Addressing Cultural Norms around Transactional Sex for HIV Prevention: Findings from the YEAH Campaign in Uganda

Objectives: Theoretically-informed and empirically-supported approaches are needed to change behaviours to reverse AIDS transmission rates among sub-Saharan Africans. One such strategy combines behavioural theory with a norms-based approach to understand, and then change, cultural norms around the practice of transactional sex that has been implicated in the literature as a significant facilitator of HIV transmission. The Young, Empowered and Healthy (YEAH) campaign adopted three approaches – the “Be A Man” (BAM) campaign to promote positive male norms; “Rock Point 256” (RP256) a radio serial drama that modeled appropriate behaviors; and the “Something For Something Love” (SFSL) campaign aimed at raising awareness about the dangers of transactional sex and taking action against it. The overall campaign used mutually reinforcing channels, including radio spots, posters, billboards, comic books, discussions, and training.

Methods: A household survey of 15-54 year-olds (n = 3,082) was conducted in 14 districts in June 2008 to assess the impact of the campaign on knowledge, attitude, normative perceptions and behaviours that reduce the risk of HIV infection. Data were collected through oral interviews in participants' preferred language. Multiple linear (hierarchical) regressions tested the associations between exposure to the campaign and study outcomes; all tests controlled for age, gender, education, income, urban/rural location, and marital status.

Results: Overall exposure to the three campaigns was high – BAM, 35.7%; RP256, 48.2%; and SFSL 64.6%. After controlling for the effects of the demographic indicators, exposure to one or more of the campaigns was associated with each of the outcomes (all p-values < .001): knowledge, self-efficacy, condom use, HIV testing, advocacy, perceived norms, and self-reported behavioral changes attributed to the program.

Conclusions: The YEAH campaign was the result of collaboration among local, national, and international agencies, with meaningful input from all stakeholders. Young people contributed in all phases of the campaign, from initial conceptualization to channel selection and implementation. The campaign itself was informed by sound behaviour theory, and it used multiple media and interpersonal channels to present a unified and reinforcing message. A significant “dose-response” effect, as demonstrated in this research, indicates that such efforts can bring about positive changes for HIV prevention outcomes.