Summary Evaluation of Lusweti Multimedia Programmes May Evaluation

Summary Evaluation of Lusweti Multimedia Programmes 2002-2007 May 2009 2002-2007 Evaluation

Acknowledgements This report was compiled by the Lusweti research team with editorial and strategic input from Soul City, Johannesburg and Dr Gill Schierhout, Consultant in Public Health. It is based on the independent research and analysis conducted by the CIET Trust, Johannesburg for the Soul City Regional Programme 2002-2007. Page 2

Table of Contents Acknowledgements 2 Table of Contents 3 List of Figures 4 List of Tables 4 Abbreviations 5 Executive Summary 6 1 Background and Methods 9 1.1 The HIV epidemic in Swaziland 9 1.2 About Lusweti 10 1.3 Evaluation Methods 11 2 Reach and Audience Reception 13 2.1 Exposure to Lusweti 13 2.2 What People Thought of Lusweti 14 2.3 Dialogue about Issues Raised by Lusweti 14 2.4 Summary of Reach and Audience Reception 14 3 Impact of Lusweti 15 3.1 Impact on Knowledge of HIV Prevention and Transmission 15 3.2 Impact on Knowledge of Treatment 16 3.3 Impact on Empowerment in Relation to Refusal of Sex 17 3.4 Impact on Attitudes toward Gender-based Violence 18 3.5 Impact on Decreasing Stigma towards People Living with HIV/AIDS 20 3.6 Impact on Safer Sexual Behaviour 21 3.7 Impact on HIV Testing 22 3.8 Summary of Impact of Lusweti 23 4 Overall Conclusion 23 Page 3

List of Figures & List of Tables Figure 1. Estimated HIV Prevalence in Swaziland by Age 2007 Figure 2. Percent Adults Exposed to Lusweti in Capital, Urban and Rural Areas Figure 3. Percent Adults Exposed to Lusweti in Capital, Urban and Rural Areas Figure 4. Percent Adults Who Know Various Facts About HIV by Exposure to Lusweti 2007 Figure 5. Percent Exposed and Unexposed Adults Who Know Various Facts About ARVs Figure 6. Percent Adults Holding Positive Attitudes towards Women's Right to Refuse Sex by Exposure to Lusweti Figure 7. Percent Men and Women Holding Disapproving Attitudes Towards Gender-based Violence - 2002 and 2007 Figure 8. Percent Adults Holding Positive Attitudes Towards People Living with AIDS by Exposure to Lusweti Figure 9. Percent Men and Women with More than One Sexual Partner in the Past Year - 2002 and 2007 Figure 10. Percent Adults Having Been for an HIV Test and Having Asked Partner to go for an HIV test by Exposure to Lusweti HIV/AIDS Action Now Booklet Table 1. Percent Men and Women Holding Positive Attitudes to Women's Right to Refuse Sex 17 Page 4

Abbreviations AIDS Acquired Immuno Deficiency Syndrome ANC Antenatal Care ART Antiretroviral Treatment DFID Department for International Development HIV Human Immuno Virus MCP Multiple and concurrent partners NSP National Strategic Plan PMTCT Prevention of Mother to Child Transmission SADC Southern African Development Community SBIS Swaziland Broadcasting and Information Service SDHS Swaziland Demographic and Health Survey SHAPE Schools Health and Population Education SHDR Swaziland Human Development Report STVA Swaziland Television Authority TV Television UNDP United Nations Development Programme VCT Voluntary counseling and Testing VOC Voice of the Church Page 5

