When South Africa’s government tackled AIDS in the late 1990s, they did something different. Other countries had largely concentrated on reaching teens through advertisements and talks in churches and schools. As journalist Tina Rosenberg recounts in Join the Club: How Peer Pressure Can Transform the World, the traditional efforts were dedicated to educating young people about what AIDS is, how it’s spread, and how to combat it (condoms and limiting partners) as well as warning them about the threat of early death. Billboards featured the AIDS red ribbon.
The problem was, none of it was working.
The South African government started by convening a group beyond the usual public health experts. They also invited psychologists, advertising executives, marketing experts, and very importantly, teens. After consulting teens, the campaign’s working title, “the National Adolescent Sexual Health Initiative,” was nixed in favor of “loveLife.” The new title reflected what the campaign found through its surveys of teens: teens didn’t want a campaign that was focused on AIDS. “Engage with me on the level of my excitement and confusion as a young person: sex, parents, friends, drugs, school, rural vs. city”—that’s how the campaign director summarized teens’ sentiments. “They were completely turned off by the red ribbon. And they didn’t want to be threatened.”
The result was a strategy that included no appeals to fear of early death. It did include the stuff that teens love: celebrities, fashion, love advice, teen slang. Billboards said things like “Get Attitude!”—which adults overwhelmingly hated because they didn’t think that the billboards had any connection to combating AIDS. The campaign had reality TV shows, a radio call-in show, and magazines. As one of the program directors put it, “The logic of the brand is to create something larger than life, a sense of belonging. That creates participation in clinics, schools—people go because they like to be a part of loveLife.”
‘loveLife is betting that the way to keep teenagers healthy is to make them feel a part of something.’
Moreover, most of the campaign’s programs are run by “groundBREAKERS,” people between the ages of eighteen and twenty-five trained in counseling and sexual health. In addition, thousands of younger teens called mpintshis, or friends, run radio stations and sports competitions for the campaign. And when those young people do talk about AIDS, they couch it in a personal story.
Take Sibu Sibaca, a groundBREAKER and corporate investment manager, who credited her success to loveLife. Her parents had died from AIDS, and she was engaging in sexually risky behavior as a young teen. When a friend told her about loveLife, she attended their programs and was transformed. “Seeing billboards of a dying person didn’t tell me about me,” she told Rosenberg, “but when someone says, ‘You have such amazing potential that HIV shouldn’t be a part of it’—then it wasn’t about HIV. It was about me. No one is wagging a finger at me, just young people, peers, telling me the way you’ve lived your life is not good and we’re going to help you.” It’s young people like Sibaca who are the face of loveLife to young teens. As Rosenberg says, loveLife “helped young people change their lives by putting them in the company of peers who had changed theirs.”
Has the campaign worked on a mass scale?
By 2006, the “loveLife” brand was one of the ten best-known brands in South Africa. By 2010, the new infection rate for young women had dropped 60 percent, a decline that was greater than in other high-prevalence countries. Condom use had increased, though teens were still having just as much sex, and just as early, with multiple partners. Of course, it’s difficult to know how much of the decline in infection rates among young women was related to loveLife. But the results are intriguing: they suggest that the best way to tackle a social problem may be to focus on something other than the problem. As Rosenberg says, “loveLife is betting that the way to keep teenagers healthy is to make them feel a part of something.”
There is some research to suggest that this strategy works. In his compelling book Redirect: Changing the Stories We Live By, psychologist Timothy Wilson describes teen-pregnancy prevention programs that encourage at-risk teens to engage in volunteer work. In the Reach for Health Community Youth Service program, for example, young teens spend an average of three hours a week doing volunteer work in places like nursing homes and medical clinics. In addition, teens participate in weekly classroom sessions about sex education.
Teens who feel alienated from their school and community are most likely to become pregnant.
To determine the effectiveness of the volunteer work, the program once assigned a control group to receive just the classroom component, while another group participated in the volunteer service as well. Two years later, 50 percent of teens who received both the community service and classroom components had never had sex, compared to 37 percent of teens in the control group, a difference that was statistically significant.
Similar results have been found in evaluations of Teen Outreach, a teen pregnancy prevention program in which volunteer service is the main component (sex education takes up only 15 percent of the curriculum). In twenty-five sites, students were randomly assigned to take part in Teen Outreach or to be part of a control group that did not participate. Girls who completed the program were half as likely to become pregnant as girls in the control group, and their academic performance improved.
Wilson’s theory is that “the volunteer work changes the participants’ narratives about themselves, fostering the view that they are valued members of the community.” Noting that teens who feel alienated from their school and community are most likely to become pregnant, he suggests that volunteer work helps at-risk teens feel that “they are valuable members of the community who have a stake in the future, thereby reducing the likelihood that they engage in risky behaviors, including unprotected sex.”
Just as loveLife made the message bigger than AIDS in order to combat AIDS, so these teen pregnancy prevention programs used more than the typical diet of sex education talks to change teens’ sexual behaviors. All of these examples suggest that change sometimes happens through indirection: in order to encourage a behavior, focus less on the desired behavior and more on the things that put a person on the path to that behavior.
The same goes for marriage. Through interviews with working-class young adults, I’ve learned that most cohabiting young couples do not need much convincing that marriage is a good idea. They want lifelong marriage, for themselves and for giving their children a stable family that many of them did not have growing up. But they often lack the confidence and social support and overall sense of well-being to get married. Sometimes they are afraid of divorce, or they struggle to trust their significant other, and they don’t have an extra thousand dollars lying around for a modest wedding celebration. Or they feel that their lives are just too chaotic at the moment to take the step of marriage.
Change sometimes happens through indirection.
For instance, I watched one young man I interviewed over the course of several years go from being afraid to get married to considering marriage. What changed? It’s hard to say for sure, but in our last interview, he said two big things had happened in his life since we had last talked: he had gotten a promotion at his job and was thriving, and his mom had died, which compelled him to think about the brevity of life and what he could do to leave a legacy. It was not a pro-marriage lecture but broader changes in his life that made him consider marrying.
To help couples reach their aspirations for marriage, then, it might be helpful to focus less on directly encouraging people to get married, and more on the factors that are likely to put them on the path to marriage. There could be a million such factors: a steady and decent-paying job that boosts a person’s dignity and overall sense of stability, psychological healing, more intentionality in sex and dating, recovery from a drug or alcohol addiction, a religious transformation, a sense of belonging in a community.
By the way, I suspect that the “focus on something else” approach might be effective for getting people married, but I’m not sure that it would work for keeping them happily married. The vast majority of unmarried young people agree that marriage is something they want to do, and that it’s serious (even sacred) stuff. But when you start talking about marital happiness and reasons for divorce, it gets more complicated: our collective thinking here has been so affected by expressive individualism that it’s hard for many of us to justify keeping moral commitments, like marriage, through unhappiness. And, to me at least, that seems like a massive problem that must be named and addressed head-on.
But sometimes, the research suggests, if you want to tackle a problem, the most effective strategy is to talk about it less. And don’t name your teen outreach campaign the National Adolescent Sexual Health Initiative.