groundBREAKERS harness youth leaders against HIV
By Scott Burnett 
About loveLife and groundBREAKERS
loveLife is a South African HIV prevention campaign that targets and is implemented by young people. It aims to bring about a fundamental shift in the sexual behaviour of 12- to 17-year-olds, thus halving the HIV infection rate for that group. Its main initiative is its outreach campaign, which consists of counselling by 18- to 25-year-old volunteers who sign up for youth leadership programmes.
These volunteers are called ‘mpintshis’ – or ‘friends’ to young people. loveLife mpintshis operate in 638 communities around SA, and are active in almost 3,000 schools. Top mpintshis are selected to become groundBREAKERS.
“groundBREAKER” is the name loveLife has given to service participants that lead the volunteer teams. It is a service model that has evolved over the past eight years. As a brand-driven campaign centred on the values of love, dignity, respect, shared responsibility and healthy sexuality, participants are orientated around the idea of providing leadership for a ”LOVE LIFE” generation. Healthy self-interest, self-motivation, and self-esteem are key elements of the programme.
Can a youth service programme, based in the community, help counter the spread of HIV and AIDS?
groundBREAKERS is a South African youth service programme that aims to motivate young people, develop their leadership skills and promote discussion about HIV and AIDS with friends and family. The results? Much safer self-reported sexual behaviour, a higher likelihood of testing for HIV, and a strong association with lower chance of HIV infection.
Below is a summary of a longer paper written by Scott Burnett. For the full paper, click here.
Identifying leadership – the start-up phase
Volunteers had been a part of loveLife since the first youth centres were launched in 2000. Initially, volunteers were peer educators who were paid a salary and volunteers who received some branded clothing.
In 2001 the groundBREAKER programme was implemented. Its aims were to reward and sustain (with a small stipend), brand (with loveLife gear), and train (with programme-specific training) the existing volunteers. Potential groundBREAKERS had to have been successful and committed unpaid volunteers before they could enter the more formal programme.
The principle that participation in a structured service programme is contingent on proven, unblemished community voluntarism is the key to the success of the groundBREAKER programme. It has spurred loveLife’s rapid expansion. loveLife franchises - community-based organisations that choose to partner with loveLife – reached 126 communities by 2003 and by the end of 2007 there will be 18 loveLife Y-Centres throughout the country.
A partnership with the National Department of Health, the National Adolescent Friendly Clinic Initiative (NAFCI), increased from about 30 public clinics in 2002 to 350 in 2005. The same year saw a new programmatic drive in partnership with the National Department of Social Development. loveLife was rolled out to 250 new communities through what was called the loveLife Outlet model, a structured partnership with schools, clinics, and community-based organisations in marginalised communities across the country.
Figure 1: groundBREAKER recruitment per annum, 2001-2006
Over the past three years, loveLife has recruited over 18 000 service participants. After groundBREAKERS have been appointed and trained, their first task is to form a team to implement the programme. These 18 to 25-year-olds are referred to as `mpintshis’. Each groundBREAKER works with an average of five mpintshis.
Mpintshis do not receive a stipend and their commitment is rewarded only with a training package, some transport money and loveLife-branded clothing.
Programmes and services
The loveLifestyle programme is designed to structure the interaction between service participants and beneficiaries. Eighteen- to twenty-five-year-old groundBREAKERS and mpintshis interact with twelve- to seventeen-year-old young people, using the following tools:
- Guide 2 ACTION 2010: A personal development programme consisting of 24 modules on 12 themes. It includes activities and projects.
- Motivation: A facilitated programme about goals, values, and choices.
- Body Ys: Fitness promotion, health and sports programmes, sexuality education, gender rights, treatment literacy and access to health services.
- Creative problem-solving: includes modular and competitive components.
- Debating: Promotes interaction, addresses stereotypes and life issues.
- Cyber Ys: Computer training that integrates with healthy sexuality for its content; facilitated in computer laboratories.
- Radio Ys: Training in broadcasting.
Outreach and events
- loveLife Games: a sports competition that creates the incentive for on-site participation in activity-based programmes.
- Youth Festivals: The local competitive platform for activity-based programmes; provides the “feeder-system” for the loveLife Games.
- “Face it” sessions: Implementers discuss and present topical issues.
- BORN FREE Dialogues: Parents and children debate issues that affect their lives, their relationships and their futures. Early and honest discussion about sex and relationships contributes to healthy sexual behaviour.
