‘It is guiding us to protect ourselves’: a qualitative investigation into why young people engage with a mass-media HIV education campaign

Abstract

This study explores how and why young people engage with MTV Shuga, a popular mass media campaign in South Africa, to understand what makes effective HIV edutainment. Young MTV Shuga viewers from the Eastern Cape, South Africa and their parents participated in remote individual interviews and focus groups in 2020. Qualitative data were transcribed and analysed using a thematic iterative approach. Young participants engaged with MTV Shuga for relatable, tolerant and complex stories about young people navigating HIV and relationships. These stories, which made viewers aware of sexual health services, inspired young people to reflect on how they might engage with different sexual health scenarios. MTV Shuga initiated conversations among peers, partners and some families about HIV that made them feel supported and equipped to tackle problems in their own lives. Complex, relatable, non-judgemental and youth-centred storylines can make HIV edutainment engaging to youth audiences. This approach allows space for reflection and inspires discussion and debate, turning young people from passive recipients of HIV messaging to active decision-makers. Television-based interventions can disseminate resources and knowledge into communities, however, watching them with parents can expose young people to judgement. HIV edutainment should therefore be available through different mediums so young people can engage in tolerant environments

Keywords:

• HIV
• adolescents
• young people
• mass media
• sex education

Introduction

South Africa, the country with the largest population of people living with HIV (UNAIDS. 2020), has a complex HIV promotion and education history. The legacies of Apartheid created deep social inequalities in income and employment, powerful predictors of acquiring HIV, and mistrust toward western medicine and public health (Fassin and Schneider 2003). Additionally, misinformation and early AIDS denialism from the South African Government in the early 2000s, led to delayed role out and mistrust in essential HIV treatment and prevention of mother to child transmission programmes (Bennet 2012; Fassin and Schneider 2003; Fourie and Meyer 2016; Walker 2021c; Chigwedere and Essex 2010). Since then, governmental and non-governmental initiatives have invested heavily in communication campaigns to combat early misinformation and HIV related stigma (Kincaid et al. 2008; Peltzer et al. 2012). Mass media ‘edutainment’ has become an important component of HIV and AIDS awareness efforts in South Africa.

Edutainment is a strategy that involves incorporating educational materials into entertainment media formats to influence the audience’s knowledge, attitudes and behaviours on that issue (Singhal and Rogers 2012). TV and radio edutainment dramas use observation, social learning, modelling - elements of social learning theory (Bandura and Walters 1977) - and parasocial interaction (Horton and Wohl 1956) to create bonds and relationships between characters and audiences (Papa et al. 2000; Walker 2021a). Through these bonds, audiences identify with the characters and their experiences, making them more likely to adopt the socially desirable behaviours they observe in the drama.

For decades in South Africa, edutainment communication programs, including television shows like Soul City (1994–2012), Soul Buddyz (2000–2011) and Intersexions (2010–2013), have raised awareness and sought to change behaviour in relation to HIV (Goldstein et al. 2005; Goldstein et al. 2001; Peltzer and Promtussananon 2003; Myers et al. 2014). Exposure to HIV communication programmes among the general population in South Africa is high, especially among youth (Peltzer et al. 2012). In research, greater exposure to HIV mass communication programmes has been associated with greater HIV knowledge, condom use at last sex, being tested for HIV in the past 12 months, and a less stigmatising attitude toward people living with HIV (Peltzer et al. 2012).

As the HIV epidemic has evolved, so has the need for new edutainment campaigns that incorporate the latest HIV prevention technologies and treatment advances, and address priority groups. Although progress in HIV prevention has occurred in recent years, the incidence of infection among young women remains high in absolute terms and declines are too slow to achieve global prevention goals (Birdthistle et al. 2019; Birdthistle et al. 2021; UNAIDS 2021). Despite HIV education being offered in many public schools and high exposure to HIV related messaging, members of the 15-24-year age group have a low perceived risk and low rates of testing for HIV (Cornelius et al. 2019; Walker 2022; Muravha et al. 2021). Edutainment can be a fun way to engage young South Africans in HIV education. However, it must overcome the messaging fatigue experienced by young people who have grown up surrounded by numerous HIV programmes in the past (Walker 2022; Baelden et al. 2008; LaCroix et al. 2014; Walker 2021b; Shefer, Strebel, and Jacobs 2012).

