This 26-page evaluation of MTV Network International's 2002 Staying Alive entertainment-education (EE) campaign, in which Family Health International (FHI)'s YouthNet programme acted as a partner, cites evidence that this campaign had significant impact on interpersonal communications about HIV/AIDS and also affected social norms in some cases.

The campaign had 3 core goals: to increase awareness of HIV/AIDS and encourage prevention
behaviour, to reduce HIV-related stigma and discrimination, and to empower
youth to take action. To accomplish these goals, organisers used multiple formats including 7 public service announcements (PSAs), a show called "Clinton Uncut" (featuring then-President Bill Clinton), live music concerts that integrated HIV education and youth interviews, and the Staying Alive website, a brightly coloured site presented in English, French, and Spanish. Following World AIDS Day (December 1) 2002, campaigns in selected countries continued to build on the 2002 campaign, including broadcasts in China and other countries.

Evaluators begin by providing some context for their research. They note that some commentators are concerned that the globalisation of media - in terms of both content and distribution methods - could contribute to a "globalisation of culture", with a potentially negative influence on attitudes and behaviours. For instance, Western media in particular has been criticised for promoting materialism and failing to celebrate diversity. But "what critics consider less frequently is the potential for positive change
and opportunities to make young people aware of social issues that affect them and to educate them about their rights and responsibilities." Citing a number of such positive examples from around the world, the authors note that there is a research void here to be addressed. They explain that "Only a few studies have examined the impact of Western media, particularly television, on youth in developing countries. Moreover, nearly all have used a cross-sectional study design, which does not have a control group or monitor changes over time."

In this context, the study described here drew on cross-sectional, population-based, household surveys conducted among young men and women ages 16 to 25 in Dakar (Senegal), Kathmandu (Nepal), and São Paulo (Brazil). These particular sites were selected because they represented different country-level experiences with HIV/AIDS, different cultures, different media environments, and different kinds of access to the Staying Alive campaign. At each site, about 1,000 young people were surveyed at baseline and post-campaign, including about equal numbers of males and females. To obtain more in-depth information, the study also included focus group discussions. During these focus groups, participants watched campaign components and then engaged in 1.5-hour discussion sessions.

FHI/YouthNet used a conceptual framework called the social diffusion model of
media effects to evaluate the impact of this global project. Underpinning this model is the notion that, to influence culturally ingrained behaviours, such as those related to HIV risk and prevention, an intervention must first influence social and cultural norms and attitudes about those behaviours. According to this model, the role of mass media campaigns is to promote interpersonal communication as a step to change social norms and support personal behaviour change. In this context, the study measured exposure to the campaign, examined the effects of exposure on interpersonal communication about HIV prevention, and looked at the joint effects of exposure to the campaign and interpersonal communication on social norms related to HIV prevention.

Evaluators found that the campaign had broad reach; for instance, 82% of all young people in Dakar (220,000) were exposed...and nearly 700,000 youth in the 3 sites surveyed had access to at least one campaign element. It also resulted in significantly more interpersonal communication on the subject of HIV/AIDS. Attitude change was also detected; for example, for the HIV prevention beliefs scale, a positive relationship existed with both exposure and interpersonal communication in Kathmandu and São Paulo.

Based on their findings, evaluators conclude that materials from a global, cross-cultural campaign about HIV/AIDS can tap into universal themes: "The focus groups showed that global images with a core set of HIV prevention messages can involve youth deeply and emotionally in such universal
themes as a sense of responsibility, blame, and empathy. In all sites, the documentary stories evoked a deep response to the complexities of the epidemic that crossed all borders, especially regarding the theme of being faithful to a partner and
not bringing infection into a relationship."

They offer several recommendations based on this research (excerpted from the Observations and Conclusions section):

• "Partnerships with radio broadcasting can expand the campaign...
• Local support can expand a global campaign but needs to be targeted to areas where there is little access to the global media or where access is prohibitively expensive to most viewers...
• Adapting a global campaign to a local culture can expand the appeal of the campaign...
• Programs developed for a global audience can spur additional programming and investments at the local level...
• Deciding whether to focus on long- or short-form programming is challenging...Formative research in various cultural settings prior to the development of new global campaigns can help identify messages that are effective and those that are not.
• Local and global media campaigns need data on youth and media..."