loveLife: Preventing HIV Among South African Youth

In 1997, South Africa was in the midst of a growing HIV epidemic. In an effort to combat the spread of HIV, the Kaiser Family Foundation, working with the National Health Foundation, began to develop a large-scale prevention effort. In the first two years, the planning team commissioned research into international prevention programs, demographic modeling, and a national survey designed to collect information on young people’s knowledge and attitudes on HIV. Using the information gathered, the team confirmed that prevention efforts should focus on youth because the bulk of the South African population was under 20 years old and young people were at greatest risk of infection given the relatively high level of sexual activity among this age group. With a goal of cutting the rate of HIV infections among 15–20-year-olds in half within five years, the loveLife media campaign and associated interactive life skills program was born. Beyond decreasing teenage pregnancies and sexually transmitted infections, loveLife also aimed to confront deeply ingrained attitudes toward sex and gender inequality. Each aspect of loveLife was managed by a different health service organization – the Health Systems Trust managed finances, the Planned Parenthood Association of South Africa was responsible for implementing youth outreach programs, the Reproductive Health Research Unit managed adolescent-friendly clinical services and conducted research and monitoring, and the NGO Advocacy Health Initiatives created and directed the media and communication programs. To establish the loveLife brand and build a social movement around a positive lifestyle that teenagers would want to join, loveLife’s media campaign adopted a commercial marketing strategy modeled after Sprite’s successful launch in South Africa. Provocative, branded billboards were displayed throughout the country, two youth television shows were developed, sponsored concerts and basketball tournaments were held, a toll-free telephone helpline was created, and celebrity endorsements were shared out. While some of these campaign elements received heavy criticism, the campaign team saw this feedback as evidence that their strategies had been successful in sparking discussion and relied on the National Advisory Board to publicly defend the program. 
LoveLife’s interactive life skills programs were predominantly led by groundBREAKERS, youth aged 18-25 who committed to one year of service as community mobilizers and peer educators. GroundBREAKERS received a monthly stipend of about $150 along with training in community mobilization, program management, computer skills, and public speaking. Working out of loveLife’s teen-friendly clinics, multipurpose teen centers, and franchised community organizations, these volunteers organized and led youth festivals and interactive programs, combining positive lifestyle messages with theater, dance, and sports. GroundBREAKERS also helped the youth centers function by providing indoor and outdoor recreation, computer training, sexual health education, life skills, counseling, and clinical services. Select youth centers also hired nursing staff that could offer reproductive health services including contraceptive pills, injections, and condoms, as well as STI diagnosis and treatment. Additional efforts were made to improve the quality of adolescent health services at government clinics through the National Adolescent-Friendly Clinic Initiative. Quality standards and a process for accrediting public-sector clinics for youth friendly services were developed and clinics were provided with loveLife branded education materials and posters. Over time, many government clinics added recreation areas and “chill rooms” where young people could hang out. A toll-free telephone helpline for young people was also set up as part of the campaign and made available in all 11 national languages. Individuals that called into the helpline could ask questions about health, sexuality, and relationships, or get information on the loveLife program. LoveLife’s largest program, loveLife Games, was a national inter-school sports and debate competition that prioritized rural areas lacking school and community sports programs. Participating youth received athletic equipment and training and had to complete life skills lessons on subjects like personal motivation and sexual health. In the first two years, loveLife was evaluated through small-scale surveys that assessed market penetration and message recall among teenagers. This evaluation method was eventually replaced with a more rigorous and comprehensive evaluation plan. Through surveys, eighty-five percent of youth reported hearing of loveLife; 65% knew of four or more loveLife products or services; and 34% reported participating in the face-to-face programs. Among young people who had heard of loveLife, 92% said it was good for South Africa, and 24% reported doing something as a result of the program, including talking or seeking information about sex. HIV prevalence among youths who had participated in loveLife was 40% lower than among those who had not.
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