Secret Lovers Kill: A National Mass Media Campaign to Address Multiple and Concurrent Partnerships

This case study is about the Makhwapheni (Secret Lovers) Campaign, a national media campaign in Swaziland which focuses on HIV prevention, with a specific focus on multiple and concurrent sexual partnerships (MCP). The campaign was launched by the government's National Emergency Response Council on HIV/AIDS (NERCHA) in 2006. The campaign launched with controversial and blunt messages about the practice of "secret lovers" which sparked passionate national debate in the media and in communities about the practice of makhwapheni. According to survey data, the number of men reporting two or more partners dropped by 50% immediately after the campaign began. However, the campaign was suspended due to objections raised about the stigmatising effect of what was termed fear-based advertising. This case study shows that if direct and hard-hitting campaigns are being designed, attention must be given to ensuring that groups within the community are not stigmatised as a result of unintended messages.

According to the report, despite efforts to reduce MCP among Swazi nationals with campaigns such as the first Makhwapheni Campaigns (2001 and 2006), I AIDS Indzaba Yetfu Sonkhe (HIV Is Everybody’s Business) campaign (2001), Likusasa Ngelami (The Future Is Mine, 2005), staff from National Emergency Response Council on HIV/AIDS (NERCHA) recognised that, despite a high level of HIV awareness among Swazis, corresponding behaviour change had not occurred. Government strategy documents described a lack of seriousness in confronting the epidemic, characterising the response as "business as usual." To promote behaviour change, NERCHA sought to stimulate public discussion of MCP.

The campaign therefore began with direct messages designed to confront the audience. For example, a young woman is shown with a message on her mobile phone which reads, "He's workin' late, cum work on me", intended to be understood as a message for her makhwapheni ("secret lover" in SiSwati). But next to the image of the phone appears another message: "Why kill your family", followed by the tagline "Secret lovers kill". In July 2006, this blunt ad first appeared in newspapers and billboards and on the radio in Swaziland. According to the report, the message struck a nerve, sparking a passionate national debate in the media and in communities. On call-in radio shows, in the newspapers, and between friends, Swazis openly discussed the formerly unmentionable practice of makhwapheni and the attitudes of fellow citizens toward multiple sexual partnerships.

However, only a few weeks after the initial advertisements first appeared, NERCHA suspended the campaign in response to objections raised by People living with HIV (PLHIV) who felt that the campaign branded all people with HIV as makhwapheni, responsible for the epidemic. They protested outside the offices of NERCHA and petitioned the Prime Minister to withdraw the ad. NERCHA agreed to review the campaign, in consultation with people living with HIV/AIDS, to consider how to address some of the concerns that had been raised. In August 2006, modified advertisements appeared. The Makhwapheni uyabulala (Secret lovers kill) tagline was replaced by the more general message, "Hha, i-HIV ibhokile" (Hey, HIV is everywhere).

Campaign Evaluation

The South Africa-based organisation CIET Trust was commissioned to survey the audience. The survey examined the impact of the Makhwapheni Campaign before the modified advertisements appeared. The results showed that people heard and understood the key campaign message and that 86% of respondents had heard of the campaign. Of those who had heard of the campaign, approximately 87% agreed with the messages. Respondents who disagreed with the messages were more likely to have multiple partners or multiple spouses or to not have used a condom the last time they had sex with their regular partners.

A comparison of the survey to 2005 baseline data revealed some positive changes in behaviour among men. The numbers who reported having two or more partners in the preceding four weeks dropped by nearly half. Approximately 16.7% of men reported having two or more partners in the last four weeks, compared to 30.6 percent in 2005. There was a similar trend in multiple sexual partners in the preceding six months, with men in 2006 significantly less likely to say they had multiple partners over that period.

According to the report, one of the striking achievements of the Makhwapheni Campaign was that it achieved fairly close to universal recognition in a very short time frame. Four key elements most likely contributed to the campaign’s achievement of a high level of interest.

• Evidence-informed: The campaign was built upon research that identified MCP as a key driver of the HIV epidemic in Southern Africa.
• Clarity of purpose: it is important that the producers of HIV mass media campaigns be clear about what they are trying to say.
• Media engagement: Generating free media coverage is a powerful way to raise the visibility of HIV campaigns, although most HIV programmers struggle to attract media attention.
• Audience engagement: A comprehensive multimedia strategy can help HIV messages reach the intended audience, but this does not necessarily mean the audience engages with the messages.

Based on what the author considers to be the successes of the campaign, as well as the controversy generated, the report recommends the following for others exploring messaging approaches on MCP:

• Ensure high-quality market research early in the process - The report suggests that this case study highlights the importance of market research for HIV campaign development. The quality of the market research will help determine the quality of the campaign. Briefings from HIV technical experts can help researchers conduct well-focused market research. The varying interpretations of the term makhwapheni highlights the importance of comprehensive pre-market testing early in the creative development phase to help producers understand how the audience might respond to the materials and whether they interpret messages as intended.
• Involve key stakeholders - Early involvement allows stakeholders to plan activities that support campaign messages. Input from stakeholders throughout campaign development and implementation can be valuable because stakeholders represent particular constituents and will bring their own set of perspectives to the process.
• Use multilevel communication programmes to achieve cultural change - According to the report, achieving cultural change is challenging for any single mass media campaign because of the range of social and environmental factors that play a role. Achieving behaviour change requires reinforcing mass media campaign messages with multifaceted HIV prevention activities.
• Involve and strengthen the capacity of PLHIV to participate - According to the report, including PLHIV throughout the planning process might have ensured comprehensive pre-test marketing to assess how campaign messages affected people living with HIV.

The report concludes that an important overall lesson learned was that if direct and hard-hitting campaigns are deemed appropriate, attention must be given to ensuring that groups within the community are not stigmatised as a result of unintended messages. Although achieving this balance can be difficult, campaign producers should not shy away from producing mass media advertisements that provoke a response from the audience. The report further mentions that the Makhwapheni Campaign has reopened an old debate within public health: When, if ever, is negative or fear-based advertising effective as an HIV prevention tool? If negative or fear-based advertising is to be used, how do you ensure such campaigns do not lead to increased stigmatisation against people with HIV or other groups within the community? Finally and most importantly, how do you ensure that any immediate impact on behaviour change is sustained?