Reflections on femininity, love and Hiv the story of 4Play: Sex Tips

Reflections on
femininity, love and HIV
The Story of 4Play: Sex Tips for Girls
TUBERCULOSIS
PROGRAM
SOUTH AFRICA
Contents
1.Introduction
2.Summary of evidence
3. Aims and objectives
4.Communication model
5.Bringing 4Play to the small screen
5.1 A snapshot of 4Play
5.2
4Play: the development phase
5.3Introducing the lead characters
5.4 Production and post-production
6.Tools for social dialogue
6.1Creating a discussion guide
6.2Training of master trainers
6.3 Building social media platforms
7.Evaluating 4Play
7.1Social modelling in action
7.2 What viewer numbers tell us
7.3 What viewer voices tell us
7.4Evaluation and Series 3
7.5Impact evaluation
8.Concluding comments
Acronyms and abbreviations
References and Videos
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3
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6
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10
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Acknowledgments
A narrative of this kind relies hugely on the unpublished documents, the
memories and the insights of many individuals who were involved in various
facets of 4Play: Sex Tips for Girls.
Thanks are due to the following people who shared their knowledge and
contributed to various aspects of this document: Lusanda Mahlasela, Bronwyn
Pearce and Darryl Crossman of Johns Hopkins Health and Education in SA;
Harriet Gavshon and Mariki van der Walt of Quizzical Pictures (formerly Curious
Pictures); and Helen Hajiyiannis of the Centre for AIDS Development, Research
and Education.
Written and researched by: Jo-Anne Collinge, Dr Maria-Elena Figueroa, Dr D.
Lawrence Kincaid, Bronwyn Pearce and Lusanda Mahlasela
Disclaimer
This study was made possible by the support of the American People through
the United States Agency for International Development (USAID). The findings
of this study are the sole responsibility of USAID/JHU HIV Communication
Programme in South Africa and do not necessarily reflect the views of USAID or
the United States Government.
2
1. Introduction
4Play: Sex tips for girls was a television drama that brought a rare touch of
glamour and a distinctly feminine sensibility to the HIV communication genre
in South Africa. 4Play also confronted the fact that – in the absence of a widely
available female-initiated and controlled HIV prevention method – the key to
protection for women lies in their ability to manage their intimate relationships.
When it comes to HIV, South African women
present a puzzling picture: the pieces just don’t
fit. HIV prevalence rates among women are
substantially higher than those for men in the
same age group. Yet, in many ways, women
display a low HIV-risk profile, except in respect of
condom use where they lag well behind their male
peers.
All of this makes little sense until the four-syllable
“R-word” enters the picture. Relationships are the
key to understanding this contradictory situation.
Women show a strong tendency to choose
partners who are at least five years older than
themselves. By doing so they are more likely to
form a relationship with a man who is HIV positive
and who is less inclined than a same-age partner
to use a condom.
4Play: Sex tips for girls deliberately placed the
complexities of intimate relationships under the
microscope. It set out to explore these from
the female perspective, asking why women act
as they do, and showing how this can expose
them to HIV infection. It was aimed primarily at
women of reproductive age in the middle of the
socioeconomic scale.
The drama was broadcast on national free-toair channel e.tv in an initial double series of 26
episodes, beginning in February 2010, followed
by a further 13 episodes about two years later. The
choice of channel meant that JHHESA would be
reaching mainly middle-income viewers.
“Middle class women are often ignored in HIV
prevention programmes and we were concerned
that this could create an impression that they were
not at risk. With 4Play we focused on women
who were relatively affluent and upwardly mobile
which was also a good fit with the e.tv audience,”
explains JHHESA’s Bronwyn Pearce.
4Play was one of four major mass media
interventions undertaken as part of the USAID/
JHU HIV Communication Programme in South
Africa1. It was conceptualised and brought to life
under the management of Johns Hopkins Health
and Education in South Africa (JHHESA).
The series used the universal
phenomenon of supportive friendship
networks among women as a natural
platform for discussion and reflection
about the dynamics of relationships.
The dominant educational mode of the series
was social modelling of positive and destructive
behaviours in the areas of love, sex, relationships
and health through strong story telling.
The drama centred on the journeys of four women
in their early 30s – good friends but nevertheless
quite different – who all have personal and
relationship issues to confront and resolve. The
individual journeys of these women are typical
of those travelled by many women in every town
and city of the country. The high potential for the
primary audience to identify with aspects of one
or other of the main characters was at the heart
of 4Play as a tool for personal development and
change.
1 The programme was underpinned by a five-year partnership between the United States Agency for International
Development (USAID) and Johns Hopkins University Center for Communication Programs (JHU∙CCP) in the United States.
3
2. Summary of evidence
The epidemiological and behavioural evidence underpinning a range of
communication initiatives undertaken by JHHESA was presented in detail
in another document in this series, Foundations of the USAID/JHU HIV
Communication Programme in SA.
The summary below is simply to aid recall of
the features that are most relevant to 4Play.
low risk-taking behaviour. The following
figures explain this seeming anomaly:
• The HIV prevalence rate for South African
women in their reproductive years is
exceptionally high, and much higher than the
rate among men of the same age. By the time
women reach the age of 24 years, one out of
five (21.1%) is HIV-positive (Shisana O et al,
2009, hereafter referred to as HSRC 2008).
Among men of this age the HIV rate is one in
20. HIV prevalence peaks for women in the
25-29 year age group, when 32.7% or one out
of every three women is living with HIV. Among
men, HIV prevalence peaks in the 30-34 year
age group. The pattern of infection among
young women therefore approximates that of
men five years their senior.
• A
high proportion of young women have a
sexual partner who is at least five years older
than them. According to the NCS 2009, 34%
of teenage girls in the 16-19 year category and
40% of young women in the 20-24 year group
reported older partners.
• In the National Communication Survey of 2009,
43% of women (and 30% of men) reported
they had taken an HIV test in the previous
12 months. (Johnson S et al, 2009, hereafter
referred to as NCS 2009)
• In the age range 16 – 29 years, between 4%
and 9% of women reported having more than
one sexual partner in the previous 12 months.
Among men the rate was more than triple the
rate for women: approximately one out of three
men reported having two or more partners in
the past year. (NCS 2009)
• Some men and women in the NCS 2009
reported having sex, including a onenight encounter, after drinking too much
alcohol. However, alcohol consumption was
substantially higher among men.
hus far the picture presented is one of high
T
HIV prevalence among women but relatively
• Condom use among men declines steadily with
advancing age. For example, condom use is
highest among young men aged 1619 years at 75%, but a decade
later (in The summary below
is simply to aid recall of
the features that are most
relevant to 4Play.
• The HIV prevalence rate
for South African women
in their reproductive years
is exceptionally high, and
much higher than the
rate among men of the
same age. By the time
women reach the
age of 24 years,
one out of five
(21.1%) is HIVpositive (Shisana
O et al, 2009,
hereafter referred
to as HSRC 2008).
Among men of this
age the HIV rate is one
in 20. HIV prevalence
peaks for women in the
25-29 year age group, when
32.7% or one out of every
4
three women is living with HIV. Among men,
HIV prevalence peaks in the 30-34 year age
group. The pattern of infection among young
women therefore approximates that of men five
years their senior.
• In the National Communication Survey of 2009,
43% of women (and 30% of men) reported
they had taken an HIV test in the previous
12 months. (Johnson S et al, 2009, hereafter
referred to as NCS 2009)
• In the age range 16 – 29 years, between 4%
and 9% of women reported having more than
one sexual partner in the previous 12 months.
Among men the rate was more than triple the
rate for women: approximately one out of three
men reported having two or more partners in
the past year. (NCS 2009)
• Some men and women in the NCS 2009
reported having sex, including a onenight encounter, after drinking too much
alcohol. However, alcohol consumption was
substantially higher among men.
hus far the picture presented is one of high
T
HIV prevalence among women but relatively
low risk-taking behaviour. The following
figures explain this seeming anomaly:
• A
high proportion of young women have a
sexual partner who is at least five years older
than them. According to the NCS 2009, 34%
of teenage girls in the 16-19 year category and
40% of young women in the 20-24 year group
reported older partners.
• Condom use among men declines steadily with
advancing age. For example, condom use is
highest among young men aged 16-19 years
at 75%, but a decade later (in the 25-29 year
category) it has dropped to 51%, according
to the NCS 2009. This trend is supported by
a series of surveys over the years. As male
condom use declines with advancing age, so
HIV prevalence builds to a peak in the early
30s.
• It is therefore unsurprising that young women
report lower condom use during sex than men
of the same age. A high proportion of women
follow the condom-use pattern of their older
partners who are less likely to use condoms
than younger men and who also have a onein-three chance of maintaining multiple sexual
relationships.
or women, the risk of HIV transmission is
F
heightened by South Africa’s extraordinary
levels of gender-based violence, including
sexual assault.
