Peter Mwarogo
Family Health International
From Behavior Change Communication to 
Strategic Behavioral Communication on 
HIV in Kenya, 1999–2006
IMPACT PROJECT EXPERIENCE AND LESSONS LEARNED 
© 2007 by Family Health International (FHI). All rights reserved. This work may be freely reviewed, quoted, reproduced, or trans￾lated, provided it is not for commercial gain. Partial or adaptive use of this work is also welcome, provided permission is first obtained
from FHI. FHI must be prominently acknowledged in any publication and two copies of the final publication or product must be sub￾mitted to FHI. To request copyright permission, contact aidspubs@fhi.org
This publication was funded by USAID’s Implementing AIDS Prevention and Care (IMPACT) Project, which is managed by FHI
under cooperative agreement HRN-A-00-97-00017-00.
From Behavior Change Communication to 
Strategic Behavioral Communication on 
HIV in Kenya, 1999–2006
IMPACT PROJECT EXPERIENCE AND LESSONS LEARNED 
The Implementing AIDS Prevention and Care (IMPACT) Project, managed by FHI, has been the flagship project of USAID for
HIV prevention, care, and support worldwide. In Kenya, the project has helped to reduce HIV prevalence and encouraged
patients to begin antiretroviral therapy. 
To obtain more information, contact
Peter Mwarogo, Country Director
Family Health International
The Chancery, 2nd Floor, Valley Road
P.O. Box 38835 – 00623, Nairobi, Kenya
Telephone +254 (020) 2713913/4/56
Fax + 254 (020) 2726130
www.fhi.org
From Behavior Change Communication to Strategic Behavioral Communication 
AIDS Acquired immune deficiency syndrome
ARV Antiretroviral 
ART Antiretroviral therapy
BCC Behavior change communication
FHI Family Health International
HIV Human immunodeficiency virus
IMPACT Implementing AIDS Prevention and Care Project
KAP Knowledge, attitudes, and practices
KGGA Kenya Girl Guide Association
NGO Nongovernmental organization
NOPE National Organization of Peer Educators
PATH Program for Appropriate Technology in Health
PEPFAR US Presidents’ Emergency Plan for AIDS Relief 
PLHA People living with HIV/AIDS
SBC Strategic behavioral communication
STI Sexually transmitted infection
TB Tuberculosis
USAID US Agency for International Development
VCT Voluntary counseling and testing
Acronyms
From Behavior Change Communication to Strategic Behavioral Communication 
PAGE
INTRODUCTION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1
1. COMMUNICATION STRATEGY DESIGN . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2
Formative Assessments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2
Creative Workshops . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3
Communication Strategy Components . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3
Revision and Expansion of the Strategy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5
2. COMMUNICATION STRATEGY IMPLEMENTATION: 
PEER EDUCATION, YOUTH CAMPAIGNS, AND INTERACTIVE PROGRAMS . . . . . . . . . . . . . . . . . . . .7
Community Mobilization . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7
Peer Education for Adults . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .8
Kati Yetu Radio Show . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .9
Youth-Focused Peer Education . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .10
Theatre Outreach . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .12
The Mural Initiative . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .14
National Museum HIV/AIDS Exhibition . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .15
3. COMMUNICATION FOR VOLUNTARY COUNSELING AND TESTING . . . . . . . . . . . . . . . . . . . . . . . . .16
Formative Research and Findings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .16
The VCT Communication Strategy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .17
Goal, Objectives, and Target Audience . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .17
Lessons Learned . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .19
4. MONITORING AND EVALUATION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .20
Survey of Sex Workers in Mombasa . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .20
Behavioral Surveillance Survey of Target Groups . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .20
Evaluations of the VCT Communication Campaigns . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .22
5. RECOMMENDATIONS AND LESSONS LEARNED . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .24
APPENDICES
1. Weekly Session Diary for Peer Educators . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .27
2. Communication Materials Produced by the IMPACT Project . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .28
3. The VCT Communication Campaign . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .30
4. Implementing Partner Organization . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .31
Contents
From Behavior Change Communication to Strategic Behavioral Communication 
vi
This document is intended for planners who seek to improve
communication programming for HIV/AIDS in resource-poor
settings. It was written by Peter Mwarogo, with the assistance of
colleagues at Family Health International (FHI) and staff of
Population Services International (PSI) and Program for
Appropriate Technology in Health (PATH).
C. Y. Gopinath made significant contributions to communica￾tion program design, its execution, and to this paper. Former
PATH/Kenya Director Michelle Folsom provided thoughtful
insights about the design and early years of the communication
program, and Rikka Trangsrud guided PATH/Kenya’s technical
assistance. Stephen Mucheke, Gordon Nyanjom, Ruth
Odhiambo, Ruth Odindo, and Jane Harriet Namwebya of
FHI/Kenya also made contributions. Gwen Morgan carried out
evaluation studies on peer education and voluntary counseling
and testing campaigns, and Mary Furnival of PSI directed the
design and execution of the early VCT communication cam￾paign. During the project’s design and implementation, support
and technical inputs were provided by Carol Larivee, former
associate director for technical support at FHI.
Deepest gratitude also goes to implementation partners and
community volunteers who patiently executed the strategy over
the eight-year period. We hope the experiences documented and
lessons shared will go a long way toward improving communi￾cation programming on HIV/AIDS.
Acknowledgments
From Behavior Change Communication to Strategic Behavioral Communication 
Since 1999, communication-related interventions have been key
components of FHI’s Implementing AIDS Prevention and Care
(IMPACT) Project in Kenya. Behavior change communication
(BCC) was an essential part of these interventions, which aim to
help people increase their knowledge of HIV and AIDS, change
their attitudes and beliefs, modify their perception of risks, and
build their skills in adopting and maintaining healthy behaviors.
As IMPACT expanded expertise in strengthening risk reduction,
care, and treatment, its communication program adapted to the
changing landscape.
Over time, BCC became associated with prevention-oriented pro￾grams, and a strategic behavioral communication (SBC)
approach to HIV and AIDS communications evolved. This
approach resulted from overcoming challenges, learning lessons,
and recognizing that young people need to be empowered to
acquire new behaviors that minimize the risk of contracting HIV. 
SBC is an interactive process, both with individuals and within
communities. It develops tailored communication strategies,
messages, and approaches, using a mix of communication chan￾nels and interventions to promote healthier behaviors and sup￾port individual, community, and societal behavior change. SBC
supports the entire continuum of HIV/AIDS prevention, care,
treatment, and support interventions, and lends communication
expertise to advocacy and social and community mobilization.
SBC also supports other interventions to deliver consistent mes￾sages through multilayered approaches and channels for maxi￾mum effectiveness. IMPACT’s communication interventions
thus embraced new developments in AIDS treatment and care,
including adherence to antiretroviral therapy (ART), counseling
on nutrition needs, prevention of transmission of HIV to part￾ners, changes in lifestyle to avoid opportunistic infection, and
the adoption of new behaviors. 
IMPACT has been a major player in the implementation of HIV￾related behavior change programs in Kenya, working in four of
the country’s eight provinces. Its BCC interventions have the
main—and sometimes the only—such program in these commu￾nities, and have contributed to the behavior change achieve￾ments recorded by the 2003 Kenya Demographic and Health
Survey. These included increased age of sexual debut between
1998 and 2003 (from 16.8 to 17.8 for women and 16.8 and
17.1 for men), increased condom use for last reported high-risk
sex (from 15.1 to 23.9 percent for women and 42.5 to 46.5 per￾cent for men) and a reduction in the proportion of women
reporting more than one partner (from 4.2 to 1.8 percent).
This document describes the design and implementation of
IMPACT’s BCC interventions and the evolution to comprehen￾sive SBC. Chapter one delineates steps followed in designing the
communication strategy, including the formative assessments
and creative workshops employed and the communication strat￾egy’s evolution and expansion. Chapter two outlines the imple￾mentation process, including the role of peer education and
youth campaigns, and describes how HIV/AIDS education and
behavior change have been communicated in interactive ways
through theatre presentations, murals, and a museum exhibi￾tion. Chapter three details the campaign to promote voluntary
counseling and testing. Chapter four shares results of evalua￾tions of the strategy, and chapter five synthesizes lessons learned
that may assist those designing or managing HIV communica￾tion programs in resource-poor settings.
Introduction
1
From Behavior Change Communication to Strategic Behavioral Communication 
2
IMPACT initially selected five primary priority community sites
in three provinces in Kenya for intensive prevention program￾ming, based on HIV-prevalence rates, intervention needs, and
gaps. The prevention programming included intensive BCC and
community outreach for men at worksites, female sex workers,
women, and youth, as well as promotion of voluntary counsel￾ing and testing (VCT) services and healthcare-sector upgrading
relating to sexually transmitted infections (STIs) and maternal
health. The project design included national-level supportive
and exploratory activities, including mobilizing private and
parastatal businesses to initiate HIV interventions; supporting
nongovernmental organizations (NGOs) and other networks to
expand coverage of HIV/AIDS interventions; improving blood
safety; strengthening serosurveillance and behavioral surveil￾lance; and supporting innovative prevention and care initiatives.
Several programming expansions and amendments followed.
With USAID’s Kenya Life Initiative funding in 2000, IMPACT’s
geographic coverage was expanded to 10 community sites in the
three provinces, and the strategic focus was broadened to
include activities linking prevention, care, and psychosocial sup￾port. In 2003, Nairobi was added as a region, and priorities set
by the US Presidents’ Emergency Plan for AIDS Relief (PEPFAR)
came into play, including care and treatment as major focus
areas linked to the prevention, care, and support program.
Because an effective communication program requires a blend of
reinforcing strategies commonly known as media mix, the
IMPACT communication strategy combined mass media, print
materials, interpersonal communication, a museum exhibit, the￾atre, and murals.
Formative Assessments
In October and November 1999, IMPACT teams in Mombasa,
Nakuru, and Kakamega carried out formative assessments at
priority sites, the first such collaborative efforts of all local
implementing partners. As partners worked together to gather
community data and share findings, their trust and respect for
each other grew. The teamwork that became a hallmark of
IMPACT’s work in Kenya began with this exercise.
Formative assessments such as these are a crucial step in the design
of any communication intervention. They permit planners to
• identify opportunities, resources, and potential barriers to
BCC interventions
• specify behaviors and current knowledge and attitudes
about HIV and AIDS of different target populations, their
likes and dislikes, and their hopes and fears for the future 
• identify specific interests and concerns about HIV/AIDS of
different target populations and the type of programming
and support they need
• define the social networks of target populations and their
risk settings
• identify ways to increase health-seeking behavior with
respect to HIV and AIDS
The IMPACT team used focus group discussions, in-depth inter￾views, and key informant interviews with members of different
target groups to determine their knowledge and attitudes toward
HIV and AIDS, their perceptions of risks and how to prevent
HIV infection, and related health-seeking behaviors. Information
was also gathered about daily life in the communities, including
how people earn their living and spend their leisure time, as well
as their living conditions, relationships, and sexual networking.
Informants also answered questions about the availability of
medical services, their religious affiliations, and their fears and
aspirations for themselves and their communities.
The team also employed mapping and zoning. Mapping involved
identifying and plotting “hot spots” where at-risk populations
are likely be found, including bars, brothels, and truck stops.
Mapping exercises also identified community resources (such as
churches, mosques, community halls, and clinics) that could be
used to support prevention interventions. The plotting and map￾ping of hot spots and community resources allowed easy identifi￾cation and targeting during implementation. Zoning entailed
1. Communication Strategy Design
Excerpts from Formative Assessments
Rumors and misconceptions
“Condoms are not at all that good. My sister died because of a condom.
She became sick for a long time. When she was taken to Russia, it was
said that a condom slipped and got into her uterus.” 
–low-income woman, Mombasa
Abstinence
“These young people have hormones they cannot control. And because
of that they find it hard to abstain.” 
–man in workplace, Nzoia
People living with AIDS
“They are treated like outcasts; nobody wants to associate with them,
and subsequently they have no friends.” 
–community leader, Webuye
Media influence
“Though some adverts may be trying to campaign against AIDS, they
are actually encouraging the youth to have sex. For instance, there are
advertisements on the television that have young girls scantily dressed
and promoting condoms.” 
–youth, Mombasa
Peer pressure
“The problem of delayed sex is the intimidation one is exposed to, especially
from boys who laugh at you when you delay sex and look at you as stupid.” 
–primary school girl, Nakuru
“Girls who abstain from sex are always subjected to abusive language
from the boys, especially when they turn them down.” 
–secondary school girl, Mombasa
From Behavior Change Communication to Strategic Behavioral Communication 
3
dividing priority community areas into manageable operational
zones with clear boundaries, and responsibilities for each zone
were assigned to implementing agencies and peer educators.
The findings of the formative assessments were rich and plenti￾ful. Along with the creative workshops facilitated by IMPACT
partner Program for Appropriate Technology in Health (PATH),
these assessments provided the basis for the development of the
IMPACT communication strategy. In addition, the assessment
process introduced partners to communities.