Executive Summary Introduction The Lusweti Programme uses edutainment to encourage the adoption of healthy behaviours among adults 16-34 years of age in Swaziland through integrating health and development issues into radio and television drama and easy to read booklets. The partner organisation in Swaziland is Lusweti. The partnership is part of The Soul City Institute of Health and Development Communication regional programme operating in 8 southern African countries. Soul City is an internationally recognized health and development organization based in Johannesburg, South Africa. The regional programme commissioned the CIET Trust, Johannesburg to conduct the evaluation of the programme in each of the 8 countries. This report summarizes the results of the findings from Swaziland. The aim of this country evaluation was to investigate the impact of Lusweti on individuals and communities. A baseline survey was performed in 2002. In 2007 an impact evaluation survey was conducted in the same communities as the baseline survey. Both surveys measured demographics. The evaluation survey also measured reach and reception of Lusweti and impact of exposure to Lusweti on knowledge, attitudes and practices related to health and well-being. In 2007, the youth sample included 10511 respondents of the age range of 8 to 17+ years sampled through schools. The adult sample included 2,599 adults aged 16-60 years sampled through a nationally representative household survey. Stratified, random cluster sampling of enumeration areas was used to ensure rural and urban representation in Swaziland. The 2007 data were analysed using bivariate and multivariate methods to enable impacts of Lusweti on key healthrelated knowledge, attitudes and behaviours to be identified. As the programming targeted adults 16-34 years, the results presented below are derived from the household survey of adults of this age range and present the intended impact of the intervention on this target audience. Results Reach and Audience Reception Lusweti achieved extremely high levels of reach across rural and urban areas and in the capital. Reach was highest for women living in the capital (93%) and lowest amongst rural women, although still high at 80%. Some 70% of adult Swazi men in rural areas and in urban areas had listened to Lusweti on the radio and 55% of adult men in the capital had done so. Amongst women, the percentage listening to Lusweti on the radio was almost equivalent in rural, urban and capital areas, at around 76%-80% having listened. Some 59% of rural men and 57% of rural women had read at least one Lusweti print material. Reach of print materials was lower in the capital, with 34% of men in the capital and 38% of women having read at least one print material. Among those who had heard about Lusweti, 85% of women and 74% of men said they liked the Lusweti material very much. One quarter of men materials and 31% of exposed women, said that they talked to others about the topics addressed in Lusweti. Page 6

Impact Knowledge of HIV Transmission and Prevention Methods Lusweti print materials and radio were associated with increased correct knowledge about the cause of AIDS (77% exposed compared to 64% unexposed); knowledge that there is no cure for HIV (77% exposed compared to 55% unexposed); knowledge that you cannot tell whether or not someone has HIV by looking at them (83% exposed compared to 71% unexposed) and knowledge that condoms prevent HIV infection (92% exposed compared to 81% unexposed). Knowledge of Treatment A greater proportion of exposed adults had heard of ARV than the unexposed (90% exposed compared to 64% unexposed). Amongst adults who had heard of ARV, those exposed to Lusweti had higher knowledge than the unexposed on a number of items: knowledge that an ARV person can still transmit the virus (78% exposed compared to 67% unexposed); that ARVs do not permanently cure AIDS (88% exposed compared to 82% unexposed); when to start ARVs (38% exposed compared to 29% unexposed) and what a person taking ARVs should do if they experience side effects (73% exposed compared to 64% unexposed). Empowerment in Relation to Refusal of Sex Amongst adults in Swaziland, those exposed to Lusweti were more likely to disagree with the statement that men have the right to sex with their girlfriends if they buy them gifts (91% exposed compared to 80% unexposed) and were more likely to agree with the statement that a woman has the right to refuse sex with her boyfriend/partner (62% exposed compared to 50% unexposed). Disapproval of Gender-based Violence There were some increases in disapproval of gender-based violence between 2002 and 2007. Lusweti was associated with this increase. In 2007, 94% of those who watched Lusweti television disagreed with the statement that if a woman is raped it is her own fault compared to 88% of the unexposed. Those who read Lusweti print materials were more likely to agree that that forcing a partner to have sex is rape (81% exposed and 75% unexposed agreed with this statement) and those who listened to Lusweti radio were more likely to disagree that women deserve to be beaten (73% exposed compared to 66% unexposed). Amongst people with higher levels of education, changes could be attributed to Lusweti. Decreasing Stigma towards People Living with HIV/AIDS Lusweti was associated with positive changes in two important indicators of stigma, namely, with a decrease in the belief that AIDS is a punishment for sin (73% exposed compared to 55% unexposed), and with a decrease in the belief that telling someone you are HIV positive does not help anything (73% exposed compared to 65% unexposed). Safer Sexual Behaviour Condom use, particularly with non-regular partners was fairly high in Swaziland. There was no significant improvement in condom use among those exposed to Lusweti compared to those not exposed. However exposure to Lusweti radio was associated with a reduction in multiple concurrent partnerships (more than one Page 7