• W
hile national statistics on intimate partner
violence do not exist, a review of populationbased studies in three provinces between 1998
and 2009 concluded that there was a “lifetime
prevalence of physical violence of 25% and a
past-year prevalence of 10% in adult women”
living in these provinces. (Seedat M et al, 2009)
• The same article noted that studies
undertaken among men and sub-groups of
women indicated that 40% of men disclosed
having being physically violent to a partner
and 40-50% of women have also reported
experiencing such violence. (Seedat M et al,
2009). In a random sample of men in several
urban and rural areas of the Eastern Cape and
KwaZulu-Natal, 27.6% reported that they had
committed rape. (Jewkes R et al, 2009)
2003 study conducted at an
A
antenatal service in Soweto found that
30.1% of participants reported physical
abuse or sexual assault by a male
partner in the previous 12 months.
It also established that intimate partner violence
and gender-based power inequalities were
statistically associated with increased risk of HIV
infection among abused women. This increased
risk was measured by the extent of risk-taking
behaviours among this group. (Dunkle K et al,
2003). According to the NCS 2012, 7.2% of
sexually active women ages 16-55 years reported
being in a fight during the last 12 months and
4.1% (372,145 women) reported being beaten up
during the same period.
he figures constitute a clear argument for placing
T
an examination of sexual relationships right at
the heart of any HIV prevention programme for
women.
5
3. Aims and objectives
The broad aims of the drama series were to:
• Portray the highs and lows of love and sex.
• Enable viewers to talk more openly about
sexuality.
• A
ddress HIV, AIDS and TB in ways that
encourage audiences to examine their own
emotional and sexual behaviour.
• Encourage personal responsibility and selfefficacy for health and sexuality.
• T
each through emotional identification –
through laughter and, occasionally, through
tears. (Centre for AIDS Development, Research
and Evaluation, 2011)
The educational objectives of the series
were to:
• E
xplore the relationship between gender-based
violence and HIV risk.
• Highlight the signs and symptoms of TB.
• Dispel common TB myths.
• P
romote HIV testing as a desirable healthseeking behaviour.
• H
ighlight the importance of knowing one’s own
and one’s partner’s HIV status.
• Increase uptake of HIV testing and TB
screening.
• H
ighlight the role of abstinence and secondary
abstinence in HIV prevention.
• D
emonstrate the relationship between alcohol
use and risky sexual behaviour.
• E
ncourage communication about love, sex and
relationships with intimate partners, friends and
family members.
• H
ighlight the increased HIV risk associated with
multiple sexual partners.
• P
romote correct and consistent condom use
with all sexual partners. (Centre for AIDS
Development, Research and Evaluation, 2011)
There were two clear thematic streams in
4Play:
• P
ersonal growth and relationship themes were
dealt with in two ways:
–– B
y the inclusion of short monologues or
“internal conversations” which featured at
the beginning and end of every episode.
–– B
y the development of the four main
characters and the telling of their stories.
• H
ealth themes were woven into the plot as part
of the stories of the four main characters.
6
4. Communication model
The social ecology model of transformational communication is the bedrock of
JHHESA’s mass media interventions. This model was less directly evident in 4Play
than in most other mass media elements of the USAID/JHU Communication
Programme because 4Play was the leanest of these interventions.
It consisted exclusively of a drama series, a
discussion guide with accompanying DVD, a
modest initiative to train facilitators or peer
educators in the use of the discussion guide and a
Facebook presence.
However, 4Play exercised an influence at more
levels than first impressions might suggest. Any
drama programme broadcast in a sustained
manner on national television has the potential to
achieve a society-wide impact as well as a personal
meaning to its individual viewers.
JHHESA’s broadcast partner for 4Play was e.tv,
the only free-to-air national channel outside of the
public broadcast stable. It has a smaller footprint
than the SABC1 and SABC2 channels, but with
an average of 23.5 million viewers a week is still a
very substantial medium. (SAARF, 2011) Its viewers
are, on average, slightly younger, more urban and
a bit more affluent than those viewing SABC1 and
SABC2.
Television viewing in many South African homes
is a family affair or a social activity. While threequarters of households own a TV set, about 90%
of individuals have access to television viewing.
(Statistics SA, 2012; SAARF, 2011) The likelihood is
quite high, therefore, that TV programmes would
be watched in a social setting and trigger some
form of discussion.
4Play was perhaps more notable for how it
depicted the impact of various social systems
on personal growth and transformation, than
for how it used these systems. The four main
characters in the drama were all in search of
greater self-fulfilment in the city of Johannesburg
in the second decade of a “free” South Africa.
4Play captured the exhilaration and loneliness of
this period of tremendous social mobility – the
opportunities, the risks, the successes and the
failures; the emotional toll taken by ambition; the
sense of straddling two social worlds; the erosion
of the extended family and neighbourhood; the
joys and the hedonism of a society in flux; and
the slow and sometimes painful change of social
values and norms.
4Play did not selfconsciously analyse the
social landscape it was
painting. But it clearly made
the point that how we live
and how we love are shaped
by a complex mixture of
social forces.
More directly, the social learning theory of Albert
Bandura informed the conceptualisation of 4Play.
The theory’s central tenet – that people learn
vicariously, by observing the practices of other
people – has been at the heart of a long tradition
of education-entertainment, starting with the Latin
American telenovelas of the 1970s.
Telenovelas are a common TV genre in Latin
America (and beyond), equivalent to an extended
TV drama series and typically running for about
a year with several episodes a week. Telenovelas
were not originally created to “educate” viewers
about social issues but some of them inadvertently
7
did so. Realising this, Mexican film maker
Miguel Sabido developed a very specific
formula for education entertainment through
telenovelas. He drew heavily on social learning
theory and the notion of modelling both
the values and behaviours that viewers were
intended to abandon and those that they were
intended to adopt. In the plot of the telenovela,
the first category values and practices were
shown to have negative consequences while the
approved behaviours yielded rewards. (Singhal
A et al, 1993)
The original formula of social
“goodies” and “baddies” and
infallible consequences has moved
on considerably since the 1970s.
But there are elements of Sabido’s approach
that persist and the underlying theory of social
learning remains pivotal.
In 4Play the social learning model is
expressed through:
• The care taken to create multiple
opportunities for audience identification
with the main characters, who are fairly
diverse in terms of their social circumstances,
family situations, occupations, and intimate
partners.
• The strong element of realism and
believability despite the glossy entertaining
production in which everyone dresses
remarkably and parties a lot.
• The clear and reasonably nuanced
representation of the personal dilemmas and
hurdles confronting the four main characters,
principally in the areas of love, sex and
relationships.
• The equally clear representation of the
consequences of how they meet these
challenges.
• U
nambiguous modelling of appropriate
responses to living with HIV and treating TB.
In terms of HIV communication and the
application of social learning principles,
dramas have certain advantages over
formats such as advertising campaigns
and talk shows:
• The development of strong, nuanced
characters and the sustained engagement
with these characters over time present
opportunities for stronger identification by
viewers.
• There is time for the unfolding of
complex story lines that speak not only to
behaviours but the underlying causes of
behaviours. Viewers have a more complete
understanding of what behaviour change
might entail.
• T
he question of female agency in sexual
relationships – which lies at the heart of HIV
prevention for women – can be addressed
appropriately in the drama format.
• P
ositive or negative reinforcement of key
behaviours is once again more impactful
when sustained through the story line.
8
5. Bringing 4Play to the small
screen
Curious Pictures2, which had previously partnered with JHHESA to produce
the television drama Tsha Tsha , became aware that JHHESA was interested in
commissioning a communication programme aimed at women.
Curious Pictures put together a short proposal
on 4Play and JHHESA responded positively to
this. Once the concept was agreed between the
two organisations, Curious Pictures facilitated
negotiations with e.tv as the broadcast partner for
this programme.
In this relatively swift and simple process, the
executive partnership for the series was set up.
Compared to the other JHHESA communication
programmes, the development and production
of 4Play involved fewer role players and less
demanding processes.
The initiative was funded by USAID/PEPFAR in
terms of the five-year agreement between USAID
and the Center for Communication Programs at
Johns Hopkins University’s Bloomberg School of
Public Health.
5.1 A snapshot of 4Play
4Play is sometimes referred to as the South
African Sex and the City. Its creators at Curious
Pictures readily admit that Sex in the City was
their major reference. But, insists 4Play producer
Mariki van der Walt, “we made 4Play gritty and
Sex and the City was never gritty”.
Both dramas were about four women in their
30s carving out their lives in tough but exciting
cities. Both were about the relationships between
women and men in this dynamic social climate.
Both began each episode with one of the four
women pondering the theme of the episode. This
added a mellow note of wisdom to both dramas
that were otherwise largely about style and image
and ambition.
Obviously the biggest difference between 4Play
and Sex and the City was HIV. No honest drama
about love and sex in South Africa in the early
21st Century can ignore HIV. Sex in the South
African city inevitably has a sombre, responsible
aspect amid the passion, romance and fun. 4Play
reflected this absolutely.
