positive role models who support a prosocial behavior; negative
role models who reject this socially-preferred behavior; and transitional models who change
17
GENDER MAINSTREAMING IN E-E HIV CAMPAIGNS
from negative to prosocial positions throughout the program (Bandura, 2002; Pajares, Prestin,
Chen & Nabi, 2009, Johnson, Harrison & Quick, 2013). Storylines present social dilemmas, and
the characters model potential strategies for coping. Audience members, who empathize with
the characters themselves, are left to arrive at their own conclusions about an appropriate
course of action.
There are many examples of successful E-E campaigns that, while addressing different
issues, share in certain techniques. The messages tend to be highly emotional, motivational
rather than strictly informational, and are framed to emphasize the negative consequences of
not adopting a certain behavior (Vaughan & Rogers, 2000; Bandura, 2009; Kuhlmann, Kraft,
Galavotti, Creek, Mooki & Ntumy, 2008). However, it’s important to note that E-E overall seems
to affect men and women differently, showing greater effects on women than men (Farrar, 2006;
Ward, 2002). Some researchers have pointed out that this may be result of the soap opera
format, which appeals to women’s tastes more than men’s. It may also be that women are
socialized to care more than men about the social topics addressed by E-E programs,
particularly as related to sexual health and family planning. Knowing that overcoming genderbased inequality is paramount for stopping the spread of HIV/AIDS, further exploration of this
issue is critical.
18
GENDER MAINSTREAMING IN E-E HIV CAMPAIGNS
Chapter 3: Methodology
This section outlines the methodology behind this study, designed to answer the following
questions: How effectively have modern HIV/AIDS prevention campaigns integrated gender into
their programs; and, What are best practices for changing attitudes regarding gender roles in
HIV/AIDS prevention?
In order to address the research questions established above, I will use a multiple case
study approach to analyze the content of three, multi-media HIV/AIDS prevention campaigns.
Looking at a collection of campaigns will provide an opportunity to explore and compare
different approaches toward gender mainstreaming within the field.
Specifically, this study will examine the LoveLife PSA series, a select chapter of the Soul
City serial drama, and a subsection of PSAs produced by the Scrutinize campaign, all airing in
South Africa during the last ten years. The three campaigns differ in length, air time, medium
(live actors versus animation) and target audiences, but, importantly, all employ a narrative
format to communicate health messages. Case studies included in this study are a convenience
sample which represents examples of HIV/AIDS prevention campaigns produced by
organizations at different ends of the spectrum of international health development, including
local non-governmental organizations as well as large-scale, international donors, USAID and
PEPFAR. Samples are restricted to South Africa, because the HIV/AIDS epidemic is considered
most extreme in this country, where high rates of sexual and gender-based violence are also
endemic. Findings of this analysis could have significant implications for HIV prevention.
Coding
The three campaigns will be coded on 12 different dimensions: target audience (age, marital
status, gender); gender equality language; representation of women; sex positive/negative
language; gender-specific roles or responsibilities; types of proscribed behavior change;
19
GENDER MAINSTREAMING IN E-E HIV CAMPAIGNS
proscribed attitudinal changes; behavior modeling; positive/negative behavior reinforcement;
empowerment or self-efficacy; and finally, representation of individual or community-level
change. The full code book is available as an appendix to this study.
20
GENDER MAINSTREAMING IN E-E HIV CAMPAIGNS
Chapter 4: Results/Case Studies
Target Audience
Target audience was determined based on the profile of prominent characters with key speaking
roles in each video. Videos featuring lead male characters were coded as having male target
audience; lead female characters were coded as having women as target audience; and videos
where both male and women characters shared equal speaking time were coded as having
male and female target audiences. Age was coded using a similar method. This study is
particularly interested in how target audience informs or interacts with the other dimensions.
Gender Equality representation
Gender-based inequality — the socially constructed power imbalance between men and women
— is cited frequently in the literature concerning the spread of HIV/AIDS. Because the value of
entertainment-education lies in modeling positive behavior alternatives, this study looked for
frequency of messages and/or modeling that promotes equality between genders. Videos were
deemed to be promoting gender equality based on three dimensions: images of women
depicted in each storyline; gender-specific roles and/or responsibility; language explicitly
promoting gender equality.
Of the 16 videos reviewed, just over half (9) include explicit messages and/or images
which challenge “traditional” gender roles (three reinforce gender inequality and four scored
neutral); seven campaigns identified specific roles for men and/or women to challenge genderbased inequality; and, nine of the sixteen campaigns included women characters with one or
more of the following characteristics: women roles operate independently of male characters,
they are not portrayed in overtly sexual scenarios or personal style, women have assertive
speaking roles. The remaining seven videos showed women characters in hyper-sexualized
21
GENDER MAINSTREAMING IN E-E HIV CAMPAIGNS
contexts, in sexually passive roles, or as props for male-centered storylines. Campaigns scoring
positively in one of the three dimensions was not a consistent predictor of scoring positively in
the two remaining dimensions.