Lusweti achieved good reach amongst adults and young people in Swaziland, with high reach to rural areas a notable achievement partner in the past month). Of those with at least one partner in the past month, 5% of those exposed had two or more partners in the past month compared to 9% of the unexposed). HIV Testing Testing increased in Swaziland between 2002 and 2007, particularly testing amongst women. In 2002, 14% of males and 14% of females had tested in the past year. In 2007, 29% of males and 49% of females had tested. In 2007, having been for a test was associated with exposure to Lusweti (54% exposed compared to 39% unexposed). Conclusion Lusweti achieved good reach amongst adults and young people in Swaziland, with high reach to rural areas a notable achievement. The radio intervention seemed to be particularly effective in achieving significant impacts on knowledge and attitudes related to HIV, ARV and gender-based violence, as well as behavioural impacts including HIV testing and a reduction in multiple and concurrent partnerships amongst sexually active men. Page 8

1. Background and Methods Swaziland is a landlocked country, situated between the Republic of South Africa to the north, south, south-east and west, and Mozambique to the north-east. The country has a land area of approximately 17 000 square kilometres with a population of approximately 1 million citizens. The country's annual Gross Domestic Product (GDP) plunged from 6 percent in the 1990s to a current level of around two percent, resulting in negative per capita growth. Swaziland remains one of the poorest countries, with 66% of the population estimated to be living below the poverty line in 2004. The high prevalence of HIV and a high unemployment rate worsen the socio-economic situation in the Kingdom. 1.1 The HIV epidemic in Swaziland Swaziland has one of the highest HIV prevalence in the world. HIV Prevalence in the general population is estimated at 26% and amongst pregnant women attending Antenatal care (ANC) it has exceeded 40% in recent years. This high HIV prevalence, and the significantly higher prevalence in women (31%) than in men (20%), give evidence of a heterosexual, generalized epidemic. Information from questionnaire survey and qualitative research suggest that most sexual relationships are of heterosexual nature and not same-sex relationships. Noticeably, the male and female curves mirror each other with the female curve peaking at 25-29 years of age and the male curve peaking at 35-39 years. Prevalence in both males and females is below 6% within the 0-14 age range, after which there is a rapid increase to a peak of 49.2% in females and 44.9% in males. Among teenagers aged 15-19 years, the female prevalence is significantly higher at 10.1%, compared to 1.9% in males. In the 35-39 age group, the HIV prevalence among men first exceeds the prevalence among women. From then onwards, the prevalence among men is consistently higher than the prevalence among women. Figure 1. Estimated HIV Prevalence in Swaziland by age 2007 Female 49 45 Male 46 40 38 44 38 28 28 28 28 22 17 24 13 10 6 5 12 3 10 5 2 2 7 4 2-4 5-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60+ Page 9