Assessment findings directly relevant to HIV included the following:
• Though wives said they believed their husbands were
unfaithful, they felt helpless to protect themselves from HIV
and other STIs.
• Attitudes toward condoms were mixed; some people felt they
promoted immorality and others questioned their effectiveness.
• Many people, especially sex workers, considered themselves
at risk for HIV and AIDS, but they had fatalistic attitudes.
• Young people who reported that they were sexually active did
not discuss sexuality issues with their partners or other adults.
• People expressed interest in VCT but feared learning their
HIV status.
Creative Workshops
The IMPACT communication strategy was also based on research
gathered in creative workshops held in Mombasa, Nakuru, and
Webuye in February 2000 that brought together key stakeholders
for three days of simulation games, role-play, and open-ended dia￾logue on important issues in the era of HIV and AIDS.
Participants included IMPACT partners, representatives of local
government health services, stakeholders from affected communi￾ties, journalists, theatre performers, artists, and others. In the
workshops, they explored their own experiences, attitudes, feel￾ings, and needs, and they examined existing communication
resources and strategies, experimented with creative expressions,
and arrived at consensus on communication requirements.
The goal of this informal, participatory approach was to probe
more deeply than is usually feasible in standard focus group dis￾cussions. The method elucidated barriers to effective behavior
change—for example, issues of stigma revolving around HIV and
AIDS—and opportunities for intervention. In addition, the
approach offered a clear understanding of the communities’ prior￾ities and the emphasis that needed to be placed on various issues.
Communication Strategy Components 
IMPACT’s initial communication strategy for HIV focused on
prevention. But the formative assessments and creative work￾shops made it clear that awareness about HIV was not sufficient
to change behavior for most people. They needed information,
but they also needed to own that information or they would not
act on it. They would own the information they asked for and
received through a dialogue, especially if their questions sprung
from heartfelt reflection.
The assessment and workshops also posited that AIDS was the
consequence of fractured, flawed, and distorted personal rela￾tionships—between husband and wife, adolescent boys and
girls, older men and younger women, widows and their inheri￾tors, teachers and their students, workers and their colleagues,
and people at risk and those close to them. These flawed rela￾tionships, rather than AIDS, were the root of the problem. Poor
relationships were considered the proximate causes of the risky
sexual behavior that fueled the vast majority of HIV transmis￾sion in priority communities. Relationships marked by miscom￾munication, power and financial imbalances, or predetermined
and entrenched cultural beliefs set the stage for the kind of
behavior that spreads HIV. With better-quality relationships,
people would be better equipped to reduce their HIV risk, and
they would have a foundation for optimism, hope, greater self￾respect, and more positive attitudes toward life. 
In the prevailing atmosphere of despair and fatalism, changing
people’s mood and perception was seen as a prerequisite for
greater acceptance and involvement with life-saving messages
about HIV and AIDS. The challenge of developing what was to be
called the “Question Your Relationships” strategy was discover￾ing how to encourage community members to ask the questions
that were important to them and their relationships and act on the
answers. The premise was that misguided trust often leads to
unprotected sex and HIV infection, since monogamous people
who trust their partners often do not see the need to use condoms.
The campaign thus encouraged individuals to reflect on their rela￾tionships with sexual partners as a way of assessing their self-risk.
Peer Education and Diffusion of Behavior Change
IMPACT’s communication strategy involved highly focused and
targeted interactions with relatively small groups of people, then
reaching out to the rest of the community (and, indeed, the
nation) through a process of diffusion. Those chosen to be in
small groups were selected, in part, because they were connec￾tors—or people with wide social networks. 
Small-group interactions were carefully designed. Peer educators
were given in-depth training to help them master detailed infor￾mation and give them skills to facilitate a variety of discussions
within fixed groups, with the objective of stimulating behavior
change among group members (see appendix 1). Peer educators
were also trained to recognize when participants may be chang￾ing their behavior.
The quality of the questions emerging from the community at
different stages of the dialogue became an important indicator
of progress. In the strategy, the delivery of information was
designed to respond to questions emerging from communities as
they deepened their ability to reflect on their predicaments
through peer education. 
One objective of peer educators was to provoke more and better
questions from the community. Behavior change was then to be
monitored by observing how questions changed as risk percep￾tions were altered. The risk continuum ranged from feeling far
From Behavior Change Communication to Strategic Behavioral Communication 
4
from the epidemic and at virtually no personal risk to living with
AIDS. In between were people who were practicing multipartner
sex or had contracted an STI, along with others who were con￾templating an HIV test. Along this continuum, increased risk
perception prompted more detailed, heartfelt, and personal
questions. The closer an individual felt to the epidemic, the more
likely was the possibility of behavior change.
Once participants demonstrated sustained behavior change that
could be linked to any of the program’s communication objec￾tives, those individuals would be encouraged to bring first-per￾son testimony to the IMPACT weekly radio show, Kati Yetu
(Between Us), and to become an exemplar of behavior change
within the community. For example, a group of young men from
Western Province spoke about their VCT experiences in one
episode with the goal of creating a climate of hope that behavior
change was already happening. By demonstrating behavior that
works positively and showing that change is possible—and, in
fact, is already happening—community members may begin to
speak passionately for change and growth. This process rede￾fined the role of mass media from a simple means of disseminat￾ing messages to an instrument that reflects to the community
what is already taking place. Radio thus becomes the magnify￾ing mirror of behavior change.
Objectives and Target Groups
The objectives of the communication strategy were to
• increase the perceived distance between exposure, HIV
infection, and AIDS
• encourage young people to delay sexual debut and to devel￾op long-term, trusting relationships
• improve negotiation skills, particularly for women and girls
• disseminate better understanding of and confidence in condoms
• create greater comprehension of the risks of unprotected sex
with multiple partners
• promote greater interest and confidence in VCT
These objectives were carefully chosen, as were the target groups
to receive the messages. Those targeted were identified in the
formative assessments as persons engaging in or associated with
high-risk behavior, whose behavior must be changed to stop the
HIV epidemic. They thus included men at worksites, female sex
workers, women in low-income communities, and in-school and
out-of-school youth.
Men at Worksites
Men at worksites were selected as having a higher than average
risk for HIV because they generally have a relatively large
amount of disposable income that may be used to purchase sex.
They may seek sex partners because they have migrated away
from their spouses and families in pursuit of employment. Other
men may live with their families, but may travel for extended or
short periods to perform work-related duties. In 2005, the
worksite target group was expanded to include the police.
Female Sex Workers 
Female sex workers are a high-risk group for HIV, and they are
also considered a “core transmitter” group. They may have
many clients, and those who do not use condoms expose them￾selves regularly to possible HIV infection.
Women in Low-Income Communities
Women in low-income communities were considered a risk
group, and those considered at highest risk were divorced, wid￾owed, or had been abandoned by their husbands or partners.
Such women may have a number of children but little education
or means of providing their support. Low-income communities
near large worksites were incorporated into BCC activities
because women living in them may seek occasional or long-term
sexual relations with male workers in exchange for money.
In-School and Out-of School Youth
The communication strategy included youth, since AIDS has a
long incubation period and many infected adults may have
acquired HIV during adolescence. It was also widely acknowl￾edged that youth were the “window of opportunity”—the gen￾eration through which society hopes to achieve an AIDS-free
population. In addition, a 1999 Population Council study in
Kisumu (part of a multicountry study of three cities in Africa)
showed that girls ages 15–19 had up to a four-fold higher
chance of contracting HIV than boys the same age.
School leavers were considered to be at risk for HIV; many drop
out due to poverty and lack of school fees, and their need for
income may expose them to HIV. In addition, formative assess￾ments indicated that those who dropped out due to low educa￾tional aspiration had less parental support, lower self-esteem, or
a combination of these and other psychosocial factors that put
them at greater risk for HIV. Furthermore, most out-of-school
youth were unemployed or idle, and they may expose themselves
to sexual risk out of boredom or hopelessness.
Male sugar-factory workers in Western Kenya attend a peer education session.
Abstinence promotion 
targeting in-school youth.
From Behavior Change Communication to Strategic Behavioral Communication 
5
Revision and Expansion of the Strategy
Decentralization
In 2002, a midterm IMPACT strategy review observed that the
national BCC strategy was still useful for creating synergy and uni￾formity across the provinces, but there was need to create local
ownership and relevance by decentralizing planning to constituen￾cy AIDS control committees, nongovernmental organizations
(NGOs), and businesses at district and community levels. Each
involvement would facilitate participatory, comprehensive, and
site-level BCC plans.
As a result, IMPACT established and built capacity of district
teams in the three regions to develop site-specific HIV communi￾cation action plans. These plans needed to ensure that messages
going out to the community were harmonized, and that commu￾nication on HIV addressed local root causes of risk behavior.
The teams were assisted to develop these local messages. For
example, the HIV communication committee in Naivasha devel￾oped a communication strategy that focused on life and associ￾ated HIV risk around the Naivasha truck stop and flower farms.
The ABC Approach
In 2003, with the availability of funds from the US Presidents’
Emergency Plan for AIDS Relief (PEPFAR), the communication
program was expanded to more sites, including Naivasha,
Malindi, Kwale, Voi, Narok, and Nairobi. At these sites, the com￾munity mobilization process was similar to the one used in 1999. 
PEPFAR funds strengthened the “ABC” approach already initi￾ated for in-school youth programs. This approach emphasized
abstinence for youth and other unmarried persons, including
delay of sexual debut; mutual faithfulness and a reduction in the
number of partners for sexually active adults; and correct and
consistent use of condoms by those whose behavior placed them
at risk for transmitting or becoming infected with HIV. 
Interventions targeting in-school and out-of-school youth empha￾sized abstinence until marriage as well as “secondary absti￾nence”—a return to abstinence—for sexually experienced youth.
Those targeting in-school youth promoted abstaining from sexual
activity as the most effective and only certain way to avoid HIV
and other STIs and eliminate the risk of HIV transmission. The
program sought to develop skills for practicing abstinence and
promoted social and community norms that support delaying sex
until marriage and denounce cross-generational sex and transac￾tional sex, as well as rape, incest, and other forced sexual activity.
Be faithful programs encouraged individuals to practice fidelity
in marriage and within other sexual relationships as a critical
way to reduce risk of exposure to HIV. The main target groups
were men and women in workplaces and women in low-income
neighborhoods. 
These programs promoted 
• the elimination of casual sexual partnerships
• the development of skills for sustaining marital fidelity
• the importance of mutual faithfulness with an uninfected
partner in reducing the transmission of HIV among individ￾uals in long-term sexual relationships
• joint HIV counseling and testing for couples unaware of
their HIV status
• endorsement of and respect for social and community norms
that support marital fidelity, avoidance of sex outside of
marriage, and a reduction in the number of sexual partners
• adoption of social and community norms that denounce
cross-generational sex and transactional sex, as well as rape,
incest, and other forced sexual activity
Correct and consistent condom use continued to be promoted by
the program, which supported the provision of full and accurate
information among highly vulnerable populations. These include
sex workers, truckers, and migrant workers, as well as uniformed
servicemen, who exhibited high rates of partner change during
formative assessments. The program also promoted correct and
consistent condom use among discordant couples.
TB Communications
IMPACT’s formative study on tuberculosis (TB) in priority com￾munities revealed that most people did not know or recognize
the critical early symptoms of TB. Most delayed seeking care
and relied on self-medication, using cough syrups and herbs. In
response, the program initiated a communication intervention
for TB whose main objectives were to 
• increase general knowledge about the critical early symp￾toms of TB
• discourage overuse or substitution of over-the-counter products
• promote adherence to TB medication 
• encourage people to seek proper diagnosis and care at rec￾ognized TB centers and promote good health facilities as
places to obtain TB care
• provide education about proper TB diagnostic procedures—
sputum tests and x-rays—as a way to promote a patient’s
right to request or seek such services
The program embarked on developing messages and materials
to address these objectives, and all peer educators received train￾ing on TB messages.
Antiretroviral Therapy
At the same time, the HIV/AIDS arena was rapidly changing.
Treatment, initially expensive and out of reach for most
Kenyans, had become affordable, and the government and
donors were exploring ways to make antiretroviral drugs
(ARV) available. 
In 2003, with funding from USAID and FHI, IMPACT started an
ART program at the Coast Provincial General Hospital in
Mombasa. As part of this intervention, IMPACT carried out a
formative assessment that revealed varying levels of knowledge
about HIV/AIDS and ART. Some people in target communities
Material developed by the 
TB communication campaign. 
From Behavior Change Communication to Strategic Behavioral Communication 
6
had never heard of HIV treatment, while others had heard about
it but had inaccurate information. Many believed incorrectly that
all people living with AIDS (PLHA) would be eligible for treat￾ment. Others were skeptical about imported ARVs, concerned
about patient confidentiality, and unaware of existing testing and
counseling services. Research also revealed high levels of stigma
and discrimination, even among health workers, which inhibited
people from seeking or continuing services. Education and com￾munication were also needed to foster a climate in which clinical￾ly eligible PLHA could meet social criteria (such as disclosure),
initiate treatment, and adhere to medications. 