The team responsible for creating 4Play was
predominantly female. The writers, directors
and producers were all female. While the then
managing director of JHHESA, Patrick Coleman,
played a central role in initiating and developing
the drama series, JHHESA’s management of the
initiative was eventually also the responsibility of
an all-woman team.
4Play was broadcast initially in two continuous 13part series on e.tv between February and October
2010. It occupied a 21h00 slot on e.tv and
averaged 1.67 million viewers per week, according
to the Television Audience Measurement Survey
(TAMS). An unfortunate feature of the scheduling
was that the broadcast of a major soccer
tournament, the UEFA Cup, cut into the broadcast
of 4Play and several episodes were postponed
without adequate forewarning of viewers.
The first two series were repeated in the first half
of 2012 and attracted 800 000 viewers per week.
Series 3 of 4Play followed immediately after this
rebroadcast and ended in July 2012.
2 Curious Pictures has been renamed Quizzical Pictures. This document, however, retains the original name because it applied
at the time series 1 and 2 of 4Play were developed and broadcast.
9
5.2 4Play: the development phase
The development phase of 4Play series 1 & 2 began with an information-gathering
process undertaken not by a research organisation but by the production company
itself. The 4Play team at Curious Pictures held a series of discussion groups to establish
how women defined the issues that arose in sexual relationships. These were “focus
groups” with a difference. There were the orthodox elements of guided and recorded
discussion. But there was also a foretaste of the 4Play brand – soft lighting, glasses of
wine and pedicures were on offer as the women discussed the subject in a relaxing,
informal atmosphere. A separate group of men was also convened to elicit male
perspectives on the same questions.
This approach had advantages and limitations. The discussions were not systematically
analysed and synthesised into a user-friendly report. Writers simply dipped into the
video recordings of the discussion groups to elucidate issues as they arose in the
development of stories and scripts. On the other hand, writers were present in the
focus groups and witnessed the discussions first-hand, receiving a much more nuanced
impression than any transcript could deliver.
Following this information-gathering phase, the story arcs were further developed
with the identification and realisation (on paper) of the four main characters and the
plotting of their individual stories (see section 5.3 below). The process of refining and
elaborating the storyline into a series of scripts followed, with JHHESA reviewing the
product at various points, recommending amendments, and finally signing off the script
for each episode.
Through her personal story, each of the main characters “carries” a share of the
educational content of the programme. According to series producer Mariki van der
Walt some of these health themes were conceived at the outset while others fed into
the stories later in the development process. “4Play (series 1 and 2) was more organic
(than other JHHESA series) in terms of the elaboration of educational objectives,” says
van der Walt.
4Play was nominated for seven South
African Film and Television Academy
awards in 2011 and took three of
these awards.
10
5.3 Introducing the lead characters
Table 1: Stories and educational themes represented by characters in Series 1 & 2
Health themes
The character
HIV prevention: Waiting
for Mr Right
The story
Noma Mkhize is the owner
of a busy hair and beauty
salon in the suburbs of
• The ‘right time’ for sex in Joburg. She is a single
a relationship
mother of a bright and
likeable teenage son,
• Peer influence and
Buhle. The boy’s father,
personal principles in
making sexual decisions Vincent, opted for a
scholarship abroad while
• Sexual abstinence,
Noma was pregnant and
including secondary
never returned. Noma’s
abstinence
salon is where the foursome
usually meets to get their
hair done or have a chat.
She is a sensible and
nurturing person whose
reflections introduced and
closed Series 1 and 2.
Noma has devoted herself
to her business and her
son, to the exclusion of
romantic involvement.
She lacks the confidence
to “date” in the formal
sense, but she gradually
forms a relationship with
Humphrey, a steady,
emotionally generous man.
She overcomes her fears of
being betrayed by a man,
withstands her son’s initial
rejection of Humphrey
and gradually the three of
them form a harmonious
household.
Health themes
The character
The story
HIV prevention:
Marriage, faithfulness
and HIV
Nox Madondo, Noma’s
cousin, is a full-time
homemaker and socialite
in Johannesburg’s affluent
suburbs. She and her
husband, Brian, fell in
love as students. He is a
successful businessman
and they have a teenage
daughter and a younger
son. Social acceptability
and the wellbeing of
her children are, initially,
everything to her.
Nox confirms her
suspicions: Brian is cheating
on her. She confronts him
and he swears he will
reform. During a medical
examination for insurance,
Nox discovers she is HIV
positive. After an initial
period of denial and
depression, she begins
to deal with her situation,
including the realisation
that only Brian could have
infected her. She discloses
her status to Brian – who
accuses her of infidelity
– and her children. She
joins a support group
and becomes involved in
community work. Brian
learns he is HIV positive
too. They struggle to
salvage their relationship
but the results are not
encouraging.
• G
ender roles and sexual
relationships
• Concepts of faithfulness
• Condoms in long-term
relationships
• Intimate partner rape
HIV counselling &
testing
• Importance of regular
testing
• K
nowing your partner’s
status
• Challenges of disclosing
status
11
Health themes
The character
The story
HIV prevention: Alcohol
and health
Danny Gibson is a harddrinking, hard-working
stylist to up-and-coming
stars of the entertainment
industry. Her life is an
endless parade of clubs and
concerts and photo shoots.
Her sexual relationships are
casual, short and numerous.
She is insecure, blunt but
loyal to her friends. She has
a troubled relationship with
her separated parents: an
alcoholic father and selfpitying mother.
Danny’s routine of work,
drink and sex is brought
up sharp when she falls in
love with photographer
Gabriel. He cares for
her but can’t accept her
alcohol-and-sex lifestyle.
As their relationship falls
apart, Danny learns she
has TB and realises she has
to change her habits. She
puts the brakes on alcohol
and sex and also goes into
counselling. All this puts
her on track to a more
realistic understanding of
her troubled family.
Health themes
The character
The story
HIV prevention: Selfesteem, multiple
partners and safer sex
Amira Mokoena is a singer
and song-writer from a
humble family. She has
looks, style and talent but
zero self-confidence. Time
after time, she is either
exploited or messes up.
Although loved by family
and neighbours in the
Soweto neighbourhood
where she was raised,
Amira opts for the hard,
exciting life of the city.
Amira has one career
set-back after another
and eventually decides
to give up singing and
sell cosmetics to support
the “greater talent” of
performance poet Tshepiso,
the current man in her
life. His career is going
nowhere; he is abusive and
depressed. Then Amira
gets an unexpected break –
and Tshepiso becomes her
self-appointed manager,
living in luxury at her
expense and cheating on
her. With her newfound
success, Amira finds the
strength to give Tshepiso
the boot. For a while she
rides the crest of the wave.
• Signs and symptoms of
alcoholism and alcohol
abuse
• Relationship between
alcohol abuse and risky
sex, HIV and TB
TB and HIV
• Signs and symptoms
of TB
• B
arriers to TB testing
and treatment
adherence
• Stigma associated with
TB
• Links between TB and
HIV
• H
ow low self-esteem
affects sexuality
• H
ow many partners
increase HIV risk
• Consistent and correct
condom use
Gender-based violence
• Types of gender-based
violence
• Factors contributing to
partner violence
• Consequences of
gender-based violence
• Gender-based violence
and HIV risk
12
The development of the story lines and scripts
for Series 3 differed somewhat from the earlier
experience. The independent qualitative
assessment conducted by the Centre for AIDS
Development, Research and Evaluation (CADRE)
yielded viewers’ opinions on various aspects of
Series 1 and 2 which were used to guide the new
series. Quite specific changes were made in the
light of this and the educational content of Series
3 was more concentrated and less embedded in
the plot and characters.
The main findings of the evaluation are
presented in some detail in sections 7.3, 7.4 and
7.5 below.
5.4 Production and postproduction
The series was directed by several female
directors of varying degrees of experience,
each taking responsibility for a few episodes.
For some, the series was their first break into
directing after many years in the film industry.
In order to rise above the white noise of HIV
education and also to reach new audiences,
a strategic decision was taken to give 4Play a
glamorous, glossy look and feel, says JHHESA
deputy director Lusanda Mahlasela. The visual
palette was richly coloured, the main characters
were stylish and their lives were buzzing with
social opportunities. Maintaining this aesthetic
and pace throughout the series was a central
consideration, says Van der Walt.
The entire series was shot in and around
Johannesburg and involved a limited cast.
Filming presented no special logistical
challenges.
The established JHHESA practice of viewing
all off-line edits and requesting changes where
needed was observed. Because only JHHESA
and e.tv had to be consulted, the process
was less complex than it had been on similar
JHHESA projects. The production company was
required to craft fewer compromise solutions to
accommodate a range of partners’ preferences.
“The positive side of this was that the story was
king and that the characters were more truthful in
their behaviour,” reflects Van der Walt.
