MTV Shuga: Changing social norms and behaviors with entertainment education in Nigeria
- Men and boys
- Urban population
- Women and girls
- Communicable diseases
- HIV/AIDS
- Sexual and reproductive health
- Information
- Norms change
An estimated 1.5 million people in sub-Saharan Africa had HIV in 2013, with adolescents and young adults at a disproportionately high risk of contracting HIV. Practicing safe sexual behaviors can reduce HIV transmission, yet many public campaigns to encourage safe sex have failed to convince people to shift young people’s behavior. In partnership with the MTV Staying Alive Foundation and the World Bank, researchers conducted a randomized evaluation to test the impact of the edutainment program MTV Shuga on young people’s knowledge, attitudes, and behavior towards HIV and risky sex in Nigeria. Watching Shuga increased young viewers’ knowledge about HIV and reduced the stigma viewers held around those with HIV. Viewers were also more likely to get tested for HIV and women were less likely to test positive for chlamydia, suggesting that the program had a positive impact on viewers’ sexual health.
Policy issue
An estimated 1.5 million people in sub-Saharan Africa had HIV in 2013. Adolescents and young adults, particularly girls and young women, are at a disproportionately high risk of contracting HIV. Despite increased access to antiretroviral treatments for HIV across the region, around 74 percent of the estimated 1.5 million deaths related to AIDS—the disease caused by HIV—in 2013 occurred in sub-Saharan Africa. Since HIV cannot be fully cured once it is contracted,1 policymakers must focus on measures to prevent its spread. Practicing safe sexual behaviors can reduce the transmission of the virus. However, many public campaigns to encourage safe sex have failed to convince people to shift their behavior.
Media that aims to change the viewers’ attitudes and behaviors by getting them invested in an entertaining storyline that centers educational messages in the narrative, known as edutainment (education entertainment), has become popular with policymakers as an alternative to traditional information campaigns. However, there is little evidence on whether and how edutainment affects viewers’ behavior. Can a television show featuring educational storylines about HIV improve viewers’ knowledge, attitudes, and behaviors around safe sex and HIV prevention?
Context of the evaluation
Nigeria, where this study took place, had the second-highest HIV/AIDS burden in the world in 2014, with a higher prevalence of HIV in urban areas compared to rural areas. About 80 percent of new cases of HIV in 2014 were the result of unprotected heterosexual sex. Risky sexual behavior among young people is prevalent. In 2012, around 24 percent of youths aged 15 to 24 could identify ways to prevent the sexual transmission of HIV, and 12 percent of adults and older adolescents aged 15 to 49 had been tested for HIV in the past year.2 Participants in this study were about 20.6 years old and had completed about 11.6 years of education on average, the majority of whom were in a relationship (about 77 percent) and lived with their families (about 76 percent). Around 47 percent of participants were women.
The MTV Staying Alive Foundation, a media initiative that educates young people about topics including sexual and reproductive health, mental health, and gender-based violence, first premiered the television series Shuga in Kenya in 2009.3 The series was designed to raise awareness about HIV/AIDS and promote safe behavior among young people in Africa through entertaining drama with performances from prominent local actors and musicians. The MTV Staying Alive Foundation filmed the third season of Shuga in Nigeria in 2013, which featured eight 22-minute episodes. The episodes presented stories about the stigma and discrimination associated with the virus, dispelled myths related to HIV transmission, and included messages aiming to promote HIV testing and reduce risky sex.
Details of the intervention
In partnership with the MTV Staying Alive Foundation and the World Bank, researchers conducted a randomized evaluation to test the impact of the edutainment program MTV Shuga on young people’s knowledge, attitudes, and behavior toward HIV and risky sex. Researchers recruited young adults between the ages of 18 and 25 from urban and semi-urban locations in seven towns across the Oyo, Osun, and Ondo states in South-West Nigeria. Researchers selected eighty local community centers, schools, and similar large community buildings as screening sites. Each screening site was randomly assigned to one of three groups:
- Screenings only (27 screening sites): Participants watched all of MTV Shuga’s third season over the course of two 90-minute screenings on either a Saturday or a Sunday one week apart. Researchers did not facilitate any organized discussions of the show’s contents after the screening to make the experience feel as if participants had watched the show in their homes.