One popular sexual health edutainment campaign in South Africa has been MTV Shuga. MTV Shuga is a mass media campaign created by the Staying Alive Foundation, and aims to educate young people about sexual health, particularly HIV prevention and testing, using relatable storylines. Over the past decade, millions of young people have been motivated to seek out, watch, and engage with the campaign. Series have been filmed in counties across sub-Saharan Africa including Kenya, Nigeria, Cote d’Ivoire and South Africa. Since 2009 MTV Shuga has reached an estimated 719 million households through 179 terrestrial channels and another 42 million viewers through rights-free streaming on the Internet. As of May 2022, the premier episode of MTV Shuga Down South season 2 (DS2), the South African series, had been viewed over 475,000 times on YouTube, with 5,000 likes and 500 comments on that platform.

Recent studies have shown that exposure to MTV Shuga is associated with greater awareness and motivation to adopt HIV and pregnancy prevention practices, including HIV testing, condom use and contraception (Banerjee, Ferrara, and Orozco-Olvera 2019; Birdthistle et al. 2022; Shahmanesh et al. 2019). A trial in Nigeria found increases in HIV and STI testing among study participants in communities randomly selected to receive group viewings of MTV Shuga Naija episodes (Banerjee, Ferrara, and Orozco-Olvera 2019). In a representative sample of young women in rural KwaZulu-Natal, exposure to MTV Shuga Down South was associated with greater awareness of pre-exposure HIV prophylaxis (PrEP) and condom use, but not with incidence of HSV-2 or teenage pregnancy (both of which were high in the setting) (Shahmanesh et al. 2019). Most recently, a mixed-methods evaluation in the Eastern Cape found evidence consistent with a causal impact of MTV Shuga Down South − 2 (DS2) on a range of HIV prevention outcomes, including knowledge of HIV status, awareness of HIV self-screening and PrEP (Birdthistle et al. 2022). Thus, across seasons and settings, MTV Shuga is demonstrating an effect on young people’s awareness of and motivation to use HIV prevention tools, although actual uptake is determined by accessibility and supply in each context. use

MTV Shuga is a compelling intervention to examine because millions of young people have actively sought out the series. At a time when messaging fatigue is thwarting efforts to reduce HIV incidence in young people, it is important to investigate how and why young viewers engage with HIV edutainment to understand what makes an effective and engaging youth HIV edutainment campaign.

Methods

MTV Shuga Down South, series 2

MTV Shuga (DS2) follows the storylines of young people from the fictitious township Zenzele in Johannesburg. The characters have recently left high school and are engaged in different romantic relationships while navigating the challenges that many young people face in South Africa, including financial hardship, family conflict and sexual identity. Some indicative storylines are as follows.

Storyline

Dineo and Que start dating, but Que discovers Dineo is engaged in a transactional relationship with an older man (a blesser) who pays her university fees. She sometimes struggles to negotiate condom use with her ‘blesser’, so Dineo goes on PrEP to protect herself and Que from HIV.

Ipeleng and Daniel meet at university and start dating. She and Daniel decide they want to have sex but first use an HIV self-testing kit together to ensure that they are both HIV negative. Ipeleng’s brother starts dealing drugs, so ultimately, Ipeleng breaks up with Daniel so she can focus on her family.

Reggie’s first boyfriend Ordirile tells Reggie that he uses PrEP to ensure he is protected from acquiring HIV. Ordirile also supports Reggie emotionally as his family struggles to accept that he is gay, but at the end of the series, Reggie introduces Ordirile to his parents.