With a grant from Pfizer, FHI developed ART literacy materials
for the Mombasa program. These included brochures and flip
charts with local images and analogies (appendix 2). USAID and
Kenya’s National AIDS and STI Control Program and the UK
Department for International Development provided additional
funding to create the materials, which were geared to both liter￾ate and low-literate audiences. Coast People Living with HIV and
AIDS (COPE), the largest PLHA association in the province, pro￾vided technical input at each stage to ensure that materials were
on target and resonated with the intended audiences.
A flip chart to enable health workers to communicate HIV/AIDS
and ART in lay terms was developed, along with booklets and
brochures on ART basics and how to manage side effects and
avoid opportunistic infections. These were developed, printed,
and distributed to all IMPACT project sites, and have since been
adapted for use in Eritrea, Ghana, Malawi, Zambia, South
Africa, and other countries.
In addition to broadening the communication strategy by incor￾porating care, treatment, and support, IMPACT provided print
materials to support interpersonal communication. A series of
workshops were held for stakeholders and target audiences that
produced support materials in a participatory manner, which
were pretested by target audiences and produced and distributed
within IMPACT priority sites.
An example of printed materials 
on antiretroviral therapy.
From Behavior Change Communication to Strategic Behavioral Communication 
7
Community Mobilization
To ensure that priority communities fully supported the imple￾mentation of the communication strategy, IMPACT held a series
of advocacy meetings with key stakeholders in the communities.
In Mombasa, IMPACT brought together political, church, and
administrative leaders for an orientation meeting on the proposed
communication strategy and their involvement in the program. A
meeting with imams of various mosques in Mombasa was also
held, and similar stakeholder meetings were held with communi￾ty, administrative, and political leaders in Western Province and
Nakuru. A total of 42 imans and 230 other community stake￾holders participated in the sensitization meetings. One challenge
was meeting their expectations. “Some community members
expected IMPACT to pay them for their participation in meet￾ings,” said Gordon Nyanjom, project manager in Western
Province. However, constant dialogue overcame this difficulty.
The meetings illuminated leaders’ level of ignorance about HIV,
moralistic views of religious leaders toward people living with
HIV, and negative attitudes toward condoms. “By promoting
condoms, we are condoning and promoting immorality among
our people, and this is unacceptable” one leader stated at the
start of the workshops for religious leaders in Mombasa. 
But the meetings also proved very useful in changing the commu￾nity leaders’ attitudes and creating the necessary supportive envi￾ronment. The Council of Imams, as well as political and Christian
leaders, became great supporters of the communication interven￾tion. “We want you to help us reach out to madrasa teachers and
students; they need this information now,” said Sheikh Mohamed
Dor, the chairman of the Council of Imams in Mombasa at the
end of sensitization meeting. In addition, the Reverend Joseph
Kashuru of the Anglican Church of Kenya in Mombasa enrolled
in peer education and community counselor training and became
a major IMPACT supporter in Coast Province.
Achievements and Lessons Learned
Sensitization meetings not only helped to bring down barriers of
suspicion and stigma, they unlocked the potential for stakeholder
participation in HIV communication interventions in the commu￾nity. The active engagement of politicians in the process helped gal￾vanize community involvement and its receptivity to the program.
Through the decentralized BCC planning process, a critical team
was built of individuals who internalized the SBC process on
HIV at the provincial level and, for Naivasha and Malindi, at
the sub-district level. A total of 60 people worked closely with
the FHI and PATH technical team on developing the communi￾cation strategy, and they acquired skills to move the process for￾ward beyond the IMPACT Project.
The IMPACT communication strategy was sound, from a com￾munication theory point of view. Several lessons emerged from
its implementation.
• Having a uniform communication strategy across IMPACT
priority sites enabled the program to have uniform standards
across three regions. The program used a uniform curriculum
for training peer educators and a quality assurance system.
• The communication program was flexible; it adapted to
emerging needs for communication about HIV.
• Having PATH as the single source of technical assistance
enabled transfer of lessons from one region to another and a
consistent message across implementing partners. 
• Decentralizing the planning and review process of BCC
activities reenergized and empowered teams in the regions.
After the USAID midterm review in 2003, IMPACT reor￾ganized the program to establish local HIV communications
committees. These met to review priorities and plan joint
activities to address local issues, including the development
of local communication materials. Local partners thus began
to own the process and identified with the outcomes.
• Whereas information for the development of the strategy was
assembled in a participatory way, the community-based
organizations that implemented the program had not been
involved in all of the design process, including determining
the objectives, developing a monitoring and evaluation plan,
2. Communication Strategy Implementation: Peer
Education, Youth Campaigns, and Interactive Programs
Community leaders attend a sensitization meeting in Mombasa.
Support for Community Mobilization
Interventions
“You can count on my support, and I will ensure that I personally partic￾ipate in the community mobilization efforts in my constituency.” 
–late Member of Parliament Emauel Karisa, Kisauni Constituency,
Mombasa 
“After the sensitization meetings, it was easy to work with highly stig￾matized groups, such as the female sex workers in the predominantly
Muslim neighborhoods in Mombasa.” 
–Ruth Odindo, IMPACT manager in Coast Province
From Behavior Change Communication to Strategic Behavioral Communication 
8
and determining methods of delivery. As a result, they did
not own the final Question Your Relationships strategy. In
addition, the need to jumpstart the program caused IMPACT
to start up activities (such as the theatre and the peer educa￾tion program) before developing a communication strategy.
Attempts to change activities mid-stream to fit into the final￾ized communication strategy were resisted by some members
of field implementation teams, since they were already used
to implementing activities in a particular way.
• The advent of treatment and the need for comprehensive
care meant the scope of the communication strategy needed
to expand. Instead of being purely about HIV/AIDS, it need￾ed to address health and development in general. People not
only required information about HIV-prevention, they need￾ed to know how to stay healthy and get information about
life-saving drugs, nutrition, lifestyles, and how to access psy￾chosocial support services.
Peer Education for Adults
Peer education, the centerpiece of IMPACT’s communication pro￾gram, was one of the first activities implemented. In March 2002,
24 peer coordinators representing IMPACT partners from all three
regions attended a week-long training-of-trainers workshop in
Nakuru. This training focused on adult education theory and par￾ticipatory education techniques, with little emphasis on HIV and
AIDS technical information. These trainers returned to their regions
and trained over 1,000 peer educators over the next few months.
The peer education groups were known as radio groups because
their feedback informed the national radio show Kati Yetu. The
groups were fixed in size, and the same people were expected to
meet each week for intensive discussions. The goal was to facili￾tate a process in which participants considered their experiences,
attitudes, emotions, and behavior as four interlinked factors
whose interplay could lead to sustainable changes in behavior.
The peer educators were selected because they were seen as connec￾tors within the community.1 In turn, they were encouraged to form
peer groups that included other connectors. Once they began to
change attitudes and behavior, those selected were expected to carry
ideas to the greater community and become advocates for change
among their many contacts. In addition, peer educators were
trained to recognize and nurture community members who were
adopting new attitudes and behaviors. Where possible, those who
changed behavior were invited to share their experiences on Kati
Yetu, magnifying their behavior change and exerting a motivating
influence on the rest of the community. By working intensively with
these connectors, the program could reach many more people than
just those who participated directly in peer education groups.
However, observations were made in the field in the first six to
eight months about the lack of accord between peer education
activities and the Question Your Relationships strategy. This was
partly the result of peer education skills being imparted in advance
of the formulation of the communication strategy. It was also
observed that peer educators did not receive the depth of knowl￾edge on HIV to enable them to respond to questions. Given that
the communication strategy was based on high-quality interaction,
questioning, and dialogue, a new approach was clearly needed.
The Splash! Methodology
The new development was the Splash! methodology, a thrust
toward increasing peer educators’ technical mastery and improv￾ing the quality of their interactions with the community. Splash!
focused on intensively training peer educators and guiding them
meticulously in conducting discussions with selected groups from
each priority community. Splash! also featured detailed guides
that steered peer educators, step-by-step, to questions to ask that
would nurture healthy and vigorous community discussion. The
discussion guide for the peer educator included procedures, ques￾tions to be asked during a particular discussion, and detailed
technical content needed for that discussion.
The term Splash! emerged from a simple analogy. If someone in
a crowd started sprinkling water from a bottle in hand, at first
only those in the immediate vicinity would get wet. If the splash￾ing continued steadily and patiently, eventually everyone within
reach of the drops would be equally drenched, even if all individ￾uals were not specifically targeted. 
This idea operated both within the peer education groups and in
the wider community. The Splash! peer educator used a gradual
yet persistent approach, meeting with the same people week
after week and “sprinkling” them with a manageable amount of
content and discussion each time. Participants were offered a
chance for dialogue, reflection, enquiry, and greater ownership
of that information—and hence, behavior change. The radio
show was the ultimate diffuser, disseminating stories of individ￾uals who had changed their behavior.
The Splash! approach to BCC was based on the following
assumptions:
• An intensive, educational engagement process is more
appropriate for early adopters.
• Early adopters will help set a community agenda for behavior
change through demonstrations and endorsements, thus exert￾ing a motivational emphasis on the rest of the community. 
1 As suggested in diffusion theory and described in Malcolm Gladwell’s The Tipping
Point (Boston: Little Brown, 2000), connectors are people who have many contacts,
through work, leisure, church, sports, or other activities.
Low-income women in Mumias attend a radio group session.
From Behavior Change Communication to Strategic Behavioral Communication 
9
• Early adopters are linkage agents between the resource system
(the IMPACT Project) and the user system (identified priority
communities in Mombasa, Rift Valley, and Western regions).
• The mass media and folk media magnify and amplify behav￾ior change among early adopters and thus exert a motiva￾tional influence on rest of the community.
These four assumptions are rooted in some of the precepts of the
diffusion of innovations theory of Everett Rodgers,2 and they
assume a behavior-change process where four interlinked and
causative factors— experience, attitude, emotional response,
and behavior—operate within the audience selected.
Peer Education Achievements
One of the notable achievements of the peer education program
was the establishment of the National Organization of Peer
Educators (NOPE), one of the fastest growing organizations
providing peer education training in Kenya. NOPE was estab￾lished in 2000, with the participation of the coordinators and
peer educators within the three priority regions, to spread the
IMPACT peer education methodology to as many groups as
possible for HIV/AIDS behavior change. In April 2001, the
organization launched its Coast chapter, which was soon fol￾lowed by launches in the Western and Rift Valley regions. In
December 2001, NOPE was officially registered as an NGO.
To date, NOPE has trained over 3,000 peer educators and train￾ers, about 1,000 of whom are workplace peer educators. About
600 company managers have also received sensitization on
workplace HIV/AIDS policies and programs. NOPE is now a
leading technical assistance provider in peer education in Kenya,
and is working with 24 companies at different stages of program
development and implementation. The quality of its services has
attracted some of the biggest business enterprises in Kenya,
including Unilever Tea, the Kenya Ports Authority, British
American Tobacco, East African Breweries, Serena Hotels, D.T.
Dobie, Coca-Cola, and Hotel Intercontinental. 
Lessons Learned
• Retaining the interest of peer educators was a challenge, but
the program experienced a 70 percent retention rate—a high￾er rate than other peer education programs.3 This was largely
attributed to the rigorous selection criteria for peer educators
and the close monitoring and supervision system in place,
along with incentives that were built into the program. Peer
educators received uniforms (mainly T-shirts) and a monthly
transport allowance of 400 Kenyan shillings (US$5)
• Starting the peer education program before the finalization of
the overall communication strategy proved to be costly in the
long run. The program had to invest in retraining trainers,
supervisors, and peer educators after the strategy was in place.
• Changing the peer education approach mid-stream, without
a proper transition plan, caused discontent among peer edu￾cators. Those who could not be accommodated in early
workshops for revised Splash! training program felt let
down. This was overcome several years later, when all the
peer educators and supervisors received Splash! training.
• Discussion guides were developed to help facilitate meaning￾ful, structured discussions, but peer educators hardly used
them, despite several pre-tests, orientations, and training.
Kati Yetu Radio Show
The Kati Yetu radio show featured a soap opera, Maisha ya
Nuru, which was developed by listeners in Mombasa, Nakuru,
and Western region during a series of creative workshops in
February 2000. Kati Yetu also featured talk sessions, interviews,
panel discussions, and songs, and the moderated segment had
Measurable Results of 
IMPACT’s Peer Education Program
Peer educators trained 10,239
Individuals reached, one-on-one 1,054,418
Individuals reached by group or 
community outreach 2,585,274
Total 3,639,692
Condoms distributed by peer educators 49,350,728
STI referrals made 90,220
VCT referrals made 158,388
Workplace managers and/or 
supervisors of peer educators trained 587
Workplaces with peer education programs 116
2 Everett M Rogers, Diffusion of Innovations, 5th ed. (New York: Free Press, 2003). 3 Population Council, Peer Education and HIV/AIDS: Past Experience, Future Directions
(Washington DC: Population Council, 1999) www.popcouncil.org/pdfs/peer_ed.pdf
A peer education session in Kwale.
