The Scrutinize Campaign

Multiple and Concurrent Partnerships

A primary goal of the Scrutinize Campaign was to address the risk of HIV transmission from multiple and concurrent sexual partnerships. Research has revealed the critical role that such partnerships play in driving HIV epidemics (Halperin and Epstein 2007).

Research among South Africans 20 to 30 years old found that 12.6 percent of men and 5.8 percent of women had concurrent partners in the past month (Parker et al. 2007). Over the previous 12 months, 32 percent of men and 12 percent of women reported two or more sexual partners.

One of the conclusions drawn from this and other research is that many South Africans do not make the connection between the number of sexual partners and the risk of HIV infection. Sixty-six percent of South Africans do not see themselves at risk of HIV infection (Shisana et al. 2005), and only 5 percent see partner reduction as a prevention strategy.

One of the conclusions drawn from this and other research is that many South Africans do not make the connection between the number of sexual partners and the risk of HIV infection.

HIV prevalence in 2005 was 10.3 percent among South Africans between 15 and 24 years old. Among those living in informal urban settlements, that figure rises to 17.8 percent. Among young women age 25 to 29, HIV prevalence peaks at 33.3 percent. Because of high prevalence among younger South Africans, the campaign targeted 18- to 32-year-olds.

Developing and Refining The Scrutinize Campaign

The objectives of the Scrutinize Campaign were to:

• Increase people’s awareness of HIV infection risk due to multiple and concurrent partners.
• Delay the beginning of sexual activity among young people.
• Reduce the number of multiple and concurrent partners.
• Promote correct and consistent condom usage with all partners.
• Increase the number of people who test for HIV on a regular basis.

To explore how to address the issue of multiple and concurrent sexual partners, Johns Hopkins Health Education in South Africa (JHHESA) commissioned formative research, which was conducted by the Centre for AIDS Development Research and Evaluation (CADRE). JHHESA then organized an expert briefing for its campaign partners to discuss the key drivers of the epidemic and appropriate communication strategies. At the briefing, qualitative and quantitative research studies were reviewed to help identify potential themes and messages.

In response to the insights provided by JHHESA and CADRE, Matchboxology, a private sector communications firm, developed a creative concept to address some of the issues. Levi’s Red for Life initiative, which works with nongovernmental organizations, musicians, and celebrities on a range of HIV activities, supported Matchboxology in this effort. As the concept progressed, the U.S. Agency for International Development (USAID), the U.S. President's Emergency Plan for AIDS Relief (PEPFAR), and more than 20 South African nongovernmental community partners also joined the campaign.

Because Matchboxology and Levi’s shared a strong marketing perspective, their initial focus was determining how best to engage young people rather than to simply develop campaign messages. They chose to produce the ads as TV animerts (animated advertisements), which are both popular with young people and cost-effective to produce. In developing the animerts, the producers drew inspiration from such animated TV shows as South Park and The Simpsons (84 percent of the population watch television weekly).

JHHESA responded positively to the two initial animerts and organized independent premarket testing to assess how the audience would respond and how it would interpret the word “scrutinize.” The results led to fine-tuning of the two ads. USAID then provided funding for an additional five animerts. Further premarket testing by CADRE helped campaign partners refine all seven animerts before they were broadcast. Each 40- to 60-second ad addressed a specific HIV prevention issue.

One example of how research directly informed the content of the campaign is the “Undercover Lover” animert. Qualitative research found that, while faithfulness has been widely promoted as an HIV prevention strategy, it was not necessarily understood as meaning monogamy. Many of the respondents said it means that one partner does not find out that his or her partner has other lovers. This potential for different interpretations of the message led the creative team to use this animert to highlight the risk of HIV transmission from multiple partners.

Research was not the only source of themes for the campaign. The “Condom Wise” animert was developed after the South African government withdrew 20 million Choice condoms because a corrupt inspector allowed millions of faulty condoms into circulation. The animert was broadcast early in the campaign to rebuild consumer confidence in the Choice brand.

But the Scrutinize Campaign was not limited to advertising. The campaign used a combination of activities to bring about behavior change. Recognizing that individual behavior is embedded within social networks (peers and friends), community (community leaders, community norms), and societal influences (policies and services), the campaign operated on the premise that change at one level can lead to change on multiple levels. Mass media creates the “buzz” that expands the impact of interpersonal communication. This approach to behavior change is reflected in the multilevel, community-based communication activities that the campaign implemented.