Kwanele’s girlfriend confronts him at work and tells him she is HIV positive. Kwanele, is too afraid to get tested until his friend Reggie goes with him to an HIV self-testing centre at a taxi rank. Kwanele finds out he is HIV positive, but with the support of the testing centre and his friends starts ART treatment.

Study setting

The South African Department of Health recommended that the research described here be conducted in the Eastern Cape of South Africa where the prevalence of HIV has been estimated at 15.3% among people of all ages (South African National HIV Prevalence, Incidence, Behaviour and Communication Survey 2017), and where there are relatively low rates of HIV testing among young people (15-24 years old). According to the 2016 Demographic and Health Survey (DHS), 48% (95%CI 33, 64) and 56% (95%CI 49, 64) of young men and women, respectively, in urban settings of Eastern Cape province had tested for HIV and received their result in the past 12 months (South Africa Demographic and Health Survey 2016). Lower levels of testing were found in young men and young women aged 15 to 19 years old: 35% (95%CI 20, 52) and 42% (95%CI 32, 54) respectively (South Africa Demographic and Health Survey 2016). The city of Mthatha was chosen as a study setting because the recent distribution of HIV self-tests would ensure that any demand generated by MTV Shuga could be met with supply. Also, access to television was high in urban settings of Eastern Cape, with an estimated 79% (95%CI 73, 84) of households owning a TV and 76% (95%CI 62, 86) and 67% (95%CI 52, 79) of young men and women watching TV in the past week respectively (South Africa Demographic and Health Survey 2016). In Mthatha, MTV Shuga DS2, was available on SABC (a national TV channel), local radio stations and YouTube. The MTV Shuga campaign also ran local peer-education and community events and distributed a graphic novel through schools in the city.

Eligibility and sampling

Participants were recruited from an online survey about MTV Shuga that targeted young people living in Mthatha (Birdthistle et al. 2022). The online survey was promoted through targeted advertising on social media platforms and school WhatsApp in Mthatha. Those who completed the survey could opt to be contacted for further qualitative research by providing their phone number. Young people from Mthatha and the surrounding areas exposed to at least one episode of DS2 were eligible to participate. 15-19 years old qualitative participants were asked if they thought their parents would like to join the study and parents were then invited to participate. Parents were also recruited through the school WhatsApp group that advertised the online survey. All participants signed informed consent forms by email, and for individuals under 18 years the written permission of parents and guardians was also required. No participant data (including names and emails) was stored except for age group, identified gender, and phone number, which was linked to a unique ID in a secure password-protected document on a private server. Participants were not linked to their online survey data.

Study design and data collection

In October 2020, young people aged 15-24 who reported having watched MTV Shuga, DS2, participated in 31 individual interviews and six age-and gender-specific focus groups of between 4-6 participants. 15 parents participated in individual interviews (Table 1). Interviews and focus groups were conducted remotely using WhatsApp and the phone for individual interviews and Zoom for focus groups. Bilingual data collectors under 30 years old and trained in qualitative interviewing and remote data collection conducted the interviews. Data collectors used topic guides that were developed in English, but participants could choose to be interviewed in English, isiXhosa or Zulu. Translators transcribed the interviews into English. Questions in the topic guides were designed using The Behaviour Change Wheel, a framework for characterising behaviour change interventions (Michie, van Stralen, and West 2011).

Table 1. Methods and design.

Sample	Methods	Sample size
Young people
	Individual telephone interviews	5 Female (15-19)
		10 Female (20-24)
		5 Males (15-19)
		7 Males (20-24)
	Individual interviews using WhatsApp	2 Female (15-19)
		2 Female (20-24)
	Focus group discussions	1 Female group (15-19)
		1 Female group (20-24)
		1 Male group (15-19)
		1 Male group (20-24)
		1 All genders group (15-19)
		1 All genders group (20-24)
Parents
	Individual telephone interviews	8 Female guardians
		7 Male guardians

Analysis

Prior to the analysis, the research team considered how the data collectors’ position (Zulu or Xhosa, male and female, and under the age of 30) and methods might affect how participants responded to interviews and focus group questions. Additionally, they reflected on how the position (White, British, female) and knowledge, attitudes and assumptions of the lead researcher conducting the qualitative analysis might affect the interpretation of results.

