2. © LOVELIFE 2014 loveLife’s Mobile Conditional Incentive Programme: iloveLife 23 July 2014

3. © LOVELIFE 2014 Introduction to loveLife

4. © LOVELIFE 2014 loveLife Driven by youth volunteers called groundBREAKERs and mpintshis Footprint in South Africa: 8000 schools 900 sites 532 government clinics >300 franchised community- based organisations 22 Youth Centres

5. © LOVELIFE 2014 Risk Construct Individual LOW SELF-ESTEEM NO SENSE OF FUTURE UNCERTAIN IDENTITY Helplessness in the face of challenges Social COERCION PEER PRESSURE LACK OF PARENTAL COMMUNICATION EXPECTATIONS OF WOMANHOOD MALE SENSE OF ENTITLEMENT Pressure to acquiesce Perception of scant opportunity HIGH RISK TOLERANCE Structural POVERTY LOW EDUCATION MARGINALIZATION INEQUALITY Sense of constrained choices EARLY SEXUAL DEBUT UNSAFE SEX MULTIPLE SEXUAL PARTNERS EARLY SEXUAL DEBUT UNSAFE SEX MULTIPLE SEXUAL PARTNERS RISKY SEXUAL BEHAVIOUR Possible HIV INFECTION

6. © LOVELIFE 2014 loveLife Evidence RHRU (2011) now WRHIHSRC (2012) loveLife awareness amongst 12-19 year olds : 85% loveLife awareness amongst 12-19 year olds : 90% Reach of loveLife face-to-face programmes to 12-19 year olds : 20% Reach of loveLife face-to-face programmes to 12-19 year olds: 33,5% Studies 1 show adjusted odds ratio for HIV infection amongst those that participated in a loveLife programme: -0.61 for young women -0.60 for young men 1- Pettifor et al., AIDS 19 (2005) Significant links with participation: -Self-reported HIV negative status -Male circumcision -Male contraceptive use -Self esteem -Decreased stigma -Greater sense of future and self- efficacy

7. © LOVELIFE 2014 Rationale for iloveLife

8. © LOVELIFE 2014 HIV and Social Determinants Two-year experiment in Zomba, Southern Malawi, using cash incentives in households with schoolgirls aged 13-22 HIV prevalence Control GroupIncentivised Group 3.0%1.2% Marriage 40% lower Sexual Activity 38% lower Pregnancy 30% lower Conditional cash transfer results: Improve school attendance Reduce sexual activity Reduce teenage pregnancy Reduce early marriage

9. © LOVELIFE 2014 Rationale Similar approaches conducted in other countries: Offered conditional cash, grocery vouchers, nutritional supplements, educational subsidies Conditional reward successfully applied worldwide across education, social welfare, and health care with South Africa as a forerunner 2-The impact of conditional in-kind subsidies on preventative health behaviours: Evidence from Western Kenya. July 2005. Pascalis Dupas, EHESS-PSE. Study in Kenya 2 incentivised visits to healthcare facilities 117% increase in prenatal care services 84% increase in HIV testing 58% increase in follow-up visits to prenatal clinics

10. © LOVELIFE 2014

11. Rationale Discovery Health (SA’s largest private health insurer) launched Vitality in 1998 Incentive and reward based wellness program with statistically significant effects: 3 Lower costs per patient Shorter hospital stays Lower admission rates for engaged members Lower chronic disease costs amongst engaged members Bottom Line Three consecutive impact sessions shared a clear association between increased vitality engagement and lower health care costs 3-Discovery Vitality Journal: Reducing the cost of healthcare through lifestyle intervention. 2008

12. © LOVELIFE 2014 Underlying iloveLife Design Principles Premise for change Interrelated individual, social, biological and structural factors associated with high HIV infections amongst young women Prevention intervention to address different drivers of sexual risk iloveLife design must provide content and activities that address these drivers Research Qualitative and Quantitative research conducted by McPhail et al. (2013) indicated young women found transfer incentives acceptable and feasible Key Consideration Decrease immediate implications of risky sexual behaviour by increasing future reward

13. © LOVELIFE 2014 Underlying iloveLife Design Principles I Focus on specific age group Achieving scale rapidly Individual, social & structural drivers of HIV New gains to be captured by doing things differently Best evidence & models of projected impact

14. © LOVELIFE 2014 Audience demands ENGAGEMENT RECOGNITION REWARDS CONTENT ENTERTAINMENT STIMULATION INFORMATION SEAMLESS SYSTEMS

15. © LOVELIFE 2014 Programme Design

16. © LOVELIFE 2014 Introducing iloveLife Overall Goal Reduce new HIV infections among youth by 15% over 3 years Incentivise young people to engage in healthy behaviours and responsible lifestyle choices Increase knowledge and understanding on HIV / AIDS and sexual reproductive health Develop self-efficacy among participants to seek helpful services: Voluntary medical male circumcision (VMMC) HIV counseling and testing (HCT) Contraceptives STI treatment Main objectives:

17. © LOVELIFE 2014 User Journey Implemented on mobile phones: – Through USSD technology via subscription – Or sign up via ilovelife.mobi Simple sign up process Create a profile Access to all content Sign up User rewarded for 2 types of behaviour: 1. Online activities 2. Real World activities Points Receive e-voucher from points earned Redeem e-voucher at store Reward