Scrutinize Campaign Animert Messages

Implementation

The seven animerts, broadcast nationally from June 2008 to June 2009, were the centerpiece of the Scrutinize Campaign. “What’s My Risk,” “Condom Wise,” and “Undercover HIV” were the three ads initially broadcast to introduce the characters, themes, and campaign brand.

The campaign animerts were broadcast in total 2,666 times. “Undercover Lover” was the most frequently screened, reflecting the importance of its message on the risks of multiple and concurrent sexual partnerships. For each animert, the frequency of broadcasting depended on how the audience responded to the message and how quickly key messages were understood, as determined by ongoing market research. Animerts were scheduled for broadcast at times when their impact could be maximized. For example, the “Booza Brain” animert, which used sports analogies to focus on alcohol use, was broadcast during soccer matches for the Confederations Cup in June 2009, and the “Condom Wise” animert was rebroadcast during Condom Awareness Week in February 2009.

Additional unplanned media exposure occurred when DJ Cleo, one of South Africa’s top house DJs, had dancers in one of his music videos wear the Levi’s Scrutinize T-shirts. This aided the campaign’s exposure and likely increased its popularity among young people.

JHHESA collaborates with 21 partners. To support the television ads, these partners implemented their own Scrutinize Campaign events and activities within their communities to encourage discussion of HIV prevention issues. Activities included doorto- door visits, community events, arts and cultural events, and workshops. For example, Lighthouse Foundation, a partner nongovernmental organization working in South Africa’s North West province, ran Scrutinize Campaign workshops in collaboration with local schools. At these workshops, students and facilitators discussed the campaign messages.

To support the work of its partners and others, JHHESA produced a Scrutinize Facilitator’s Guide and a Community Action Guide. These guides outlined the campaign messages and included suggestions on how to adapt the campaign to the community.

Peer educators stage a play at a community event exploring the risks of concurrent sexual partnerships.

Soon the campaign developed a significant and interactive Internet presence. Victor Scrutinize has his own profile on Facebook, the popular social networking site, with more than 1,400 friends who post comments or questions and are kept up-to-date about the Scrutinize Campaign. There is even an unofficial Facebook page, produced by a supporter of the campaign, which has more than 1,800 members. A Scrutinize Campaign website contains the seven animerts as well as detailed prevention information, and also encourages partners and communities to profile their activities on the site.

Promotional items, including bar coasters, stickers, umbrellas, hats, risk cards (used by audiences at campaign events to indicate if a sexual activity is high risk or low risk), and the much-in-demand Levi’s Scrutinize T-shirts helped raise awareness of the campaign. Three campaign posters were produced: one showed how to correctly use male condoms, another addressed sexual networks, and a third, linking into the soccer theme, addressed the risk of multiple partners. The third poster appeared as an insert in an edition of the Sunday Times of Johannesburg.

Because the campaign’s themes were seen as particularly relevant for young students, the team created Scrutinize Live, a program of performances and educational events held at university campuses around the country. For three days, trained peer educators organized activities, usually a mixture of art, dance, music, and drama. On the fourth day, the stars of the animerts, comedians, and musicians presented a large-scale concert or show to bring the campaign’s messages to students.

DramAide community outreach events use a mix of entertainment and education to interactively engage the audience in campaign messages.

Staging Scrutinize Live was truly a collaborative effort. DramAidE, a not-for-profit organization that uses drama to educate university students about HIV, trained peer educators at 21 campuses. ABC Ulna trained campus radio DJs to promote on-campus discussions around the themes of the Scrutinize Campaign. During the build-up to Scrutinize Live, a Scrutinize radio broadcast reached an estimated 400,000 listeners. New Start, a nonprofit HIV counseling, testing, and referral service, offered HIV testing to students. Matchboxology coordinated the participation of celebrities and musicians and organized the necessary logistics for the event. To date, Scrutinize Live has trained 375 peer educators and reached an estimated 36,500 students.

Next Phase: Scheduled for broadcast in late 2009, a series of new Scrutinize animerts address partner reduction, transactional sex, and alcohol. The partnership continues to evolve, with the Western Cape Department of Health funding the development of a new animert that focuses on delayed sexual debut, an issue that was not specifically addressed in the first phase of the campaign. The campaign is fine-tuning the animerts through premarket testing and findings from the evaluation of the first phase to develop the second phase. Scrutinize Live is expanding beyond university campuses to include vocational training institutions, while JHHESA partners continue to receive support for implementing activities within their communities.

Campaign Evaluation

Mediology, a media communication agency, helped develop the TV ad strategy for the Scrutinize Campaign. Using television consumption data, the agency estimated that the Scrutinize Campaign reached 98 percent of the intended target audience, with an average of 90 viewings per person. This means that approximately 6.7 million 18- to 32-yearolds have seen the campaign ads repeatedly.