Using a thematic iterative approach (Corbin and Strauss 2008) to analyse the data, the researcher familiarised herself with, and coded, the transcripts. As themes and codes developed, constant comparisons were made, and divergent viewpoints that challenged emerging interpretations were identified. To overcome bias, the researcher discussed the findings with the transcriber and data collectors to ensure the findings accurately reflected the data.

Quotes were then extracted from the transcripts to illustrate how findings were grounded in the data. To maintain confidentiality, pseudonyms are used to label the quotes from young participants. Table 2 presents the pseudonyms, characteristics of participants, and the types of interviews they participated in. No pseudonyms have been applied to parents who are simply referred to as mother or father.

Table 2. Pseudonyms and characteristics of young participants featured in this study.

Pseudonym	Self-identified gender	Age range (years)	Interview method
Akona	Male	20–24	Focus Group Discussion
Alunamda	Female	20–24	Phone Interview
Angel	Female	15–19	Focus Group Discussion
Ayanda	Male	20–24	Focus Group Discussion
Blessing	Male	20–24	Phone Interview
Enzokuhle	Male	15–19	Phone Interview
Faith	Female	20–24	Phone Interview
Gift	Male	20–24	Focus Group Discussion
Grace	Female	15–19	WhatsApp Interview
Hope	Female	15–19	Focus Group Discussion
Iminathi	Male	20–24	Phone Interview
Junior	Male	20–24	Phone Interview
Khayone	Female	15–19	Phone Interview
Kungawo	Male	20–24	Phone Interview
Likuwe	Female	20–24	Phone Interview
Linomtha	Female	15–19	Focus Group Discussion
Lubanzi	Male	20–24	Focus Group Discussion
Luphawu	Male	20–24	Phone Interview
Melokuhle	Male	20–24	Phone Interview
Ncumisa	Female	15–19	WhatsApp Interview
Othalive	Male	15–19	Phone Interview
Oyintando	Male	15–19	Phone Interview
Prince	Male	20–24	Focus Group Discussion
Princess	Female	20–24	WhatsApp Interview
Thandiswa	Female	20–24	Phone Interview

Findings

Young people engaged with the HIV prevention in MTV Shuga because the series 1) was relatable and trustworthy; 2) provided non-judgemental information about HIV and sex; 3) captured the attention of the viewers in a nuanced and involved way through storytelling; 4) fostered debate and shared learning; 5) broke the ice about sexual health conversations; and 6) provided an environment for sharing sensitive sexual health information. A barrier to engaging with the intervention was the fact that young people avoided watching MTV Shuga with their parents.

Relatable and trustworthy

Young participants felt involved in MTV Shuga because it accurately captured what life was like as a young person in South Africa, making them confident in the series as a source of information. The series, based in Johannesburg, showcased current South African music, and integrated local languages and township slang.

It’s relatable as they were South African actors. There are Xhosa characters and I’m Xhosa too. So that really kept me engaged. Just the storyline and the characters were so interesting and the language too. It’s easily relatable, it was easy to keep in tune with. – Enzokuhle (Male, Focus Group Discussion)

Additionally, participants liked that the fact that the show used young actors and was tailored to a youth audience.

She [the character] is my age, she’s going through the same things that I’m going through, so I want to see how they make their decisions and what’s the next step. – Alunamda (Female. Phone Interview)

Numerous informants reported that MTV Shuga storylines reflected what was ‘happening in real life.’ Participants identified stories that resonated with them, such as transactional relationships, conflict with intolerant parents, violence and masculinity, bullying, and trust in a sexual partner. When asked if they trusted the information given about HIV self-testing and PrEP in the series, young participants regularly commented that they did because the series offered an accurate and believable representation of their lives.

