Catalyzing Personal and Social Change Around Gender, Sexuality, and HIV: Impact Evaluation of Puntos de Encuentro's Communication Strategy in Nicaragua

Somos Diferentes, Somos Iguales (SDSI) is a communication for social change initiative that aims to prevent future HIV infections in Nicaragua by means of mass communication actions, including entertainment-education (edutainment) programmes, local capacity building, and the development of links, coordination, and alliances within communities.

This 82-page report presents the results of the SDSI impact study, an inter-institutional evaluation that included collaboration from PATH, the Horizons Program/Population Council, the National Autonomous University of Nicaragua's (UNAN-León's) Center for Demographic and Health Research (CIDS), independent consultants, and Puntos de Encuentro, a feminist Nicaraguan non-governmental organisation (NGO). The purpose of the evaluation was to explore the intervention's impact on a representative group of young people, on collective processes, and on the local environment. In particular, it measured SDSI's impact on the following areas: gender equity, stigma reduction, personalisation of risk perception, knowledge and use of services, interpersonal communication, HIV prevention practices, and personal and collective efficacy for HIV prevention.

As detailed here, Puntos de Encuentro initiated SDSI in 2000 to coordinate its complementary media, capacity-building, and networking activities. The 2002–2005 project evaluated in this report constituted the second phase of the overall SDSI strategy. The overall objective of the project was to promote young people's rights and individual and collective empowerment, especially in relation to sexual and reproductive health and rights issues. In Nicaragua's national context of low HIV prevalence, SDSI focused on addressing social and cultural issues that hinder HIV prevention. The project's intervention activities were designed to mutually reinforce each other and included: a national "social soap" TV series called Sexto Sentido; a nightly youth talk call-in radio show; development and distribution of methodological materials for use by local groups; and various community-based activities such as training workshops for young people involved in communications work, youth leadership camp, and coordination with local non-profits/coalitions, health and social service providers, national and local journalists and media outlets, and youth organisations and leaders in other Central American countries.

In particular, the project's second phase included a special focus on HIV prevention within the context of young people's sexuality, gender norms, risk perception, and decision making. The "machismo as a risk factor" approach was central to the project’s work with adolescents and young people. This work included a multi-media campaign and a series of regional workshops developed under the slogan, "We need to be able to talk." The idea was to point out the power of speaking about taboo subjects and the importance of social support in the process of creating change. The campaign included methodological guides for workshops and training courses for local activists as well as agreements with local health and social service providers. Billboards in 17 cities publicised the slogan, Sexto Sentido TV and Radio, and identified health service providers in each locality. Local organisations distributed educational pamphlets and flyers. These materials were also distributed during cast tours to schools and community centres, during which Sexto Sentido cast members led discussions on HIV and sexual abuse. This phase also included a joint effort with the PATH-sponsored "Entre Amigas" project, a multi-level programme dealing with sexual and reproductive health issues relevant to 10–14 year-old girls.

The SDSI evaluation was conducted using both quantitative and qualitative survey instruments. Evaluation of SDSI included household surveys, as well as in-depth interviews and focus group discussions with participants, non-participants, and key stakeholders. A longitudinal panel study was used to quantitatively evaluate SDSI's impact in individuals. The study consisted of three surveys, administered in October 2003, 2004, and 2005 to the same group of young people, whose ages ranged from 13 to 24 years in 2003. The surveys were implemented in 3 Nicaraguan cities: Estelí, Juigalpa, and León.

Editor's note: Table 6 on pages 32-26 of the report provides a summary of the research results. The results of the evaluation reveal that exposure to the SDSI project was widespread. At the end of the intervention, 9 out of every 10 people interviewed were familiar with at least one of the mass communication components. Sexto Sentido TV was widely watched on a regular basis by a large part of the adolescent and youth population, with 59% the sample watching at least 2 of the 3 previous seasons of Sexto Sentido TV "almost always" or "occasionally"). The proportion of people who had heard the Sexto Sentido radio programme increased substantially over time, from 9% in 2003 to 29% in 2005.

The survey findings indicate that greater exposure to SDSI led to positive changes on a population level - all of which are detailed in the report. Broadly, the intervention resulted in a significant reduction of stigmatising and gender-inequitable attitudes, an increase in knowledge and use of HIV-related services, and a significant increase in interpersonal communication about HIV prevention and sexual behaviour. Qualitative findings indicate that SDSI played an important role in promoting community-based dialogue on key topics, strengthened youth leadership, and fostered alliances between organisations.

An excerpt from the Executive Summary follows:

"The data suggest that greater exposure to SDSI has positive effects on interpersonal communication, which in turn helps people perceive their own personal risk of contracting HIV, and provides greater capacity for individuals to address the issue of prevention with their partners. Partner communication about HIV prevention is directly and positively correlated with consistent condom use. The evaluation suggests that the indirect effects of SDSI on condom use are strong and positive, at the same time there was also a direct association between SDSI and condom use with casual partners.

The impact evaluation demonstrates that the SDSI strategy has made a large-scale contribution in key aspects of HIV prevention. In addition to individual behavior changes directly associated with greater exposure to SDSI and societal-level changes identified in the evaluation's qualitative studies, the results validate the conceptual framework of both the intervention and the evaluation. The results suggest that individual behaviors (e.g., consistent condom use in sexual relations) are not isolated from the environment in which people live, but rather are related to social contexts and processes."