From Behavior Change Communication to Strategic Behavioral Communication 
10
interviews with audience members who had demonstrated
changed behavior or become advocates of attitudes that can
reduce the risk of HIV and AIDS. 
Both the drama and talk show segments were shaped by feed￾back from peer education groups in IMPACT priority areas.
These groups listened to the show live or on cassette tapes. The
moderated talk show component responded to issues and ques￾tions raised by listeners’ letters, as well as feedback received
from peer education groups. The topic of each week’s show was
often expressed in the form of a question, in keeping with the
communication strategy.
Kati Yetu also served a key function within the Question Your
Relationships strategy: magnification of behavior change. When
individuals adopted a new behavior as a result of their participa￾tion in IMPACT activities, they were asked to appear on the
show to share their stories. For example, after a young man
from Mumias who had been a regular in Magnet Theatre activ￾ity told of his decision to go for VCT, a number of other youths
from the same group also went for VCT.
Community members participated in the radio show in other
ways. For example, early in the series, a group of women in the
Changamwe section of Mombasa responded to the rape scene in
Maisha ya Nuru by composing a song that urged Nuru, the vic￾tim, to be strong and resolute. The song was woven into the
story and became part of a later episode.
Achievements and Lessons Learned
During the project period, 123 radio shows were produced and
aired twice a week. They reached over 2 million Kenyans,4 and
more than 5,000 letters were received from listeners. 
Though a 2002 evaluation study established the reach and impres￾sive effect of Maisha ya Nuru, it never became the talk of Kenyans.
This is partly because radio listenership culture was changing with
the advent of FM stations in Kenya. The FM stations introduced
formats such as live call-ins and competitions that engaged listen￾ers, while Maisha ya Nuru relied on letters from listeners for feed￾back. In addition, the cost of production and broadcasting was
very high. Efforts were made to negotiate preferential rates with
stations, but the best IMPACT could get was a free repeat of the
broadcast at 3 pm, not the most convenient time for listeners.
Youth-Focused Peer Education 
Nuru Comic Books
Nuru comic books produced by IMPACT centered on Nuru, the
teenaged girl and protagonist in the Kati Yetu radio soap, and the
challenges and choices she and her friends face concerning friend￾ships, dating, and sexuality. The comics used bright colors, youthful
language, a gripping story, and characters to whom young people
can relate, creating an entertaining read for young people that also
encouraged them to think about relationships and behavior.
The three-volume book series, produced in both English and
Kiswahili, was field-tested with in-school and out-of-school
youth. The series was designed to help young people consider
the everyday pressures and challenges they experience, since they
are bombarded with conflicting messages about how to succeed.
The decisions they make and how they behave—in terms of rela￾tionships, love, sex, and peer dynamics—are often linked to
their perceptions of themselves and others and their visions of
the future. The series fostered positive attitudes and perspectives
to help youth consider quality relationships and encourage sex￾ual behavior choices that can save their lives.
The goal was to be thought-provoking: Did Nuru do the right thing?
Should Oscar emulate Leon’s ways? Will Angel’s relationship with
the sugar daddy be her undoing? The problems were real, and so
were the characters’ struggles. Some made irresponsible choices and
faced the consequences. Others reacted to the challenges with grow￾ing self-esteem and the courage to do what they knew was right.
Life Skills for Girls in School 
IMPACT worked with the Kenya Girl Guides Association
(KGGA) to implement a youth-focused peer education interven￾tion in schools in the three regions. The Girl Guide program is the
largest program for girls in Kenya (and Africa), and it could use its
existing patrol structure for HIV education. By funding KGGA for
HIV and AIDS education, IMPACT allowed the association to
increase the number of schools with a Girl Guide program.
The IMPACT program began in October 1999 with orientation
and sensitization on HIV and AIDS for adult leaders of the Girl
Guides (active or retired teachers who volunteer in the Girl
Guide movement) and the KGGA national leadership. The first
Girl Guide leaders were trained in November 1999 with the
manual Training of Guide Leaders on Participatory Peer
Education for HIV and AIDS Prevention: A Life Skills Manual
for the Kenya Girl Guides Association. Before it could be used,
the manual had to be approved by various stakeholders, includ￾ing the Ministry of Education, parents, and some key represen￾tatives of religious and community organizations. Young people on a bus read Nuru comic books.
The cover of the Kenya Girl Guides
Association handbook on HIV and
AIDS badges.
From Behavior Change Communication to Strategic Behavioral Communication 
11
Adapted for the project, the manual drew on or borrowed ele￾ments from several behavior change models (such as the health
belief model, the theory of reasoned action, and the social cogni￾tive theory), and it aimed to incorporate individual, social, and
environmental influences on behavior change. It covered topics
such as personal, community, and family values; gender roles and
equality; sexuality, adolescent development, and relationships;
pregnancy prevention; HIV/AIDS and other STIs; and communi￾cation and self esteem. The 39 weeks of training sessions could be
adapted to various age groupings. The manual was also highly
interactive, incorporating discussions, role-play, brainstorming,
case studies, guest speakers, and games and exercises.
The key elements of the manual were condensed into Talking Points,
a small, user-friendly booklet that became the main reference docu￾ment for peer educators. The booklet was laminated to withstand
frequent use, and each section covering a specific subject was color￾coded for easy access. Each of these sections was divided into three
broad components: factual information; a “did you know?” compo￾nent that highlighted key aspects; and questions and answers to test
knowledge acquired. Sessions led by Girl Guide leaders or peer edu￾cators were held at least once a week (although some schools held
them daily), usually during lunch or immediately after school.
The KGGA integrated a new HIV/AIDS badge into its elaborate
badge system used to recognize achievement, and the association
has developed a special booklet to guide the young people through
the acquisition process. There are three levels of HIV/AIDS badge,
corresponding to the three cadres within the Girl Guide system,
and members of each cadre has to accomplish different sets of
activities to earn the badge. Brownies (the youngest cadre) are
required to undertake simple activities, such as making drawings
about HIV/AIDS, writing a poem, or learning how HIV is trans￾mitted. Older Girl Guides might need to make a 10–15 minute
presentation about HIV/AIDS to their peers, visit someone with
AIDS, or write an essay about self-esteem and negotiation skills.
Rangers and Cadets undertake more difficult tasks, such as inter￾viewing a VCT counselor, writing letters to a newspaper about
HIV/AIDS, organizing discussion groups with peers, developing
HIV/AIDS risk-assessment questionnaires, and regularly assisting a
child orphaned by HIV/AIDS. The emphasis on care and support
in the HIV/AIDS badge system is designed to counter stigma and
discrimination against PLHA. 
Once trained, the Girl Guide leaders returned to their schools to edu￾cate patrol leaders, who then became peer educators. Each school
had about 10 peer educators, and each was the head of a Girl Guide
patrol. The trained peer educators embarked on information dissem￾ination activities for their patrols, schoolmates, communities, church
groups, and any other audiences they could access. Each peer educa￾tor was required to reach at least 10 other individuals. Thus, eventu￾ally, a peer educator’s audience included boys, parents, community
leaders, religious groups, and others in the community.
Sara Comic Book Series
The KGGA program integrated the Sara Communication
Initiative, a multimedia project that has produced to date seven
comic books and five animated films, in collaboration with
UNICEF and PEPFAR. The animated films have elements of
realism and drama, blended with serious messages, and imparts
educational content in unique and entertaining ways. 
The Sara character was designed to capture the concept of a “posi￾tive deviant” and be a promising behavior model for young girls in
Africa. The charismatic heroine is an adolescent girl living in peri￾urban Africa. Like many girls her age, Sara faces nearly insurmount￾able sociocultural and economic obstacles. But her aspiration to
improve herself and her community and her quest for alternative
solutions to problems inspire anyone who encounters her. Sara’s
ability to negotiate and persuade and her determination never to
give up, even in desperate situations, make her a dynamic role
model for girls; she inspires self-esteem and models the lifeskills
essential for empowerment. Rather than being presented as a vic￾tim, evoking pity and sympathy, Sara emphasizes girls’ potential.
The stories expose the issues that hinder girls’ development and
illustrate the supportive environment that they need to flourish. 
The Special Gift, the first Sara story, was a communication tool
for HIV/AIDS prevention. All subsequent stories were built
around themes with a direct relation to HIV/AIDS and its
impact on adolescent girls. However, AIDS messages do not
dominate the stories because audience fatigue might result.
The reality of HIV/AIDS in Africa has been woven integrally and subtly through Sara stories:.
The Empty Compound
Sara’s cousin has died, leaving his young wife, Sofia, and their baby son.
Although Uncle says his son died of cancer, everyone knows he died of
AIDS. Then Uncle starts blaming Sofia for his son’s death and banishes her
from his compound. Sara is delighted when Sofia comes to stay with her
family, but people whisper and point at them whenever Sara and Sofia go
out together. Some even call Sofia a witch. Sara and her family show how
and why it is necessary to confront prejudice and the reality of AIDS.
The Trap
Mr. Mbuta, the shopkeeper and local sugar daddy, tries to trick Sara into
becoming yet another of his “girlfriends.” Sara cannot turn to her mother,
who is away. Then Sara’s grandmother tells a story about men who turn into
monsters. Sara realizes she has to take decisive action against Mr. Mbuta
and the diseases he might be spreading. With some quick thinking and help
from friends, Sara turns Mr. Mbuta’s trick around.
From Behavior Change Communication to Strategic Behavioral Communication 
12
Straight Talk and Straight Talk Clubs
In collaboration with the Kenya Association of Professional
Counselors, IMPACT supported Straight Talk, a newspaper
addressing adolescent sexual and reproductive health and dedicated
to educating young people on HIV/AIDS and helping them develop
and maintain behavior that supports eradication of the risk of infec￾tion through abstinence. A continuous abstinence campaign
appeared in a regular column called “behavior change alphabet.”
The content was determined by an editorial board of youths,
who were guided by questions and requests received from young
readers ages 13–19. Straight Talk was distributed as an insert in
the Daily Nation, a Kenyan newspaper, on the last Friday of
every month. Other copies were directly mailed to schools and
youth-serving organizations, including Straight Talk Clubs. 
The clubs were established in secondary schools, and their main
activities were group discussions, health talks, debates, quizzes,
exchange visits, conferences, and community services. Straight
Talk clubs, managed by adolescents elected as officials and guid￾ed by teachers trained in facilitation and group management,
allowed discussion of many issues relating to HIV prevention
and offered a forum to explore issues appearing in the newspa￾per. Members also generated their own topics, based on their
reproductive health concerns. The clubs met once a week when
schools were in session.
Program support needed during school holidays to maintain the
focus on prevention was achieved by working with commercial￾and faith-based organizations in communities. Youth-friendly
and youth-developed supporting materials (such as posters,
brochure, T-shirts, and badges) motivated participation and pro￾moted program ownership. Inclusion of additional relevant
information, such as youth-friendly counseling and VCT servic￾es, made the program relevant to youth, some of whom were
taking care of family members with AIDS-related illnesses.
Achievements and Lessons Learned 
Comic books provide a very useful means of communicating
health messages to youth in a language they can understand. In
an entertaining way, the comic characters in the Nuru series
depicted the challenges that youth face and reinforced the fact
that their lives depend on choices they make. The comic charac￾ters effectively communicated health messages and provoked
lively, informal discussion among young people.
A small number of comic books can reach many youth: a single
copy was read by more 20 young people. In addition, Nuru was
serialized in local newspapers, and a short story was published
in youth-focused magazines each month, dramatically increasing
the number of readers. The number of youth reading Nuru was
estimated in the hundreds of thousands.
In 1999, the KGGA program broke new ground in reaching in￾school youth—particularly young girls—with information on
HIV in Kenya. Until then, the Ministry of Education and faith￾based groups could not allow education about sexuality in pri￾mary schools in Kenya, save for subtle mention of HIV within
the subject of social ethics. Through the KGGA program, 900
teachers received orientation, and 50 leader coordinators and
875 Girl Guide leaders were trained. About 5,000 Girl Guides
have earned the HIV/AIDS badge.
The Sara Communication Initiative reached 80,000 pupils in 800
schools, where 43,200 copies of Sara communications were dis￾tributed and 1,500 girls earned Sara badges. There were no devel￾opment costs, as materials are already printed and available. They
are adapted to the African context, and supplement existing peer
education and classroom reading in schools. One comic is read by
many pupils, and videos serve whole classes.
Some 980,000 copies of Straight Talk were produced and dis￾tributed, and 180 Straight Talk clubs were established in second￾ary schools, increasing openness and dialogue on reproductive
health issues. The dialogues generated created ownership of
information. Such ownership is seen as the precondition for
behavior change, which starts with individual appreciation of
the magnitude of risk, being in control of the new behavior, and
cues to action to help maintain the new behavior. 
Youths are a strong influence on other youths, and can reach
them with HIV/AIDS prevention information if provided with
the right support. However, messages sent out to youth on con￾dom use need to be harmonized. Glorifying the condom through
celebrity advertisements sends confusing signals to young people
when the key message is abstinence.