It covers the relationships that most young people find themselves in. So, they are dating, they have social lives, and there is also an issue struggling financially… So, I think it represents or reflects what’s happening in South Africa. – Blessing (Male, Phone Interview)

Provided non-judgemental information about HIV and sex

A key motivation for watching MTV Shuga was to gain information about HIV and sexual health.

I watched Down South because I wanted to know more about what is happening around us as youth, things we experience. And also, to have more information about HIV and AIDS. – Princess (Female, WhatsApp Interview)

Young participants were eager for more information about sex because, though ‘these things are happening,’ ‘no one was talking about them.’ Participants stated that parents and older people didn’t want to talk about sex and relationships with them, although participants also admitted that they too avoided these conversations.

When I was watching I learned a lot. It [MTV Shuga] has issues that are needed to be addressed in our community and issues that we can’t discuss with other people or older people. – Angel (Female, Focus Group Discussion)

MTV Shuga was said to be different to other sex education because it taught them, as Kungawo expressed, ‘not [to] judge a person.’ The series raised awareness about the situation’s others face, which helped them be more empathetic and tolerant. Some participants wished more people, including parents, teachers, and friends, were exposed to the show to make other people more sympathetic and educated, or to feel less judged.

I actually recommend this show to other people now so that they won’t feel judged when they’re talking about their sexuality, so that they could be more open. – Othalive (Male, Phone Interview)

Captured viewers a nuanced and involved way of learning through storytelling

The immersive nature of the 10-episode TV drama was an important factor that engaged young people with the show. The emotional and dramatic storylines kept participants engaged as they wondered what would happen next. Young people ‘learned with the actors,’ as they watched them navigate scenarios, make decisions and experience the consequences of their actions.

They [MTV Shuga] were not throwing or force-feeding you the information, but instead they were just explaining everything through the actors themselves, so as the actors are learning, you are learning at the same time. - Melokuhle (Male, Phone Interview)

I found out how each one [HIV self-testing and PrEP] works from each experience. The characters showed me the HIV testing; I saw it [HIV self-testing] from [the character] Ipeleng and her boyfriend, then I saw how PrEP works from [the character] Que’s girlfriend. – Grace (Female, WhatsApp Interview)

Participants felt empowered to form their own opinions about HIV and sexual health topics and services after absorbing the information they saw in the show. Khayone said she liked watching MTV Shuga because she was not forced to subscribe to ‘right or wrong’ behaviours and opinions. She enjoyed the poll questions at the end of the episodes, which ask viewers their opinions about what the characters should do.

I liked that there was an option of, ‘I’m not sure, and I don’t know.’ It wasn’t really forcing you to actually have an answer to it. And it made it interesting for you to engage [in discussions] with other people. It didn’t make you feel bad for your opinion. […] It’s not every day you are given an opportunity to say ‘I don’t know’ and I really liked that. – Khayone (Female, Phone Interview)

Participants described how MTV Shuga storylines ‘guided them’ to make their own decisions by showing them the potential consequences of choices and the sexual health services and tools they could access. Participants hinted that this ‘guiding’ was quite different from the prescriptive health messages they received at school or from ‘lecturing’ parents. In MTV Shuga, young people were compelled to engage in complicated storylines where characters were often not presented with an easy choice. Participants worked through the character’s situations by weighing up different options and engaging in debate which made them feel more prepared to face challenges in their own life. Ncumisa explained how she and her cousin would ‘discuss how we could have solved the particular problem that one character dealt with if it was me.’ Similarly, Alunamda said she watched the show so that when she ‘comes across such [problem,] I know how to deal with it.’