Gender equality & Target Audience
Gender equality scores differ among the three target audiences found in this study. Two-thirds of
the campaigns with male target audiences scored negatively for promoting gender equality,
along all three dimensions. Women characters are hyper-sexualized without significant
relevance to storylines and male characters’ attitude toward women characters is not
considered. The remaining third was scored neutral. Campaigns targeting women, or women
and men, scored positively or neutral for gender-based equality content.
Sex Positive/Negative Framing
Sex-positive feminism took root in the 1980s, designed to reject sexual negative attitudes
toward sexuality that those within the movement felt negatively affected women, LGBT
communities, and society more broadly. It’s basic argument is that any form of protected,
consensual sexual expression is a positive component of human relationships. Cultural and
religious attitudes toward sex have featured prominently in HIV prevention campaigns over the
past several decades, ranging from fear-based content, which portrays sex as a dangerous and
potentially dirty exchange, to messages promoting sexual freedom and exploration. This study
found an overwhelming preference for value-free framing of HIV prevention messages, meaning
issues affecting HIV prevention are included, but without comments on sexuality more broadly.
Thirteen of sixteen campaigns are coded neutral; two are coded positively framed; and one is
coded negatively framed. Target audience is not a significant predictor of value framing.
22
GENDER MAINSTREAMING IN E-E HIV CAMPAIGNS
Promoting Behavior Change
The remaining six dimensions coded in this study — proscribed behavior change; proscribed
attitudinal changes; behavior modeling; positive/negative behavior reinforcement; self-efficacy;
and level change (individual or community) — combine to account for the type of change these
case studies seek to promote. Campaigns are coded for multiple messages within one
dimension when appropriate.
The overwhelming majority (14 of 16) of campaigns featured storylines that promote selfefficacy with either direct messaging or implicit suggestions. These micro-stories feature a
character successfully negotiate and overcome a particular obstacle linked to making safer
choices. Notably, self-efficacy translates differently in stories wherein the lead character is male
versus female. In most videos with male leads, and by extension targeting male audiences, the
underlying message is that men can stop the spread of HIV by abstaining from problematic
behaviors: unprotected sex, multiple partners, infidelity, and sexual exploitation of women. With
women lead characters, messages focused on improved self-esteem and confidence,
demanding better treatment from male sexual partners and avoiding risky relationships. In
cases with male and female co-leads, messages focused on shared responsibility. One PSA
targeting men and women, for example, promotes bystander interventions to prevent sexual
assault and exploitation.
The Scrutinize campaign features different levels of self-efficacy messaging, from its
slogan, Turn HIV into HI Victory, suggesting to audience members that they have the power to
stop the spread of HIV, to implied messages encoded into the narratives of its PSA series. Each
of the micro-narratives follows a similar story arch: the main character is introduced; he or she
makes sexually or personally risky choices; the narrator intervenes; and finally, the main
character is compelled to make better choices. In each scenario the main character realizes he
23
GENDER MAINSTREAMING IN E-E HIV CAMPAIGNS
or she has the power to make different choices. The Soul City serial drama’s main character is a
woman whose husband is having sexual relationships outside of the marriage. After confronting
him about the dangers of unsafe sex, she makes clear to him and her mother, who preaches
conservative gender relations, that while she may “not be able to change the world, she can
change what happens in [her] house.” LoveLife, whose target audience is younger than the
other two case studies included here, focuses on character development and self-esteem. In
this series, the young characters are confronted with scenarios wherein they realize it’s okay to
diverge from activities in which their friends are engaged. Examples include bullying,
promiscuity and over concern with physical appearance.
The range of behavior and attitudinal changes endorsed through these three case
studies operate on a largely individual level, with some exceptions. Problematic behaviors
identified in the coding process include: reducing the number of sexual partners, consistent use
of condoms, improving gender equality in relationships, increased frequency of HIV testing,
cultivating a strong sense of personal character, and bystander intervention to prevent sexual
assault or exploitation. PSAs are coded for more than one behavior change message where
appropriate. Consistent condom use is the most common behavior change found among the 16
campaign videos, followed closely by active consent or bystander intervention and improved
gender equality in relationships. Closely related are attitudinal changes. Key attitude shifts
embedded among these case studies are: awareness of personal risk of contracting HIV;
individual responsibility; a rejection of casual sex; women’s responsibility for safe sex; respect
for women in broad terms; and ending the sexual double standard. Among these, individual
responsibility appeared most often, followed by personal risk and respect for women.
Target Audience and Behavior Change
Campaigns targeting male audiences produce the most messages focused on reducing sexual
partners, condom use, and cultivating character. The two campaigns targeting women alone
24
GENDER MAINSTREAMING IN E-E HIV CAMPAIGNS
advocate for improved self-confidence and independence, gender equality within marriage, and
the importance of HIV testing. Content addressing transactional sex with “sugar daddies and
sugar mamas,” consensual and informed sex and bystander intervention is featured in
campaigns with men and women target audiences.