1.2 About Lusweti Lusweti Institute for Health Development Communication is a nongovernmental Communication for Social Change organization. It started as a programme under the Soul City Regional Programme Communication housed in the Schools Health and Population Education in 2002. Lusweti was formed to promote health and development in Swaziland. It implements its programmes in partnership with Soul City Institute for Health and Development Communication (SC: IHDC). As a regional initiative, Lusweti is implemented along with partners in nine SADC countries. The programme is supported by DFID, the Royal Netherlands Embassy and Irish Aid. As a locally-based health and development communication brand, Lusweti's mission is to facilitate social and behavioural change for the prevention and control of HIV and AIDS by reaching vulnerable people in Swaziland through scaling up mass media, communication, advocacy and social mobilisation. Its target audience is the population age group of 16-34. Lusweti shared the overall Soul City regional programme objectives for the period 2002 to 2007 which were to: 1. Reach 40% of the total population 2. Effect positive behaviour change amongst 15% of exposed people 3. Improve knowledge amongst 20% of the population 4. Improve attitudes towards people living with AIDS amongst 15% of exposed people. The Lusweti intervention comprised the following: Print HIV and AIDS Action Now! booklet (distributed in 2005), dealing with basic facts about HIV and AIDS, stigma and discrimination, VCT and Care and Support: 400,000 booklets in siswati and English were distributed in Swaziland Alcohol and You booklet (distributed in 2007), dealing with alcohol abuse, including causes and relationship with HIV and AIDS and how individuals and communities can best deal with alcohol abuse: 400,000 booklets in siswati and English distributed in Swaziland. Radio Two radio drama series of 45 episodes each: Series 1 dealing with living positively with HIV, disability and rape broadcast on Swaziland Broadcasting and Information Service (SBIS) between November 2004 and February 2005 Series 2 dealing with parents' death and support of orphaned and vulnerable children. It was broadcast on national radio, Swaziland Broadcasting and Information Service (SBIS) between November 2006 and February 2007 and also on Voice of the Church (VOC) between June and August 2007. Television Three Soul City TV drama combined with three local content documentaries in three series Lusweti TV Drama Series 1 dealing with infant mortality, safe motherhood and PMTCT, co-parenting, child sexual abuse, sexual and reproductive rights, alcohol abuse, and HIV and AIDS broadcast on Swaziland Television Page 10

A representative sample of schools was selected across the country. School pupils within these schools formed the youth sample. Authority (STVA) between October and December 2004. Series 2 dealing with the dangers of hypertension, youth sexuality and peer pressure, sexual harassment, domestic violence, discrimination at the workplace due to HIV/AIDS, treatment adherence, young women's empowerment/independence, entrepreneurship, and living positively broadcast on Swaziland Television Authority (STVA) between November 2005 and January 2006. Series 3 dealing with psychosocial support for people living with HIV and AIDS, disability, young women's empowerment, home based care, rape, stigma and discrimination, dealing with death and dying and alcohol abuse broadcast on Swaziland Television Authority (STVA) between December 2006 and February 2007. 1.3 Evaluation Methods The evaluation used quantitative data analysis methods to measure the impact of Lusweti. Evaluation activities for the national adult population included a baseline survey conducted in 2002, a mid-term qualitative evaluation conducted in 2006 and a follow up nationally representative survey conducted in 2007. The survey used a stratified random cluster sample of the enumeration areas based on the 1997 population and housing census of Swaziland obtained from the Central Statistics Office. A total of 25 sites were randomly selected in both the 2007 evaluation and the 2002 baseline. Of the 25 sites, 19 represented rural areas, 4 urban and 2 the capital, Mbabane. A representative sample of schools was selected across the country. School pupils within these schools formed the youth sample. Data collection for the in-school youth sample took place during March 2003. The same sites were selected for the 2007 and 2002-2003 baseline surveys, although not the same individuals. This report focuses on analyses of the 2007 national adult population survey and 2007 school survey and assesses the HIV/AIDS impacts of Lusweti. In the 2007 surveys, data were collected from a total of 11 128 youths between ages of 8 17+ years from 64 schools and 1975 adults aged between 16 to 60 from 1894 households. In this survey, randomly selected adults were interviewed and asked about their values and behaviours, regardless of whether or not they had been exposed to Lusweti. Through comparing attitudes and behaviours between those who were exposed to Lusweti with those who were not exposed, changes attributable to Lusweti could be measured. A similar approach was used for youth in school, aged 8-17 years, although youth self-completed interview forms, in a classroom situation under the guidance of a teacher. Multivariate analytic methods were used in order to ensure that any changes reported were due to the intervention and not change that may have happened despite the intervention, or because of some other interventions. Page 11

