Programme Summary: Shuga: Engaging Tanzanian Young People in HIV Prevention through Edutainment Radio - Tanzania - the United Nations Children's Fund (UNICEF) Tanzania in collaboration with the Tanzania Commission for AIDS (TACAIDS), the United Nations Educational, Scientific and Cultural Organization (UNESCO), and other partners (see below) - July to November 2014.
Issue addressed: In Tanzania, HIV prevalence among young people remains a problem. Shuga is a participatory radio serial drama aimed at increasing knowledge and uptake of HIV testing and counselling (HTC) and condoms among youth aged 15-24.
Background and situation analysis: While Tanzania is making progress in the fight against HIV among adults, with the prevalence decreasing from 7.0% in 2003/04 to 5.1% in the 2011/12, it is still lagging behind in protecting its youth, who comprise almost one-fifth of the population. HIV prevalence among boys and girls aged 15-19 has not decreased in the past five years. HIV rates increase dramatically in the transition to adulthood, particularly for women (from 1.1% among 15-17 year old girls to 6.6% among women aged 23-24; and 0.6% among 15-17 year old boys to 2.8% among men age 23-24 (THMIS 2007-08; 2011-12). Only just over half of 15-19 year olds (53% girls and 62% of boys) know that using condoms and limiting the number of sexual partners can reduce the risk of HIV transmission. The actual use of condoms is also low, especially for high-risk sex. Combined with low uptake of HTC, these are among the challenges that need to be addressed to reduce HIV infections among young people.
More information on the situation of young people in Tanzania can be found in The Adolescent Experience In-Depth Report1, which presents the findings from the in-depth analysis of data from the Tanzania Demographic and Health Survey (TDHS) 2010, the Tanzania HIV and Malaria Indicator Survey (THMIS) 2011-12, and the Violence Against Children in Tanzania Survey (VACS) 2009. The report analyses approximately 40 key indicators - related to: knowledge, attitudes, behaviours, and outcomes (including living arrangements, school attendance, illiteracy, marriage, pregnancy, violence and HIV) of females and males ages 10-14, 15-19, and 20-24 years - in order to determine their specific vulnerabilities at national and regional levels, where possible.
1 Population Council, Tanzania Commission for AIDS (TACAIDS), Zanzibar AIDS Commission (ZAC), and UNICEF Tanzania. 2015. The Adolescent Experience In-Depth: Using Data to Identify and Reach the Most Vulnerable Young People, Tanzania 2009-2012. Dar es Salaam: Population Council, TACAIDS, ZAC, and UNICEF Tanzania.
Programme focus: The Shuga radio series is a multi-country public-private partnership initiative developed by UNICEF, the MTV Staying Alive Foundation, and the U.S. President's Emergency Plan for AIDS Relief (PEPFAR) Partnership for an HIV-Free Generation in 6 countries in Africa - South Africa, Lesotho, Kenya, Cameroon, Democratic Republic of the Congo, and Tanzania - aimed at reaching an audience of 45 million in the region. Young people from the respective countries were involved from the beginning to develop the characters, storylines, and scripts, which were finalised by the consultant and later reviewed by the technical staff at UNICEF. Shuga radio drama series were produced in French, English, and Swahili. Tanzania then adapted the Swahili version to the local context and broadcast it through national and community radio stations, with special focus on the regions with high HIV prevalence.
The 12-episode entertainment-education (EE) drama series showcased the daily lives of 4 young fictional characters (Sofia, Fally, Amina, and Karis). Through the drama, their choices, dreams, friendships, challenges, and triumphs were designed to resonate with the realities of many young people in a country where HIV is an ever-present threat. The storyline examined a range of themes, including HTC, condom use in stable relationships, positive prevention, gender inequality and sexual violence, transactional sex, alcohol abuse, and the role of multiple and concurrent partnerships in driving the HIV epidemic.
The Shuga episodes can be listened to here.
C4D strategies and approaches:
- Fostering national leadership and collaboration through the Shuga Advisory Committee - Chaired by TACAIDS, the National Shuga Advisory Committee has linked Shuga with the government, development partners, and civil society organisations (CSOs). Committee members included UNICEF (secretariat), Ministry of Health and Social Welfare (MOHSW), the National AIDS Control Organization (NACP) and Health Promotion, UNESCO, the United States Agency for International Development (USAID), and CSO partners engaged in behaviour change communication (BCC): Johns Hopkins Center for Communication Programes (JHU/CCP), Population Services International (PSI), the Tanzania Youth Alliance (TAYOA), the African Medical and Research Foundation (AMREF), Restless Development, Shuga ambassador Ms. Faraja Nyalandu, and the national broadcast partner, Clouds Media Company. The committee led the adaptation of the Tanzanian series and provided ongoing technical support in reviewing and endorsing of all contents of the drama and multimedia messages.
- Partnership with a community media capacity initiative - UNICEF collaborated with UNESCO to expand reach to rural young people through community radio stations, as well as enhance capacity of the stations for sustained youth sexual reproductive health (SRH) programming through UNESCO's Community Media Development Program. UNESCO supported each station to roll out complementary programming to enhance outreach and participation of young people, provide relevant localised information, and address unique contexts and challenges faced by youth in a culturally appropriate and gender-sensitive manner.
