Centre for AIDS Development, Research and Evaluation (CADRE) - Presented at the South African AIDS Conference in Durban, August 2003

LoveLife was launched in September 1999 as "the most comprehensive effort to positively influence adolescent lifestyle" in South Africa. Its core aim is to reduce "the incidence of HIV among 15-20 year-olds by 50% over the next three to five years". This was to be achieved through "a brand-driven, sustained multi-dimensional national programme focusing on making condom usage part of youth culture; establishing adolescent friendly reproductive health services as an integral part of public health services; education, community outreach and institutional support" (loveLife, 2000a:2). loveLife brought together a wide range of patrons, funders, and advisors.


This paper reviews the conceptual framework of the loveLife campaign. It critically examines assertions made about the HIV/AIDS context at the outset of the campaign as well as references made to parallel initiatives and claims made via internal research.

The context

The report states that since the outset of the organisation's activities, loveLife publications have put forth an unsubstantiated dismal picture of the HIV/AIDS context in South Africa and of unsuccessful interventions by South African HIV/AIDS programmes. It is further found that many of the statements and statistics quoted in loveLife materials refer to findings, projections and contexts that are inconsistent with research studies available at the time.

For example:

"Already more than 4-million South Africans (10% of the population) are HIV positive. Conservative estimates are that in excess of 10 million South Africans will die of AIDS in the next 5-10 years" (loveLife, 2000a:1)

The report counters this statement saying that it is unclear how a baseline of 4-million infections in 1999, could translate into a death rate in excess of 10-million 5-10 years later – a death rate of roughly one quarter of the South African population, and that no research could be found that confirmed such an alarming estimate. LoveLife's own research report, "The Impending Catastrophe", which was produced in early 2000, contradicts this assertion. The report estimates that a maximum of 635 000 persons would die of AIDS in 2010, with cumulative deaths between 2000 and 2010, in the worst case scenario, totaling approximately 5.7million (loveLife, 2000b). Other unsubstantiated assertions relate to condom use not having changed over the past five year's and to birthrates amongst teens accounting for a third of total births.

loveLife and HIV prevention

The loveLife intervention involves a diverse range of activities centered around a national level communication campaign incorporating broadcast, print and outdoor media. Other components include: telephone helplines for youth and adults; event-based activities including ‘love-tours', a ‘love Train' and loveLife games; service provision through a relatively small number of community-based Y-centres and adolescent friendly clinics; peer education incorporating youth and ‘GroundBreakers' who are also involved in yacht trips (eg. to Antarctica, Rio and Africa's east and west coasts); and a programme focusing on parents. The programme's communication activities focus on promoting ‘positive sexuality' via a ‘lifestyle brand' that combines communication about sex and sexuality with the promotion of consumption of fashion items, music, film and branded goods. It is these activities, combined with identification with the loveLife brand that are intended to halve youth HIV incidence. There are a number of problems with loveLife's core HIV prevention goal. For example, no research establishing baseline levels of HIV infection was conducted at the outset making it impossible to measure any declines of HIV at the 1999 launch baseline. Other examples include:

Previous and parallel interventions

According to this report, the loveLife intervention suggests that it will accomplish its intended impact largely within its own programme. Thereport states that loveLife downplays the importance of othersimultaneous interventions. This is perpetuated by little reference to any other HIV prevention activities targeting youth in South Africa, and where such references do occur, they are situated within a framework of failure and negligible impact. . For example, loveLife is described in the context of other interventions as "Moving beyond the failed ‘do or die' messages of the past… loveLife combines well-established public health approaches with innovative marketing techniques, reaching young people by speaking in a language young people relate to and understand; using a tone of optimism, rather than relying on scare tactics – which have little credibility with youth; harnessing the power and influence of South Africa's youth culture, including television, music and sports to promote healthy living".

As the report points out, fatalistic messaging was specifically problematised by a national communication forum of AIDS communicators who met regularly to inform AIDS communication messages for HIV/AIDS campaigns in South Africa. LoveLife's supposed move beyond ‘do or die messages' is also contradicted by the organization's 2003 campaign which states: "…the fact that if today you are under the age of 20 you have a 50% chance of getting HIV – that's a one in two chance! And even with access to AIDS treatment your expected lifespan could only be around 38 years."

The report further explores the loveLife's rejection of the widely used Red Ribbon AIDS symbol, based on findings from research from focus groups conducted at the outset of the campaign that found that the Red Ribbon was rejected by youth, as symbolising death. It is pointed out that internationally the red ribbon has been central to promoting stigma reduction in relation to HIV/AIDS and has been actively promoted as a symbol of care and concern, as a symbol of hope and as a means of symbolic support to those living with HIV/AIDS.

In 1999-2000, specific mass media campaigns were conducted by the Beyond Awareness Campaign, associating the red ribbon with the concept of care and promoting the wearing of red ribbons. In 2002 the marketing survey group Markinor included the red ribbon in their ‘Top Brands' survey and found that over 96% of urban and 87% of rural respondents recognized the ribbon. A survey of commuters found that 48% had worn an item of clothing with an AIDS message or had worn a red ribbon. The Nelson Mandela/HSRC survey found that over 80% of urban respondents and over 70% of rural respondents had seen the red ribbon in their communities in the past year. Preliminary results from a survey of 18-24 year olds in three South African communities found that 36.6% had ever worn a red ribbon.

loveLife surveys

loveLife have regularly conducted evaluations of their activities, and national surveys have been overseen by the founding funder, Kaiser Family Foundation. The report problematises the inadequate description of sampling methods, as well as the limitations of using leading questions to suggest causal relationships of the intervention to behaviour change.

Conclusions

The report concludes that LoveLife is an enormously well-resourced programme that includes considerable investment by the South African government, as well as a large commitment of funds by the Global Fund for HIV/AIDS, TB and Malaria. This review of the programme¹s approach points to a lack of rigour in the use of contemporary research findings, a dismissive and competitive approach to other South African HIV/AIDS interventions, and inadequacies in evaluative research.

It furthermore states that "LoveLife¹s brochures refer to a complex of advisory and technical review structures ­ including an advisory board of over 30 individuals, a technical review panel of eight highly qualified social and biomedical scientists, independent external review by an expert panel, and day-to-day management overseen by the Vice Chancellor of the University of the Witwatersrand. Yet, for all this expertise, there appear to be fundamental limitations to loveLife¹s evaluative research and these have not been problematised."

The author states that "clearly there is a complex environment of interventions addressing HIV prevention amongst youth in South Africa. Clearly causal impacts on HIV incidence amongst youth cannot be reduced to a single intervention. Clearly, the undermining of parallel interventions is intolerable. Clearly, evaluative research of the programme should address possible conflicts of interests. Clearly, if HIV prevention amongst youth in South Africa is to be addressed in a committed way, it must be addressed coherently and assessed objectively. We can ill afford a journey in the wrong direction."