A mobile phone-based health programme designed to improve access to sexual health information and boost safe sex in rural central Uganda had the opposite effect, according to the findings of a Yale University study published in May.
The programme, designed by Google and the Grameen Foundation's AppLab and provided free of charge by mobile phone firm MTN, allowed users in 60 central Ugandan villages to text questions on sexual and reproductive health to a server and receive pre-prepared responses from a database.
"Quantitative survey results allow us to reject the hypothesis that improving access to information would increase knowledge and shift behaviour to less risky sexual activities. In fact, we find that the service led to an increase in promiscuity and no shift in perception of norms," says the study, a partnership between Yale University, NGO Innovations for Poverty Action, Google, the Grameen Foundation and the Uganda National Council of Science and Technology.
"We find no increase in health knowledge regarding HIV transmission or contraception methods and no change in attitudes. Rather than seeing reductions in risky sexual behaviour, we actually find higher incidence of risky sexual behaviour and more infidelity, although more abstinence as well.”
The assumption was that access to HIV knowledge changes attitudes towards safer sexual practices, but the study found that the platform instead increased infidelity from 12 to 27 percent among participants.
Possible reasons for the unexpected results include the fact that participants did not use the service in a sustained manner after the initial marketing period; many complained that the quality of the search algorithm in the local Luganda language was unsatisfactory; and the service sometimes returned inappropriate answers. In addition, respondents said they had no funds to get tested and seek treatment for sexually transmitted diseases, which hampered their ability to act on advice the service provided.
Some women complained that they found it hard to stand up to their husbands, and those who demanded safe practices such as condom use or HIV testing were often denied sex - and refusal to have sex with a spouse on the basis of information from the service sometimes led men to have extra-marital affairs. "Once he wants sex, he means it, yet the woman is dodging him around [because she became aware of the risks], so he decides to get another one to satisfy his desires," said one study participant.
"The findings of the study suggest that we should think very carefully about the impact of new information-based interventions and test them carefully... As the study shows, results can be unexpected and interventions should be carefully vetted," Pia Rafller, one of the authors of the report at Yale University's department of political science and a partner of Innovations for Poverty in Action, told IRIN via email.
"The findings do show that the reality is more complicated than at times we like to think, that information can have a different impact on different types of people, and that information-based campaigns need to be very carefully designed and tested in order to yield the desired effects," she added.
She noted that the net effect of the intervention was not necessarily negative, pointing to results that showed an increase in abstinence and an improved ability by participants to assess their level of risk.
A number of studies have found that improved knowledge is linked with safer sexual practices, but some researchers have found that better HIV-related knowledge does not always lead to safer sexual practices.
"I don't think the findings suggest we should abandon such campaigns in the future. They suggest we need to design and test them carefully and that there can be positive and negative effects for different people at the same time," Raffler said.