1. Addressing gender, violence and HIV through communication for social change Irela Solorzano, Puntos de Encuentro Julie Pulerwitz, Horizons/Path Rodolfo Peña, CIDS-UNAN-León Mary Ellsberg, PATH Amy Bank, Puntos de Encuentro

2. Were different were equal Intervention Study in Nicaragua (Puntos de Encuentro, Horizons, PATH, CIDS) Communication for social change program to empower youth, promote gender equity, and reduce violence and HIV/STI risk Communication for social change program to empower youth, promote gender equity, and reduce violence and HIV/STI risk

3. Weekly national edutainment telenovela (Sexto Sentido) Daily call-in radio show SDSI Intervention Activities

4. Educational materials

5. Community-based activities Coordination across organizational networks Cast visits to schools Youth training camps

6. Multi media campaign

7. Hypotheses Those exposed to SDSI would show positive changes in knowledge, attitudes and support for norms and behaviors related to partner violence, gender equity, stigma and Those exposed to SDSI would show positive changes in knowledge, attitudes and support for norms and behaviors related to partner violence, gender equity, stigma and Changes would be greater among youth exposed to more activities (dose response) Changes would be greater among youth exposed to more activities (dose response)

8. Research Methodology Longitudinal sample in three representative cities – Esteli, Leon, Juigalpa Longitudinal sample in three representative cities – Esteli, Leon, Juigalpa – Track change of individual people, not just group overall Triangulation of results Triangulation of results – Pre, mid-term and post surveys with 4567 male and female youth aged 13-24 at baseline (over 70% response rate at 3rd round), in- depth interviews and focus group discussions, Participatory Action Research Multivariate and multi-level analyses Multivariate and multi-level analyses –linear regression for repeated measures, Generalized Estimating Equations, Structural Equation Modeling, Population Attributable Risks Percents

9. Measures of gender norms, stigma, Gender Equitable Men (GEM) Scale Gender Equitable Men (GEM) Scale Scales on HIV Stigma, violence, Sexual Power in Relationships Scale, collective and individual efficacy Scales on HIV Stigma, violence, Sexual Power in Relationships Scale, collective and individual efficacy

10. Emerging results Exposure to SDSI components 9 of each 10 have seen or heard SDSI 9 of each 10 have seen or heard SDSI 80% of women - 70% of men 80% of women - 70% of men 59% 59% Watched "frequently" or "occasionally" during 2-3 seasons 41% 41% Hardly ever watched it or only watched one season.

11. Attitudes towards gender, stigma and violence Index value up 20% over the three surveys. (p = 0.000) Index value up 20% over the three surveys. (p = 0.000) Individuals exposed to the intervention were more likely to say: Individuals exposed to the intervention were more likely to say: Women should not be the only ones in charge of housework (OR= 1.3) Women should not be the only ones in charge of housework (OR= 1.3) A man never has a right to hit his wife (OR=1.4) A man never has a right to hit his wife (OR=1.4) * After controling for age, sex, region, education

12. Greater knowledge and use of health and social service providers 33% greater probability of knowing a center that provides attention for cases of domestic violence. (p = 0.000) 33% greater probability of knowing a center that provides attention for cases of domestic violence. (p = 0.000) 48% greater probability of having been to a center that attends to cases of domestic violence in the last six months. (p = 0.001) 48% greater probability of having been to a center that attends to cases of domestic violence in the last six months. (p = 0.001) Population Attributable Risks Percents (PAR): The following are attributable to SDSI: 23% of those who know a center that provides attention for cases of violence (= 13,554 young people in the 3 cities) 23% of those who know a center that provides attention for cases of violence (= 13,554 young people in the 3 cities) 29% of those who in the last six months have been to a center that attends to cases of domestic violence (= 2,826 young people in the 3 cities) 29% of those who in the last six months have been to a center that attends to cases of domestic violence (= 2,826 young people in the 3 cities)

13. Greater interpersonal communication about SDSI issues 62% greater probability of having talked with someone in the last six months about domestic violence, HIV/AIDS, or the rights of young people. (p=0.000) 62% greater probability of having talked with someone in the last six months about domestic violence, HIV/AIDS, or the rights of young people. (p=0.000) Specific topics: domestic violence (53%), HIV/AIDS (49%), young peoples rights (48%) Specific topics: domestic violence (53%), HIV/AIDS (49%), young peoples rights (48%) PAR: Among those who said that they had talked to someone about one of these topics in the last six months, 21% can be attributed to greater exposure to SDSI PAR: Among those who said that they had talked to someone about one of these topics in the last six months, 21% can be attributed to greater exposure to SDSI (= 10,650 young people in the 3 cities) (= 10,650 young people in the 3 cities)

14. Gender differences Positive changes were greater among young men than young women, although young men had more conservative attitudes at baseline Positive changes were greater among young men than young women, although young men had more conservative attitudes at baseline Changes were greater among youth exposed to more activities (dose response) Changes were greater among youth exposed to more activities (dose response)

15. Cost study Cost per adolescent/young viewer of Sexto Sentido in Nicaragua was roughly US$0.04 per episode, or U$0.60 per season (15 episodes). Cost per adolescent/young viewer of Sexto Sentido in Nicaragua was roughly US$0.04 per episode, or U$0.60 per season (15 episodes). The cost per viewer for the three seasons between 2003 and 2005 works out to roughly $1.80. The cost per viewer for the three seasons between 2003 and 2005 works out to roughly $1.80. Compared to other kinds of interventions, Sexto Sentido is a very cost effective way to reach and effect change in a large number of people. Compared to other kinds of interventions, Sexto Sentido is a very cost effective way to reach and effect change in a large number of people.

16. Changes in social context The impact of SDSI on the local social context was evaluated using qualitative methodology. SDSI has contributed to gradual and diverse changes in relation to: The impact of SDSI on the local social context was evaluated using qualitative methodology. SDSI has contributed to gradual and diverse changes in relation to: –Local work and the development of initiatives –Opening up to dialogue and debate about taboo subjects –Strengthening leadership among youth –Increasing collective efficacy –Links and alliances

17. Conclusion A national communications for social change program focuses on gender, violence and HIV prevention led to significant positive changes over time on a population level A national communications for social change program focuses on gender, violence and HIV prevention led to significant positive changes over time on a population level Longitudinal study design is unique Longitudinal study design is unique