At four points during the broadcast schedule, two weeks after broadcasting began and then after new animerts were first broadcast, CADRE conducted audience research to assess how young people were responding to the animerts. The research found that the animerts were seen as relevant and educational, depicting contexts and situations that were familiar to the viewers. The animerts prompted youth to think about their risk and question their sexual behaviors. Over time, the two primary messages that the audience associated with the campaign were that 1) having multiple and concurrent sexual partners increases the risk of contracting HIV, and 2) inconsistent condom use with all partners increases the risk of HIV infection.

An evaluation of the Scrutinize Campaign is currently in progress, with findings to be released in late 2009. The Second HIV and AIDS National Communication Survey is examining the extent and impact of the Scrutinize Campaign, as well as other HIV communication campaigns, using a sample size of 10,000. The survey will examine the effects of the campaigns on knowledge, attitudes, perceptions of risk, self-efficacy, HIV testing, condom use, and sexual behavior. The second component of the evaluation will gather qualitative feedback from the audience through 12 focus group discussions with young people across five provinces. Three additional focus groups are planned with parents to gain their impressions of the campaign and its impact on young people. All annual workplans submitted by JHHESA partners explain how they will implement upcoming campaigns and identify appropriate indicators against which they will report.

What Worked Well

Connection with the target audience: Producing an advertisement that connects with the audience all too often eludes HIV prevention campaigns. As the Khuza Award demonstrated, the Scrutinize Campaign not only engaged the attention of young people but also had a high “talkability factor,” which led young people to discuss the animerts among themselves

The Scrutinize Campaign not only engaged the attention of young people but also had a high “talkability factor,” which led young people to discuss the animerts among themselves. Unlike previous HIV prevention messages, the tagline was somewhat more open to personal interpretation. Rather than telling the audience what to do, it encouraged those in the audience to scrutinize their own behavior.

This reflects how much thought was given to how to engage the audience during campaign development. One likely reason for its success was that the look and tone of the campaign were surprisingly fresh and new. With its animated characters, it did not look or sound like any other HIV campaign. The animerts were peppered with slang and street-wise expressions. The characters and situations appeared “real” to the audience. Celebrity involvement contributed star power to the campaign. “Scrutinize” proved popular as a tagline. Unlike previous HIV prevention messages, the tagline was somewhat more open to personal interpretation. Rather than telling the audience what to do, it encouraged those in the audience to scrutinize their own behavior.

Partnerships: The Scrutinize Campaign was truly a collaborative effort. Private companies—Levi’s, Matchboxology, and Mediology—contributed their expertise in youth marketing, advertising, and media. USAID provided financial support for campaign development and implementation. JHHESA contributed its HIV expertise and its experience in implementing prevention campaigns, and JHHESA partners integrated the campaign into their work with communities. Celebrities lent their names to the project and also contributed their acting and comedic skills to bring the characters to life. DramAidE trained peer educators and partners to undertake

Artists—ranging from DJs, comedians, and hip-hop artists to the stars voicing the animerts— were excited about being involved in Scrutinize Live and other events; their participation ensured the campaign's appeal to young people.

educational and entertainment activities. New Start provided HIV testing services to coincide with campus events. Each partner played to its strength by contributing in its area of expertise, and partners respected each other’s contributions.

Multilevel communication: While television broadcasting of the animerts was the focal point of the campaign, the Scrutinize Campaign also used a wide variety of multilevel communication activities to broadly disseminate campaign messages. Community outreach facilitated interpersonal communications, workshops enabled more interactive discussions, entertainment-education events in the community and on campuses raised awareness of the campaign messages, and the Internet components (the campaign website and Facebook) facilitated interactive online engagement.

Broad support: As a result of the strong partnerships that developed, a high level of campaign buy-in resulted from many different quarters, which proved enormously beneficial.

Artists—ranging from DJs, comedians, and hip-hop artists to the stars voicing the animerts—were excited about being involved in Scrutinize Live and other events; their participation ensured the campaign’s appeal to young people.

Levi’s Red for Life, which had been instrumental at the development stage, continued its association with the campaign, which was invaluable given Levi’s appeal among young people. The Levi’s campaign T-shirts proved hugely popular. Mediology worked hard to secure the support of media organizations, which doubled the value of the advertising budget. Achieving a high level of media buy-in also required some goodwill and compromise, as demonstrated by Levi’s, which generously agreed to remove its logo from the animerts so that media companies would more readily broadcast them for free.