However, the more flexible management
situation occasionally led to late requests for
Curious Pictures to rewrite episodes in order to
insert additional educational content into the
script at a late stage.
The production and post-production aspects
of 4Play Series 3 were also influenced by the
qualitative evaluation of the first two series,
Curious Pictures indicated. There was clearer
direction from JHHESA at the start of Series 3
on the health-related educational content which
the developers found useful. Partly as a result of
the health themes that needed exploring, the
individual stories of the characters became more
serious and the overall mood of 4Play became
more sombre.
The series was directed by several
female directors of varying
degrees of experience, each
taking responsibility for a few
episodes.
13
6. Tools for social dialogue
6.1 Creating a discussion guide
JHHESA commissioned CADRE to develop a discussion guide on 4Play in order to expand the reach of
the programme into non-broadcast environments and to extend dialogue on the key issues beyond the
life of the series.
The focus groups that CADRE had facilitated during the evaluation of Series 1 and 2 gave the
organisation useful insights for the discussion guide. CADRE’s Helen Hajiyiannis says that they were left
with a keen appreciation of which topics elicited excitement and discussion and where viewers were left
with an incomplete understanding of a topic.
The result was a glossy 70-page 4Play discussion guide with accompanying DVD containing excerpts
from the series that matched the topics defined in the guide. (CADRE, 2011)
The guide embraces four themes:
HIV counselling and
testing
Gender-based
violence
aiting for Mr Right
W
(which looks at the
right time for sex in a
relationship through
Noma’s story).
lcohol and health
A
(Danny’s story)
TB and HIV
HIV prevention
Self-esteem, multiple
partners and safer sex
(Amira’s story)
Marriage, faithfulness
and HIV (Nox’s story)
Each theme has clear objectives, deals with the meaning of various concepts, relates the personal story
tied to the theme, and contains discussion topics. There is a list of services and references at the back of
the guide.
The DVD is designed to stimulate discussion and it comprises a series of clips on a given theme. The
most pertinent footage was selected from nearly 13 hours of film.
A total of 3 000 copies of the guide and DVD were produced.
14
6.2 Training of master trainers
JHHESA, CADRE and Drama AIDS Education
(DramAidE) offered training on the use of the
4Play discussion guide to master trainers from
their funded partner organisations and selected
non-governmental organisations. This two-day
training took place in September 2011, more than
a year after the first run of Series 1 and 2, and was
attended by 25 master trainers. While it centred
on the content of the discussion guide, it also
included skills-building for facilitation.
The 25 individuals who attended the master
trainers’ course subsequently provided training
to more than 300 individuals in their own
organisations.
6.3 Building social media platforms
While on air, 4Play was supported by on-line and
social media platforms in the form of a regular
blog and a Facebook group/page.
The 4Play blog, managed on behalf of JHHESA
by Marcus Brewster Publicity, provided a weekly
synopsis of the relevant episode plus a lighthearted “sex tip”, often designed to stimulate
discussion between partners. It also carried
information on health and sexuality topics –
for example, on negotiating condom use in
relationships or spicing up relationships – and ran
a weekly poll on an issue drawn from the drama.
The Facebook group/page was used to provide
news about forthcoming episodes in the series,
provide a platform for sharing of reflections on
topics aired in the drama and to test opinion by
holding weekly polls on issues in the drama. The
Facebook discussions were moderated by an
experienced sexologist.
Although the 4Play Facebook page gradually
consolidated a new following it unfortunately
also attracted individuals who expected it to be a
pornography site, making management of the site
quite challenging.
The 4Play experience underscored the social
media lessons from other multimedia initiatives
undertaken by JHHESA. Social media are
labour intensive channels requiring constant
monitoring, refreshing and – where the subject
matter is sexuality and sexual relationships
– sensitive mediation. According to
JHHESA’s Programme Manager for
Monitoring and Evaluation,
Darryl Crossman, the
organisation has also learnt
the value of sustaining and
updating social media
platforms between periods
of broadcast in order to
carry over a substantial
core of fans from one
series to the next.
15
16
7. Evaluating 4Play
4Play may be evaluated in terms of: the size and the nature of the programme’s
viewership and its power to retain viewers over a period of time; the results of
qualitative research conducted by CADRE among a limited number of viewers
immediately after the end of Series 1 and 2; and its ability to realise its chosen
theoretical model.
7.1 Social modelling in action
Social learning can occur both through models who demonstrate the desired pattern of behaviour and
through those who epitomise inappropriate or destructive responses, provided the viewer is clear that
the latter are behaviours to be avoided, not emulated.
4Play created clear behavioural models through its four lead characters and through supporting
characters. At times these characters modelled behaviours that were negative and virtually carried an
“avoid this” label. Examples of behaviour modelled by the female leads are set out in the tables below.
Table 2: Noma, the salon owner and single mom
Positive roles & behaviours modelled
Negative roles & behaviours modelled
An attractive woman who has abstained from sex
for an extended period and who makes a decision
to find the right relationship.
A woman who has lived in the past, investing her
emotions in the memory of a man who failed to
honour his responsibility as the father of her child.
A woman who battles with and overcomes her
deep mistrust of intimate relationships.
A confident single mother bringing up her son
to be responsible for his sexual relationships,
to protect himself and to stop cheating on
girlfriends.
A good (if somewhat poorly informed) friend to
Nox when she learns that Nox is HIV- positive.
17
Table 3: Nox, the faithful wife who contracts HIV
Positive roles & behaviours modelled
Negative roles & behaviours modelled
A woman with a sense of social privilege who
struggles with HIV stereotypes and coming terms
with having HIV – and eventually succeeds, joins
a support group and discloses to her family and
friends.
A cheated wife who gives in to a single “tit for
tat” act of infidelity in reaction to her husband’s
serial cheating.
A dependent wife who tolerates her husband’s
infidelities for many years – ignoring the signs –
for the sake of security and family “harmony”.
A woman who risks her husband’s anger rather
than having unprotected sex with him once she is
aware of her HIV-positive status.
(Possibly negative)
A wife who finally demands that her husband
break off his sexual relationship with a colleague
and is prepared to try and mend their marriage.
An abused wife who fails to take any immediate
decisive action in response to being raped by her
husband.
A mother who communicates with her children in
an appropriate way about family problems.
A woman who becomes involved in community
work, developing a strong interest outside her
home and family.
Table 4: Danny, the hardworking, hard drinking, promiscuous party girl
Positive roles & behaviours modelled
Negative roles & behaviours modelled
A successful career woman who pays her own very A woman who pursues a lifestyle certain to
stylish way in life.
destroy her health: excessive drinking, incessant
partying and too many sex partners to count. In
her early 30s she pays the price with TB.
A woman who tackles the crisis of TB head-on:
seeks treatment, modifies her lifestyle and gets
A daughter who idolises her alcoholic father, who
cured.
deserted the family when she was a child, and for
most of the series is blind to how his behaviour
A woman who struggles with accepting help
hurt her and her mother.
for her emotional problems but resolves this
positively and benefits from counselling.
A commitment-phobe who is incapable of
forming long-lasting and trusting relationships
with men.
18
Table 5: Amira, the vulnerable and self-destructive singer
Positive roles & behaviours modelled
Negative roles & behaviours modelled
A woman who is able to take action when
she holds the trump card of success,
breaking decisively with a man who has
abused her in every way.
An insecure woman who not only has multiple
relationships in quick succession but hands over her soul
to each man in her life, opening herself to abuse.
A self-absorbed woman who in turn abuses the boynext-door who has loved her for years.
A singer who takes her talent for granted and is too lazy
or unsure to work at being her best.
Clearly, 4Play modelled a wide range of roles
and behaviours pertinent to the prevention and
management of HIV and TB. Many of these
focused on the behavioural drivers of the HIV
epidemic – multiple partners, excessive use
of alcohol and other drugs, transactional sex,
gender-based violence, and unequal power in
sexual relationships.
The modelling also suggested the psycho-social
factors which make individuals more or less
likely to take up the behaviours that drive the
epidemic. For example:
• D
anny is the only child of divorced parents
who hate each other bitterly and she chooses
multiple partners over commitment. She is a
heavy drinker from a line of drinkers.
• N
ox is the trophy wife in a world where
appearances count more than reality. Her
considerable privilege depends totally on
her status as a wife and she makes endless
relationship compromises to hold onto her
position.
• Noma is in every way a capable woman
with just one chink in her armour: the man
who deserted her many years ago. And she
allows that single vulnerability to continue to
undermine her.
• A
mira is swimming out of her social depth
without a life jacket. Her family inhabits
another slower world. They cannot help her
negotiate the shark-infested waters of the
entertainment industry and she is constantly
looking for a man to “rescue” and guide her.
The positive and negative behaviours depicted
in 4Play are, for the most part, shown to have
appropriate consequences as proposed by
the Social learning theory – although there
are sometimes long delays in showing these.