Key features of the evaluation are summarised in the box below. Key Features of the Evaluation Survey 2007 (Adults aged 16-60 years and Young People aged 8-17 years) Households were selected using stratified cluster sampling methods and personal face-to face interviews were conducted with approximately 1975 adults aged 16-60 years from these households. 64 schools were randomly selected from 25 sites across Swaziland and all children in these schools in the relevant grades (grades 6-9 and grades 3-5) self-completed questionnaires that were specifically designed for children of that age. A total of 11 128 in-school Swazi youth provided data for the survey in this way. Data were collected from households and schools in Swaziland during July 2007. For adults, personal at-home interviews were conducted using a structured pre-tested interview schedules. Interviews were conducted in the home language of the respondent. For the adult sample, data were weighted up to the National population of Swaziland. Methods of Analysis Key frequencies and percentages were calculated for 2002-2003 and 2007. Where estimates are provided, these are weighted up to the national population of Swaziland. Frequencies of key outcome variables were compared between the 2002-2003 and 2007 surveys. Using the 2007 data only, frequencies of key outcomes were compared between those who had been exposed to Lusweti and those who had not been exposed. In some instances, comparisons were also made by intensity of exposure that is, how many of the materials or interventions respondents had been exposed to. Where statistically significant associations were observed, multivariate analysis was undertaken which adjusted for effects of age, gender, educational level and exposure to other AIDS programming. This report focuses on the findings which remained significant in the multivariate analysis as this gives the best available indication of the impact of Lusweti. Ethical approval CIET obtained ethical approval from the CIETAfrica Ethical Review Board as well as from ethics review boards in Swaziland. Approvals were also obtained from the ministries of Health and Education and community leaders in each community. The report has the following objectives: To determine levels of exposure to the Lusweti interventions. To describe the patterns of exposure and the audience. To determine the impact of Lusweti on the intended HIV and AIDS-related attitude and behavioural outcomes that the Lusweti media series intended to address. Page 12

2. Reach and Audience Reception 2.1 Exposure to Lusweti Since its inception in Swaziland in 2002, Lusweti has attracted considerable interest from the target audiences 16-34 year olds, and is also popular amongst age groups outside this range. Figure 2 shows the percent of adults aged 16-34 years who were exposed to Lusweti by area of residence. Reach was highest for women living in the capital (93%) and lowest amongst rural women, although still high at 80%. Figure 2. Percent Adults Exposed to Lusweti in Capital, Urban and Rural Areas 100 80 82 83 88 88 93 80 60 40 20 0 Males Females Rural Urban Capital Reach was fairly good for all of the media interventions (Figure 3). Radio had the highest reach of all of the Lusweti media. Exposure in rural areas was high for all Lusweti media except television. Figure 3. Percent Adults Exposed to Lusweti in Capital, Urban and Rural Areas 100 80 60 40 20 69 69 55 80 76 76 68 32 16 16 38 57 59 51 57 61 34 38 0 Listened to Lusweti on Listened to Lusweti on Watched Lusweti on Watched Lusweti on Read at least one Lusweti Read at least one Lusweti radio - males radio - females television - television - print - males print - females males females Rural Urban Capital Page 13

2.2 What People Thought of Lusweti Those who had heard of Lusweti were asked what they thought of it. Among those who had heard about Lusweti, 85% of women and 74% of men said they liked the Lusweti material very much. Some 78% of those who had heard of Lusweti said the material is what people need and 92% felt that Lusweti material helped with things in their lives. 2.3 Dialogue about Issues Raised by Lusweti One goal of Lusweti was to promote dialogue about issues of relevance to HIV and AIDS as such dialogue is an important part of achieving social change. Lusweti was successful in promoting dialogue, with 30% of adults who were exposed to Lusweti saying that they spoke to others about things they saw, heard or read from Lusweti material (25% males and 31% females). 2.4 Summary of Reach and Audience Reception Lusweti has achieved high levels of brand awareness and reach of each of the media in Swaziland amongst both males and females. Excellent reach was achieved in rural areas. The media with the highest reach was Lusweti radio. Most people who are exposed feel that Lusweti is relevant to their lives, and they say that they like the programming. Almost one third of people who have been exposed to Lusweti say they talk to others about what they have seen or heard on Lusweti, thus potentially increasing the reach and impact of the intervention. Page 14