High-quality production: Recognition of the high quality of the animerts came when the campaign was selected as a finalist in the prestigious International Animation Festival 2009 held in Annecy, France. One of the strengths of the animerts was their clever use of visuals to explain key concepts and reinforce the spoken word. These visuals helped communicate complex messages, such as how HIV can be easily spread through sexual networks or how infectiousness rises during the early stage of HIV acquisition. For example, the ads show the HIV Ninja stealthily moving across sexual networks (see poster). The concept of “scrutinize” was conveyed by Victor’s eye enlarging and popping forward, like a magnifying glass, to emphasize the importance of checking things out for yourself.

Challenges

How would the audience respond to the animerts? Was the use of animation acceptable to the audience? Could humor be used to address such a serious topic? These were the questions confronting the campaign producers, who sought to break new ground in HIV communications.

Premarket audience testing gave the producers confidence that the use of animation was acceptable and engaging to most of the audience. This led to the next important question for the campaign producers: Were the animerts effective at communicating their messages?

During campaign development, some partners expressed concern that the animerts contained too many complex concepts and multiple messages. The animerts are busy and fast moving, with lots of slang, which some feared would inhibit message comprehension. Others felt that those features were a strength of the animerts, since they require greater engagement from the viewer. Another point of debate was whether the “scrutinize” tagline would be understood.

To address these concerns, the animerts were screened frequently; TV viewers saw the campaign animerts an average of 90 times over the course of the year they were broadcast. This increased the likelihood that if not all messages or concepts were understood the first time, viewers had many opportunities to absorb the information. To improve comprehension, the team refined several messages before they were first aired. For example, early versions of the “Sugar Surprise” animert initially ended with a condom message. In the final broadcast version, the reference to condoms was

The condom message dominated the overall message of avoiding risky sexual behavior, but as the campaign progressed, the other key messages on reducing sexual partnerships eventually came through as strongly.

Scrutinize Campaign partners with their 2009 Khuza Award.

removed because audience premarket testing found that it was thought to legitimize risky behavior. Market research suggests this change successfully kept the focus on avoiding risky sexual partnerships.

What emerged from the market research is that early in the broadcast schedule, the condom message dominated the overall message of avoiding risky sexual behavior. Yet as the campaign progressed, the other key messages on reducing sexual partnerships eventually came through as strongly. Perhaps this should not be surprising, given that the three initial animerts all concluded with a condom message, with only one animert specifically including a partner reduction message.

But later market research found that as individuals viewed all seven animerts over time, they were able to articulate multiple messages from each animert as well as the multiple messages from the campaign overall. The results of the current evaluation are likely to yield more data on how effectively the animerts communicated their messages.

Recommendations

Know your epidemic: Good research up front increases the likelihood of success. Campaign messages were informed by research on the regional drivers of the HIV epidemic. HIV experts provided technical briefings to present up-to-date information on the epidemic to Matchboxology and JHHESA. A range of quantitative research informed the broad campaign themes, while qualitative research helped the producers better understand the context of HIV risk. Environmental factors, such as the condom corruption scandal, were also addressed.

Know your audience: Even though the Scrutinize Campaign characters were animated, the audience could identify with them and the situations they found themselves in. For example, the “Booza Brain” animert mimicked the gameplaying behavior that can occur among young men drinking in taverns. The slang words and phrases used reflected the everyday language used by the audience. Popular celebrities well known to young people aided audience engagement. Understanding

During premarket testing, each animert was reviewed for message clarity to see whether the message was understood as intended and whether there were any unintended interpretations.

the media consumption of the target audience also ensured that the campaign reached the intended audience.

Conduct ongoing market research: Market research helped the campaign producers understand their audience. During premarket testing, each animert was reviewed for message clarity to see whether the message was understood as intended and whether there were any unintended interpretations.

This led to the further refinement of the animerts and their messages. Market research also enabled the campaign producers to explore how the audience might interpret the term “scrutinize” and the benefits and drawbacks of using the word. During the broadcast schedule, market research at various points assessed how the audience was responding, how they were interpreting the messages, and whether interpretations changed over time. This enabled the campaign producers to judge whether they needed to adjust the broadcast schedule or the campaign messages.

Engage the audience by using their language and symbols: Engaging and connecting with the audience is a challenge for any mass media campaign. One of the key lessons for those interested in replicating the Scrutinize Campaign is to use stories, characters, language, and symbols that reflect the local culture. This requires good partnerships with researchers, the private sector, creative agencies, celebrities, and prevention programmers. It also means that the campaign producers must understand their local epidemic and their audience.

