The impact of cultural relevance on outcomes in a South African school-based HIV/AIDS prevention program

Background and Purpose:

The Shout-It-Now program represents a novel approach to increase the effectiveness of in-school HIV/AIDS prevention programs in South Africa. Specifically, Shout-it-Now is a USA inspired, South African based HIV/AIDS program that uses MTV-format videos with local celebrities talking to young adults about important issues related to HIV/AIDS prevention, such as condom usage, Voluntary Counseling and Testing (VCT), and responsible decision-making. The current study hypothesized that based upon the cultural content and celebrity exposure involved in the program, cultural groups would be impacted differentially based upon their levels of program satisfaction, understanding of HIV/AIDS, and levels of participation in VCT.

Methods:

Purposive sampling was used to select and recruit five secondary schools that were representative of the population demographics of the Western Cape, including one predominantly white school, one predominantly black school, and three predominantly “colored” schools. Participants included students from grade 8 to grade 12. Participants were asked to complete a pre- and post-test survey, before and after watching the Shout-It-Now video. Following the post-test, participants were invited to take an HIV test, which included confidential one-on-one counseling session with a trained VCT counselor.

Results:

Respondents (n=3271) represented 94.4% of all learners who were eligible to participate. Results indicated that the age appropriate entertainment format of the Shout It Now video had a positive impact on participants: i) significant improvements in understanding of HIV/AIDS were found between pre and post tests, ii) 95% enjoyed the video, iii) 95% were of the opinion that celebrities had a positive influence on them, and iv) 88% had blood tests done after the program.

Results of the study also indicated that students from the predominantly black school had the highest intent to be tested for HIV, had the highest level of knowledge gain, had the highest satisfaction with the video, and reported the highest levels of positive influence from celebrities. Subsequent content analysis of the Shout-It-Now video indicated that the majority of interview time (67.7%) was dedicated to celebrities of Black African ethnicity. Whites on the other hand, despite their advance knowledge of HIV/AIDS and initial high levels of intention to be tested, had lower post-intention scores and was the group with the lowest percentage that followed through with testing. The percentage of White interview time in the video was also the lowest.

Conclusion and Implications:

Shout It Now's youth focused formatting and use of young South African celebrities contributes to literature which reports significant improvements in HIV/AIDS prevention outcomes when educational materials are mixed with entertainment. The programs high levels of success among black respondents and slightly lower levels of success with white respondents, emphasizes the importance of cultural relevance in HIV/AIDS prevention programs, and is best explained in terms of Bandura's concept of identification, whereby audiences believe that they share common traits with the celebrity, or Everett Rogers' concept of homophily, which indicates that ideas are most often transferred between individuals who are alike.