Fostered debate and shared learning

Engaging in discussion and debate seemed to be a key aspect of the viewing experience and a motivator to engage with the series. Many young people watched Shuga with a group of friends, especially older participants living in halls of residence at tertiary institutions. Likuwe described, ‘everyone is quiet and concentrating so that after the show we could have like a little debate.’ In these conversations, young people often engaged in shared decision making about how they would react or address the situations present in the MTV Shuga storylines. One example of this was a conversation captured between Ayanda and Lubanzi during a focus group. They discussed the storyline when Que discovered his girlfriend Dineo has a Blesser - an older rich man who provides money and gifts young women in exchange for sexual favours.

I would use a different approach instead of Que’s because I’d actually sit down with Dineo and ask her what’s going on. What would make you do what she did? Because Que took a different approach by coming on her strong, and I think that’s what made them have a misunderstanding. - Ayanda (Male, Focus Group Discussion)

I agree with him [Ayanda]. We must try and sit down with people and try to find out the root of their problem, so we can help them, so that we do not have to sell our bodies. We must try and have another solution. – Lubanzi (Male, Focus Groups Discussion)

Breaking the ice about sexual health conversations

Young people explained that debates in MTV Shuga usually led to more personal conversations with friends, partners and parents about sexual health and relationships on topics they felt they couldn’t usually discuss.

Straight after watching the show, I had an open debate with my friends about sexual things that are happening around the youth and stuff. So, MTV Shuga helped me talk about issues that I wouldn’t even think of talking to my friends about. – Iminathi (Male, Phone Interview)

One participant explained that, though it was awkward, watching MTV Shuga with her mother had allowed them to talk about HIV prevention which they would not have done if they had not watched it.

Before, I was reluctant to discuss things with mom, but after watching, we would discuss the show and relate some things to real-life […] Things my mom liked talking about is knowing your status whether you’re sexually active or not, and the use of protection, and knowing your partner’s status - Thandiswa (Female, Phone Interview)

Participants such as Princess, who were open to watching MTV Shuga with their parents, believed parents could ‘learn that being honest and talking about these things will make us more aware of what is going on.’ Luphawu stated that parents could directly benefit from the series because they ‘do have problems like mine’ and they ‘need to know about self-screening and PrEP.’

After seeing clips of MTV Shuga in the interviews, almost all the parents in this study said they would be open to watching the show with their children. They felt it was their responsibility to educate their children about sex despite acknowledging that these conversations are often difficult and awkward.

There is no beating around the bush about these things. You need to speak about things like this, same-sex relationships, blessers, HIV. So, I would definitely speak to them. Whether we like it or not, we have to have these conversations, and as parents, we need to play our part and be more informed and talk about these things with them. – Father

It is important to talk to your child about these things so when your child does engage with these things, they know the consequences. Because my mom talked to me about these things. It was also not easy for our parents to talk to us also, but it had to be done. – Mother

Providing an environment for sharing sensitive sexual health information

Young participants felt safer disclosing their HIV status and other personal sexual health information to their peers after watching MTV Shuga together. Based on their discussions about MTV Shuga, they felt their friends would be supportive and understanding.

I was happy that we got to have a discussion like that. It was long overdue for us to have because we’ve been friends for a very long time. […] It made me see that I really wouldn’t be afraid to tell my friends that I am HIV positive. […] God forbid I would find myself in such a situation where I am HIV positive, I know that I can tell my friends and they will be very supportive. – Khayone (Female, Phone Interview)

Couples, in particular, explained how MTV Shuga helped initiate conversations about HIV testing, status disclosure, PrEP, and trust and safety within relationships.

You can get a head start on that thing about the HIV status of your partner and stuff because it [MTV Shuga] would be playing on TV, so you will just be doing a follow-up. – Oyintando (Male, Phone Interview)

[We discussed] the importance of knowing about each other’s statuses. And if you are not honest and have other girlfriends, he needs to take PrEP so that we’ll be protected. – Alunamda (Female, Interview)

For Iminathi, watching and discussing the series together had led to action as it had motivated his girlfriend and himself to get tested together, sharing ‘now we both know our statuses.’

