TV's Healthy Influence

One in five South Africans is HIV-positive. Efforts to halt the spread of the infection must persuade South Africans to be tested, encourage them to use condoms, promote abstinence and fidelity, and confront the social stigma of being HIV-positive.

One of HBS' major components, the Center for Communication Programs (CCP), has been working in South Africa to change attitudes toward HIV/AIDS. CCP has collaborated with the South Africa Broadcasting Corporation to produce a primetime soap opera called Tsha Tsha. Set in the fictional rural town of Lubusi, it portrays young, attractive adults confronting the complexities of adulthood, and its purpose is to dramatize the ecology of HIV/AIDS. One of the principal characters, Andile, struggles to care for his mother, who is dying of AIDS. Another, Viwe, is a spoiled and arrogant young woman who early in the series discovers that she is HIV positive.

One episode dealt with the death of Andile's mother from AIDS-related complications. Before she became infected, she had been a cornerstone of Lubusi, but after her death almost no one comes to pay their respects. Andile asks the priest who will officiate at his mother's funeral if he intends to speak of the disease, and the priest counsels no mention of it. In her room as she dresses to attend the funeral, the HIV-positive Viwe pins a red AIDS ribbon to the lapel of her jacket. Her conservative father orders her to take it off. She refuses, tearfully stating that she will no longer live a lie. When everyone gathers at the side of his mother's grave, Andile spots the ribbon in Viwe's lapel and resolves to act. He takes a red scarf from around his sister's neck, fashions it into an AIDS ribbon, and tosses it onto his mother's casket. One by one, people from the town take other pieces of red cloth and do the same. Says Andile in a voiceover, "Our past travels with us, and AIDS isn't going anywhere."

D. Lawrence Kincaid, a CCP associate scientist, has been a script consultant on the show and now studies its influence. "Instead of a doctor in a public service announcement saying you should do certain things, drama is absorbing. People identify with the characters," he says. In a drama, "safer sex is not just an abstract concept. It's two people arguing about it, suffering consequences." In Tsha Tsha, all the characters use condoms; safe sex is portrayed as normal behavior, with the hope that it will become normal behavior for viewers.

For three years, the program has been the most-watched television series in South Africa, and outcomes research indicates that audiences are getting the message. In an evaluation of the first 26 episodes' influence, viewers reported greater fidelity to sexual partners, more frequent abstinence, more use of condoms. More viewers came away persuaded that HIV-positive people could still have satisfying relationships. Says Kincaid, "There's no guarantee, even if you do it right, that you're going to have an effect on people's thinking and attitudes. It's always a pleasant surprise to see it have the impact that you designed it to have."

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