25
GENDER MAINSTREAMING IN E-E HIV CAMPAIGNS
Chapter 5: Analysis & Discussion
This case study began with the goal of evaluating how effectively modern HIV/AIDS campaigns
that use entertainment-education (E-E) integrate gender considerations into their narrative
designs. Given the significance of gender-based inequality in the proliferation of HIV, close
examination of the socio-cultural factors which inform sexual dynamics in affected communities
and the communications strategies most able to affect change in this part of the world is critical.
Using South Africa as a geographic sample, three case studies were selected for indepth content analysis, and were coded on a variety of dimensions related to health
communication theory and gender mainstreaming. Particular attention was paid to how
audience segmentation intersects with message design.
Entertainment-education uses popular culture to promote social change, and on the
surface at least, it appears to be successful. Whereas some campaigns aim to inform audiences
about risks or symptoms associated with various diseases, E-E programming takes this work a
step further by promoting related behavior change using socially and culturally relevant
messages. This approach uses a familiar entertainment format, but embeds in its programming
storylines that address a particular social issue. By developing characters who audiences
recognize and identify with and who model behaviors that confront and uproot problematic
social issues, the show both informs audiences about the dangers of – in this case HIV/AIDS –
and guides the audience to arrive at its own conclusions about how best to avoid it.
This study examined two PSA series – LoveLife and Scrutinize – and one episode from
the Soul City serial soap-opera style drama, a format quickly dominating the E-E field. The two
formats operate under different time constraints, which affect producers’ options for story line
and character development, placing greater limitations on the former category. Still, despite the
different format, narrative message design — the heart of E-E programming — was consistent
26
GENDER MAINSTREAMING IN E-E HIV CAMPAIGNS
among all three. All in all, the case studies demonstrate sophistication in applying health
communications theory (social cognitive theory and health belief model) and tailoring health
messages to target audiences, segmented by gender, age, and marital status. However, the
study also revealed inconsistent messaging regarding gender and gender-based inequality.
Gender Analysis
Gender mainstreaming is often misconstrued to mean a project focuses on women, and with
good reason, as historically, development interventions involving gender have focused primarily
on women’s empowerment and specifically, the role of women. However, as Wanner and
Wadham (2015) report, over the last several decades, efforts towards achieving gender equality
and women’s empowerment have had not been successful because programs did not take into
account the role of men and masculinity. Similarly, the 2003 Report of the UN Secretary General
on men and gender equality argues that “Men in many contexts, through their roles in the home,
the community and at the national level, have the potential to bring about change in attitudes,
roles, relationships and access to resources and decision-making which are critical for equality
between women and men”(UN ECOSOC, 2003). This inclusive type of gender mainstreaming,
or men-streaming as its sometimes called, has the greatest potential for impact in gender-based
violence and sexual and reproductive health (Wanner & Wadham, 2015).
Perhaps as a sign toward progress, the case studies examined here target male
audiences with greater frequency than they do women. However, an increase in health
messages focused on reaching men is not a positive thing in and of itself; critical examination of
the tactics employed in these campaigns is essential.
Among the three case studies, videos with women target audiences promote gender
equality as a foundational component of HIV prevention; those targeting male viewers did not.
For videos with both men and women target audiences, gender messages were mixed. The
Scrutinize campaign, for example, promotes behavior change such as condom use and limiting
27
GENDER MAINSTREAMING IN E-E HIV CAMPAIGNS
sexual encounters among young men to decrease risks of infection. These storylines targeting
male audiences only focus on the lead male character, his personal vulnerability and selfinterest in making safer sexual choices. The campaign fails to address gender relations at all,
and at times, reinforces traditional or even problematic gender roles. Hyper-sexualized images
of young women, for example, are frequently used in episodes targeting young men. In
episodes one and two of the Scrutinize series, women do not have speaking roles and are used
as sexual props to support male characters’ storylines. Moreover, female sexuality is portrayed
as threatening to the lead male character. In this case, while the campaign promotes important
behavior change to limit the risk of exposure to HIV/AIDS, its implicit messages are problematic.
While the Scrutinize campaign fails to adequately consider the gender implications of its
programming it does demonstrate sophistication in wielding the power of E-E. The campaign
succeeds in creating material with which young men can identify and relate. Visually, they are
provocative and artistic with references to pop culture and modern music. Characters use slang
language and participate in activities common among South African youth. According to the
extended-elaboration likelihood model, these tactics likely decrease counter-arguing among
young male viewers by increasing identification and transportation. In other words, if they can
relate to the characters, they are more likely to absorb the social messaging underpinning the
narrative — a key step for creating behavior change.
