Participants in post-broadcast focus groups reported "...that the drama series brought about a new level of consciousness about their personal risk to HIV, in part due to an increased sense of awareness or even suspicion of their sexual partners..." and that the series "sparked a considerable degree of meaningful self-reported behaviour change as a result of participants' engagement with Intersexions."
These are two of the findings outlined in this 212-page report discussing the post-broadcast evaluation of the second series of Intersexions, a South Africa television programme designed to prevent HIV transmission and promote attitudes and behaviours to enhance sexual and reproductive health. The series comprised 25 interlinked episodes and a one-hour long final docudrama episode. The report presents qualitative research findings on audience responses, presented in terms of how participants engaged with the series: whether they perceived it to be realistic; the extent to which it encouraged critical self-reflection; the integration of social media; the extent to which it encouraged interpersonal communication; audience reception of the storylines related to sexual minorities; the use of the docudrama approach; and the extent to which it changed behaviours.
Produced by Quizzical Pictures and Ants Media, in partnership with Johns Hopkins Health and Education in South Africa (JHHESA) and SABC Education, the series' overall objective is the prevention of HIV and the promotion of attitudes and behaviours that enhance sexual and reproductive health. As stated in the report, "the focal content of Intersexions II differed from the first series' focus on the sexual network, with the current series focusing on secrets; on how that which is left unsaid or hidden in our personal and sexual relationships places us at risk of HIV infection." The second series included other topics not previously covered in Intersexions, such as medical male circumcision, corrective rape of lesbian women, same-sex relationships, post-exposure prophylaxis (PEP), and antiretroviral treatment for children (See Related Summary below for more information on the series).
Fourteen focus group discussions and 12 individual interviews were conducted with regular viewers immediately following the broadcast of the final episode. Participants were recruited from urban, peri-urban, and rural localities and included people in three age ranges: 18 to 24 years, 25 to 29 years, and 30 years and older.
Focus group participants described Intersections as being both of high entertainment value and as "an eye-opener" and "life changing". The series also prompted viewers to reflect on their own relationships and the quality and type of communication they have with their sexual partners. It was also seen as a tool to prompt dialogue. "Watching Intersexions created a space for a new level of openness in a number of participants’ family relationships. Many described how their engagement with the series led to more honest and meaningful discussions about sexual and reproductive health issues with children, parents, friends and partners as a result."
On the other hand, there was a mixed response to the series’ objective to promote greater acceptance of sexual minorities. Numerous participants indicated that those storylines were effective at either reinforcing existing positive attitudes or by helping to build greater acceptance of the lesbian, gay, bisexual, transgender, and intersex (LGBTI) community, but a number of participants continued to express significant levels of intolerance towards sexual minorities, which may have even been strengthened by their exposure to Intersexions.
The overall theme of communication or "sexual secrets" was well received by the viewers interviewed. "A message about the importance of being honest with one's partner, friends and family was often articulated, with honesty being identified as a key strategy to avoid unnecessary conflict, protect one's health and to achieving 'real love'. The idea that one's secrets 'will catch up with you' was also frequently expressed as a reason to be truthful in one's relationships." There was evidence of "audience members honestly reflecting on their lives, relationships and the secrets that they have kept from significant others or feel have been kept from them (and the actual or potential impact on their personal and sexual relationships). As well, "participants reported an increase in their personal condom use as a result of their engagement with Intersexions; for some, this decision came from a greater realisation that 'feeling safe' is not a sufficient reason to have unprotected sex."
One notable strategy of Intersexiosns is the use of the final episode docudrama, which provides an overview of the whole series, linking different plot elements and educational content, and reiterating the main theme of communication. The episode broke form and explicitly revealed in documentary style how the various secrets, risk scenarios, and behaviours portrayed in the previous 25 episodes either thwarted or helped the HIV virus to thrive. The narrator of the docudrama is the personification of HIV, who many research participants commonly referred to as "Mr. V". "Hearing 'Mr. V' narrate the final episode led some participants to internalise the reality of the virus and to assess its relative proximity in their lives through conscious reflection on the risky behaviours they have engaged in."
The report also provides a number of recommendations moving forward, including continuing with a third series, broadcasting more frequently, and making the series available on DVD. A need to better understand all aspects of mass media and social media is also noted. In terms of content, there are still potential gaps in HIV communication which need to be addressed going forward. For example:
- "...there are still significant misconceptions related to HIV infectivity. The need for greater education about serodiscordancy and the actual infectiousness of HIV at different stages of infection in order to counteract prevailing myths about immunity is needed."
- "Some participants seemed unclear about the length of the window period, how often they should test for HIV, and may regard regular HIV testing as a prevention strategy in itself."
- "Other potential HIV content that was regarded as relevant and could be included in the next series includes: continued focus on the sexual network, sexual violence, the link between tuberculosis and HIV, how to live well with HIV and ART [antiretroviral therapy], how to manage HIV in relationships, adolescent sexual health (including teenage pregnancy), the prevention of mother to child transmission (PMTCT), and repeated information about post-exposure prophylaxis."