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Impact Data - Punishment of Love

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In May 2003, Population Services International (PSI)/Cambodia launched a 12-week integrated, multimedia HIV/AIDS prevention campaign featuring a television soap opera called Punishment of Love (hereafter, PoL). The campaign's main communication objectives were to stimulate discussion of HIV/AIDS among relatives and friends, improve personal risk assessment skills, encourage care and compassion for people living with HIV/AIDS, and promote social acceptance of condom use, particularly between regular partners. The intended audience was 15-49 year-old Cambodians, with a focus on youth, couples, and sex workers and their partners. One special focus was "sweetheart relationships", which in Cambodia refer to non-commercial, non-marital sexual relationships that possess a certain degree of affection and trust from at least one partner.

Methodologies
An initial pilot survey was conducted to determine exposure, followed by questionnaire for those who fulfilled quota requirements. In total, 5 groups were surveyed:
  1. general population 15-49
  2. youth in school 15-24
  3. youth out of school 15-24
  4. potential male clients of sex workers
  5. female hospitality/garment workers

The study questionnaire included questions on exposure to PoL, likes and dislikes about the soap opera and talk show, retention of key messages, and attitudes and behaviours regarding HIV/AIDS, condoms, and PLWHA. The sampling strategy featured a household survey, street intercepts (conducted at a systematically selected sample of outlets frequented by youth and the clients of IDSWs), and a "target group survey" designed to reach women in the hospitality and garment industries.
Knowledge Shifts
94% of viewers surveyed said they learned something from the television series.
Practices
Of those who had seen the series, 28.5% had ever used a condom, as compared to 21.9% of non-viewers and 19.0% of those interviewed during the KAP. The difference between viewers and non-viewers was significant, as was the difference between viewers and respondents from the KAP (p<.01), but no significant difference was detected between non-viewers and respondents from the KAP survey. The same pattern was repeated for condom purchase, with those who had watched the series significantly more likely to have ever purchased a condom than those who had not seen the series (28.5% vs. 21.9%, p<.01). Viewers of PoL were also more likely to have ever purchased a condom than respondents in the KAP survey (28.5% vs. 19.0%, p<.01). However, when controlling for condom use, marital status, education level, socioeconomic status (SES), and age, the association between exposure to PoL and condom purchasing behaviour was no longer significant.
Attitudes
In order to measure social support for condom use, respondents were asked what they thought of people who use condoms. The most common answer was "they are people who know how to protect themselves". Significantly more viewers of PoL provided this response than non-viewers (86.8% vs. 78.1%, p<.01). This finding also demonstrates a significant increase in social support for condom use over baseline knowledge, attitudes, and practices (KAP) findings (86.8% vs. 75.9%, p<.01). Likewise, significantly more viewers than non-viewers said that people who use condoms are responsible people (32.1% vs. 12.1%, p<.01). This finding also demonstrates a significant increase in positive attitudes towards condom use over the baseline KAP (32.1% vs. 16.8%, p<.01). Significantly more respondents who had watched PoL found it acceptable for married women to carry condoms than those who had not watched the series (70.8% vs. 61.3%, p<.01). High percentages of individuals from all three groups believed that suggesting condom use implies mistrust in one's partner. However, significantly fewer PoL viewers than non-viewers agreed with this statement (78.1% vs. 81.0%, p<.01).

Personal risk perception of HIV/AIDS was very low. There were only minimal differences in risk perception between those who watched PoL and those who did not.

On the issue of stigma:
  • Respondents who watched PoL demonstrated more positive attitudes to people living with HIV/AIDS than those who did not watch the series. The differences observed between PoL viewers and non-viewers remained significant even after controlling for socio-demographic characteristics and condom use. However, it is possible that the differences may be associated with other variables not measured in this survey, such as whether respondents knew anybody with HIV/AIDS personally.
  • Viewers were better able to cite methods for showing support for people living with HIV/AIDS than non-viewers
  • As compared to non-viewers, viewers were significantly more likely to have shared a meal with a person known or suspected to have HIV/AIDS (21.7% vs. 14.2% and 12.8% respectively, p<.01) and also more likely to say that they would care for a male or female relative with AIDS in their own home (91.7% vs. 82.2% and 75.0% respectively for male relative, 91.7% vs. 83.1% and 77.1% respectively for female relative, p<.01). Respondents who had watched PoL were less likely to want a family member's infection with HIV/AIDS to remain secret than those interviewed during the KAP (29.6% vs. 40.2%, p<.01).
Increased Discussion of Development Issues
The majority of general population respondents watched PoL with other people (83.3%). Among the general population, 38% discussed the series/talk show with someone else, generally with a sibling, spouse, or same-sex friend of the same generation. (Since no data are available for other TV programmes, it is difficult to say whether this represents a high or low level of discussion). More than half (50.7%) of in-school youth, 41.3% of out-of-school youth, 47.1% of potential clients of indirect sex workers (IDSWs), and 49.8% of hospitality/garment workers said they had discussed PoL with someone else. 70% of those who discussed the series discussed the key message: condom use for HIV/STI prevention. However, further analysis suggested that the campaign did not affect levels of discussion about condoms or their use when socio-demographic factors were considered.

To situate these figures: Among the general population, bi-variate analyses revealed that those who had seen the series were significantly more likely to have discussed HIV/AIDS during the previous 3 months than those who had not watched PoL (p<.01). Viewers were significantly more likely than non-viewers to have discussed HIV/AIDS with a male friend, female friend, colleague/classmate, parent, sibling (p<.01) and/or spouse (p<.05). Very few respondents had discussed HIV/AIDS with their regular or casual sex partner, with sex workers, or with their boyfriend or girlfriend during the previous 3 months.
Access
Half of those surveyed recalled watching at least one episode of the television series. Those who watched the series tended to be young, educated, and have a relatively high socio-economic status. Percentages of viewers were higher in urban (59.2%) than in rural areas (46.7%), with Phnom Penh particularly high (78.8%). In the latter area and in other urban settings, slightly more women watched than men. On average, respondents who watched the series watched a mean of 5.1 episodes of the drama; 19.2% of those who watched the series viewed the subsequent talk show.

Among the general population, 42.3% had no exposure to any of the components of the media campaign and 8.8% had only minimal exposure (had heard radio spots or read newspaper advertisements but had not watched the series or the talk show). Just over one quarter (26.2%) had low levels of exposure (watched between 1 and 4 episodes), 14.8% had medium exposure (5-8 episodes), and 7.9% had high exposure (9-12 episodes). Less than 3% of respondents read the newspaper ads.
Source
Letter sent from Karrie Carnes to The Communication Initiative on March 19 2004; and "Cambodia AIDS Campaign Gets Royal Blessing", by Jacqueline Devine, PSI News, May 26 2003; and "Declining HIV Gives Hope in Cambodia" [PDF] - PSI Profile, April 2004.