For example, participants in the focus groups
described in section 7.3 (below) pondered how
Danny had escaped HIV while faithful wife Nox
had the bad luck to become infected. In Series
3, of course, the full consequences of Danny’s
lifestyle were revealed as her HIV-positive status
was disclosed.
4Play taught by the mistakes of its characters
as well as by their strengths. In the qualitative
evaluation, some participants expressed
impatience that the lead characters did not
always show independence and initiative. It
seems that they grasped the negative role
modelling and rejected the demonstrated
behaviour, as intended.
7.2 What viewer numbers tell us
The initial run of 4Play attracted an average
of 1.67 million viewers a week, according to
the Television Audience Measurement Survey
(TAMS). Women constituted a larger share of
this audience (about 56%) than men. However,
the over-representation of women viewers of
4Play was no greater than for Intersexions,
which did not specifically define women as its
primary audience. The suggestion of focus group
participants that 4Play offended male viewers
and caused them to avoid the drama was not
borne out by the viewership statistics.
The reruns of 4Play Series 1 & 2 and the first
broadcast of Series 3 were watched by an
average of one million viewers per episode,
19
TAMS ratings indicated. This was a substantial
decline, of about one-third, on the original
broadcast audience.
NCS 2012 measured public exposure to all
JHHESA mass media interventions examined in
this document. (Kincaid DL and Figueroa ME,
2012) It revealed that:
• 2
2% of respondents (approximately 6,014,962
men and women aged 16-55 in all provinces)
had ever been exposed to 4Play and 13%
(approximately 3,619,380), reported watching
4Play in the last 12 months prior to the survey.
• The average number of episodes seen among
those who watched in the last 12 months
was 9.26, which is about a third of the total
number of episodes.
• M
ore than a quarter (27%) of those who
watched in the last 12 months, saw 13 or
more episodes and the remaining 73%
watched 12 or fewer episodes. Only 6%
of 4Play viewers watched all 26 episodes,
which is about half the percentage of the
Intersexions’ audience that watched all 26
episodes of that drama series (13%).
The slightly reduced extent of exposure
compared to Intersexions was possibly to be
expected as e.tv has smaller audiences than the
SABC and 4Play catered strongly to the interests
of its primary female audience.
7.3 What viewer voices tell us
CADRE undertook a qualitative evaluation of
4Play through the facilitation and analysis of nine
focus group discussions involving women and
men in the 18-30 year age group and women
only in the 30+ age group. The 60 participants
were drawn from five provinces: Free State,
Gauteng, KwaZulu-Natal, North West and
Western Cape. They were required to have
watched at least half the episodes of 4Play Series
1 and 2. The fieldwork took place three months
after the conclusion of Series 1 and 2. (Clarfelt A
et al, 2012)
The focus groups sought to establish the general
response of viewers to the series – its overall
concept, its interest and appeal, and its narrative
format. They also explored participants’ ability
to identify with the characters or situations
depicted; and they explored their response to
the educational content, especially HIV and
TB messaging, as well as whether participants
gained any new understanding from 4Play.
Overall views
CADRE reports that participants used terms such
as “true to life”, “realistic” and “rich” to describe
4Play. They remarked that “it communicated
the meaning of true friendship, honesty and
trust and that it was educational, breaking down
stereotypes and stimulating debate”. (Clarfelt A
et al, 2012)
CADRE summed up: “Critical reflection and
debate took place around the four leading
characters and their relationships with each other
and with their male partners, and viewing the
series was described as ‘a kind of therapy’ for
women. Whilst there was little evidence of actual
behaviour change, there were some examples
of attitudinal shifts in relation to participants’
individual health behaviours.”
There were aspects of 4Play that some
participants did not like:
• They felt that the representation of men was
too negative.
• They argued that the female leads
should have been more empowered and
economically independent.
• They felt that the title of the series – 4Play:
Sex tips for girls – was misleading and
created false expectations about the nature of
the drama.
The depiction of relationships and the portrayal
of HIV, TB and alcoholism were felt to be realistic
and to have avoided the pitfalls of stereotyping.
The strong bond of friendship among the female
leads was seen as a particular asset of 4Play.
The relative dependence or empowerment of
the female leads was a matter for debate. There
were those who appreciated that the drama
depicted things as they were and not some ideal
state, while others insisted more empowered role
models would have been helpful.
20
Participants considered that
educational messaging was fairly
discreet and they felt that the subject
of intimate relationships and related
challenges (such as HIV transmission
in committed relationships and nonconsensual sex) emerged as the core
message of the series.
“Learning and message take-out took the form
of critical engagements with and reflection
upon the characters and their relationships.
. . . Often a critical perspective of what goes
wrong in the characters’ various relationships
led participants to think deeply about what they
want from their own relationships.”
(Clarfelt A et al, 2012)
It was educational (and) motivational as well
because you tend to think ‘I need to do
something about myself’. (Female, 30+, Free
State)
You kind of put yourself in that woman’s
(character’s) position and you think, ‘If I was in
that situation, would I have acted the way she
acted or solved the problem in the way she did,
or what?’ (Female, 30+, Free State)
The mismatch between the series’ title and its
content was a subject of considerable discussion.
Several participants had been attracted by
the title and were disappointed with what the
programme actually offered.
One minute they are talking about alcohol,
the next they are talking about work, the next
minute they are talking about HIV. There were
no (sex) tips, which is what we really wanted.
(Male, 18-30 years, Gauteng)
Some men had thought watching 4Play might
give them insight into the way women view and
experience sex.
I wanted to know what women talk about. I
mean, we play a role in the sex part of life,
so we need to know. We also need to be well
informed about what they want, what do they
really fantasise about? . . . So I expected to
know more about those things, but I was a bit
disappointed. (Male, 18-30 years, Gauteng)
Several male participants said that they had
found the portrayal of men to be mainly
negative.
What I disliked about the show was the fact that
men were given that reputation of being jerks.
Every man in the series was a jerk. That was the
impression that was given about men. (Male,
18-30 years, Western Cape)
The behaviour of the character, Tshepiso, who
abused Amira both physically and financially, was
dismissed as the action of a non-man.
Tshepiso was not a man. A man must be a
provider . . . Who abuses a woman who gives
you money? (Male, 30+ years, Gauteng)
21
Themes and messages
The CADRE report highlights that there are
different forms of engagement with messages
in education entertainment from basic
engagement, through in-depth reflection to
conceptualising forms of personal action and
even actual behaviour change.
(Clarfelt A et al, 2012)
“These responses are not necessarily
hierarchical. For example, in-depth reflection
and discussion of a key message may be just
as important as reporting actual changed
behaviour,” the CADRE report notes. It considers
the responses of participants to a range of key
messages of 4Play.
Alcohol abuse
Participants engaged with the pattern of
alcohol abuse displayed by character Danny to
the extent that they speculated on its causes
and discussed its impact on her only serious
relationship. A few participants indicated it
had made them reflect seriously on their own
drinking habits.
I see Danny drinking like me. So she’s got a
problem – maybe I do, but I don’t know if I’ve
got it. (Female, 30+ years, Gauteng)
There were other participants who reported that
4Play’s messaging on alcohol had caused them
to moderate consumption. Equally, there were
those who felt that the consequences of alcohol
abuse had not been portrayed strongly and
clearly enough.
HIV and AIDS
Nox’s story shows how women in committed
relationships become infected with HIV because
of their partner’s infidelity. After a period of
adjustment, Nox is able to disclose her status
beyond her family and live openly with HIV.
These messages struck home with focus group
participants.
I learnt that you don’t just get it (HIV) because
you are not married or because you are bitching
around. You will get it no matter what. There
are things that can happen in your life that you
cannot control . . . It has opened my eyes that
even if you are in a relationship and you are
loving, it doesn’t mean you should trust.
(Male, 18-30 years, KwaZulu-Natal)
It sent that message very well. It made us
realise that we must have ourselves checked so
that we can feel comfortable.
(Female, 30+ years, KwaZulu-Natal)
While some individuals questioned how
believable Nox’s progress from denial to public
disclosure of her status was, the benefits that
flowed from overcoming denial and disclosing
were appreciated by others.
22
That is true, a lot of people face denial. People
keep quiet until a time you see that they are
now dying and there is no need for that. When
you are open, you get the help you need . . . We
are killed by denial.
(Female, 30+ years, Gauteng)
CADRE concluded: “Overall participants
expressed an in-depth engagement with themes
around HIV/AIDS, particularly in connection with
the character of Nox and how she deals with her
HIV status.
There were no explicit examples of behaviour
change related to HIV testing and counselling
but several examples of conceptualised forms
of action, including disclosing to a friend,
communicating with children and one’s sexual
partner, and having an HIV test.”
(Clarfelt A et al, 2012)
Reflection and deliberation on issues
like the importance of being strong
and disclosing one’s status, of being
supported, and of knowing that HIV
can affect anyone irrespective of
social class or relationship status,
were key messages extracted from
the series.