Build sustainable programming: One of the characteristics of the campaign was that, wherever possible, the campaign worked with and supported existing prevention programs. JHHESA partners integrated the campaign into their prevention activities. On campuses, Scrutinize Live worked

One of the advantages of animation is that it more easily addresses a range of sensitive issues than actors can.

with existing HIV prevention programs. In addition, the training of peer educators on campuses provided an ongoing resource for prevention programs. Tools such as the Facilitator’s Guide helped partners and other interested parties incorporate interactive discussion about campaign messages into their work.

Consider animation as a medium for reaching youth: Of the many valuable lessons that emerged from the experience of the Scrutinize Campaign, an especially useful one is that animation can be used effectively in HIV prevention campaigns. One of the advantages of animation is that it more easily addresses a range of sensitive issues than actors can. Using animation also means that visuals can be used to communicate complex concepts.

Future Programming

One of the strengths of the Scrutinize Campaign is that it incorporated a range of HIV prevention messages, although the evaluation will ascertain the extent to which combining messages affects the retention of varied messages. New animerts with new messages—such as delayed sexual debut— are being developed for the second phase of the campaign, and existing messages will be reinforced. The Scrutinize Campaign may have longevity as a prevention activity as long as the audience remains engaged. New ideas, stories, and characters may help keep the campaign fresh and engaging, allowing new prevention messages to be inserted as needed.

One of the issues that emerged from the Scrutinize Campaign is how to achieve the right balance between HIV prevention messages that focus on condom use versus partner reduction. Does the inclusion of both messages within a campaign potentially dilute the impact of one or both messages? Pretest market research indicated it may be detrimental to include both messages in a single animert because the audience may be alert to only one of the key messages, as shown by the audience response to the early version of “Sugar Surprise.” However, the market research also shows that as the campaign progressed, the audience was able to absorb multiple messages from both single and multiple animerts. This issue is one that many prevention campaigns are likely to face, and one that ongoing Scrutinize Campaign evaluation will likely illuminate.

In South Africa, the Scrutinize Campaign specifically targeted young people. However, it occured in the context of a range of HIV prevention campaigns and activities by a range of other players, including other HIV prevention campaigns planned by JHHESA. With a recently reported decline in HIV prevalence among young people, from 10.3 percent in 2005 to 8.7 percent in 2008 (Shisana et al. 2009), one of the challenges will be to ensure resources for prevention programs to sustain reductions in HIV transmission.

Resources

Scrutinize Campaign

DramAidE

First HIV and AIDS National Communication Survey 2006

Johns Hopkins Health and Education in South Africa

Matchboxology

Multiple and Concurrent Sexual Partnerships in Generalized HIV Epidemics. Report on a Technical Consultation in Washington, DC, October 29–30, 2008. Convened by the PEPFAR General Population and Youth Technical Working Group and AIDSTAR-One. (PDF, 464 KB) (accessed July 8, 2011).

Parker, W., M. B. Michaela, P. Ntlabati, and C. Connolly. Concurrent sexual partnerships amongst young adults in South Africa: Challenges for HIV prevention communication .

References

Halperin, D., and H. Epstein. 2007. Why Is HIV Prevalence So Severe in Southern Africa? The Role of Multiple Concurrent Partnerships and Lack of Male Circumcision: Implications for AIDS Prevention. The Southern African Journal of HIV Medicine 8: 19–25.

Parker, W. et al. 2007. Concurrent sexual partnerships amongst young adults in South Africa: Challenges for HIV prevention communication. Pretoria: CADRE.

Shisana, O. et al. 2005. South African national HIV prevalence, HIV incidence, behaviour and communication survey, 2005. Cape Town: HSRC Press.

Shisana, O. et al. 2009. South African national HIV prevalence, HIV incidence, behaviour and communication survey, 2008: A turning tide among teenagers? Cape Town: HSRC Press.

Acknowledgments

This case study was written by Aldo Spina with the support of AIDSTAR-One, USAID's global HIV and AIDS technical assistance program. Special thanks to Johns Hopkins Health and Education in South Africa for sharing its experiences and insights about implementing the campaign. Thanks also to the many partners who generously gave their time: Matchboxology, Levi's, Mediology, DramAidE, Lighthouse Foundation, and the Western Cape Department of Health.

Recommended Citation

Spina, Aldo. 2009. The Scrutinize Campaign: A Youth HIV Prevention Campaign Addressing Multiple and Concurrent Partnerships. Arlington, VA: USAID AIDS Support and Technical Assistance Resources, AIDSTAR-One Task Order 1.