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Engaging adolescents to mitigate HIV/AIDS by challenging stigma and social norms

Project

Guyana HIV/AIDS Reduction Plan (GHARP)

GUYANA

Challenge

In 2004, Guyana was experiencing rapid increases in HIV prevalence. Adolescents, then 35% of the nation’s population, were at heightened risk due to lack of information and poor access to products and services for HIV/AIDS counseling. Stigma and fear significantly deterred vulnerable populations, such as out-of-school youth, from seeking testing and counseling services (even if they were available). In addition, disparate gender norms led to power imbalances in negotiating sexual activity. Characteristics such as forcefulness and sexual promiscuity were reinforced in boys, while submissiveness was expected for girls with a common practice of engaging in relationships with ‘sugar daddies’. These norms result in earlier sexual debut with lower rates of condom use. Mitigating the HIV/AIDS crisis required increased availability and uptake of products and services, but also addressing underlying societal norms that underlie poor sexual health.

Innovation

From 2004-2012, HDI partnered on the Guyana HIV/AIDS Reduction Plan (GHARP) by designing and implementing a multimedia campaign, which addressed social, structural, and behavioral barriers to adolescent sexual health. HDI was an early innovator to address stigma which is rooted in fear and misunderstanding through popular music videos and youth-focused events.  As is a signature approach of HDI, interventions responded to key insights from the key target audiences creating appealing platforms and messaging to promote the supply of quality HIV prevention, treatment, and care products and services while creating demand for them among at-risk adolescents. Interventions focused on destigmatizing those living with HIV/AIDS, while challenging gender norms that create power imbalances within adolescent relationships. In applying these principles, HDI:

  • Developed multimedia interventions that promote confidence in girls and challenged “macho” male stereotypes.

  • TV spot featured a young, confident adolescent girl on a basketball court who promotes girls’ agency and decision-making in relationships by declaring “My body, my court, my rules”. Girls were presented with the question: “Boys like to score, are you going to let them?”

  • “Choose your own adventure” style comic book in which adolescents chose the ending of a story related to relationships and sexual health (accepting or rejecting the advances of a “sugar daddy”).

  • TV and print media that depicted the realities of teenage fatherhood, encouraging boys to delay sexual debut.

  • Addressed stigma by creating media messaging that depicted HIV+ individuals engaging in everyday activities.

  • Presented facts and debunked myths surrounding HIV transmission.

  • “Don’t Dis Me” music video, written by an HIV+ artist, communicates that anyone can be vulnerable to HIV, while encouraging people to embrace others living with HIV. Novel for its time, the video included special effects and was produced entirely by local creative talent. This video was premiered at a ‘Don’t Dis Me’ concert headlining international musicians and performers.

  • Advocated for risk-reduction behaviors and practices to be more visible and desirable.

  • Social marketing of condoms to adolescent boys promoted safety and responsibility as masculine traits.

  • Created with mobile testing sites positioned where youth ‘want to be’  to make testing, screening, and counseling more accessible.


Ensuring that the demand aligns with the supply, HDI:

  • Created a micro-lending program to develop sales promoters and micro entrepreneurs to sell and distribute condoms and lubricants.

  • Created a ‘whole-market’ approach through the sales promoter network.

Results

Our approach was designed to create a sustainable feedback loop of citizen participation and government response. The results followed suit. Because of the SLDG program, citizens didn’t just become more aware of government programs- they actively supported them. Citizens began to pay taxes more reliably, demonstrating that they understood taxes as an investment in valuable government services. As a result, unions (small administrative units) saw a 98% increase in revenues, which directly contributed to the implementation of 925 new community projects. Confidence in government also grew: nearly 100% of citizens reported believing that their feedback was considered in local government processes. Citizen satisfaction with local officials also rose by 20%. Communication of value, outlets for citizen discussion, and increased government accountability led to this mutually beneficial result.