Tuberculosis
Participants appreciated that 4Play dealt with TB
as it is not commonly featured in entertainment
genres. They noted the “subversion” of
racial stereotyping by making TB part of the
story of the white character, Danny. Several
participants felt more information on TB
detection and treatment should have been
included. Interestingly, these participants were
extraordinarily well informed and spoke as if they
were health workers.
CADRE observes that focus group participants
reflected very little on the connection between
Danny’s TB and her unhealthy lifestyle of heavy
drinking, endless partying and multiple sex
partners.
Safer sex
Promoting safer sex through consistent condom
use was an objective of 4Play but the use of
condoms at various points in the series was not
remarked on by focus group participants. In
relation to safer sex, people questioned how
Danny with her many partners was not HIV
positive while faithful wife Nox had the bad luck
to become infected by her husband. There was
speculation that Danny was smart enough to use
condoms.
Violence and abuse within relationships
There was substantial focus group discussion on
the abusive relationships between Tshepiso and
Amira and between Brian and Nox.
The rape of Nox by her husband, Brian, gave rise
to some debate. On the one hand, there were
individuals who readily identified this act of nonconsensual sex as rape.
So often we think rape takes place in dark dingy
places, around corners, but it actually happens
in the house. (Female, 18-30 years, Free State)
Others were disbelieving.
Because they are married, you think, is it really
rape if you are married?
(Female, 18-30 years, Western Cape)
Tshepiso’s abuse of Amira was something that
several female participants related to from their
personal experience.
Referring to Amira, a woman from Western Cape
observed:
I think most people are blinded by love when
it comes to money. For example, with me,
I’m always available to do whatever when the
people I love want something, and sometimes
I end up losing a lot. I think it was a bit of an
awakening to see it happening to Amira, how
the partner was using the money and abusing
her. (Female, 18-30 years, Western Cape)
I’m like Amira. I have an abusive boyfriend, so
that’s why I like Amira the most. Yes, like the
23
way she wants to leave Tshepiso but somehow
she can’t. Her friends advise her on what to do.
That happened to me.
(Female, 18-30 years, Western Cape)
Male responses to the subject of rape within
relationships were diverse.
A young man from Western Cape acknowledged
that:
most guys, we think that women that we are
dating, we are entitled to have sex with them
even if they don’t want to. (Male, Western Cape)
In contrast, a male participant in a Gauteng
group attacked Amira for her lack of consistency.
Okay, fine, he raped her but what is she, the
so-called victim, crying about? She wanted
Tshepiso all along, this perfect thing – and she’s
got it. But it’s not so perfect; this perfect thing
has come home and it’s raping her. So what is
she crying about? The rape? (Male,Gauteng)
In this same group there was discussion about
whether a man could “persuade” a reluctant
partner through foreplay and whether this was
consensual sex.
The CADRE report indicates that the primary
female audience engaged with and reflected on
the partner violence messages as intended but
the male participants, while grappling with the
issue of male partner violence, did not construe
the message as intended by 4Play’s producers.
Female independence
Cadre commented that “several participants
struggled with a portrayal of women who are
emotionally vulnerable and in some cases
economically dependent on men. They
expressed a desire for the series to portray
successful women who conquer life”.
(Clarfelt A et al, 2012)
But some drew lessons from the personal
struggles that others construed as weakness.
Watching 4Play just made me think that I have
got so much to do on my own without my
husband, on my own without my children. I am
an individual at the end of the day. And I have
been doing that and I am enjoying it because
I’ve found myself. I’ve been lost for 10 years and
I’ve found myself.
(Female, 30+ years, KwaZulu-Natal)
Focus group participants viewed
the relationships between some
characters as unhealthy and others as
positive.
Intimate partner relationships
Nox’s relationship with Brian was mostly
associated with his rape of her and his lack of
support when she disclosed her HIV status. It
was clearly seen as a destructive relationship in
which love and sexual desire had faded. In Series
1 and 2 Nox remained in the marriage and made
some attempts to rekindle the relationship. This
was seen either as a sign of weakness, financial
dependence or a sacrifice for the sake of the
children.
CADRE noted that the power dynamics between
Amira and Tshepiso “were generally perceived
by participants to be more complex and not as
clearly unequal as between Nox and Brian”. This
appeared to be linked to the fact that Amira
was able to find employment and that she was
“gutsy” with “a strong character”.
Noma’s relationship with Humphrey was widely
regarded as the most positive in the series.
Her strength and confidence combined with
his supportive, genuine manner were seen as
a good combination. Viewers gave her a great
deal of credit for being a fine single parent.
Interaction about 4Play
Several focus group participants reported
conversing on Facebook about 4Play and others
indicated that they had watched it with family
members and afterwards discussed some of the
content. 4Play was also said to be discussed
among women in the workplace or while
socialising.
Other participants felt more comfortable
watching alone, in case explicit sex scenes
occurred.
24
CADRE remarks on a “pervasive theme” that
emerged mainly from women participants: the
difficulty or impossibility of watching with their
intimate partners.
“Some participants reported trying to watch
the series with a male spouse or partner and
to talk about it with them. However, instead of
generating positive discussions, this was said
to lead male partners to become closed about
sexuality and health issues and in some cases to
become antagonistic to their girlfriends. Several
participants reflected that this negative reaction
was in response to the series’ portrayal of key
social realities about men, such as infidelity and
gender-based violence.” (Clarfelt A et al, 2012)
CADRE reasons that 4Play’s general failure to
reach men might limit women in their attempts
to actualise certain health-promoting behaviours
advocated by the series. “Without reaching and
changing normative ideas of male sexuality and
encouraging men to communicate more openly
about sexual health, the empowerment of women
to change behaviour and take change of their
sexual health will ultimately be limited.”
Identification with characters
The preceding discussion of viewers’ responses
to themes and messages has already indicated
to some extent the nature of identification with
various characters. The CADRE evaluation deals
with this in detail. A short summary is presented
here:
• P
articipants found positive characteristics in all
four main female characters, with Nox possibly
being seen as the most interesting and Noma
the most admirable. Danny drew a fair amount
of empathy because of her uncaring family.
• Focus group discussions proposed alternative
plot trajectories for most of the female leads.
They wanted them to behave differently in
future from the way they had behaved so far
in the series. In terms of social learning theory,
this suggests that the women characters,
although liked, quite often served as models
of behaviour that should be avoided or
transcended.
25
• In terms of major male characters, the
responses of focus group participants indicated
that Brian and Tshepiso were disliked and
judged for their abusive behaviour while the
capable and kind Humphrey was universally
liked and respected.
Production values
JHHESA and Curious Pictures made numerous
value-based judgements about the production
of 4Play, such as: how explicit the sexual scenes
should be in a series about sex; how to position
the production in terms of social class and race, in
a very unequal society; and how much prominence
to give to “feminine” touches in terms of look and
feel.
This was the feedback that the focus groups
yielded on the decisions taken.
• A
number of participants felt that 4Play was not
sexy enough.
I think a lot of the sexual moments were also not
very special. I didn’t feel like (they were) making
love. (Female, 18-30 years, Western Cape)
Like, when Noma is in bed with Humphrey . . .
she is just lying there and you kind of get that
they are scared of each other.
(Female, 18-30, Western Cape)
• The upmarket feeling established by the way
the women dressed and their homes were
styled was applauded. Participants liked the
warmth and the colour and even those who
could not afford to live this way felt it was
motivational. The romantic, girlish touches
were also appreciated, in the main, and the
central setting of a beauty salon was felt
to provide a suitable meeting point for the
diverse characters.
• The portrayal of men raised several questions
(as mentioned earlier) and it was suggested
that stronger male characters might improve
the series.
26
7.4 Evaluation and Series 3
The CADRE evaluation of 4Play Series 1 and
2 made several recommendations, including a
proposal that at least one more season of the
drama be produced. This last recommendation
was adopted, while other recommendations were
selectively followed.
The main difference between the initial seasons
of 4Play and the third was the degree to which
health themes and health messaging stood out.
The integration of messaging, usually a hallmark
of Curious Pictures education entertainment, was
less natural in Series 3. Examples of conspicuous
messaging were:
• H
aving a clinical psychologist in private practice
offer help in locating a TB treatment supporter
for Danny.
• G
etting Noma’s teenage son, without reference
to any other feature of the story, to start
wondering whether to get circumcised.
It appears that some of the feedback on 4Play
alienating men was taken into account in Series
3. The established male characters did not
change fundamentally, but the voice-over which
introduced every episode changed. Although this
was largely in order to reflect the unfolding of the
story, the new voice-over was arguably less sharp
and more man-friendly.
Table 6: Comparison of introductory voice-overs by series
Introductory voice-over Series 1 and 2
Introductory voice-over Series 3
• Is sex the gateway to love?