3.Impact of 3. Lusweti Impact of Lusweti Lusweti was designed to address multiple issues related to health and well being of the Swazi population. These included knowledge of HIV transmission and prevention methods; knowledge of treatment; decreasing negative attitudes to gender-based violence; decreasing stigma towards people living with AIDS and increasing safer sexual behaviour and increasing HIV testing. Data collection for the evaluation survey was conducted in July 2007. Therefore, the impact reported reflects the situation approximately 4-5 years after the launch of the intervention. 3.1 Impact on Knowledge of HIV Prevention and Transmission Part of empowering people against HIV infection involves making them knowledgeable about modes of HIV transmission. Such knowledge is crucial for promoting safe sexual behaviour. Knowledge of the following basic facts about HIV prevention and transmission are highlighted below: Correct knowledge of what causes AIDS That you cannot tell whether someone has HIV by looking at them That there is no cure for AIDS That always using condoms can prevent HIV transmission. In 2007, overall knowledge of these basic facts about HIV was high in Swaziland - over 75% of the sample having correct knowledge per item. Lusweti was associated with increased correct knowledge about the cause of AIDS, knowledge that there is no cure for HIV, knowledge that you cannot tell whether or not someone has HIV by looking at them and knowledge that condoms prevent HIV infection (Figure 4). These associations remained significant in the multivariate analysis indicating that differences can be attributed to Lusweti Figure 4. Percent Adults who various facts about HIV by exposure to Lusweti -2007 Page 15

3.2 Impact on Knowledge of Treatment As more affected families and households have access to antiretroviral treatment (ARVs), it is helpful for people to understand basic facts about ARVs, both to give them realistic expectations about treatment and to allay unnecessary fears about the drugs. One of the objectives of Lusweti was to increase knowledge about ARVs. The impacts of Lusweti on the following indicators related to knowledge of treatment are reported below: Having heard of ARVs Knowing that children with AIDS need to get ARVs Knowing that HIV infected people on ARVs may live longer Knowing that ARVs need to be taken for life. Awareness of ARVs was fairly high in Swaziland, at 85% of both men and women having heard of ARV. Lusweti was associated with increased correct knowledge about ARVs. More exposed adults had heard of ARV than the unexposed (90% compared to 64%). Amongst adults who had heard of ARV, those exposed to Lusweti had higher knowledge than the unexposed on a number of items: knowledge that an ARV person can still transmit the virus, that ARVs do not permanently cure AIDS, when to start ARVs and what a person taking ARVs should do if they experience side effects. Figure 5. Percent Exposed and Unexposed Adults who Know Various Facts About ARVs. Page 16

In multivariate analysis, the associations illustrated in Figure 5 remained statistically significant indicating that changes can be attributed to Lusweti. The Lusweti booklet Action Now and Lusweti radio, rather than television were responsible for increased knowledge of ARV amongst Swazi adults. Despite the fact that the materials were not directed at youth, there was considerable spill over of positive impacts of ARV knowledge amongst youth; some 61% of exposed youth had heard of ARVs compared to 25% of unexposed youth. 3.3 Impact on Empowerment in Relation to Refusal of Sex Societal expectations that sex can be demanded by a man in a relationship can make it harder for women to refuse unsafe sexual encounters, for example, with partners who are not faithful to them. When communities and individuals respect women's personal choices in relation to sex in their relationships, the chances of safer sexual behaviour can be increased. Lusweti included content that intended to promote gender equality and respect on this issue. In 2007, the majority of men (84%) and women (90%) disagreed that men have the right to sex with their girlfriends if they buy them gifts, and 59% of men and 60% of women agreed that women have the right to refuse sex with their husbands or boyfriends. Positive attitudes towards women's empowerment in relation to refusing sex increased since 2002. This is shown in Table 1. Table 1. Percent Men and Women Holding Positive Attitudes to Women s Right to Refuse Sex. 2002 2007 Male Female Male Female Men have the right to have sex with their girlfriends if they buy them gifts (disagree) Women have the right to refuse sex with their husbands or boyfriends (disagree) 75% 81% 84% 90% 53% 58% 59% 60% Page 17

