If you think telling people how to have safe sex means they’ll cut out risky behaviour, then here’s pause for thought.
When a free sex information service was launched in Uganda in 2009, people’s risky behaviour actually increased, researchers at Yale University have found.
The service, called 6001, allowed people to send free SMS messages with questions in English or Luganda about sexual health, family planning and local health services, as well as receive automatically generated answers.
It was developed by Google, the Grameen Technology Centre and MTN, the largest mobile phone company in Uganda. And the database of answers was produced by Marie Stopes International, a non-governmental organisation working on reproductive health issues, and Straight Talk Foundation, a Ugandan charity specialising in communication on adolescence and sexuality.
The researchers asked more than 1,700 people in 60 villages in central Uganda about condom use, number of partners, fidelity and so on – both before the service was launched and again a year later.
When asked direct questions about their sexual behaviour, people’s answers didn’t seem to change much after the service was launched. Researchers think this is because they knew the kind of answers they should be giving.
But when people were asked indirectly (using dice and a few random phrases – delve here if you want to know more) it seems their behaviour had actually become riskier.
Uganda is a prime candidate for this kind of mobile telephone information service. HIV rates are high – 7 percent in 2011 – knowledge about sexual health and AIDS is low and mobile phone use is growing fast.
A similar service in Australia improved people’s understanding of sexual health and, in other countries, services to encourage people to stop smoking have also had a positive impact. So why is this one different?
Well, the researchers came across a few pointers.
Although the majority of people surveyed said they found the service useful, many people said they simply forgot the service existed, and several said the answers in Luganda – the main language spoken in the country – weren’t relevant to their questions.
Also, the service wasn’t able to change the facts on the ground – poverty and the relative powerlessness of women.
One woman surveyed said: “You may tell him that let’s start using condoms to protect ourselves, after getting advice from these messages … He then asks why you are worried …. When you tell him the source of the information, trouble then starts … (with him) saying that MTN does not live in my house so cannot decide for me what to or not to do."
Another respondent said: “Now, you have the information, and you are even told where to get further tests and treatment, but you don't have money for treatment, or even transport to the place you have been referred to. Now have you been helped at all?"
But that doesn’t explain why risky behaviour actually increased.
Researchers noticed one nugget of information that may help shed some light on the issue.
Both men and women surveyed said that married women used the information from the service about the risks of having an unfaithful partner to insist their husbands be faithful and go for testing with them. Some husbands complied, but others refused, leading women to deny them sex and the men to seek it elsewhere.
So simply making it easier for people to access information about safe sex doesn't seem to be enough to change their behaviour.
Having a “guiding hand, such as a local health worker” may be the answer, the researchers concluded.