But all was not positive. Luphawu described how a conversation with friends after watching the series revealed he could not trust them because of their reactions to a gay character on MTV Shuga. ‘It [the discussions] made me see that if I would tell my friends that I’m gay, they would kick me out of our friendship.’ Although the series had not made his friends more tolerant and accepting, it helped him realise they were not safe people to disclose to.

Young people avoid watching MTV shuga with parents

Relatively few young participants were willing to watch the show with their parents because they feared judgement and lectures. As Hope explained, ‘they will think you are also doing these things that are happening on the show.’ Linomtha said her father thought the show had a ‘bad effect on us since we are underage.’

I would never, ever commit suicide by watching with my parents. For me, this is primarily because the show is too explicit. At home, it is because of religious reasons. Well growing up, my mother prohibited us from watching soap operas. - Gift (Male, Focus Group Discussion)

Participants were also resistant to the show becoming more parent friendly.

It is too explicit for parents, but us, as youth, I feel as if we are mentally liberated enough and open-minded to understand that such ‘soapies’ [Soap operas] have now become a place for us to learn. […] So, for youth generally, it’s a very good way, but for parents and those who come from the stone age - No. - Prince (Male Focus Group Discussion)

A couple of parents said they were uncomfortable with the sexual content in the show and wished the series could include storylines on abstinence.

I’m a Christian man, so having sexual relations outside of marriage, that I do not teach my children. […] Normalising this thing makes adults more uncomfortable and will create a negative impact on the world we live in. It makes us uncomfortable because we grew up in a time where abstinence is key. – Father

Other parents said they wanted to use MTV Shuga to teach their children about protecting themselves against HIV and getting tested. This was in contrast to the discussions young people wanted to have, which were more open and nuanced, with children and parents learning from one another.

Discussion

Findings from this study reveal that TV drama edutainment continues to be an appealing method to engage young people in South Africa with messages about sex and HIV. However, to be successful edutainment should be youth-centred, non-judgemental, and contain nuanced storylines that leave room for audience decision-making and debate. MTV Shuga’s edutainment approach avoided HIV fatigue and created dialogue among peers and partners about sexual health that made young people feel supported and prepared for their sexual health choices.

Despite reports of HIV messaging fatigue among young people (Walker 2022; Walker 2021b; Shefer, Strebel, and Jacobs 2012; LaCroix et al. 2014), our findings showed young people still want to engage in discussions about HIV and sexual relationships. MTV Shuga’s messaging felt unique because it was embedded in nuanced storylines. Research in South Africa has shown that young people do not want explicit reference to HIV but rather HIV should be embedded within broader issues concerning relationships, lifestyle and youth identity (Shefer, Strebel, and Jacobs 2012). Providing viewers with dilemmas and problems that are complex and not easily resolved can inspire reflection and debate, turning young people from the passive recipients of HIV messaging to active decision-makers. Participants particularly enjoyed HIV messaging that allowed space for uncertainty and ambivalence in sexual health decision-making. As many young people are making sexual health decisions often for the first time, they relate to storylines that acknowledge that these decisions are often complicated and can evolve as circumstances change.

Our findings show that though young people wanted to have conversations about sex, they actively avoided discussions in which they felt they would be lectured at or judged. It is well reported that young people have experienced judgement from teachers, healthcare workers and parents when looking for information about sex (Muller et al. 2016; Holt et al. 2012; Swanepoel, De Wet, and Beyers 2017; Lesko 2007; Wilbraham 2009). Edutainment can offer a space for young people to receive and discuss non-judgemental HIV and sexual health information, especially when viewing alone, with friends, partners and peers.

