Tremendous progress against HIV/AIDS over the last 15 years has inspired a global commitment to end the epidemic by 2030. However, globally, progress made in improving knowledge of HIV status was lower than progress in other areas of the cascade, with gaps in knowledge of HIV status often largest among young people. Closing those gaps requires that a higher priority be placed on interventions to improve knowledge of HIV transmission and prevention, comprehensive prevention services and HIV testing, in particular among young people. Long distances to testing facilities, long queues to access services and fear of stigma and discrimination act as barriers to HIV testing, especially among young people. HIV self-screening (HIVSS) can play an important role in addressing these barriers and in achieving the first 90 target by moving the locus of testing from health facilities to community settings and providing a discreet and convenient way to screen for HIV. Set in South Africa, the MTV Shuga “Down South season 2” multi-media campaign, broadcast in 2019 and 2020, aimed to raise awareness of and create demand for HIVSS, as well as PrEP and other prevention strategies, among young audiences under age 25 years.

MTV Shuga Intervention

MTV SAF’s mission is to “equip young people with the knowledge, confidence and resources to make informed choices about their sexual and reproductive health and avert HIV”. In 2009, MTV SAF launched the first season of MTV Shuga, an award-winning TV drama that blends HIV and sexual health messaging with entertaining stories to which young people can relate. There have been 9 seasons of MTV Shuga, produced in Kenya, Nigeria, Ivory Coast, and South Africa - the later being called MTV Shuga Down South.

MTV Shuga is centred on TV drama series portraying the lives of young Africans, and incorporates complementary media to increase engagement with broader audiences and populations underserved by TV. Additional elements based on the TV series include a radio drama, a graphic novel, digital and social media, and peer education. Utilising multiple media, a highly popular, youth-relevant brand, and relatable characters and storylines, it has experienced ever-increasing reach and popularity.  The content is distributed license-cleared and cost-free to global broadcasters.

Set again in South Africa, MTV Shuga Down South season 2 targets young people with HIV prevention, HIVSS, PrEP and HIV treatment as predominant themes. The campaign focusses on the existence and benefits of HIVSS; shows the administration of an HIVSS kit on-screen; highlights the importance of follow-up testing and treatment following a positive diagnosis from HIVSS; PrEP, condoms and repeat testing for those testing negative. The aims of the MTV Shuga Down South 2 media campaign are to simultaneously raise awareness of and create demand for HIVSS, PrEP and other prevention strategies among young people aged 15-24 years, while steering audiences to HIV testing and prevention services.

Evaluation Design

The primary objective of the evaluation study is to assess the effect of the MTV Shuga, and its wrap-around multi-media campaign, on the proportion of young people who know their HIV status. The secondary objectives are to evaluate the effect of the campaign on awareness of, demand for, and use of HIVSS, and awareness of PrEP among young people.

To generate evidence for an effect of the campaign, we triangulated data collected approximately 12 months after the campaign’s initial television broadcast. We conducted an online, cross-sectional survey with a target sample size of at least 2,250 young males and females aged 15-24 years. A qualitative study nested within the survey of young people, comprised of telephone in-depth interviews (IDIs) and virtual focus group discussions with young people and parents/guardians, and participant filmed observations.  Additionally, we reviewed routine data from HIVSS and PrEP distribution outlets. The study was conducted online in 2020, with a targeted focus on Mthatha, in the OR Tambo District, Eastern Cape. The data has been analysed, disseminated and applied to improve subsequent MTV Shuga campaigns and other multi-media and health promotion efforts targeting young people, particularly to help close the HIV testing gap.

Due to the Covid-19 pandemic, no face-to-face research methods were used. All methods were conducted via internet and phone platforms, to ensure the safety of all participants and researchers and to avoid contributing to transmission of SARS-Cov-2 in South Africa.