• Is it ever OK to sleep with your ex?
• H
ow many frogs must I kiss before I find a
prince?
• H
ow come men need to be wanted and
women want to be needed?
• Who has the time to date and find romance?
• How can something so wrong feel so right?
• No-one knows what men want – not even men. • W
hat is it about men that turns sane, beautiful
women into crazy people?
• Men should come with a regularly updated
user manual (giggles).
27
7.5 Impact evaluation
and causal pathways (direct and indirect effects)
between communication exposure and dependent
variables via multiple regression analysis. Dose
response analysis was also conducted.Some of
these results are summarised below.
The third National HIV Communication Survey
(NCS 2012) was undertaken in the first half of 2012
approximately two years after the initial broadcast
of 4Play. It evaluated the reach and impact of a
range of communication programmes, including
4Play, on the behavioural drivers of the HIV
epidemic. The survey sampled 10 034 males and
females from all provinces in the age range 16 –
55 years.
The analysis framework used is represented
in Figure 1. It is the same framework used for
the impact analysis of Intersexions as a drama.
The framework indicates that communication
interventions that use drama need to take into
account the “intervening” process through which
drama works on the intended audience. Drama
can create strong audience identification with
characters, concern about what happens to them
and ultimately get the moral lesson portrayed
by the character in the drama. The evaluation
of drama interventions needs to measure this
character identification and lessons learned to
properly analyze the impact of the drama on
intermediate outcomes and behaviours (see
columns 3 and 4 in Figure 1 below).
Dr Lawrence Kincaid and Dr Maria-Elena
Figueroa, from Johns Hopkins University Center
for Communication Programs (JHU∙CCP),
undertook specific analysis on the impact of 4Play.
Multivariate causal attribution (MCA) analysis
(Kincaid DL & Do MP, 2006; Babalola S & Kincaid
DL, 2009) was used to justify causal inference and
estimate the impact of 4Play on HIV prevention
behaviors. MCA analysis includes structural
equation modeling (SEM) to test the directions
Figure 1: Framework for study of impact of Drama Series on HIV prevention
DRAMA
CONTENT
Characters
Plot
Concepts
Dialogue
Music
Visuals
INTERVENING
PROCESSES
INTERMEDIATE
OUTCOMES
AUDIENCE
RESPONSE
Identification with
characters
Caring about what
happens
Getting the moral
lesson
?
BEHAVIOUR
CHANGES
INDIVIDUAL &
COLLECTIVE
RELATIONAL
CHANGES
Beliefs & values
Social norms
Self-efficacy
Partner reduction
or mutual fidelity
Condom use
HIV testing
Adapted from Kincaid DL and Figueroa ME (2012). The impact of Intersexions TV drama on prevention behaviour.
Unpublished presentation.
28
Exposure and recall of 4Play
NCS 2012 data show that nearly a quarter of the sample (22%) watched 4Play and viewership was higher
among the younger groups (Figure 2). Exposure was also higher among women (25%) compared to
men (20%). By age, exposure among women was much higher in the younger age groups compared to
men (Figure 3). Among those in the older age group (36-55 years old), exposure was similar between
men and women. Although overall exposure was relatively low, these findings suggest that 4Play
reached the younger age groups of females as it had intended to do.
Figure 2: Percent who watched 4Play in the past 12 months, by age group
Percent
40
30
20
29
25
13
10
0
16 to 24
25 to 35
Age Group
36 to 55
n=10 034, representing 28 092, 79 men and women 16-55 years old. n=2 351 who ever watched 4Play, representing
approximately 6 245 808; weighted percentages.
Figure 3: Percent who watched 4Play in the past 12 months, by age group
and gender
Percent
40
Male
33
30
20
25
29
21
13 13
10
0
Female
16 to 24
25 to 35
Age Group
36 to 55
n=10 034, representing 28 092 779 men and women 16-55 years old. n=2 351 who watched 4Play, representing approximately
6 245 808; weighted percentages.
From all the audience that ever watched 4Play (approximately 6 014 962 men and women),
about half (56%), equivalent to 3 388 534 men and women, watched the series in the last 12
months prior to the survey. This loss of viewership occurred across all age groups (Figure 4).
29
Figure 4: Percent who ever watched 4Play and those who watched in last 12
months by age group
Percent
40
30
29
20
25
16
10
0
Ever watched
Watched in last
12 months
16 to 24
15
25 to 35
Age Group
13
8
36 to 55
n=10 034, representing 28 092 779 men and women 16-55 years old. n=2 351 who ever watched 4Play, representing
approximately 6 245 808; n=1 426 who watched in last 12 months, equivalent to 3 619 380; weighted percentages.
Among those who watched the series in the last 12 months, about 73% watched 12 or fewer of the 26
episodes and the remaining 27% watched 13 or more. About 6% watched all 26 episodes (Figure 5).
The mean number of episodes watched among those who watched the series in the last 12 months was
9.3, which is about a third of the series. This compares to a mean number of 12.8 episodes that viewers
of Intersexions watched.
Figure 5: Exposure to 4Play in the last 12 months, by number of episodes
watched
60
50
Percent
40
47
30
26
20
15
10
0
1 to 6
6
7 to 12 13 to 18 19 to 25
6
All 26
n= 1 426 who watched 4Play in the last 12 months, weighted percentages.
30
Identification, meaning and lessons learnt
As opposed to Intersexions, which featured a large number of characters with only a few appearing
in more than two episodes, 4Play featured four very distinct female characters that appeared in all
episodes. There was, therefore, opportunity for viewers to develop an emotional attachment to these
characters. The results of the analysis show that 84% of those who watched in the last 12 months cared
about at least one of the characters (Figure 6). The character the audience most cared about was Nox
followed by Noma with Amira and Danny being the least cared about.
Figure 6: Characters of 4Play that viewers most cared about
Percent
40
30
20
10
15
12
0
Danny
24
32
16
Amira
Noma
Nox
Name of character
None
n= 1 426 who watched 4Play in the last 12 months; weighted percentages.
Some characters seemed to have created a similar identification among men and women in the
audience. This is the case of Nox and Amira; similar proportions of men and women cared about these
two characters. Slightly more men than women cared about Danny, while by far more women than men
cared about Noma (Figure 7).
Figure 7: Characters of 4Play that viewers most cared about, by sex
Percent
40
Male
30
29
20
10
0
14
10
Danny
15 15
Amira
31
33
20
18
Noma
Female
Nox
n= 1 426 who watched 4Play in the last 12 months; weighted percentages.
12
None
31
The NCS 2012 asked respondents what they thought were the main lessons that each of the four
characters learned after what happened to them. Results showed that recall of key lessons ranged
between 30 to 50% for each character (Table 7). The lesson least mentioned was the existence of HIV
support groups which is primarily discussed in Nox’s story. Overall, the results showed a good level of
understanding of the lessons that 4Play tried to convey with each character’s story including HIV risk due
to alcohol, infidelity, and lack of condom use, as well as empowerment of women and self-confidence
(through the stories of Noma and Amira).
Table 7: Lessons viewers learnt from 4Play, by character
Character
Lesson Learned
Noma
1. No need to have sex when you first meet a guy to keep him.
53%
2. Do not have sex until it feels right for you.
43%
3. No need to stay with a man if he does not see the relationship the same
way you do.
33%
1. Any one from any race or economic status can get infected with HIV.
52%
2. People who are HIV positive can live a normal life.
43%
3. Even if only one partner cheats, both partners can get infected with HIV.
37%
4. There are support groups that help people live with HIV.
22%
1. Drinking too much can lead to having too many sex partners.
47%
2. Drinking too much can make you forget about using condoms.
42%
3. Too much drinking can increase your risk for HIV.
38%
4. Too much drinking can increase your risk for other diseases like TB.
29%
1. Women should not neglect themselves in order to be loved by a man.
47%
2. Women need to achieve their own dreams.
43%
3. Men who truly care about you will help you achieve your own goals.
40%
Nox
Danny
Amira
n = 1 426 that watched 4Play in the last 12 months; weighted percentages.
Percent
32
Impact of 4Play on HIV prevention behaviours
To measure the impact of 4Play on HIV prevention behaviours, the research team created a 3-level
measure of exposure. This measure takes into account whether respondents cared about the 4Play
characters (identification) as well as how many episodes they watched. Identification with key characters
indicates a higher level of involvement in the drama and hence is theoretically expected to increase the
drama’s impact. Moreover, the drama was built around four dynamic women characters who appeal
to other women in the audience. As explained before, about 22% of respondents were exposed to
the 4Play drama series in the last 12 months. This figure increases to 25% among the sexually active
(reported having sex in the last 12 months), with about half of those (12%) saying that they cared about
one of the four main characters.
In what follows, the analysis is referred to the sexually active population. Statistically significant impacts
were found for HIV testing and for condom use, but not for reduction of multiple sex partners which was
not a priority of this communication programme.