Figure 6. Percent Adults Holding Positive Attitudes towards Woman s Right to Refuse Sex by Exposure to Lusweti 3.4 Impact on Attitudes toward Gender-based Violence In Swaziland, similar to many other countries, gender-based violence is thought to be one of the underlying barriers to safer sexual behaviour, and in some cases, fear of violence prevents disclosure and access to appropriate care and support. Lusweti aimed to address issues of gender-based violence through both the print and radio materials by raising public awareness about the dangers of gender-based violence, particularly in a context where it is still kept as a 'family matter'. There were fairly substantial improvements in levels of disapproval of gender-based violence in Swaziland between 2002 and 2007. This is shown in Figure 7 below. Societal expectations that sex can be demanded by a man in a relationship can make it harder for woman to refuse unsafe sexual encounters,... Page 18

Figure 7. Percent Adults Holding Positive Attitudes towards Woman s Right to Refuse Sex by Exposure to Lusweti The 2007 evaluation survey revealed that exposure to Lusweti was significantly associated with an increase in disapproval of gender-based violence in Swaziland. For example, 94% of those who watched Lusweti television disagreed with the statement that if a woman is raped it is her own fault compared to 88% of the unexposed. Those who read Lusweti print materials were more likely to agree that that forcing a partner to have sex is rape (81% exposed and 75% unexposed agreed with this statement) and those who listened to Lusweti radio were more likely to disagree that women deserve to be beaten (73% exposed compared to 66% unexposed). The multivariate analysis showed that, for better educated people, increased disapproval of gender-based violence on these measures could be attributed to exposure to Lusweti. The survey also measured social norms in relation to gender-based violence through asking people if they believed that it was culturally acceptable in their community to beat women and whether their community feels that violence against women is a serious issue. These social norms were found to have shifted between 2002 and 2007. The majority of men (79%) and women (88%) disagreed that in their culture it is acceptable for a man to beat his wife. These levels of disapproval were around 5% higher than the 2002 data. In 2007, 65% said violence against women was considered a serious problem in their community there were no marked changes between the 2007 and 2002 surveys on this measure. Page 19

3.5 Impact on Decreasing Stigma towards People Living with HIV/AIDS Stigma towards People Living with HIV and AIDS (PLWA) is a cross cutting issue that affects the quality of life of those infected and affected by the disease. Through presentation of factually correct information about HIV/AIDS, Lusweti aimed to decrease stigma in Swaziland. Adults in Swaziland did not show high levels of stigma on the measures used in the survey. In 2007, the majority of Swazi (94%) did not agree that HIV positive people should be made to live apart from others and 93% said that they would provide care for someone with HIV if they had the means to do so. Some 70% did not agree with the statement that AIDS is a punishment for sin. Exposure to Lusweti was associated with positive changes in two important indicators of stigma, namely, with a decrease in the belief that AIDS is a punishment for sin, and with a decrease in the belief that telling someone you are HIV positive does not help anything (Figure 8). Figure 8. Percent Adults Holding Positive Attitudes Towards People Living with AIDS by Exposure to Lusweti. Page 20

3.6 Impact on Safer Sexual Behaviour Using condoms at every act of penetrative sexual intercourse is one of the most reliable and well known forms of preventing transmission of HIV between sexual partners. Other critical components of safer sexual behaviour include abstinence and reducing the numbers of sexual partners, if sexually active. There has been a reduction in the proportion of adults with multiple partners over the five-year period in Swaziland. Among adults in 2002, 56% of males and 19% of females had had more than one sexual partner in the previous 12 months. In 2007, this had dropped to 24% and 5% respectively (Figure 9). Figure 9. Percent Men and Women with more than One Sexual Partner in the Past Year - 2002 and 2007 56 24 19 5 Amongst those sexually active (i.e. with at least one partner in the past month), 13% of men and 1% of women had more than one partner in the past month. Exposure to Lusweti radio was associated with decreases in having more than one partner in past month (5% exposed compared to 9% of the unexposed). In multivariate analysis, exposure to Lusweti radio was found to have significant impacts on this measure among men with higher levels of education. Page 21