18. © LOVELIFE 2014 Online and Real World Activities On site / online activities include: Reading, commenting on and sharing articles and videos Taking part in online quizzes and polls View memes such as bitstrips and images ActivitiesReward Rating Reading and sharing/commenting on compelling content that promotes delaying sexual debut I Online quizzes I Participation in campaigns and competitions I loveLife programme participation and activations (i.e., loveLifestyle and games) II

19. © LOVELIFE 2014 Online and Real World Activities Real world activities include: Clinic visits HIV status check ups Participation in loveLife events games Unique codes are generated for specific real world activities Real World Activity Example IndicatorExpected OutcomeReward FrequencyEvidence/VerificationReward Rating Access to SRHR services (prevention and treatment) Health service attendance (clinic, vitality centre) for SRHR service Improved sexual and reproductive health Each visit approved by health care provider as necessary (for information, commodity or service)DoH database3 Accessing HCT services Number of HCT services accessed Early initiation of ART, prevention of reinfection and increased protected sex Once every three months Code provided by health care provider3

20. © LOVELIFE 2014 Programme’s M&E

21. © LOVELIFE 2014 Expected Results Increased sense of access to things young people Reduced transactional sex relationships Reduced age differences in sexual Reduced HIV incidence among young people Increased access to Healthcare services (i.e. HCT, STI etc.) Increased sense of purpose among young people Reduced levels of school drop- out’s Increased school attendance Increased number of young people who complete Grade 12 Increased self- esteem and positive self- image Increased awareness of risk Delayed sexual debut Increased condom use at first sex Increased uptake of VMMC services Increased consistent condom use Results loveLife contact centre and online- media services Online Content- messages/interaction Incentives

22. © LOVELIFE 2014 Theory of Change Delayed sexual debut Reduction of sexual partners Increased VMMC Increased condom use Suppressed viral load Increased uptake of ART Increase VCT Reduced HIV incidence in young people (12-19) Reduced inter-generational and transactional sex Increased school attendance Impact Behaviour change (outcomes) Predictors of behaviour (outputs) Increased SRHR knowledge Increased awareness of risk Changes in attitudes (e.g. shared responsibility) Increased self-esteem Increased self-efficacy to seek help Increased sense of purpose Increased sense of access to resources Key Activities Provide links to opportunities Provide self- assessments Provide forums and facilitate interactions between users Provide motivational messages and motivational talks Provide online quizzes Provide content on SRHR Provide special campaigns and competitions Providing incentives for HCT and VMMC Providing incentives for online participation Providing incentives for school attendance and school performance Providing incentives for participation in clinical committees and health talks Providing incentives for real world programme participation

23. © LOVELIFE 2014 Indicators at Output Level Intervention LogicIndicators Increased SRHR knowledge % of young people (12-19) who both correctly identify ways of preventing sexual transmission of HIV and who reject major misconceptions about HIV transmission (in correlation to time and level of engagement with iloveLIfe) Change in attitudes regarding discrimination of people living with HIV % of young people (12-19) who agree with the statement “if a teacher has HIV but is not sick, he or she should be allowed to continue teaching” (in correlation to time and level of engagement with iloveLife) Increased self-esteem Average score of young people on the Rosenberg Self-Esteem Scale (selected questions) (in correlation to time and level of engagement with the iloveLife) Increased sense of purpose % of young people who report that they have many opportunities in life and that they have a good idea where they are heading in the future (in correlation to time and level of engagement with iloveLife) Increased self-efficiency to seek help % of young people who report that they know where to go if they need advice on SRH (formulation to be tested – in correlation to time and level of engagement with iloveLife) % of young people who report that they have the confidence to test for HIV (formulation to be tested/defined) (in correlation to time and engagement with iloveLife)

24. © LOVELIFE 2014 Indicators at Outcome Level Intervention LogicIndicators Condom use % of young people (12-19) who report that iloveLife motivated them to use condoms more consistently % of young people (12-19) who report that they always used a condom during sex in the last 12 month (intervention compared to control group) Increased of HCT No. of awarded rewards for HCT % of users of rewards who report that the reward was important to motivate them to test % of young people who report that they have tested for HIV in the last 12 month (intervention compared to control group or in correlation to engagement with iloveLife ) Reduction of sexual partners % of young people (12-19) who report that iloveLife motivated them to use condoms more consistently Self-reported number of sexual partners in the last 12 month (intervention compared to control group or in correlation to engagement with iloveLife) Reduced transactional sex % of young people who report to have had transactional sex in the last 6 month (intervention compared to control group) Increase school attendance No. of awarded rewards No. of young people who report that the reward motivated them to go to school Additional indicator to be defined in coordination with the Department of Education

25. Live Demonstration

26. © LOVELIFE 2014 Tel +27 (0)11 523 1000 Fax +27 (0)11 523 1001 48 wierda rd west, wierda valley, sandton, 2196 P O Box 45 parklands 2121 south africa talk@lovelife.org.za www.lovelife.org.za Thank-you.