- Peer videos (27 screening sites): In addition to watching Shuga’s third season over two 90-minute screenings, participants in this group also watched video clips containing information about the values and beliefs of peers in their communities. Clips included both interviews with young people who had watched pilot screenings of Shuga and statistics on the prevalence of certain beliefs in the participants’ communities.
- Comparison (26 screening sites): Participants attended two 90-minute weekend screenings of the television show Gidi Up, a show that followed characters of a similar demographic and was aimed at the same target audience as Shuga, but did not contain any educational content.
Chosen from both the screenings only and the peer videos groups, researchers randomly invited 1775, or half, of the participants at each of the Shuga screening sites to invite up to two of their friends to attend the screenings.
Researchers administered an initial survey in September 2014 to participants selected to attend the screenings of Shuga. The surveys asked about participants’ attitudes and self-reported behaviors related to HIV prevention and safe sexual practices, their attitudes on the importance of tradition and conformity with peers, and demographic information.
Researchers conducted a second survey eight months after the screenings between May and August 2015. After the survey, researchers invited participants to take part in health camps located at local schools, where participants could play a game where they were given the choice between receiving a cash sum equivalent to the value of one pack of condoms or one, two, or three packs of condoms. At the health camps, participants also had the opportunity to get tested for Chlamydia, another sexually transmitted infection, and received medication if the test was positive. Participants were also given a voucher for a free HIV test at a local testing center. After the health camps, researchers collected information about participants’ attendance, whether they tested positive for Chlamydia, if they redeemed the voucher for HIV testing, and their choice of cash versus condoms in the game.
Results and policy lessons
Watching Shuga increased young viewers’ knowledge about HIV and reduced the stigma viewers held around those with HIV. Viewers were also more likely to get tested for HIV and women were less likely to test positive for chlamydia, suggesting the program had a positive impact on viewers’ sexual health.
HIV testing: Participants who viewed Shuga were 2.5 percentage points more likely to report being tested for HIV, compared to 8.6 percent of participants in the comparison group (a 29 percent increase), and were 94 percent more likely to redeem the voucher for free HIV testing, an increase of 3.1 percentage points relative to 3.3 percent of the comparison group. Additionally, participants who viewed Shuga were 4.9 percentage points more likely to know that HIV tests need to be taken three months after a potential exposure, compared to 12.9 percent of those who did not watch the show (a 38 percent increase).
HIV knowledge and attitudes: On an index that measured participants’ knowledge about HIV, exposure to Shuga increased viewers’ awareness of methods for HIV transmission, options for treatment, and timing for testing by 0.13 standard deviations relative to the comparison group. On an index measuring attitudes towards HIV, viewing Shuga reduced negative perceptions of community members with HIV and increased participants’ inclination to reveal their HIV status to partners by 0.10 standard deviations relative to the comparison group.
Sexual health and behavior: Women who watched Shuga were 1.7 percentage points less likely to test positive for Chlamydia at the health camps, a 55 percent decrease relative to 3.1 percent of women in the comparison group. Chlamydia did not decrease among men who watched Shuga relative to those who did not, though researchers suggested that the lack of difference is due to Chlamydia being less common among men than women. Participants who watched Shuga were 3.3 percentage points more likely to report not having multiple sexual partners, relative to the comparison group. However, watching Shuga had no impact on whether participants reported using condoms or their selection of condoms versus cash at the health camps.
Social effects: Watching peer videos in addition to Shuga had no additional impact on participants’ attitudes toward HIV watching Shuga without the peer videos. Bringing friends to the screenings also had no impact on participants’ knowledge or attitudes regarding HIV. However, bringing a friend of the opposite gender increased participants’ knowledge of HIV by 0.9 standard deviations relative to participants who only brought friends of the same gender. Researchers suggest that the impact on HIV knowledge may have been greater among participants who viewed Shuga with a potential intimate partner, which could explain the difference between participants who brought same-gender versus opposite-gender friends.
Taken together, these results suggest that MTV Shuga increased viewers’ knowledge of HIV and led to reductions in risky behavior and improved sexual health, suggesting that edutainment programs like Shuga may be effective tools for encouraging healthy sexual behavior. More research is needed to examine the role of social networks and conformity in the success of edutainment in other contexts.
Use of results:
MTV Staying Alive Foundation has used the results of this evaluation, along with other research, to tailor the messaging presented in Shuga in three subsequent seasons in Nigeria and two seasons in South Africa. The study has also supported the launch of a research program on entertainment education at the World Bank Development Impact Evaluation unit.