Local music, language and famous actors are integral elements of the series that allow the audience to identify with the storylines and lead them to trust the messages in the series. (Walker 2022; Brockington 2014). Young people trusted the series because it captured the everyday experiences of South African youth. MTV Shuga storylines also placed youth at the centre of problem-solving, with young characters often learning from peers, partners and past mistakes. They also learned from trusted adults, but sometimes adults such as health care workers and parents could be closed-minded. This differs from other edutainment series such as like Soul Buddyz where young characters’ problems are solved by consulting adults (Cousins 2009). In contrast, MTV’s approach allows young people to take a critical view of the values and attitudes their parents might hold and signalled how that parents too could learn from their children if they were open-minded. This was an empowering aspect of the series.

In South Africa, people often watch television in groups or communal spaces, so edutainment dramas can inspire conversations among viewing groups (Papa et al. 2000). MTV Shuga facilitated discussion about sexual health in homes, schools and universities among people who, participants reported, do not usually talk about sexual health. Although television can capture out of school youth and facilitate productive conversations across social generations, young people wanted to watch the show in a non-judgemental space, often without parents or older family members. Young people do not want sexual content to be made ‘parent appropriate’ and instead would like to consume the content away from parents.

Limitations

Participants in this study were recruited via an online survey, likely attracting digitally connected youth. Many participants said they had watched the series on YouTube, which meant they were likely to have reliable Internet access. We did not include those exposed to only the graphic novel, perhaps leaving out less digitally connected youth. Though young people regularly use the Internet and digital devices in the Eastern Cape (South Africa Demographic and Health Survey 2016), Internet data is expensive. Uncapped Wi-Fi is difficult to access unless attending higher education, which could have biased our sample towards a higher income and more educated population. Our participants had also sought out MTV Shuga and may have different HIV promotion and education preferences than those who had not engaged with MTV Shuga. Those who opted-into further research on MTV Shuga may also represent the most enthusiastic viewers, and we may therefore have missed the perspectives of those with less interest in the show. Finally, many young people were resistant to referring their parents to the study. Likely, those who did make referrals were already relatively comfortable discussing sexual health with their parents.

Conclusion

By examining young people's experiences and reactions to MTV Shuga DS2, we identified key components of that campaign that made youth audiences want to engage with HIV messaging and storylines. First, television storylines should be youth-centred and relatable, with young characters solving their own dilemmas within a context familiar to the audience. Second, HIV messaging should be rooted within complex and nuanced storylines that engage with broader issues of youth culture and relationships. Third, HIV and sexual health issues should be approached without judgement allowing young audiences the space to feel uncertainty and ambivalence about sexual health issues as they formulate sexual health decisions often for the first time. Incorporating these components into edutainment campaigns can turn youth audiences from the passive recipients of HIV messaging to active decision-makers who are inspired and confident to engage in debate and discussion with peers and partners about HIV related topics. Television edutainment interventions like MTV Shuga can disseminate resources and knowledge into communities and help to initiate conversations about HIV among friends, partners, and sometimes family members. However, watching with parents can trigger judgement and lectures, so HIV edutainment should also be made available through different media and outside the home to ensure young people can receive sexual health messages in what for them is a safe and tolerant space.

Acknowledgements

We thank the young people who gave their time to this study. We especially thank Luntu Fica, Bawelile Madlala, Samkele Khuma and Lunga Mkrezo for their hard work collecting data and valuable ideas which strengthened this research. We are grateful to Dominique O’Donnell for her assistance with recruitment, Antonio Duran-Aparicio for his support managing the grant, and Sithembele Ntenteni for translation. We acknowledge the dedication of MTV Shuga peer educators and coordinators (Yvonne Diogo, Lesedi Thwala) and the commitment of the MTV Staying Alive Foundation, especially Alistair Chase, Georgia Arnold and Sara Piot.

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

This work was supported through a grant from Unitaid through a sub-contract from MTV Staying Alive Foundation to the London School of Hygiene & Tropical Medicine, grant 1317919.