While this is a critical component of producing successful E-E programming, failing to
address problematic gender roles does not get at the root cause of the HIV/AIDS epidemic in
South Africa, a country with some of the highest incidents of gender-based violence worldwide.
LoveLife and Soul City, in contrast, directly address conceptions of masculinity and manhood as
well as femininity and women’s roles within relationships and in society more broadly. In the
LoveLife series, younger characters are confronted with scenarios that call into question their
own self-value and self-perceptions. With titles such as, Who are you?, Who are you without
28
GENDER MAINSTREAMING IN E-E HIV CAMPAIGNS
your crew?, Who are you without your gear?, and I am somebody, the series ask young viewers
to take a moment to consider how the pressures of peer groups affect their own actions. This
type of critical self-reflection has strong implications for how young people may approach other
social pressures in life, including issues of gender and sexual relations.
Whereas Scrutinize and loveLive are communicating with young, mostly single
audiences, the Soul City episode addresses issues affecting married, adult couples in South
Africa. The episode analyzed here is one snapshot of a multi-episode storyline, however, its
content is abundant in cultural criticism, behavior modeling and crucial information about the
high-risk behaviors related to HIV/AIDS. A key difference between this campaign and the other
two campaigns reviewed is that where Scrutinize and loveLife focus on individual-level
interventions, Soul City questions societal-level attitudes and beliefs. In negotiating the fallout of
infidelity, the two main characters, a husband and wife, each confront societal beliefs and
attitudes that helped to shape their predicaments and which will need to be overcome in order to
move forward.
The woman character faces pressure from her husband and mother to accept infidelity
as a reality of married life in South Africa, despite the emotional pain and sexual health risks
associated with this arrangement. Her insistence on practicing safe sex within the marriage is
rebuked by her husband, leading her to temporarily separate altogether. This character
demonstrates several levels of resistance to cultural attitudes which put her emotionally and
physically in danger. She begins with the most benign intervention: safe sex within the marriage.
Next, she challenges the “sexual double standard” and finally, she demonstrates that no
marriage at all is preferable to one devoid of mutual respect and power.
For his part, the husband character also progresses along a continuum of self-reflection.
Although he is resistant at first to calls for change, he is forced to examine critically the effects of
his actions, his own values and priorities, and the type of man he aspires to be. Importantly, his
29
GENDER MAINSTREAMING IN E-E HIV CAMPAIGNS
“traditional” attitudes are rejected by a male elder in his life, who affirms the same messages put
forth by the wife character: the threat of HIV is real; women have a legitimate claim to fidelity
and honestly from their partners; and, manhood comes with responsibility. Although at the end
of the episode there is not a positive resolution to the couple’s troubles, the audience does see
resolution within each characters’ own personal struggles. Rather than neatly wrap-up the
conflict, the show’s progression models real-life scenarios which will take time to define and
uproot. By pointing to the socio-cultural framework that shapes gender-based inequality and
high-risk sexual behavior, Soul City achieves two critical objectives: it accurately assesses the
scope of the problem at hand and clarifies the level of change needed to make a lasting impact.
Use of Theory
This study confirmed the central roles of health belief model (HBM) and social cognitive
theory (SCT) in shaping effective HIV-focused E-E campaigns. Each of the storylines analyzed
progress along the HBM continuum. First, the character is confronted with the seriousness of
either HIV itself or risky sexual behavior, which is followed by a reminder of his/her own
personal vulnerability; and finally, characters are reminded that they have the power to
determine their own choices. This final step, the concept of self-efficacy, is quintessential to both
the health belief model and social cognitive theory. The two argue that health messages which
inform but do not empower audiences will stop short of producing behavior change in target
populations. Only when individuals believe in their own ability to produce desired outcomes will
they be compelled to act. This belief can be shaped, in part, from watching characters navigate
the same challenges in E-E programming.
Across the three case studies, we see examples of the three E-E character types
discussed earlier: the positive role model who supports a prosocial behavior; the negative role
model who rejects this socially-preferred behavior; and transitional models who change from
negative to prosocial positions throughout the program. They’re also tailored to the South
30
GENDER MAINSTREAMING IN E-E HIV CAMPAIGNS
African cultural, economic and political context, which creates a bond between the audience and
characters. The Soul City program messaging is embedded within the serial drama, which could
be watched for entertainment purposes alone. The two PSA campaigns, in contrast, are explicit
in their objects by ending with a clear call to action. Although this breaks with a traditional E-E
format, the micro-narratives within the campaigns build on HBM and SCT principles
nonetheless, with compelling and engaging storylines.
31
GENDER MAINSTREAMING IN E-E HIV CAMPAIGNS
Chapter 6: Conclusion
HIV/AIDS is among the most pervasive and lethal diseases the modern world has ever known.
Despite the prevalence of proven prevention methods that have driven down new infections in
European and North America populations, some parts of the world — most notably SubSaharan Africa — continue struggle with growing infection rates. In African countries, women
and girls are twice as likely to contract the disease than their male counterparts. In a world
where HIV can be prevented, the enormity of regional and gender-based disparity in infection
rates is unacceptable.