Combination of Communication Platforms:
- Creating media outreach and feedback mechanism through radio listening clubs - Forty radio clubs were established through 10 community radios under UNESCO's capacity-building programme and UNICEF's CSO partners - Restless Development, SUMASESU, Baylor, and Pastoral Activities and Services for people with AIDS Dar es Salaam Archdiocese (PASADA) - working in regions where HIV prevalence is the highest. Each club comprised up to 20 young people, who gathered weekly to listen to the radio series and engage in discussion guided by a trained facilitator who compiled feedback and shared it with the UNESCO/UNICEF monitoring team. Click here to view a radio discussion guide (in Swahili, PDF format) used by the listening clubs.
- Promoting of Shuga in various platforms - Shuga messages with illustrations and photos were posted on various Facebook pages including UNICEF Tanzania, Clouds FM, Vijana TZ, and UNESCO's blogging network. (As of October 25 2015, there have been nearly 50 media mentions of Shuga; URLs can be provided via the contacts listed below.) Teasers, reminders, and key messages were disseminated through SMS (text) messages, and promotional radio spots were broadcast through national and community radio stations. Multimedia packages were also distributed by implementing partners and listening clubs.
- Employing a mix of monitoring and evaluation approaches - Different approaches were used to monitor and evaluate the feedback from listeners clubs as well as wider audiences including: household surveys using mobile phones at baseline and endline, qualitative feedback from listener clubs, and an SMS survey with self-subscribed survey respondents.
Addressing participation: As indicated above, young people participated as listeners, listening club participants, and research participants.
Specific results, impact, and methods for evaluation: From July to November 2014, weekly broadcasts of Shuga nationally and on 10 regional community radios reached approximately 4 million youth, and over 20,000 young people were reached through various multimedia promotional messages. Forty listener clubs were established and trained, engaging over 700 members to actively listen to the series and provide feedback. Radio presenters and managers, as well as regional HIV and AIDS coordinators, were trained in youth SRH programming.
Baseline and endline comparison of a mobile phone survey to youth in >1,000 randomly selected households in three high HIV prevalence regions (Mbeya, Iringa, Njombe) revealed that HTC awareness increased, particularly among adolescents age 15-17 (from 74% to 84%). Sixty percent of respondents confirmed to have been HIV tested during 12 months preceding the survey, compared to 42% at baseline. Overall, reported HTC rates in the past 12 months increased from 40% at baseline to 55% at endline for males aged 15-24, and 45% to 56% for females of the same age. HTC rates increased by age, with the largest increase observed among youth of age 23- 24 (60% to 79%).
There is a challenge of attribution of particular social behaviour change communication activities to HTC outcomes, since the increases observed could not necessarily be attributed to exposure to Shuga radio alone, given other ongoing initiatives to promote HTC, such as demand creation for voluntary medical male circumcision. However, the survey confirmed that radio was among the top three sources of information for young people about HTC (along with health workers and teachers) and suggested that more efforts should focus on adolescents, who were less likely than young adults to be aware about HTC and to report being HIV tested.
An SMS (text messaging) survey with self-subscribed survey respondents who had listened to Shuga radio serial drama revealed that, while 91% of respondents believed that condoms prevent pregnancy, only 80% believed they prevent sexually transmitted infections (STIs), and 71% believed that condoms prevent HIV transmission. According to organisers, these results highlight the need for consistent and comprehensive condom messaging, as well as point to the need to better understand, through qualitative approaches, why the belief that condoms prevent pregnancy is stronger than that of condoms preventing STIs and HIV. Qualitative data from radio listening clubs showed that youth believe that good communication with their parents has a big influence on their behaviours and can help them to make healthier and more informed decisions.
Lessons learned: Multi-sectorial support is needed to design successful behaviour change communication programmes. Much of the success of Shuga radio is because of the support obtained from other partners through the Shuga Advisory Committee and the partnership with UNESCO, as well as within UNICEF. For example, planning and monitoring and evaluation (M&E) colleagues played a big role in supporting the M&E framework and data analysis, and UNICEF's communication advocacy and partnership section supported the initiative in Facebook posts and by connecting with another national radio station, Radio 5, which opted to rebroadcast the Shuga radio serial drama for free.
Under the continued leadership of TACAIDS, Shuga radio is moving into its second phase in Tanzania, promoting HTC and correct and consistent condom use among young people, with a renewed focus on protection. Organisers hope to expand broadcasting to all corners of Tanzania (including Zanzibar) through UNESCO's community radio network. The plan is to innovate with SMS and mobile phone surveys to get the views of young people on each episode.
UNICEF Tanzania, TACAIDS, UNESCO, and other partners as detailed above.
Emails from Kerida McDonald and Alison Jenkins to The Communication Initiative on October 22 2015 and October 25 2015, respectively.
- First image: On July 26 2014, young people joined government and UN officials, community service organisations, youth leaders, and other stakeholders for the Shuga Radio launch at Samora Stadium in Iringa. Serenaded by local pop stars, launch participants attended mini-lectures on reproductive health, and were offered HIV testing and counselling. ©UNESCO/2014
- Second image: Young people at Shuga Radio launch at Samora Stadium in Iringa in July 2014. ©UNESCO/2014