Theatre Outreach
In 1997, a group of young people approached FHI with an idea
of holding an annual youth theatre festival with an HIV/AIDS
theme to coincide with World AIDS Day, observed every
December 1. FHI supported the concept through its small grants
program known as Rapid Response Fund, and about 8,000
young people turned out to watch 43 groups compete for tro￾phies in the first two-day festival. However, most performances
had negative messages and depicted the prevailing hopelessness
of people with HIV.
IMPACT provided funding to Artnet Waves, the group that organ￾ized the festival, to establish theatre outreach in Mombasa, Nakuru,
Nzoia, Webuye, and Busia. In each region, coordinators trained
youth theatre leaders in organizing outreach events. “The entire
outreach process was carried out on young people’s own terms; this
allows them to interpret the meaning of HIV/AIDS for themselves
A Straight Talk editorial meeting at school. 
From Behavior Change Communication to Strategic Behavioral Communication 
13
and, through dramatic arts, to explore associated values, conflicts,
and solutions pertinent to their own generation,” said Hamisi
Salim, an Artnet Waves theatre coordinator in Mombasa.
A group typically began by identifying a problem related to HIV
affecting youth in the community. The artists prepared a per￾formance to address that problem, using poems, oral narratives,
song, dance, and drama. The theatre group would then organize
an outreach event for the community and invite young people. 
After each performance, a facilitator stimulated debate on the
issues raised or invited comments from the audience. Very often,
audience members themselves came up with solutions.
Audiences clearly enjoyed such exchanges. “It’s about the youth
and by the youth; it has to be fun,” said Chrispine Mwakideo, a
member of St. Luke’s theatre group in Mombasa.
Challenges and Redesign
Scaling up the theatre program from a fixed World AIDS Day
activity to a regular community outreach reaching more people
brought major challenges. Artnet Waves—essentially an organi￾zation of young people—had excellent theatre skills, but lacked
program and institutional management experience, such as finan￾cial accounting. They could not set up systems for program man￾agement and concurrently plan and assure quality performances.
FHI started noticing that financial reports and records were inac￾curate and arriving late; the quality of facilitation, message con￾ceptualization, and delivery also waned. The theatre troupes
were too large (16–20 people), making it difficult to control qual￾ity of performances. The performances also moved from place to
place in the community, making in-depth engagement of the
audience to elicit a behavior change response impossible.
FHI asked PATH to provide technical assistance that would revi￾talize the theatre program and make it respond to IMPACT’s
communication objectives. FHI decided that PATH should take
over management of the staff of Artnet Waves and put them
through an induction program to enable them to internalize
behavior change program design and processes.
PATH immediately did a SWOT (strengths, weaknesses, oppor￾tunities, and threats) analysis of the existing approach. Among
issues to be addressed were the cost of outreach and the number
of people in a theatre troupe. The limit was set at 8–9 members,
instead of 16–20, and the cost per outreach was similarly nego￾tiated downward. Regional theatre coordinators who joined
PATH finally came to appreciate the need for these reductions,
but they had to get buy-in from the theatre troupes, which was a
definite challenge.
Magnet Theatre
Magnet Theatre evolved as a response. IMPACT used it to reach
out-of-school youth, and aimed to increase their HIV and AIDS
knowledge, confidence in condoms, and interest in VCT, as well
as encourage delay in sexual initiation, abstinence before mar￾riage, and reductions in the number of sexual partners.
The idea for the project happened organically, with self-expres￾sion, analysis, dissent, and consensus at every step. The buy-in
of the regional coordinators was a huge advantage, since they
already enjoyed the respect of the communities. There was own￾ership of outcome from the start, and this helped the coordina￾tors speak with conviction.
Theatrical performances by and for youth.
A Theatre Outreach Story
A taxi driver drives different makes of cars. “One day he drove this big
BMW (Be My Wife), with a big bum and lovely curves,” says the story￾teller, sending the audience into gales of laughter. “The next day, he
squeezes into a tiny Japanese model. He was the envy of the taxi drivers
in his neighborhood.” 
The narrator continues, “All this time, he never used to buckle up. One
day, he had this terrible accident, which left him with scars all over his
face and a broken leg, putting to an end his exploits with different models
of cars. His experience made him become an advocate of safety-belt use.” 
The facilitator then turns to the audience, seeking interpretations of the
story. An audience member identifies the parallel with safe sex, leading
to a lively discussion on condom use.
A Magnet Theatre performance attracts a crowd.
From Behavior Change Communication to Strategic Behavioral Communication 
14
Magnet Theatre drew performers from local theatre groups, and
they performed at fixed venues within communities, including
under trees in open spaces. Rather than performances moving to
different places on different days, the audiences were “pulled” to
attend Magnet Theatre. 
Performances were pre-scripted, based on issues and situations rel￾evant to youth. Each performance had several “dilemma points,”
where actors freeze in a dramatic moment and face multiple behav￾ior options. The audience was asked to choose the best decision,
and the story proceeded on the basis of that behavior option.
Each performance was followed by a post-show discussion,
when audience members sat with the theatre facilitator and
shared their experiences and feelings. These became emotional
sessions; participants often said they had shared issues they
would not have raised in larger groups. After each show, indi￾viduals who changed behavior and consented to talk about it
shared their experiences with the community.
Achievements and Lessons Learned
To implement Magnet Theatre, 362 youth received both AIDS
competency and Magnet Theatre facilitation training. Over
800,000 youth were reached in priority communities.
Magnet Theatre was a very successful program that engaged
youth through edutainment. The intervention engaged youth to
do what they like to do, but structured in a way that helps them
assess their personal risks and make choices that enhance their
survival and that of their generation.
Fixed venues allowed a sharper focus on the specific target audi￾ence because sites could be chosen near youth hangouts and per￾formances timed when out-of-school youth were more likely to
be present. They also allowed for repeat audiences and the pos￾sibility of some continuity in discussions from show to show. 
By introducing incomplete stories and “freeze” points when audi￾ences could intervene and challenging the crowd to think through
how the story should or could end, the level of participation was
boosted enormously. Simultaneously, detailed human resource
and financial accounting was implemented, and the cost of the
shows was dramatically reduced by reductions in troupe size.
The Mural Initiative
The mural initiative began in Western and Coast Provinces in
May 2000 with sensitization by Sanaa Art Promotions that
raised muralists’ awareness and knowledge about HIV and
AIDS; design and painting of the murals begun in June. In 2002,
Global Fund funding expanded the initiative into a national pro￾gram, which was implemented in several parts of the country
between 2003 and 2005.
Youth Murals
To begin the youth mural project, students were selected from 35
clusters of schools in the Western, Rift Valley, and Coast regions.
Students from three to five schools in each cluster gathered on a
Saturday for a day of drama and discussion. Performers enacted
skits on a relationship-focused dilemma that required a response.
(One example: a boy is insisting on sex with a girl within a few
days after meeting her. How should she respond?) The students
then reenacted the skits, role-playing behavior change options
and expressing different behavioral responses. Based on the
behavior change options being acted out by the students, graph￾ic artists began sketching proposed scenes for the murals. The
students then selected the scenes that would be used. 
After the discussion, a topic was chosen for an essay contest
organized for students. A week later, they submitted essays (with
titles such as “Mary finds a way to say no,” and “John solves a
tricky problem”). Students who wrote the best essays received
awards, as did the schools submitting the most essays. The
7,641 essays submitted were evaluated not so much for literary
merit as for their use of certain key phrases and expressions used
as “tracers” during the mural discussions, since the appearance
of these phrases and expressions provides clues on the extent to
which discussions have been internalized and disseminated to
other youth.
Community Murals
As with the youth murals, community murals were developed
with a participatory approach and interactive discussions within
communities. The main objective was to provoke discussion
about relationships, health, coping with HIV and AIDS, behavior
options, and life choices. The intervention provided an informal
and non-threatening forum for a semi-structured discussion of
health issues affecting the community. The discussion provoked
Magnet Theatre performers convey education about HIV and AIDS. new and deeper questions among participants, a key feature of
One of the youth murals that resulted from a day of drama and discussion.
From Behavior Change Communication to Strategic Behavioral Communication 
15
IMPACT’s Question Your Relationships communication strategy.
The mural process also engaged participants in the creative activ￾ity of mural painting.
After sites were selected, themes for the murals were chosen, dis￾cussions facilitated, and behavior options explored. Artists then
drew up comprehensive lists of appropriate and inappropriate
behavior options and sketched basic illustration templates for
each option on separate sheets.
The day of the mural session, facilitators guided participants through
discussions of themes and options that had emerged. The template
corresponding to behavior options was colored over rapidly and
shown to the group. While drawing was in progress, facilitators
moved discussions forward. The process was brisk and energetic, but
also allowed time for participants to ponder and come up with their
contributions. Eventually, the whole mural was sketched using this
technique, and artists started painting after the crowd dispersed.
Achievements and Lessons Learned
In all, 93,140 students from 152 schools participated in the
youth mural project, and over 200,000 people were reached
through the youth and community mural program. Of the 20
community murals, 10 were in Western Province, 6 in Nakuru,
and 4 in Mombasa. 
With youth participation, 35 murals were designed for schools.
Another set of 20 murals were designed with adult and commu￾nity participation for other buildings. Both sets of murals were
developed in a participatory manner, enabling youth and the
larger community to identify with their messages. 
The mural paintings depicted real-life experiences and behavior
options, and they had both visual and emotional impact. They
communicated health messages to a large number of people
without incurring the cost of billboards, and they remain on
view over a long period. Because mural images are derived from
local discussions undertaken, they can reveal responses and
behavior options appropriate to a given cultural setting. 
National Museum HIV/AIDS Exhibition
Among opportunities used to expose individuals to information
on HIV/AIDS was an exhibition IMPACT organized with the
theme “Take a Positive Step” at the Kenya National Museum in
Nairobi, a location popular with members of public, including
school children. Over 105,305 students and teachers and 10,530
adults went through the exhibition at the museum between 18
August and 30 October 2005. 
The exhibition included poster displays on what HIV is, how the
virus is transmitted and how its transmission can be prevented,
the benefits of VCT, and basic facts on prevention of mother-to￾child transmission. It also included information on what a per￾son living with HIV and AIDS should do for care and treatment,
such as use of ART, better nutrition, and treatment of TB and
other opportunistic infections. For school children, the exhibi￾tion also included a large screen that aired the shortened episode
of UNICEF’s Sara communication video.
The exhibition’s messages and more in-depth topics were also
provided interactively for teachers and other people with access
to computers. The museum’s website brought these into people’s
homes and offices and provided links to major HIV/AIDS web￾sites. A video clip on the importance of home-based care for
PLHA was also part of the interactive program.
Discussion Topics for Community Murals
The most practical way to protect yourself and your loved
ones from HIV is by using condoms.
HIV is not AIDS. Learn the difference and start living.
It is a long way from liking someone to feeling faithful to
that person.
Till you are sure you trust each other, stay happy by staying safe.
A faithful, loving relationship with one person can keep
HIV out of your life.
A section of the gallery walk in the HIV/AIDS exhibition at the museum.
From Behavior Change Communication to Strategic Behavioral Communication 
16
As part of IMPACT’s effort to increase uptake of VCT in Kenya,
a national communication strategy was designed and imple￾mented by Population Services International (PSI), in collabora￾tion with other stakeholders. The formative research that
informed the design of the strategy included a national KAP
(knowledge, attitudes, and practices) survey in 2000, focus￾group discussions with non-VCT users, and in-depth interviews
with current VCT users and those currently and potentially
making referrals to the centers—teachers, healthcare providers,
counselors, and religious and business leaders.
Formative Research and Findings
Of those surveyed by the KAP, 78 percent had a strong interest in
getting an HIV test. Interest was strongest among those ages 20–24
and 25–29 (82 percent and 80 percent, respectively), and weakest for
those ages 30–34 (72 percent). However, only 14 percent of those
surveyed had actually been tested. This rate was lowest among those
ages 15–19 (6 percent) and higher among those ages 25–29 and
30–34 (19 percent and 18 percent, respectively). Although awareness
of HIV testing was high, the level of knowledge about the range of
VCT services was low, especially with respect to counseling and vol￾untarism. Only 4 percent cited a VCT center when asked where they
could go to get a HIV test; 93 percent stated a hospital or clinic.
Among those who reported that they were not interested in hav￾ing a HIV test, the most common reason given was fear of the
outcome (53 percent), which affected more women than men
(56 versus 49 percent). Others—42 percent—said they did not
need the test. Within this grouping were more men than women
(47 versus 38 percent) and more single than married people (48
versus 38 percent). Adolescents 15–19 (53 percent) were most
likely to believe they did not need to be tested.
Focus group discussions and in-depth interviews indicated con￾siderable potential interest in knowing one’s serostatus. Youth
and young adults were thought to be at particular risk, since
they were more likely to have more than one sexual partner.
Sexually active youth and adults who thought they had engaged
in risky behavior also indicated an interest in knowing whether
they had contracted HIV. Married people felt they were at risk if
they did not trust their spouses’ sexual fidelity.
