Johns Hopkins University, Bloomberg School of Public Health, Center for Communication Programs (Bertrand); PhD Program in Health Policy, Harvard University (Anhang)

"Given that adolescents are so attuned to mass media for information and cues about how to behave, the media have tremendous potential for reaching them with messages about HIV and AIDS..."

This 37-page report reviews the strength of the evidence for the effects of 3 types of mass media interventions (radio only, radio with supporting media, or radio and television with supporting media) on HIV/AIDS-related behaviour among young people in developing countries. Its purpose is to assess whether these interventions - defined here as "any programmes or other planned, time-limited efforts that have the explicit goal of changing knowledge, attitudes and behaviours that are related to preventing the transmission of HIV and that disseminate messages among an intended population through channels that reach a broad audience" such as radio, television, video, and/or printed materials - reach the threshold of evidence needed to recommend widespread implementation.

The authors evaluate the strategy of using mass media of various types to address HIV/AIDS among youth through a systematic review of studies published or released between 1990 and 2004. Studies were included if they evaluated a mass media campaign that had the main objective of providing information about HIV/AIDS or sexual health (8 quality criteria were developed and applied for methodological rigour). To be eligible for inclusion, studies had to use a pre-intervention versus post-intervention design or an intervention versus control design, or had to analyse cross-sectional data comparing those who had been exposed to the campaign with those who had not been exposed. Studies also had to comprehensively report quantitative data for most of the "outcomes of interest" - which as identified here included:

• increase awareness and knowledge of information on how to avoid HIV infection
• increase access to the skills needed to avoid HIV infection (measured, by self-efficacy)
• increase access to the health services needed to avoid HIV infection (measured by awareness and use of services)
• decrease young people's vulnerability to HIV (measured by more accurate perceptions of personal risk, and changes in social norms)
• decrease HIV prevalence (measured by its proximate behavioural determinants, such as use of condoms)

Of the 15 programmes identified, 11 were from Africa, 2 from Latin America, 1 from Asia, and 1 from multiple countries. One programme used radio only, 6 used radio with supporting media, and 8 others used television and radio with supporting media. The data support the effectiveness of mass media interventions to increase the knowledge of HIV transmission, to improve self-efficacy in condom use, to influence some social norms, to increase the amount of interpersonal communication, to increase condom use and to boost awareness of health providers. The studies reviewed in this article did not tend to show significant effects with regard to creating awareness that healthy looking people may have HIV/AIDS or improving self-efficacy in terms of abstinence. They also did not show significant
effects in terms of increasing the proportion of adolescents who delay their first sexual experience or decreasing the number of sexual partners.

Based on these findings, the authors conclude that mass media programmes - particularly those that are comprehensive - can be valuable in influencing HIV-related outcomes among young people, although not on every variable or in every campaign. They note that campaigns which include television require the highest threshold of evidence, yet they also yield the strongest evidence of effects. They also observe that - when comparing interventions that use radio together with other media, on the one hand, and those that use radio and television together with other media, on the other - "for most outcomes, the two types of interventions showed a surprisingly similar pattern....It might be tempting to conclude that radio used with other media can produce the same results as radio and television used with other media. However, this
presupposes that the settings for the different mass media programmes are comparable; this is a tenuous assumption...." They stress that "Given that television is generally more costly than radio...radio used with other media may be a valuable means of reaching young people when budgets are constrained....Thus, our findings...point to the value of both, depending on the media habits and preferences of the intended audience and the costs involved in programming."

The authors conclude with a chart identifying several recommendations: for policy-makers
(e.g., large-scale campaigns must be closely coordinated with other interventions
(such as those that are school- or clinic-based) to maximise their effects), for programme development and delivery staff (e.g., mass media interventions should be tailored for young people, and campaign materials should be pre-tested among young people), and for researchers (e.g., recognise that randomized controlled trials are not the method of choice for evaluating full-coverage mass media programmes. Instead, use strong quasi-experimental designs and analytic approaches that build a case for inferring causality.) They also discuss a few of the factors that either facilitate or obstruct effective HIV/AIDS-related media campaigns for youth, such as cultural sensitivities and availability of local talent (to develop the entertainment-education intervention).

Note: This article is Chapter 7 of the World Health Organization (WHO) publication Preventing HIV/AIDS in Young People: A Systematic Review of the Evidence from Developing Countries - ed. David A. Ross, Bruce Dick & Jane Ferguson. To access it online, click here for the full book in PDF format; this chapter begins on page 205 of the publication.