This study examined how entertainment-education campaigns in South Africa are
integrating gender into their HIV-prevention messages. Results showed that concerted effort is
underway to incorporate men and boys into safe-sex dialogue and to promote key behavior
change needed to stop new infections. The programs are grounded in behavior change theory
and use culturally specific content. However, it was also discovered that messages related to
female sexuality, gender-based equality and female empowerment were inconsistent among
content intended for male audiences. It is important to note, however, that due to time and
resources constraints, this content was only analyzed by one coder, thus results could benefit
from additional verification. Likewise, the sample is not representative of the entirety of E-E
campaigns in the regions, and thus readers should refrain from over-generalizing the results.
Despite these limitations, the findings of this study have important implications for HIV
prevention in the region.
Given the scale of the HIV/AIDS epidemic in Sub-Saharan Africa and the parallel
prevention effort taking shape in mass communications campaigns, further examination of
gender mainstreaming in this field is critical. This study focused on the unique capacity of
entertainment-education to reach target audiences with health messages. However, the use of
32
GENDER MAINSTREAMING IN E-E HIV CAMPAIGNS
the soap opera format raises questions. This sub-genre of drama traditionally attracts female
audiences over men. While reaching women with messages about HIV prevention is
undoubtedly important, given the prominence of gender-based inequality as a driving factor of
spreading HIV, understanding how men relate to this entertainment format is important.
Women, after all, cannot by themselves affect attitudes toward gender relations. Men must
change, too.
33
GENDER MAINSTREAMING IN E-E HIV CAMPAIGNS
References
Airhihenbuwa, C., Obregon, R. (2000). A critical assessment of theories/models used in health
communication for HIV/AIDS. Journal of Health Communication, 5, 5-15.
Asare, M., & Sharma, M. (2012). Role of health belief model on sexual communication
among African immigrants. American Journal Of Health Studies, 27(2), 97-106.
Bertrand, J., O’Reilly, K., Denison, J., Anhang, R., & Sweat, M. (2006). Systematic
review of the effectiveness of mass communication programs to change HIV/
AIDS-related behaviors in developing countries. Health Education Research
Theory & Practice, 21(4), 567-597.
Bandura, A. (1986). Social foundations of thought and action: A social cognitive
theory. Englewood Cliffs, NJ: Prentice Hall.
Bandura, A. (2002). Social cognitive theory of mass communication. In J. Bryant & D.
Zillmann (Eds.), Media effects: Advances in theory and research (pp. 121–154).
Connolly, S., Elmore, K., & Ryerson, W. (2008). Entertainment-education for social
change. World Watch, 21(5), 28-29.
Creel, AH., Rimal, RN., Mkandawire, G., Bose, K., & Brown, JW. (2011). Effects of a
mass media intervention on HIV-related stigma: ‘Radio Diaries’ program in
Malawi. Health Education Research, 26(3), 456-465.
FaIola, T., & Heaton, M. (2007) HIV/AIDS, illness, and African well-being. New York:
University of Rochester Press.
Freimuth, V.S. (1992). Theoretical foundations of AIDS media campaigns. In T. Edgar,
M.A. Fitzpatrick, & V.S. Freimuth (Eds.), AIDS: A communication perspective (p.
91-110).
34
GENDER MAINSTREAMING IN E-E HIV CAMPAIGNS
Glik, D., Nowak, G., Valente, T., Sapsis, K., & Martin, C. (2002). Youth performing arts
entertainment-education for HIV/AIDS prevention and health promotion: practice
and research. Journal of Health Communication, 7, 39-57.
Green, E., Witte, K. (2006). Can fear arousal in public health campaigns contribute to
the decline of HIV prevalence? Journal of Health Communication, 11, 245-259.
Hochbaum, G., Rosenstock, I., & Kegels, S. (1952). Health belief model. United States
Public Health Service.
Janz, N. K., Champion, V. L., & Strecher, V. J. (2002). The health belief model. In K.
Glanz, B. K. Rimer, & F. M. Lewis (Eds). Health behavior and health education:
Theory, research and practice (pp. 45 -47). San Francisco, CA: Jossey-Bass.
Kennedy, M. G., O'Leary, A., Beck, V., Pollard, K., & Simpson, P. (2004). Increases in
calls to the CDC national STD and AIDS hotline following AIDS-related episodes
in a soap opera. Journal Of Communication, 54(2), 287-301.
Kuhlmann, AS., Kraft, JM., Galavotti,C., Creek, TL., Mooki, M., & Ntumy, R. (2008).
Radio role models for the prevention of mother-to-child transmission of HIV and
HIV testing among pregnant women in Botswana. Health Promotion
International, 23(3).