Notwithstanding, fear of an HIV-positive outcome constituted the
greatest barrier to being tested for many. Many Kenyans assumed
or greatly feared that they would test HIV-positive, which would
result in severe personal trauma, societal stigma and discrimina￾tion, and the equivalent of a death sentence. Many Kenyans said
they would commit suicide if they tested HIV-positive. For many,
these fears far overshadowed the benefits of knowing one’s status,
including preventing the infection of one’s own family members.
Another barrier was the belief that the test was not needed
because there had been no risk of HIV-infection. Focus group
discussions with non-VCT users indicated that this belief was
particularly prevalent among youth. Being a virgin, married, not
“promiscuous,” and using condoms were seen as reasons for
being in this category, although partners’ sexual pasts do not
seem to have been taken into account.
One perceived benefit of knowing one’s serostatus was the chance
to take control of one’s future. For youth, this meant achieving
aims and goals; for those in their 30s, it meant planning for chil￾dren and family. Adolescents tended to perceive taking control as
a way to maintain their negative serostatus, while adults tended to
perceive taking control as learning how to manage a positive
serostatus. People in their 20s demonstrated characteristics of
both cohorts. Another reason for wanting to know one’s serosta￾tus was a change in lifestyle, including courtship, marriage, having
children, or separation and divorce. VCT users overcame fears of
testing HIV-positive when they needed to plan for the future or
were about to make a lifestyle change. Others would go for VCT
because they assumed their test results would be HIV-negative.
Counseling offered helped to motivate individuals to access VCT
services. It encouraged people to go to the centers, and focus
group discussions with non-users indicated that many saw coun￾seling as an important tool in decreasing fear associated with HIV
testing. VCT clients perceived counseling as the way to take con￾trol of their HIV serostatus (when they were ready to) and learn
how to manage it, whether it was positive or negative. They could
learn to take the steps needed to protect a negative serostatus or, if
HIV-positive, learn how to have a healthy lifestyle and not infect
others. Counseling was also seen as helping prepare clients to
counsel others, within and outside of their own peer groups.
The focus groups and interviews also illuminated barriers affect￾ing access to VCT centers. One such barrier was the general lack
of awareness about VCT services and their benefits. Many people
associated VCT with diagnostic HIV-testing, and they were
unclear about what counseling entailed. Those who knew more
about VCT had serious concerns about the quality of service,
including the confidentiality of counseling discussions and test
results; safe, accurate testing; and professional, courteous, and
friendly counseling. Another barrier was accessibility, including
the locations of centers and their operating hours before and after
work or school. Affordability was yet another barrier, since many
were concerned about the cost of services and related transporta￾tion. This was a particular concern for youth, rural respondents,
and some married women. Youth were particularly affected by
peer pressure and, for some, lack of parental support. Some mar￾ried women reported their husbands would not allow them the
time or money to go to a VCT center or would force them to dis￾close their status.
Societal barriers have also affected access to VCT services.
Many Kenyans expressed concern about the stigma associated
with HIV/AIDS; they feared being branded HIV-positive if seen
going to a VCT center, and they feared being treated differently
if they tested HIV-positive. VCT users tended to have more open
attitudes toward people affected by HIV/AIDS than non-users.
For example, men from Kakamega who had used VCT services
were those most likely to report that they had discussed
HIV/AIDS-related issues with their wives. VCT users obviously
3. Communication for Voluntary Counseling and Testing
From Behavior Change Communication to Strategic Behavioral Communication 
17
overcame the stigma of being seen going to a VCT center, and
several returned for repeat VCT services.
Most focus group respondents were enthusiastic about the use
of multiple media channels to promote VCT services.
Suggestions included electronic media, public announcements,
and folk media such as drama and puppetry. Most non-users
supported using “HIV/AIDS” in promotional efforts, but they
were hesitant about using the acronyms on billboards because of
the related stigma.
Individuals who make referrals were an important channel for
linking potential clients to VCT centers. Such people feel a high
sense of duty toward preventing the spread of HIV/AIDS, and
they are excellent resources who are already connected to com￾munities. Several VCT users reported having gone to the centers
because of such referrals.
The VCT Communication Strategy
Research findings greatly influenced the way the VCT commu￾nication strategy was designed. It was decided that VCT mes￾sages needed to address manageable barriers to VCT use, and
that initial campaigns should create awareness of VCT as a new
service. In particular, they needed to draw attention to the attrib￾utes and benefits of the counseling offered, build consumer con￾fidence in the quality of services, and address issues of
accessibility and affordability.
VCT messages needed to reinforce the idea that individuals are
vulnerable to HIV infection, that sexually active people are most
at risk for contracting HIV/AIDS, and that getting infected will
affect their future plans and ability to provide for their families.
These self-risk perception messages needed to include the impli￾cations of the sexual past of one’s partners, since this concept
was not well understood.
The communication strategy also sought to help manage the fear
of an HIV-positive test result, the most serious barrier to VCT
use. Though the campaign needed to convey that most Kenyans
will test HIV-negative, it was important to uphold the need to
know one’s serostatus and to communicate that VCT is an excel￾lent tool that allows a client to protect a negative serostatus,
take control of his or her future, and embark on long-term
lifestyle and behavioral changes. The campaign also needed to
convey to those testing HIV-positive that VCT provides a chance
for a “fresh start,” and that VCT services help them to learn
how to live healthily and avoid infecting others. The tone of
campaigns needed to be positive and upbeat, since fear is a par￾alyzing factor in proactive decision-making.
VCT messages also needed to highlight the confidential counseling
and related support services that help clients manage their fears
and issues on their own terms. Communicating the supportive
care aspect of VCT, both psychological and medical, was geared
to help potential clients reduce their fears of testing HIV-positive
and their dread of the rejection and isolation that might ensue.
A corollary campaign strategy needed to address the societal
issues of stigma and discrimination against PLHA, since many
Kenyans preferred ignorance of their serostatus to the rampant
stigma and discrimination they face if they test HIV-positive.
Since this stigma is partly rooted in the fear of accidental HIV
infection by being around someone HIV-positive, it was impor￾tant that messages stress that fear is irrational, and that stigma
and discrimination against PLWA are unjustifiable.
A mix of electronic and interpersonal channels was deemed
appropriate for communication-related messages, since both
approaches could deliver VCT messages in an effective, synergis￾tic manner. Each medium has its strengths, and a well-consid￾ered mix can maximize VCT message delivery. The electronic
media would be used to increase consumer awareness of VCT
benefits and attributes, while interpersonal communications,
including the use of referral makers, reinforce these messages
and provide a link between clients and services.
Because many people fear being branded as HIV-positive if they
are seen using VCT services, “HIV/AIDS” was not used on
logos, slogans, or signboards. However, associating VCT with
HIV/AIDS was appropriate during promotional activities, since
potential clients believe it is the best way to create awareness of
VCT services.
Goal, Objectives, and Target Audience 
The goal of the strategy was to decrease HIV incidence in Kenya
by increasing safer sexual behaviors. The growth of individual
commitment to manage one’s serostatus—whether HIV-positive
or negative—is believed to increase these safer sexual practices. 
The strategic objectives of the communication strategy were to
• create awareness of VCT as a new service
• reinforce behavior related to serostatus management
• increase personal conviction in the benefits of managing
one’s serostatus and self-efficacy
• build societal elements that encourage knowing and manag￾ing one’s serostatus
The strategy targeted sexually active men and women ages
25–39, with a focus on couples making lifestyle decisions (such
as getting married and having children) or planning their and
their children’s futures. The primary target audience included
couples worried about past risky behavior and wanting to
strengthen a current relationship. Youths ages 15–24 were also
targeted, particularly those making lifestyle decisions and plan￾ning their futures.
A quantity of materials—including radio and television spots,
print publications, road signs, and billboards—were produced to
promote VCT and reach youths and young and established cou￾ples (appendix 3). Communications messages and creative
approaches were significantly different for youth and adult audi￾ences because of their differing perceptions of the benefits of
knowing their serostatus. For youths, the prime benefit was the
ability to achieve aims and goals, while adults saw the prime ben￾efit as being able to plan for their children and families. The dif￾fering market profiles and motivations of the two groups meant
that separate campaigns were needed to promote VCT services.
From Behavior Change Communication to Strategic Behavioral Communication 
18
Phase One
Phase one of the VCT communication campaign had three waves,
each of which ran for six months. The first wave sought to brand
VCT services for ease of recognition. After pre-testing several ver￾sions, the VCT logo design shown was adopted. It was placed on
signposts in strategic places, along with directions.
Wave one activities aimed to create
general awareness of VCT as a new
service in Kenya. The activities pro￾moted existing VCT centers and
responded to typical consumers’ ques￾tions about what, where, why, and
how much. Questions posed about
HIV by participants in focus group discussions and in-depth inter￾views were cited in the campaign, with VCT centers stated as the
places to go to obtain answers. For wave one and wave two, radio
was the main communications channel, supplemented by TV, bill￾boards, and the print press. 
Wave two focused on youth and their perception that VCT provid￾ed a way to take control of their future and achieve their plans and
goals. The youth-oriented “Take Control of Your Serostatus” cam￾paign promoted knowing one’s serostatus and adopting the appro￾priate behavior to actively conserve a negative serostatus or
proactively manage a positive serostatus.
The youth campaign used a generic
Swahili word, Chanuka (be informed),
which soon became a popular slogan. The
campaign also employed popular young
celebrities, including musicians, disk jock￾eys, and comedians. In addition, youth
who actively managed their serostatus
became trendsetters for other youth. 
The third wave of the youth campaign,
targeted to ages 15–24, aimed at estab￾lishing the context of a youth culture
that supported proactive serostatus man￾agement by reinforcing positive deviant
(or early adopter) behaviors. This wave, designed to create
demand, centered on increasing personal conviction about the
benefits of managing one’s serostatus, in particular within the
context of dating, considering marriage, or conserving a sero￾negative status. The campaign aimed at increasing the desire to
know one’s serostatus and decreasing the fear associated with
taking a HIV test.
Phase Two 
Phase two focused on creating demand for VCT services by couples
and adults. Formative research had established that adults had con￾siderable general interest in knowing their serostatus, although this
varied by age, sex, and marital status. However, barriers to knowing
one’s serostatus included the widespread fear of testing HIV-positive
and losing marital support. Nonetheless, many adults perceived
VCT to be a useful tool that enabled them to plan for the future and
take care of their families and children. Although studies demonstrat￾ed the epidemiological and economic benefits of couples receiving
VCT services, few Kenyan couples were accessing VCT together.
This demand-creation campaign targeting adults and couples
centered on increasing personal conviction about the benefits of
managing one’s serostatus, in particular within the context of a
relationship. This was to be achieved by increasing the desire to
know one’s serostatus and one’s self-efficacy and decreasing and
managing fears associated with taking an HIV test. 
The last wave of the national VCT mass media campaigns, from
January to April 2005, focused on the importance of HIV test￾ing as a lifestyle strategy for those who feel perfectly healthy and
promoted the message of positive living and treatment options
Active Serostatus Management
• Maintaining a negative status
• Living positively with HIV/AIDS
Self Efficacy
• Skills related to knowing HIV status
• Skills related to managing serostatus
Personal Conviction in Benefits of
Managing Serostatus
• Commitment to know serostatus
• Decreased fear of knowing serostatus
Awareness of VCT
• Attributes that inspire consumer
 confidence
• Accessibility and affordability
Societal Factors that Enable or
Reinforce Objectives
Reinforced Ideal Behaviors
• Know serostatus
• Manage serostatus
Figure 1. The VCT Communication Strategy Framework
The branded VCT logo design.
A poster used in the youth campaign. A poster used in the
couples campaign.
From Behavior Change Communication to Strategic Behavioral Communication 
19
for people who test HIV-positive. The focus was on couples was
retained: the campaign targeted established couples ages 18–35
as well as male family decisionmakers.
Lessons Learned
• For a communication strategy promoting services to suc￾ceed, planners should work closely with those delivering
services, ensuring that services, supplies, and consumables
are available. The VCT communication campaigns went
alongside a rapid expansion of services in Kenya, and the
coordinator of the communication campaign was on the
national VCT planning committee.
• Communication campaigns promoting uptake of services
can be rendered ineffective by interruption of services.
During the VCT campaigns, test kit outages sometimes
occurred, and the launch of some phases had to be post￾poned until test kits were available at VCT sites. There were
also occasions when the few urban centers could not meet
the demand for VCT services.
• The rapid expansion of VCT provided to be a challenge to
the VCT communication planners. IMPACT could not meet
the growing need for VCT materials for all the government
and private sites.
• Not all communication campaign waves and phases were
equally successful. Whereas the initial campaigns (questions
on HIV and youth VCT) created interest in VCT, the young
couples’ campaign was not as successful, and not many
young couples visited VCT centers.
• Mass media campaigns are very expensive. Those chosen
from the media mix should have maximum reach, but be
cost-effective.
• Monitoring the effectiveness of the VCT campaigns by uti￾lizing data from outside the IMPACT sites was not possible;
there was no routine system of channeling VCT data from
areas outside the IMPACT program focus regions.