Getting tested for HIV
The overall results of the impact analysis of 4Play indicate that the drama was effective in increasing
discussion about HIV testing. Identification with the drama characters had the expected positive impact
on HIV discussion. Among respondents who were exposed in the last 12 months but did not care about
any of the characters, 51% reported discussing HIV testing with their sex partners. This figure climbs to
57% among those who were exposed and cared about at least one of the drama characters (Figure 8).
Percent who discussed HIV testing
Figure 8: Discussion of HIV testing by type of exposure to 4Play
60
50
40
45
57
51
30
20
10
0
None
Exposure
without character
identification
Exposure
with character
identification
Type of exposure to 4Play
n= 6,062 sexually active; adjusted by logistic regression analysis
The NCS 2012 analysis further showed that:
• R
espondents who reported having discussed HIV testing with their sex partner were more likely to
have tested for HIV in the 12 months prior to the survey.
• R
espondents with high perceived norm for testing were also more likely to have taken an HIV test in
the 12 months before the survey. (Figure 9)
The analysis did not show any impact of the drama on the perceived social norm for HIV testing.
33
Percentage tested for HIV
Figure 9: Percent testing for HIV in the last 12 months, by discussion of HIV
testing and perceived social norm
70
None/Low
60
63
50
46
40
30
20
Any/High
52
33
10
0
Discussion of
testing
Perceived
Social Norm
Intervening variables for testing
n=6 062 sexually active; adjusted by logistic regression analysis, p<0.001
Condom use at last sex
One of the most perplexing and persistent characteristics of the AIDS epidemic in South Africa is the
higher rate of HIV prevalence among women compared to men. There are likely many reasons for this,
but one that stands out is the difference in their use of condoms, presumably because of the lack of
control that women have over a male method of HIV prevention. Prevention programmes over the last
decade have tried to reduce that gap and increase women’s sense of assertiveness, empowerment, and
self-efficacy in their relationship with men, especially in terms of HIV prevention behavior. To measure the
impact of 4Play on condom use, the NCS 2012 included a five-item scale to measure the level of selfefficacy for condom use (Table 8).
Table 8: Scale used to measure self-efficacy of condom use
Items used to measure self-efficacy of condom use
1
I can use a condom even when I have too much to drink.
2
I can refuse to have sex if my partner refuses to use a condom. [WOMEN]
3
I can buy a condom without feeling embarrassed.
4a
I am confident that I can put a condom on correctly. [MEN)
4b
I am confident that I can correctly put a condom on a man when having sex with him. [WOMEN]
5
I am confident that the man that I have sex with can put a condom on correctly. [WOMEN]
Response scale: 1=Strongly disagree; 2=Somewhat disagree; 3=Somewhat agree; 4=Strongly agree. Coefficient of reliability,
alpha=0.68 (2 467 men), 0.76 (3 595 women)
34
The last two National Communication Surveys have revealed that the gender gap in condom use has
narrowed by almost 50%. Between 2008 and 2012, condom use during the most recent sex with any
of one’s sex partners increased from 42.3% to 50.6%, an 8 percentage point increase in 4 years. But
the increase among women was greater than among men. In 2008, the gap in condom use between
men and women was 12.8 percentage points (48.7% and 36.0%, respectively). By 2012, that gap had
declined to 6 percentage points (54.1% and 42.3%, respectively).
The statistical analysis revealed that exposure to 4Play had statistically significant impact only on women
viewers, not men. Moreover, no direct effect on condom use was found, but rather an indirect effect
though a significant effect of women’s self-efficacy for condom use, if they identified with one of the four
main female characters in the drama. Among women who watched the drama and who cared about one
of the characters, 53.2% had a high level of self-efficacy for condom use. This drops to 50.8% among
women who watched the drama but did not identify with any character, and then to 48% among women
who did not watch the drama at all. Only the last difference, those who identified with one of the
characters, was statistically significant (Figure 10).
Percent with high level of
condom self-efficacy
Figure 10: High level of self-efficacy for condom use by type of exposure to 4Play
60
40
50,8
48
53,2
20
0
Exposure
Exposure
without character with character
identification
identification
Type of exposure to 4Play
None
n=3 595 sexually active women; adjusted by logistic regression analysis.
One’s level of self-efficacy had a substantial impact on condom use. Among women with low condom
self-efficacy, condom use was only 43% compared to 53% among women with a high level of condom
self-efficacy, a 10 percentage point difference (Figure 11). This finding supports the decision to
emphasize personal responsibility and the sense of self-efficacy for condom use, in particular, in the
4Play drama.
35
Percent condom use at
last sex
Figure 11: Condom use at last sex by level of self-efficacy for condom use
among women
Low
60
40
43
High
53
20
0
Self-Efficacy for condom use
n=3 595 sexually active women; adjusted by logistic regression analysis
The 2012 survey also showed that condom use was significantly higher among women who had
multiple sex partners; had higher levels of education; were single, widowed or divorced, or had
a steady/regular sex partner; reported having a casual sex partner; knew that a sex partner had
other partners; or used a condom the first time they had sex. High condom self-efficacy was
also higher among women who had a steady/regular sex partner; had higher levels of education
and socio-economic status; used a condom the first time they had sex; or shared their HIV status
with their sex partner.
Overall, the 4Play television drama had an indirect effect on HIV testing behaviour on men and
women through increased discussion of HIV testing with their sex partners, and on condom use
at last sex on women through increased self-efficacy for condom use.
36
8. Concluding comments
With 4Play: Sex tips for girls, JHHESA once again
demonstrated an ability to isolate a particular facet of the HIV
epidemic – in this instance its impact on young women – and to
address this with insight in a popular manner.
The programme tackled the singular contradiction of HIV among
South African women: generally low-risk behaviour, yet ultra-high
rates of HIV infection. It exposed some of the fault-lines in family
and sexual relationships that contribute to the high rate of HIV
among women.
Curious Pictures MD Harriet Gavshon summed up the intention of 4Play
as follows: “The central message of 4Play was women taking responsibility
for their own sexuality and their own sexual health.”
The series examined how difficult it can be for women to assume responsibility
for the way they conduct their sexual relationships. 4Play certainly painted a
fairly complex, true-to-life picture of the trade-offs, the insecurities and the
mixed motives that colour intimate relationships. The messaging on HIV and
TB was relatively more direct, but much of it focused on testing and treatment
rather than on prevention. Dealing with HIV infection after-the-fact was a fairly
roundabout way of “teaching” about prevention.
The qualitative evaluation suggested that 4Play secured strong female viewer
identification and rich food for thought about viewers’ own conduct.
The results of the quantitative impact evaluation showed
that although overall exposure was relatively low
compared to Intersexions, 4Play reached the younger
age groups of females as it had intended to do, viewer
recall of the main lessons was high and the series
created a positive character identification that resulted
in increased impact.
4Play also had a positive impact on HIV testing behaviour among men
and women through discussion of HIV testing with their sex partners,
and it had a positive impact on condom use at last sex among women
by increasing their self-efficacy for condom use.
4Play has all of the intuition and creativity that viewers have come
to expect of the partnership between JHHESA and Quizzical
Pictures.
37
Acronyms and abbreviations
CADRE
Centre for AIDS Development, Research and Evaluation
CCMS
Centre for Communication, Media and Society, University of KwaZulu-Natal
DramAidE
Drama AIDS Education
HSRC
Human Sciences Research Council
JHHESA
Johns Hopkins Health and Education in South Africa
JHU
Johns Hopkins University
JHU∙CCP
Johns Hopkins University Center for Communication Programs, Bloomberg
School of Public Health
NCS
National (HIV) Communication Survey
SABC
South African Broadcasting Corporation
SBCC
Social and behaviour change communication
38
References
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episodes 1-26. Johannesburg: CADRE.
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agenda for prevention. The Lancet Special Edition on South Africa: 374(9694):1011-1022..
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39
Video material
4Play: Sex tips for girls. Series 1 and 2 (26 episodes)
4Play: Sex tips for girls. Series 3 (Approximately 10 out of 13 episodes)
Interviews
Mariki van der Walt, producer of 4Play and head of productions at Curious Pictures (now Quizzical
Pictures)
Harriet Gavshon, MD of Curious Pictures (now Quizzical Pictures).
Bronwyn Pearce, deputy director at Johns Hopkins Health and Education in South Africa.
Lusanda Mahlasela, deputy director research, monitoring and evaluation at Johns Hopkins Health and
Education in South Africa.
Helen Hajiyiannis, acting director, Centre for AIDS Development and Research.
TUBERCULOSIS
PROGRAM
SOUTH AFRICA
JOHNS HOPKINS HEALTH AND EDUCATION IN SOUTH AFRICA
257 Brooklyn Road, Block D, Equity Park
Brooklyn, Pretoria, Gauteng, 0011
Primary Contact Number: +27 12 366 9300
Fax Number: +27 12 366 9301
www.jhhesa.org.za