Meursing, Karla. (1999) Barriers to sexual behaviour change after an HIV diagnosis in
Sub-Saharan Africa. Resistances to behavioural change to reduce HIV/AIDS
infection in predominantly heterosexual epidemics in third world countries, 35-39.
Moser, C. (2005). Has gender mainstreaming failed?. International Feminist Journal Of
Politics, 7(4), 576-590.
Moyer-Gusé, E., & Nabi, R. L. (2010). Explaining the effects of narrative in an
entertainment television program: Overcoming resistance to persuasion. Human
Communication Research, 36(1), 26-52.
35
GENDER MAINSTREAMING IN E-E HIV CAMPAIGNS
Noar, S. M. (2006). A 10-year retrospective of research in health mass media
campaigns: Where do we go from here? Journal of Health Communication. 11,
21-42.
Noar, S., Palmgreen, P., Chabot, M., Dobransky, N., & Zimmerman, R. (2009). A 10-year
systematic review of HIV/AIDS mass communication campaigns: Have we made
progress? Journal of Health Communication, 14, 15-42.
Nyawasha, TS., Chipunza, C. (2013). Radio broadcasting in the era of HIV/AIDS: Can
this be the magic bullet? International Social Work, 58(2) 223-237.
Olinyk, S., Gibbs, A., & Campbell, C. (2014). Developing and implementing global
gender policy to reduce HIV and AIDS in low- and middle -income countries:
Policy makers’ perspectives. African Journal of AIDS Research, 13(3) 197-204.
Pajares, F., Prestin, A., Chen, J., & Nabi, R. (2009). Social cognitive theory and media
effects. The SAGE Handbook of Media Processes and Effects. Sage
Publications, Inc.
Papa, M. J., Singhal, A., Law, S., Pant, S., Sood, S., Rogers, E. M., & Shefner-Rogers,
C. L. (2000). Entertainment-education and social change: An analysis of
parasocial interaction, social learning, collective efficacy, and paradoxical
communication. Journal Of Communication, 50(4), 31.
Pappas-DeLuca, K. A., Kraft, J. M., Galavotti, C., Warner, L., Mooki, M., Hastings, P., … &
Kilmarx, P. H. (2008). Entertainment-education radio serial drama and
outcomes related to HIV testing in Botswana. AIDS Education & Prevention,
20(6), 486-503.
Rosenstock, I., Strecher, V., & Becker, M. (1988). Social learning and the health belief
model. Health Education Quarterly. 15(2), 175-183.
36
GENDER MAINSTREAMING IN E-E HIV CAMPAIGNS
Sallar, A., & Kpagnane Somda, D. (2011). Homosexuality and HIV in Africa: An essay on using
entertainment education as a vehicle for stigma reduction. Sexuality &
Culture,15(3), 279-309.
Scott, S. (2009). HIV/AIDS: Understanding socio-cultural factors and their influence on
sexual behaviour and decision making in Africa. Journal of the Manitoba
Anthropology Students’ Association, 28.
Singhal, A., & Rogers, E. (2002). A theoretical agenda for entertainment-education.
International Communication Association. 12(2), 117-135.
Slater, M. D. (1999). Integrating application of media effects, persuasion, and behavior
change theories to communication campaigns: A stages-of-change framework.
Health Communication, 11(4B), 335.
Slater, M. D. (2002a). Entertainment education and the persuasive impact of narratives. In M.
C. Green, J. J. Strange, & T. C. Brock (Eds.), Narrative impact: Social and
cognitive foundations (pp. 157–182).
Slater, M. D. (2002b). Involvement as goal-directed strategic processing: Extending the
elaboration likelihood model. In J. P. Dillard & M. Pfau (Eds.), The persuasion
handbook: Developments in theory and practice (pp. 175–194).
Sood, S., Menard, T., & Witte, K. (2004). The theory behind entertainment-education. In A.
Singhal, M. J. Cody, E. M. Rogers, & M. Sabido (Eds.), Entertainmenteducation and social change: History, research, and practice (pp. 117–145).
Tully, M., & Ekdale, B. (2014). The team online: Entertainment-education, social media, and
co-created messages. Television & New Media, 15(2), 139-156.
Vaughan, P. W., & Rogers, E. M. (2000). A staged model of communication effects:
Evidence from an entertainment-education radio soap opera in Tanzania. Journal
Of Health Communication, 5(3), 203.
37
GENDER MAINSTREAMING IN E-E HIV CAMPAIGNS
Wadham, B., & Wanner, T. (2015). Men and masculinities in international development: ‘Menstreaming’ gender and development? Development Policy Review, 2015, 33 (1): 15-32.
Wilkin, H., & Fernandes, S. (2003). An integrative model of entertainment-education
processes and outcomes. Conference Papers -- International Communication
Association, 1-29.
Yoder, P. S., Hornik, R., & Chirwa, B. C. (1996). Evaluating the program effects of a
radio drama about AIDS in Zambia. Studies in Family Planning, 27(4), 188-203.