• Development of the logo ensured a brand identity, but not
service quality. During the campaign, the National AIDS
and STD Control Program developed a national quality
assurance strategy, which involved registration of sites and
annual assessments to ensure adherence to set standards.
However, there was no punitive measure for those who
failed to meet standards yet continued to display the VCT
logo. With the rapid expansion of VCT in Kenya, there is
need to enforce annual accreditation and deregister sites that
do not meet minimum standards.
• Toward the end of the project, there was push for diagnostic
testing and counseling (as opposed to voluntary counseling
and testing) to initiate ART for as many people as possible.
This push required a different communication strategy and
affected the VCT campaign, since it emphasized the volun￾tary part of counseling and testing and made it the selling
point for VCT.
• A public relations strategy should be part and parcel of
future communication campaigns to mitigate any negative
reaction. A quick public relation campaign was needed after
the Association of Kenya Medical Laboratory Scientific
Officers issued statements to discredit VCT services because
non-laboratory personnel were engaged in the testing,
though this practice had been recommended in national
guidelines. 
• Future challenges for national VCT campaigns include
reaching sexually active young people ages 15–19 whose
risk perceptions are very low, along with married people
with low levels of education and those less exposed to mass
media, particularly those in rural areas in Nyanza, Coast,
and Rift Valley. This calls for a greater synergy and coordi￾nation between mass media campaigns and ongoing inter￾personal communication campaigns in rural and
underexposed areas.
From Behavior Change Communication to Strategic Behavioral Communication 
20
Since monitoring and evaluation determine whether a program
has accomplished its goals and objectives, IMPACT put in place
mechanisms to monitor the implementation of its complex BCC
program. In the communities, forms were used to collect infor￾mation on various activities, based on agreed-upon indicators.
These data were used to measure progress toward achievements
of targets. Pre-intervention and post-intervention surveys were
conducted for selected interventions (special studies), and a pop￾ulation-based survey was used to determine the extent of expo￾sure to IMPACT interventions. The VCT campaign was also
evaluated though an August 2004 baseline survey and a follow￾up survey conducted in April 2005.
Survey of Sex Workers in Mombasa
Pre- and post-intervention cross-sectional surveys were conduct￾ed among 503 female sex workers in 2000 and 506 female sex
workers in 2005. The same location and study methods were
used for both surveys, and participants had similar baseline
characteristics—age, marital status, education, ethnicity, and
religion. The sex workers were recruited through the snowball
method over a two-month period. Structured questionnaires
were used to collect information on demographics and sexual
behaviors, and gynecological examinations and laboratory
investigations established the prevalence of HIV and other STIs.
Between 2000 and 2005, sex work had changed from a mainly
part-time to a full-time activity for these women. While 67 per￾cent had alternative incomes in 2000, only 37.7 percent had
alternative incomes in 2005. While their mean number of sexu￾al partners increased from 2.8 to 4.9 over the period, consistent
condom use with paying clients increased from 28.8 (145/503)
to 70.6 percent (356/506).
Knowledge and attitudes regarding HIV and other STIs and pre￾vention remained unchanged between 2000 and 2005, though
the proportion of women who saw benefit in knowing their HIV
status increased from 78.3 to 94.4 percent. The percentage who
could cite two or more correct ways to prevent HIV increased
from 65.3 to 76.1 percent in the five-year period, and the per￾centage who could cite two or more correct ways of preventing
STIs increased from 44 to 49 percent. 
In both surveys, 90 percent of women reported condom use during
last sex with paying clients and claimed this had been their idea.
About 70 percent said they had provided the condom. In addition,
77.7 percent said they had refused clients unwilling to use a con￾dom, compared to 41.4 percent who were in this category in 2000.
Behavioral Surveillance Survey of Target Groups
The Kenya behavioral surveillance survey in 2002 was a proba￾bility-based, random survey of most at-risk populations that
included the five IMPACT focus districts. This survey captured
exposure to interventions of the IMPACT BCC program, as well
as outcome effects of attitudes and risk behaviors of target
groups in priority communities. 
Attitudes and behaviors related to each BCC objective were
investigated so that relationships between respondents’ expo￾sure to interventions and the objectives could be determined. A
series of questions were added to the survey to assess the cov￾erage of the Kati Yetu radio show. As with all communication
programs, it is difficult to attribute success to one set of inter￾ventions. However, IMPACT was the main implementer of HIV
communication programs and activities within priority commu￾nities at the time.
With the exception of female sex workers, all groups inter￾viewed for the Kenya behavioral survey exhibited high levels of
knowledge about HIV and AIDS. Even so, respondents exposed
to IMPACT peer education were significantly more likely to
score high on HIV and AIDS knowledge and refute commonly
held misconceptions than respondents not so exposed. Similarly,
respondents who had attended peer education sessions were bet￾ter informed on condom use, and they believed that condoms
were necessary after relationships became serious.
The evaluation also found that Magnet Theatre participants
were significantly more likely than non-participants to know the
difference between HIV and AIDS, along with how long it takes
to test positive for HIV. They were also more likely to believe
that condoms were necessary, “even if a relationship moves from
casual to serious,”
Respondents who had participated in peer education were sig￾nificantly more likely to have heard of VCT and know about
benefits associated with it than respondents who had never been
in peer education programs. In addition, HIV-positive respon￾dents were more knowledgeable about VCT services that those
who had tested negative. Theatre participants were also more
4. Monitoring and Evaluation
Figure 2. Consistent condom use reported by sex workers, 
2000 and 2005
80
70
60
50
40
30
20
10
0
Percent
2000 2005
Consistent condom use
From Behavior Change Communication to Strategic Behavioral Communication 
21
likely to name two or more benefits of VCT for those testing
negative and those testing positive.
The Kati Yetu radio show was meant to extend BCC reach;
improve HIV and AIDS knowledge; increase confidence in con￾doms and interest in VCT; and foster positive attitudes toward
reducing partners, abstinence before marriage, and delay in sex￾ual initiation. To determine whether the radio show had its
intended effect within the four target communities, the evalua￾tion compared the responses of recent listeners (within the past
four weeks) with respondents who had listened to Kati Yetu but
not in the past four weeks (non-recent listeners), and with non￾listeners (respondents who had never listened to the program).
Young listeners were likely to know the difference between HIV
and AIDS than non-listeners, even after controlling for educa￾tion. Recent listeners were more likely than non-recent listeners
and non-listeners to be aware of the interval between infection
and testing positive for HIV. Recent listeners were also signifi￾cantly less likely than non-recent or non-listeners to believe
myths about HIV, including that it can by transmitted by mos￾quitoes or the sharing of meals, that healthy-looking people do
not have it, and that HIV can be cured by having sex with a vir￾gin or with many partners.. Sex workers who were recent listen￾ers were significantly more likely than non-recent listeners and
non-listeners to know the difference between HIV and AIDS and
answer correctly all questions related to the sequence of HIV
infection, illness, and death.
Nearly all respondents had heard of condoms. Even after con￾trolling for education, recent young listeners were more likely to
believe that condom use protects against HIV. Three-quarters of
men believed that correct, consistent use of condoms could pro￾tect against HIV, and they could name three or more benefits of
condom use. Among men in large worksites, 95 percent believed
that “having one uninfected, faithful sex partner” was protective
against HIV, and 93 percent believed this to be true of “abstain￾ing from sexual intercourse.”
Women and sex workers who listened to Kati Yetu were signifi￾cantly more likely to possess a greater level of knowledge and
positive attitudes toward condoms than non-listeners. In addi￾Figure 3. Knowledge of HIV/AIDS and attitudes toward condoms of target groups, with and without exposure to peer education (PE)
0
Percent
10
20
30
40
50
60
70
80
90
Refute HIV misconceptions
Suspect condoms have holes
Know length of window period
Know three or more benefits of condom use
Men in worksites
With PE Without PE
Low-income women
With PE Without PE
Sex workers
With PE Without PE
Figure 4. Target group knowledge of VCT among listeners to Kati Yetu program and non-listeners
0
Percent
10
20
30
40
50
60
70
80
90
Men in worksites
Listener Non-listener
Low-income women
Listener Non-listener
Sex workers
Listener Non-listener
Youth
Listener Non-listener
Ever heard of VCT
Correctly named two benefits of VCT for those who test negative
Correctly named two benefits of VCT for those who test positive
From Behavior Change Communication to Strategic Behavioral Communication 
22
tion, listeners were more likely to believe that condoms can pre￾vent HIV and to name three or more benefits of condom use.
Nearly half the youth and over 70 percent of female sex workers
who were recent listeners reported that they had discussed perti￾nent issues heard on Kati Yetu with friends and family.
All recent listeners were significantly more likely to have heard
of VCT than non-recent and non-listeners. Recent listeners were
also more likely to name two or more benefits of VCT for those
testing negative, and they were significantly more likely to name
two or more benefits for those testing HIV-positive.
Evaluations of the VCT Communication Campaigns
Two surveys among over 23,000 people ages 15–35 were con￾ducted in randomly selected households in 13 of Kenya’s largest
towns and cities. Two-thirds of samples were from urban resi￾dential areas and one-third from peri-urban areas of selected
study sites. Both surveys were conducted in the same sites and
used the same sampling methodology. Results showed that 71
percent of married or cohabitating respondents (n=933) were
exposed to at least one channel of the VCT campaign—whether
radio, TV, print ad, billboard, or poster. Over half of these
respondents (53 percent, n=671) discussed the campaign with
family or friends, and 97 percent said they wanted to continue
seeing it aired in the media.
Among married or cohabiting couples who had never received a
HIV test, the intention to go for testing increased significantly
between the baseline and follow-up surveys. This was true even
after controlling for differences in sociodemographic character￾istics between the two survey rounds: at baseline, 34 percent of
married couples (n=480) strongly agreed with the statement, “I
plan to get a HIV test,” and 46 percent (n=510) strongly agreed
at follow-up, after the campaign. In addition, 57 percent of
respondents exposed to three or more channels of the campaign
strongly agreed, compared to 40 percent of those who reported
no exposure. 
Nevertheless, few married couples reported that they had gone
for a HIV test together, either before or immediately after the
campaign, and this percentage did not increase within a few
months of the campaign or over the campaign. About 8 percent
of all married respondents (n=1760, both surveys combined)
reported taking a voluntary HIV test with a partner in the year
previous to each survey. 
A segmentation analysis of respondents who went for voluntary
testing as married couples the previous year indicated that this
was more likely for those who were employed, had a least some
secondary education (or higher), read a newspaper or magazine
at least once a week, and were in their mid-20s to mid-30s.
Couples who went for voluntary testing were also reported to be
more likely to trust their spouse or partner. In addition, these
couples reported they had received some kind of interpersonal
communication about HIV in the past three months, and they
had seen three or more channels of the most recent national
VCT campaign.
Married respondents from the Rift Valley, Coast, and Nyanza
were significantly less likely to go for voluntary testing as cou￾ples than respondents residing in Nairobi or Central Province.
However, religiosity (feeling strongly religious) made little differ￾ence, and neither did variables related to self-risk and locus of
control concerning HIV. 
One of the communications challenges in promoting VCT is that
most people get tested for a disease when they feel unwell and
when they know medical treatment is available. Generally
speaking, Kenyans are still learning about the range of treatment
options and medications for HIV and AIDS. If they perceive that
the health of a person with AIDS cannot be improved by treat￾ment, marketing VCT services as an entry to treatment for
PLWA will not be effective.
The baseline and follow-up survey asked questions about the
advantages of testing and, for those who said they had never
been tested, the factors that were likely to prevent someone from
going for a test, such as fear of testing positive, lack of aware￾ness of sites, and affordability of services. Specific questions
were also asked to determine if the hypothetical availability of
ARVs would be an inducement. None of these factors, however,
changed significantly, both over time (from baseline to follow￾up) or as a result of exposure to the campaign. While married
Figure 5. Stated intentions of all surveyed urban couples 
(ages 15–35) concerning HIV testing
100
80
60
40
20
0
Percent
n=480
Strongly agree (baseline)
n=510
Strongly agree (follow-up)
I plan to get a HIV test
Figure 6. Stated intentions concerning HIV texting of surveyed
urban couples exposed and not exposed to VCT campaign
100
80
60
40
20
0
Percent
Exposed to three or more
communication channels
No exposure to
communication channels
I plan to get a HIV test
From Behavior Change Communication to Strategic Behavioral Communication 
23
respondents’ willingness and interest to get tested increased sig￾nificantly, potential access to ARVs was not a major inducement
to get tested. Only 7 percent of married or cohabitating respon￾dents who had never been tested and reported no interest in
receiving a HIV test said they would be interested in a HIV test
if ARVs were affordable and available in their community.
Qualitative research gathered over the past five years on VCT-seek￾ing patterns of Kenyans confirms this analysis: that couples are
more likely to go for testing when they are in their mid to late 20s,
have recently married or made a life commitment to their partners,
and when they are working, urban, educated, and exposed to
health messages. The research also revealed that men are more like￾ly to go for testing on their own than as part of a couple
Future campaigns should continue to stress VCT as a choice for
engaged or recently married couples and should also target men
as decision makers. While it may be important to continue
stressing messages on the possibility of testing HIV-positive and
the availability of care and treatment, this research suggests that
these messages are probably not likely to sway individuals who
already feel healthy and at low risk of HIV.