Using condoms at every act of penetrative sexual intercourse is one of the most reliable and well known forms of preventing transmission of HIV between sexual partners. Condom use with non-regular partners is thought to be particularly important as such partnerships are often not monogamous, increasing the chances of contact with an infected person. Most adults in Swaziland (over 88%) said that they did not have any difficulty getting condoms if they needed them. Overall, consistent condom use with a non-regular partner did not improve over the five year period. Overall, condom use with non-regular partners was fairly high in both 2002 and 2007 at around two thirds of men and a half of women with non-regular partners saying that they used always used condoms with these non-regular partners. Amongst sexually active adults and youth, there were no significant associations between exposure to Lusweti and condom use with regular or non-regular partners. 3.7 Impact on HIV Testing Through knowing their HIV status, people can be motivated to remain HIV negative, or to care for themselves and access appropriate treatment and other services if HIV positive. VCT services have long been regarded as a critical bridge between HIV prevention and care and support services. Through its positive role modelling of testing situations, Lusweti aims to encourage Swazi to go for HIV testing, and also aims to encourage people to ask their sexual partners to go for testing. In 2007 nearly all respondents reported knowing where to get tested for HIV (93%). In 2002, 14% of males and 14% of females had been for an HIV test in the previous year. In 2007 this had increased to 29% of males and 49% of females having been tested in the past year. The greatest increase in testing was amongst females. Figure 10 below shows the percent of people who had been for an HIV test in the past 12 months and the percent who had asked a partner to go for HIV testing by exposure to Lusweti. Those who had read the Action Now booklet were significantly more likely to have gone for a test in the past year and more likely to have asked a partner to test. Figure 10. Percent Adults having been for an HIV Test and having been for an HIV/AIDS action now booklet. 60 40 54 Exposed 39 Unexposed 56 48 20 0 Gone for an HIV test in the past year Asked partner to go for an HIV test Page 22

3.8 Summary of Impact of Lusweti 1. Lusweti was found to have positive impacts across many measures related to HIV and AIDS knowledge, knowledge of ARV and knowledge and attitudes to gender-based violence. 2. Impacts across all areas were strongest for exposure to radio, and to a lesser extent to print materials. The television intervention did not demonstrate the same consistent positive impacts. 3. Despite fairly high levels of knowledge of HIV prevention and transmission amongst adults in Swaziland, Lusweti was successful in increasing knowledge on a number of measures. 4. Lusweti contributed to increased disapproval of gender-based violence in Swaziland. More exposed adults agreed for example, that women have the right to refuse sex, disagreed that men have the right to sex if they buy gifts and did not think that women deserve to be beaten, or that disagreed that if a woman is raped it is her own fault. 5. Lusweti was successful in decreasing levels of stigma towards people living with AIDS. 6. The evaluation did not find any significant impacts of Lusweti on increasing condom use with regular or nonregular partners. However the radio intervention did appear to be moderately successful in contributing to sexually active men having fewer partners. 4 Overall Conclusion Lusweti has become established as a leading health promotion intervention in Swaziland, indicated by high levels of reach amongst the target population, and also in age groups outside this range. Reach of radio was impressive, particularly in rural areas. The impact of Lusweti is seen in relation to increased knowledge about HIV transmission and prevention, stigma reduction, and increased disapproval of gender-based violence. Behavioural impacts were seen for reduction in multiple and concurrent partnerships and increases in HIV testing. Further work is needed to identify ways to increase reach and impact of Lusweti television this may involve modification of the presentation or content of the programming. Page 23

N I am a homemaker. Fulfilment comes from knowing my family is safe. And to keep it safe, I stick to only my man, who sticks to only me. I m a one man woman. E R C H A Printpak 404-1081