38
GENDER MAINSTREAMING IN E-E HIV CAMPAIGNS
Appendix: Coding Tables
CAMPAIGN
TARGET
AUDIENCE
GENDER
REPRESENTA GENDEREQUALITY
TION
SPECIFIC
LANGUAGE or of SEX:
ROLES OR
IMAGERY
RESPONSIBIL
POSITIVE
ITY
-YES
NEGATIVE
-NO
NEUTRAL
-YES
-NEUTRAL
-NO
-Neutral
TYPES OF
BEHAVIOR
CHANGE
ATTITUDINAL
CHANGES
Youth
Male
Single
No
Negative
No
Reduce # of
sexual
partners
Increase
awareness of
personal risk of
contracting
HIV; Personal
responsibility
for stopping
the spread of
HIV
Youth
Male
Single
No
Positive
No
Condom
use with
every
sexual
experience
Increase
awareness of
personal risk of
contracting
HIV; Personal
responsibility
for stopping
the spread of
HIV
Youth
Male
Single
Neutral
Positive
No
Condom
use with
every
sexual
experience
Increase
awareness of
personal risk of
contracting
HIV; Personal
responsibility
for stopping
the spread of
HIV
Youth
Male &
Female
Single
Yes
Neutral
No
Monogamou
s sexual
relationship
s
Increase
awareness of
personal risk of
contracting
HIV; Personal
responsibility
for stopping
the spread of
HIV;
Preference for
monogamy
-AGE
(YOUTH/
ADULT)
-GENDER
-MARITAL
STATUS
SCRUTINIZE
PSA #1
“What’s my
risk?”
SCRUTINIZE
PSA #2
“Undercover
HIV”
SCRUTINIZE
PSA #3
“Condom Wise”
SCRUTINIZE
PSA #4
"Undercover
Lover"
39
GENDER MAINSTREAMING IN E-E HIV CAMPAIGNS
SCRUTINIZE
Youth &
Adults
Men &
Women
Single &
Married
Yes
Neutral
Neutral
Condom
use within
establishe
d
relationshi
ps
Importance
of safe sex
even within
committed
relationships;
Condom-less
sex is
exclusively
for
reproduction
Youth
Men &
Women
Single
Yes
Neutral
Neutral
Avoiding
transactiona
l sex with
older “Sugar
Mamas/
Daddies”
Sugar Mama/
Daddy
relationships
are dangerous
SCRUTINIZE
PSA #7
“Booza Brains”
Youth
Men&
Women
Single
Yes
Neutral
Yes
Make good
choices
about when
to have sex;
condom use
with every
sexual
encounter
Women too
must ensure
condoms are
in use; Women
too must make
good sexual
choices; Use
condoms every
time
SCRUTINIZE
PSA #8
“Dangerous
Passes”
Youth
Men &
Women
Single
Yes
Neutral
Yes
Bystander
intervention;
Do not take
advantage
of drunk
women
Men and
women must
protect women
from male
sexual
predators;
personal
responsibility
SCRUTINIZE
PSA #9
“Birds on a
Wire”
Youth
Men &
Women
Single
Yes & No
Neutral
Yes
Avoid risky
relationship
s with older
men; active
bystanders
Men and
women must
protect women
from male
sexual
predators;
personal
responsibility
SCRUTINIZE
PSA #10
“Red Card”
Youth
Men &
Women
Single
Yes
Neutral
No
Make
informed
choices
about sex;
Be informed
about
partners’
status
Casual sex is a
danger to
one’s health;
personal
responsibility
PSA #5
“Love Words”
SCRUTINIZE
PSA #6
“Sugar
Surprise”
40
GENDER MAINSTREAMING IN E-E HIV CAMPAIGNS
SCRUTINIZE
PSA #11
"Puza Protocol"
Youth
Men &
Women
Single
Neutral
Neutral
Yes
Informed
consent;
Bystander
intervention
Women are
not sexual
conquests;
drunk sex is
not safe sex
LOVELIFE
PSA #1
Campaign
“Who are you?”
Youth
boys
Neutral
Neutral
Neutral
Eludes to
safe sex;
Character
building
In general
terms; making
better
decisions;
cultivating
personal
values
LOVELIFE
PSA #2
“Who are you
without your
gear?”
Youth
Girls
Neutral
Neutral
Yes
Women
should find
value in
themselves
extend
beyond
physical
appearance.
Young women
should find
self-value in
terms
unrelated to
physical
appearance
and male
attention
LOVE LIFE
PSA #3
"Who are you
without your
crew?"
Youth
boys
single
Neutral
Neutral
Neutral
Independen
ce; Respect
for others;
developing
strong
values.