From Behavior Change Communication to Strategic Behavioral Communication 
24
1. Improve planning and coordination of communication 
interventions at the national level.
IMPACT was one among many programs in Kenya implementing
communication interventions. Since there was no forum for shar￾ing workplans and coordinating the efforts of different players in
HIV/AIDS communication, valuable opportunities for leveraging
communication interventions and campaigns were lost. For exam￾ple, several HIV mass media campaigns were planned and execut￾ed with little linkage with IMPACT and other HIV/AIDS
communication interventions taking place at grassroots levels. To
maximize effectiveness and minimize AIDS information fatigue,
an HIV/AIDS working group at the national level needs to be
established to coordinate and harmonize the many BCC cam￾paigns and create linkages between national mass media cam￾paigns and community-level communication interventions.
2. Improve planning and coordination of communication 
interventions in communities.
During implementation of the IMPACT Project, other resources
became available, such as the Global Fund and the World Bank
Community Initiative Account. This meant that more communi￾ty groups were able to implement prevention interventions.
District-level HIV communications committees became impor￾tant vehicles in ensuring quality and maintenance of standards
in communities, regardless of the funding source. Future strate￾gic communications for HIV in communities need to build in
coordination at district and constituency levels. District HIV
communications committees (established under IMPACT) and
constituency AIDS control committees aim to ensure coordinat￾ed planning and execution of communication interventions at
the community level. 
3. Standardize peer education.
IMPACT invested in developing and improving the standards of
peer education in Kenya through the development of a uniform
curriculum across priority community sites and uniform quality
assurance procedures. With the increased resources for
HIV/AIDS in Kenya—and hence the increase in the number of
community groups implementing HIV-prevention interven￾tions—there is need to adapt a uniform peer education curricu￾lum as a first step in assuring quality of HIV/AIDS
communication interventions in Kenya.
4. Develop print materials cooperatively.
The need for print educational materials increased as the pro￾gram evolved. Through decentralized communication program
planning, IMPACT was able to help community groups develop
materials relevant to their cultural settings, but the project did
not have enough resources to print adequate quantities. While
this was happening, other programs implementing communica￾tion interventions were also developing materials. This duplica￾tion of effort need not happen. Future community interventions
should consider pooling resources to develop communication
materials together. This will ensure that the materials are rele￾vant, uniform messages reach the community, and an adequate
number of copies are produced.
5. Scale up effective approaches without compromising quality.
Attention to quality is needed as HIV-related communication
interventions scale up. When scaling up approaches, programs
should invest in maintaining quality so that effects are main￾tained as more people are reached.
6. Widen the scope of communication programming in HIV.
Globally, the HIV/AIDS response has shifted from being primari￾ly prevention-focused to comprehensive programs of HIV/AIDS
prevention, care, treatment, and support. Experience and
advances in medicine have made it possible for HIV/AIDS to be
managed like other chronic illnesses. Thus HIV/AIDS communi￾cation strategies should move from being purely prevention-ori￾ented to being integrated with comprehensive HIV/AIDS
programming efforts, whatever the goals of different program￾matic areas may be. 
Communication program planners should provide related
responses to move beneficiary audiences closer to the intended
behavior. HIV/AIDS communication programming should thus
aim at increasing knowledge among in-school youth about the
basic facts of HIV/AIDS and its prevention and transmission to
reduce risky behaviors and increase prevention. Communications
should also aim to influence the adoption of positive health
behaviors, such as abstinence, being faithful, and using condoms.
HIV/AIDS communication programming should also stimulate
community dialogue on appropriate responses to issues relating
to orphans and vulnerable children, create demand for VCT and
services that prevent mother-to-child transmission, and help
communities fully utilize available resources. In addition, pro￾gramming should seek to change social norms so as to encour￾5. Recommendations and Lessons Learned
An assortment of materials developed by the Impact Project
From Behavior Change Communication to Strategic Behavioral Communication 
25
age more open discussions of sexuality between parents and
children that may help delay the onset of sexual activity.
For PLHA and ARV clients, communication programming
should seek to improve skills and self-efficacy that help them
adhere to the ARV regimen and seek medical help, as needed.
This requires increasing their knowledge of side effects and
opportunistic infections and their awareness of the benefits of
good nutrition and exercise. Trained healthcare outreach and
home-based care workers can deliver appropriate messages dur￾ing home visits, and healthworkers should be encouraged to
reduce stigma and discrimination and improve care and treat￾ment services for PLHA.
Finally, HIV/AIDS communication programming should pro￾mote essential attitude-change in policymakers to increase budg￾et allocations for ARV drug purchase. Communication
programmers should also work with mass media to stimulate
more press coverage of HIV/AIDS so as to advocate for an effec￾tive response to the epidemic
The IMPACT communication intervention started the shift in
these directions. However, there are many components in the
continuum of prevention to care that require more emphasis.
This can be achieved through the development of a comprehen￾sive national communication strategy for HIV/AIDS that can be
adapted for different communities in Kenya.

From Behavior Change Communication to Strategic Behavioral Communication 
27
Appendix 1. Weekly Session Diary for Peer Educators
Weekly Session Diary for Peer Educator
Section 1: Introduction
Name of Group
Province Rift Valley Western
Coast Nairobi
Priority Area
Zone
Peer Educator’s Name
Monitor’s Name
Group FSW Worksite
Community Women Youth
Community Men
Section 2: Details of Session
Session Held? Yes No
Day Month Year 
Start time AM/PM
End time AM/PM
Duration minutes/hours
Number of MALE participants 
Number of FEMALE participants 
Number of ALL participants 
Section 3: Details of Session
Methods Used
Picture Code Role Play Timeline
Experience Sharing Radio Listening
Guest Speaker Discussion Guide
Discussion Theatre
Magnification Condom Demonstration
Topic
Name of Guest Speaker (if any)
Number of QUESTIONS harvested
Number of PEOPLE asking for condoms 
Number of MALE CONDOMS distributed
Number of FEMALE CONDOMS distributed
Key questions and concerns raised
1.
2.
3.
Section 4: Other Activities During this Week
Number of outreaches conducted (if any)
Number of condoms distributed in outreaches
Date of submission
Signature
Number of people reached in the outreaches
Number of male condoms distributed 
in outreaches
Number of male condoms distributed 
outside the session
Number of people reached through
one–on-one discussions this week
Number of VCT referrals
Number of Sexually Transmitted Infections
(STI) referrals
Number of TB referrals
Number of Optimistic infections 
(OIs) referrals
Number of Home Based Care 
(HBC) referrals
Number of PMCT referrals
Number of CCC referrals
MALES FEMALES
From Behavior Change Communication to Strategic Behavioral Communication 
28
Appendix 2. Communication Materials Produced 
by the IMPACT Project
Titles Type Target Audience Purpose
Just ask me about VCT
Antiretroviral therapy (ART) improves health
Healthy living: A counseling guide for health workers on opportunistic infections
Healthy living: A counseling guide for health workers on antiretroviral therapy
(ART) and management of ART side effects
Chanuka
Mighty Kong
Mercy Myra
Redykyulass
Chanukeni Pamoja
Robert and Eve
Njoroge Waweru
Kwach and Felicia
Topic: VCT
brochure
flip chart
guide
posters
youth and young adults
health personnel
youth and young adults
couples
1. Promote information- seeking
and discussions on VCT
2. Help ART patients under￾stand and better adhere to
treatment
3. Encourage young couples to
discover their status together
Antiretroviral therapy (ART): Managing the side effects 
Maudhi yanayoweza kutokea unapotumia dawa za ART
Antiretroviral therapy (ART). ART may help you feel strong even 
if your immune system is weak
Maelezo kuhusu dawa za ART, Dawa za ART zinaweza 
kukuongezea nguvu hata kama kinga yako ya mwili imedhoofika
Understanding opportunistic infections
Antiretroviral therapy (ART) improves health
TB can be cured
Maelezo kuhusu Magonjwa Tegemezi
Vyakula vyetu kwa afya bora
Antiretroviral therapy (ART) What you need to know about
Making your TB treatment a success
Jinsi ya kufanya tiba ya TB ifanyike
How to use ART drugs
Jinsi ya kutumia dawa za antiretroviral (ART)
Topic: ART
brochures
book
brochure
brochure
booklet
booklet
card
low-literacy audience
with HIV, TB, or
opportunistic infections
HIV-positive persons,
caregivers, and 
community
TB patients
ART patients
1. Reach out to low-literacy
audience with basic facts
and help them to manage
and cope with ART side
effects
2. Educate people that TB can
be cured
3. Educate public on oppor￾tunistic infections
4. Educate on locally available
foods
5. Support adherence to ART
and make adherence easier.
6. Educate community on good
nutrition
Go for an “A”: Abstain
Smart teenies: “Chill” it is a good thing!
Say no to excess alcohol consumption
Choose da best: Maisha iwe poa
Talking points for peer educators (KGGA)
Participatory peer education for HIV and AIDS prevention: 
A manual for trainers of peer educators (KGGA)
Peer education for HIV and AIDS prevention
Handbook for award of an HIV and AIDS badge (KGGA)
Topic: Youth
poster
brochure
brochure
booklets
manual
manual
handbook
youth in and out of
school
youth out of school
youth in school
youth in school
youth in school
youth in school
1. Encourage youth to abstain
2. Discourage excessive drink￾ing of alcohol
3. Provide choices for reproduc￾tive health
From Behavior Change Communication to Strategic Behavioral Communication 
29
Titles Type Target Audience Purpose
Protecting ourselves and those we love
A community HIV and AIDS response: Protecting those we love
Protecting our heritage, ourselves, and those we love 
A pocket calendar for Kenya police officers:
Protecting ourselves and caring for those we love
The purple diary (KWS) operation ABC 
Tuangamize ukimwi
Knowing your HIV status is a step towards better living
Kuwa na virusi sio mwisho wa maisha 
Tunalinda na kuhifadhi urithi wetu 
Tunalinda na kuhifadhi urithi wetu 
Topic: Uniformed Forces (Kenya Police)
picture 
brochure
brochure
pocket diary
pocket diary
poster
poster
poster
calendar
uniformed forces 1. Encourage prevention and
self-protection among police
Eat good food and maintain cleanliness to stay healthy
Preventing sexually transmitted diseases and pregnancy among 
HIV-positive persons
Keeping families affected by HIV together
Treatment of opportunistic infections and management of ARV side effects
Topic: Orphans and Vulnerable Children
poster
poster
poster
booklet
PLHAs
Children and HIV series
Nutrition
Basic facts
Treatment side effects
Emotion and feelings
Basic facts
Treatment side effects
Emotion and feelings
A guide for health workers
Topic: Pediatrics
brochures
booklets
guide book
public
caregivers
healthworkers
From Behavior Change Communication to Strategic Behavioral Communication 
30
VCT Promotion
Media placement May–September 2002 (5 months)
Radio: approx. 540 spots aired
Print: approx. 11 advertisements placed
Road signs: 60 distributed
Billboards: 15 used
Advertisements placed by City Clocks: 4
Youth Campaign
Media placement Aug 2002–January 2003
TV: 126: approx. spots aired
Radio: approx. 338 spots aired
Print: approx. 28 advertisements placed
Posters: approx. 15,000 distributed
Young Couples Campaign
Media placement August–December 2003 
(no spots aired in November)
Radio: 340 spots aired
TV: 118 spots aired
Print: 27 advertisements placed
Posters: 26,000 distributed
Road signs: 60 distributed
Wall signs: 60 delivered
Billboards: 17 used
Established Couples Campaign
Media placement December 2004–April 2005 
and March–August 2006
Radio: 1571 spots aired
TV: 341 spots aired
Print: 41 advertisements placed
Posters: 13,000 distributed
Road signs: 140 distributed
Wall signs 140 delivered
Billboards: 33 used
Appendix 3. The VCT Communication Campaign
African Medical Research Foundation
Anglican church of Kenya
Bungoma Organization for the Empowerment of Women 
Family Planning Association of Kenya 
Goal Ireland
International Center for Reproductive Health/University of Ghent
Kenya Association of Professional Counselors
Kenya Girl Guide Association
Kenya Police
Kenya Wild Life Service
Kima Integrated Community-Based Program
K-NOTE
Lifebloom Services
Malindi Education Development Association
Mkomani Clinic Society
Mumias Muslim Community Program
National Museums of Kenya
National Organization of Peer Educators 
Program for Appropriate Technology in Health 
St. Johns Ambulance
Society of Women and AIDS in Kenya 
Solidarity with Women in Distress
Strengthening Community Partnership and Empowerment 
Supreme Council of Muslims in Kenya
University of Nairobi /University of Manitoba Strengthening STD/HIV Control Project
Appendix 4. Implementing Partner Organizations
From Behavior Change Communication to Strategic Behavioral Communication 
31