The three levels of support for groundBREAKERS and mpintshis
loveLife’s national training team aligns programme content and training methodology with loveLife’s behaviour-change communication model, relevant unit standards and programmatic needs, as well as implementing the training of trainers. This team is located at loveLife’s national office in Sandton, Johannesburg.
Provinces have either one or two provincial trainers who are responsible for training trainers, quality assurance at training events, and monitoring programmes.
loveLife has a training infrastructure of 23 regional offices, each with a Regional Training Leader and two Regional Trainers. This team moves from site to site, doing training, problem-solving and quality assurance.
Line managers are generally employed by the partner organisation on-site rather than by loveLife. If groundBREAKERS are situated at a clinic, then the clinic manager will often double as a Line Manager. The Line Manager ensures that the groundBREAKER complies with the basic contractual requirements, including signing a daily register, abiding by the code of conduct and following HR procedures.
Area co-ordinators are top-performing ex-groundBREAKERS recruited by regional teams to serve for a year or longer as a groundBREAKER mentor.
Area co-ordinators are programme and personal development experts who stay on to help their area (usually four to five sites) in the key performance areas outlined below.
Tools for managing groundBREAKERS and mpintshis
All five of the groundBREAKER and mpintshi key performance areas (KPAs) are intended to increase outreach to the community, primarily through schools, enabling increased interaction with young people.
KPA #1: Represent and market loveLife in local communities.
KPA #2: Recruit, lead and co-ordinate a team of young people to implement loveLifestyle programmes.
KPA #3: Uphold the loveLife brand.
KPA #4: Drive the local HIV prevention campaign, organise local events and drive community-based HIV projects.
KPA #5: Drive personal development.
International evidence has shown that behaviour change is arduous and incremental, requiring sustained efforts of sufficient scale and intensity. Also, measurement of change is difficult and open to variable interpretation. Assessment of the effect of a national programme is even more difficult, as control sites are likely to be contaminated by pervasive media components and spill-over of programme elements. Randomised control trials are not practicable and assessment of impact is probably best demonstrated by monitoring trends and associations between HIV, sexual behaviour and programme exposure over time, through repeated cross-sectional surveillance. [2,3]
In 2003 the first nationally representative household survey of close to 12,000 youths, aged 15-24 years, found significantly lower HIV rates among those who have participated in loveLife’s services [Table 1]. 
Males 15-24 yrs
AOR (95% CI)*
|Females 15-24 yrs
AOR (95% CI)*
Adjusted for completed high school or not, race, age, urban/rural residence, marriage, electricity in the home, awareness of two different national HIV prevention campaigns, participation in youth groups in past month, knowing someone who died of AIDS, and testing for HIV.
Source: Pettifor et al AIDS 2005 19:1525-1534
Table 1: Adjusted Odds Ratios (AOR), 95% Confidence Intervals (CI) and associated
p-values for HIV infection associated with participation in loveLife programmes vs not having participated
While there is no direct (causal) evidence to link declines in new infection rates among teenagers to loveLife’s intervention, those exposed to loveLife’s programmes report greater self-motivation, more discussion about HIV and AIDS with friends and family, a higher likelihood of testing for HIV and higher levels of condom use.
After adjusting for possible confounding factors such as age, education, and exposure to other prevention campaigns , sexually experienced youth who had participated in at least one loveLife programme were significantly less likely to be infected with HIV, in contrast with youth who had not done so.
Although these findings are encouraging, results should be interpreted with caution. The implications of the study are that loveLife needs to sustain the media campaign that drives demand for service components. At the same time, it should sustain face-to-face engagement with enough young people to have realistic prospects for behaviour change.
 Scott Burnett is the Head of Youth Leadership Development at loveLife.
 Global Consultation held in Talloires, France 25-28 May 2004 (http://www.who.int/child-adolescent-health/publications)
 World Health Organisation (2005) Guide to indicators for Monitoring and Evaluating National HIV/AIDS Prevention Programmes for Young People. www.who.int/hiv/pub/me/youngpeople/en/index.html
 Pettifor A, Rees H, Kleinschmidt I, Steffenson A, MacPhail C, Hlongwa-Madikizela L, Vermaak, Padian N. Young people’s sexual health in South Africa: HIV prevalence and sexual behaviours from a nationally representative household survey. AIDS 2005, 19:1525-1534