• Editors' Summary
• Credits

1. The Invisible Epidemic
2. How Young People Become Infected
3. Why So Vulnerable?
4. Addressing the Epidemic
• Towards an Enabling Environment
• AIDS Education
• Mass Media Communication
• Condom Use
• Voluntary Counseling, Testing, and Referral
• HIV Treatment and Care
• Youth Livelihood Approaches
5. Reaching Out
6. Consequences of Inaction
7. HIV/AIDS: What Young People Want to Know
8. Profiles
9. Youth at the Center

• Figures
• Tables
• Side-bars
• Bibliography

• Why young women face more risk
• Culture can hurt
• Profile: Going public
• Education should start early
• Condoms for dual protection
• Orphans: A new challenge
• What can parents do?
• Reaching street children
• Putting youth at the center

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Published by the Population Information Program, Center for Communication Programs, The Johns Hopkins University Bloomberg School of Public Health, 111 Market Place, Suite 310, Baltimore, Maryland 21202, USA.

The mass media—especially television and radio—reach large numbers of young people around the world and have enormous influence. In a 23-country study among 12-year-old school children whose homes had electricity, over 90% watched an average of three hours of television per day (365). In virtually all developing countries most women ages 15 to 19 have regular access to television and radio (45). While young people obtain a great deal of information about reproductive health from entertainment programs in the mass media, many of these programs have the effect of promoting unsafe attitudes and behavior and portraying sex in ways that encourage risk-taking (23, 346).

Increasingly, reproductive health groups are working with the mass media and entertainment industries to develop accurate and healthy presentations of sexual topics and to raise media literacy among young people (263). A 1999 review in Europe found that the mass media promoted open and frank discussion about responsible sexuality. Messages encouraged healthful sexuality and did not stress fear or shame (23). In the US the Media Project honors members of the entertainment industry who incorporate accurate and honest portrayals of sexuality into their programs (234). In South Africa a program by Soul City helps young people understand that television and radio programs do not always reflect reality and that viewers should think critically about what they see and hear (246).

JHU/CCP

In rural Thailand a student peer educator prepares a presentation on HIV/AIDS for youth. Peer educators are credible among young people; they communicate well and are believable role models.

Because mass media entertainment is so popular, it can reach many young people with positive health information. In Uganda, for instance, The Safer Sex or AIDS Campaign, which encouraged young people to make responsible decisions about HIV/AIDS, reached 92% of its intended audience (210). In Zimbabwe a similar communication campaign reached 97% of youth surveyed (182). In Botswana Tsa Banana, a mass media campaign to improve adolescent reproductive health, reached about 70% of adolescents (114).

Mass media can be an efficient way to reach and influence young people. For example, in Kenya a call-in radio program for youth cost just three US cents per young person reached. The cost of getting one young person to take action to improve reproductive health—for example, visiting a health clinic—was 12 cents (188).

AIDS-prevention programs can use a variety of media, including dance, drama, folk theater, and sports events as well as television, radio, and print media. Programs such as Africa Alive! work with popular entertainers and sports heroes to reach young people with messages about HIV/AIDS (146, 152, 159, 206). Different communication channels reach different audiences, and messages are most effective when reinforced by various communication channels (182, 210).

Mass media communication can lead to positive health behavior. In Zimbabwe, for example, young people reached by a communication campaign to encourage "saying no" to sex were 2.5 times more likely than those whom the campaign did not reach to change their sexual behavior for the better (182). In Zambia adolescents exposed to a TV campaign promoting abstinence and condom use were 87% more likely to use condoms. In addition, viewers were 46% more likely to be abstinent or to have resumed abstinence (439). In Uganda self-reported condom use among sexually active young men rose from 33% to 70% following The Safer Sex or AIDS Campaign, and from 58% to 73% among young women (210). In South Africa 38% of young people who watched the TV program Soul City reported always using condoms compared with 26% of those who did not watch (323).

Mass media programs are not able to address all aspects of HIV prevention (114, 210). Experience shows that the most effective communication programs involve both mass media and face-to-face communication, such as peer education in small groups (296).

Increasing condom use is crucial to controlling the spread of HIV/AIDS. Condoms are the only contraceptive method that offers dual protection—that protects against infection as well as pregnancy (see side-bar Dual Protection: Avoiding Pregnancy and HIV/AIDS). Despite increasing needs, worldwide donor support for condom purchases declined from about US$68 million in 1996 to $38 million in 1999 (291).

Most unmarried young people who have sex do not use condoms. For example, in surveyed countries of sub-Saharan Africa, the percentage of unmarried sexually active women ages 15 to 19 who reported using condoms in their most recent sexual encounter ranged from 2% to 18% (see Figure 3). In Colombia, Peru, and Kazakhstan from one-fifth to about one-third used condoms. Condom use among unmarried sexually active young men was slightly higher.

Better access to condoms can increase their use (66, 71). Condom social marketing—the promotion of healthy reproductive behavior and sale of condoms at subsidized prices—increases both the demand for condoms and their supply (83, 95). Social marketing can make condoms better known, more affordable, and widely available through shops, pharmacies, and other retail outlets. In studies young people often say that they prefer private-sector sources—especially retail outlets— as their source of condoms (224, 237).

Population Services International	JHU/CCP
Left: In an AIDS-prevention campaign in Côte d'Ivoire, rival football stars join together to promote condom use. Right: In Kenya a counselor hands out educational materials to football fans as part of a campaign to involve more young men in preventing HIV/AIDS.

Some social marketing programs have successfully focused on adolescents, including the Social Marketing for Adolescent Sexual Health (SMASH) Project in Botswana, Cameroon, Guinea, and South Africa. This program relied on radio and television messages, designating youth-friendly outlets where young people could buy condoms and receive counseling, and outreach activities such as peer counseling and youth clubs. As a result of the SMASH project, in all four countries awareness of condoms increased, while personal barriers to condom use, such as shyness about buying condoms and difficulty discussing use with a partner, diminished (296).

Some social marketing programs are making the female condom available, although on a limited basis. The female condom is a female-controlled contraceptive method that can prevent HIV/AIDS (117). Experience with social marketing of female condoms in Zambia and Zimbabwe suggests that women need considerable counseling and other support to keep using them (5, 84, 258). Even at subsidized social marketing prices, female condoms are still much more expensive than male condoms, and too costly for many adolescents (84, 291). Many public facilities make male condoms available free of charge, but not female condoms (229).