Young men
need to define
their own
values
LOVE LIFE
PSA #4
"I am
somebody"
Youth
Young
women
Single
Yes
Neutral
Yes
Female
confidence
Women have
value beyond
sexuality;
women can
succeed;
women have
academic
potential
Soul City
Series 9
Adult Men
& Women
Women
Yes
Neutral
Yes
HIV testing;
Fidelity;
condom
use;
Gender
equality in
sexual
relationship
End to the
sexual double
standard in
S.A.;
Importance of
safe sex; HIV
testing is no
longer optional
41
GENDER MAINSTREAMING IN E-E HIV CAMPAIGNS
BEHAVIOR
MODELING
FOCUS ON POSITIVE
OR NEGATIVE
BEHAVIOR
SELFEFFICACY
-YES
-NO
-NEUTRAL
LEVEL OF
CHANGE
GENERAL MESSAGE
REPRESENTATION OF
WOMEN
Negative
Yes
Individual
Personal
Responsibility;
Danger of Unsafe
Sex; Danger of
multiple partners;
HIV can be stopped
Shown as sex objects;
No speaking roles;
Depicted in relation to
male characters
-YES
-NO
Yes
-Danger of unsafe
sex
-Danger of multiple
partners
No
Positive
Yes
Individual
Be informed; Get
tested; Use
Condoms
Shown as sex objects;
No speaking roles;
Depicted in relation to
male characters
No
Positive
Yes
Individual
Be informed; Use
condoms
Speaking roles; Overly
sexualized; Active
character
Yes
Positive & Negative
Yes
Community
Personal
Responsibility;
Danger of Unsafe
Sex; Danger of
multiple partners;
HIV can be stopped
Active characters;
equal participants in
sexual scenarios as
men
Yes
Negative
Yes
Individual &
Community
Most partners are
unfaithful; Personal
Responsibility;
Danger of Unsafe
Sex; Danger of
multiple partners;
HIV can be stopped
Active characters;
equal participants in
sexual scenarios as
men
Yes
Negative
Yes
Individual
Women are
responsible for
protecting
themselves; Danger
of unsafe sex; HIV
can be stopped
Woman narrator; Active
characters; equal
participants in sexual
scenarios as men
Yes
Positive & Negative
Yes
Community
Intervene to prevent
sexual exploitation;
Drunk people cannot
consent
Man & woman narrator;
men & women shown
as partners
Yes
Positive
Yes
Community
Avoid risky relations;
Young women are
not play-things for
older men; young
men must
intervene,too
Women in traditional
cheerleading roles;
women empowered to
reject older men
No
Negative
Yes
Individual
Be informed about
HIV status; Avoid
casual sex
Women & men conarrate; Women are
active characters;
women have
responsibility
Yes
Negative
Yes
Community
Intervene to prevent
sexual exploitation;
Drunk people cannot
consent
Woman victim; women
& male active
bystanders; rebuke of
traditional male
42
GENDER MAINSTREAMING IN E-E HIV CAMPAIGNS
BEHAVIOR
MODELING
FOCUS ON POSITIVE
OR NEGATIVE
BEHAVIOR
SELFEFFICACY
-YES
-NO
-NEUTRAL
LEVEL OF
CHANGE
GENERAL MESSAGE
REPRESENTATION OF
WOMEN
Yes
Positive & Negative
Yes
Individual
Young people must
cultivate a sense of
self, guided by
personal values
No women featured.
Yes
Negative
Neutral
Individual
Young women
should find self-value
in terms unrelated to
physical appearance
and male attention
Critique of: Young girl
dressed provocatively;
superficial; looking to
men for approval;
Yes
Negative
Neutral
Individual
No women featured.
Yes
Positive & Negative
Yes
Individual
Women have value
Strong, independent,
beyond sexuality;
determined young
women can succeed; woman
women have
academic potential
Yes
Positive & Negative
Yes
Individual
Women have the
right to expect fidelity
from their husbands;
the sexual double
standard is
antiquated; Men are
not invincible;
masculinity includes
vulnerability.
-YES
-NO
LOVE LIFE
Strong, independent
woman willing to
challenge tradition; new
generation of women in
South Africa;
communicative and
authoritative.
43
GENDER MAINSTREAMING IN E-E HIV CAMPAIGNS
Tabulations
Gender-Based Equality
Gender-Based Inequality
Neutral
Male
9
9
6.75
6.75
4.5
4.5
2.25
2.25
0
Gender Equlaity Representation
Proscribed Attitudinal Changes
3%
19%
16%
19%
29%
13%
Personal Risk
Individual Responsibility
Rejection of Casual Sex
Women's Responsibility for Safe Sex
Respect for Women
End to Sexual Double Standard
0
Female
Male & Female
Target Audience By Gender
Proscribed Types of Behavior Change
24%
20%
20%
16%
12% 8%
Gender Equity in Relationships
Bystander Intervention/Consent
HIV Testing
Avoiding Transactional Sex
Fidelity/ Reducing # of Sexual Partners
Condom Use
70
53
35
18
44
0
Community-Level Change
Individual-Level Change