Implemented in Nicaragua by the non-governmental organisation (NGO) Puntos de Encuentro, Somos Diferentes, Somos Iguales (We're Different, We're Equal), or SDSI, is a communication initiative featuring a weekly national edutainment telenovela called "Sexto Sentido" (SS) with a particular focus on HIV risk, a daily call-in radio show, and community-based activities (coordination across organisational networks, cast visits to schools, youth training camps, and information, education, and communication (IEC) materials).

A longitudinal panel study was used to quantitatively evaluate SDSI's impact in individuals. The study consisted of 3 surveys, administered in October 2003, 2004, and 2005 to the same group of young people, whose ages ranged from 13 to 24 years in 2003. The surveys were implemented in Estelí, Juigalpa, and León, 3 Nicaraguan cities. The research also included in-depth interviews and focus group discussions (FGDs); participatory action research methodologies informed this process. Multivariate and multi-level analyses were carried out.

Nine out of 10 urban residents surveyed had seen or heard of the show. Sexto Sentido TV was widely watched on a regular basis by a large part of the adolescent and youth population, with 59% the sample watching at least 2 of the 3 previous seasons of Sexto Sentido TV "almost always" or "occasionally".

The proportion of people who had heard the Sexto Sentido daily radio programme increased substantially over time, from 9% in 2003 to 29% in 2005. The vast majority of listeners reported having tuned in "occasionally" or "frequently".

The "We need to be able to talk" pamphlets were distributed toward the end of 2004 through organisations linked with Puntos de Encuentro. They were also distributed during the Sexto Sentido cast tours to various Nicaraguan cities. By the last survey, 8 out of every 10 people interviewed said they had seen the leaflet.

Billboard signs were posted in all 15 departmental capitals as well as the capitals of the two Atlantic Coast Autonomous Regions. The billboards displayed information about the local health and social services people could access. They were initially posted during the second half of 2004 in preparation for the second season of Sexto Sentido TV. Their contents were then changed at the beginning of 2005, prior to the final season. During the last survey, 8 out of every 10 people interviewed said they had seen the billboard in their city.

The project's non-mass communication activities occurred on a smaller scale. For example, only 6% of survey participants said they had attended an activity held by the Sexto Sentido TV cast in their area.

After controlling for age, sex, region, and education, evaluators found that individuals exposed to the intervention were more likely to have talked to someone about HIV in the previous 6 months (OR = 1.4). Participants with greater exposure to SDSI demonstrated:

• a 62% greater probability of having talked with someone in the last 6 months about domestic violence, HIV,
  homosexuality, or the rights of young people. (Breakdown of specific topics is as follows: domestic violence: 53%; HIV: 49%; homosexuality/lesbianism: 31%; young people's rights: 48%);
• a 32% greater probability (in longitudinal analysis) of having talked with their partner about condom use;
• 41% greater probability (in last survey) of interpersonal communication about SDSI-related issues (57% in men and 27% in women); and
• increased interpersonal and intimate partner communication that resulted in greater probability of consistent condom use with both steady and casual partners. Interpersonal communication with a casual partner resulted in a 63% greater probability of consistent condom use.

After controlling for age, sex, region, and education, evaluators found that individuals exposed to the intervention were more likely to know where to find information and services on HIV and violence (OR = 2.2). Participants with greater exposure to SDSI demonstrated:

• a 21% greater probability of knowing that it is possible to live with HIV for many years;
• a 30% greater probability of saying that condom use can prevent HIV;
• a 33% greater probability of knowing of a centre that provides attention for cases of domestic violence;
• a 31% greater probability of knowing of a centre that provides attention for sexually transmitted infections (STIs)/
  HIV;
• a 23% greater probability of knowing of a centre for addressing concerns about sexuality; and
• a 17% greater probability of knowing where to take an HIV test.

Evaluators identify the following changes between 2003 and 2005: more support for gender equity, and a decrease in stigmatising attitudes toward (and decreased support for discrimination against) people living with HIV/AIDS (PLHA). For instance, participants with greater exposure to SDSI demonstrated 11% greater probability of perceiving capacities among their group of friends to jointly do something to solve problems of domestic violence. After controlling for age, sex, region, and education, they found that individuals exposed to the intervention were more likely to say that:

1. women should not be solely responsible for housework (odds ratio (OR) = 1.3);
2. they would be willing to be friends with PLHA (OR = 2.0);
3. a man never has a right to hit his wife (OR = 1.4).

Participants with great exposure to SDSI showed:

• Greater increase over time in percentage of respondents who would maintain a friendship with a homosexual friend. The percentage rose from 36% in 2003 to 49% in 2005 among those more exposed to SDSI; it rose from 23% to 32% during the same time period among those with less exposure (p < 0.05).
• Greater increase over time in the percentage of respondents who would maintain a friendship with a lesbian friend. The percentage rose from 38% in 2003 to 48% in 2005 among those more exposed to SDSI; it rose from 26% to 31% among those with less exposure (p < 0.05).

Evaluators found that there was an increase in those who had ever had an HIV test.

Condom use among casual partners increased for those exposed to the show, compared to those who were not exposed. Participants with greater exposure to SDSI demonstrated:

• greater condom use with casual partners (among those who said they'd had casual partners).
• 44% greater probability of having used a condom during the last sexual relation with a casual partner.
• 42% greater probability of having consistently used a condom with casual partners in the last 6 months.
• 56% greater probability among men of condom use with casual partners during the last 6 months.
• 48% greater probability of having been to a centre that attends to cases of domestic violence in the last 6 months.
• 58% greater probability of having visited an organisation with concerns about sexuality not related to HIV in the
  last 6 months.

However, participants with greater exposure to SDSI demonstrated no difference in condom use with steady partner (among those who said they had steady partners), with an overall trend of decreased condom use.

Organisations that participated in SDSI reported gradual and diverse changes in relation to: local work and the development of initiatives; opening up to dialogue and debate about taboo subjects; strengthening leadership; greater collective efficacy among youth linked to organisations; and increased alliances.

Global Health Council website; "Positive Impact of an HIV Prevention Communication for Social Change Program on Youth in Nicaragua" [PDF], by Irela Solórzano, Julie Pulerwitz, Rodolfo Peña, Mary Ellsberg, and Amy Bank; and "Catalyzing Personal and Social Change Around Gender, Sexuality, and HIV: Impact Evaluation of Puntos de Encuentro's Communication Strategy in Nicaragua" [PDF], by Irela Solórzano, Amy Bank, Rodolfo Peña, Henry Espinoza, Mary Ellsberg, and Julie Pulerwitz - June 2008.