India has long had a history of education through entertainment. In the old days, when there were no newspapers, theatre groups or singers would go from village to village entertaining the people, but also carrying news from other parts. Today, India is home to the largest film industry in the world, producing more films each year than Hollywood. As the HIV/AIDS epidemic escalates in the state of Tamilnadu (population 63 million) in Southern India, a Chennai-based NGO called Nalamdana has undertaken the challenge to tap into this public thirst for popular entertainment and use it to raise awareness on HIV/AIDS. 

One of Nalamdana's productions, a one-hour TV film in Tamil – Pesu Maname Pesu ("Speak, O My Heart, Speak") – addresses the lack of choice many women have in arranged marriages. While arranged marriages themselves are not the problem, the overwhelming social pressure to enter into a marriage without the woman or even the family insisting on a background check or HIV test for the prospective groom (and even bride) is a problem. These marriages of blind faith are only one of the problems that can lead to HIV transmission in India's complex societies, where traditional practices and sexual conservatism co-exist with covert promiscuity and HIV. The story of Karpagam represents the stories of many Indian women. Nalamdana told this story through a TV film and gave it multiple endings. The viewers were to choose the one that moved them most and write in. There was a flood of responses and the debate sparked by the movie was exactly the intended effect. A week later, this film was followed up with a one-hour discussion with a prominent doctor. She answered frequently asked questions about HIV/AIDS and addressed issues that arose from the film.

"Karpagam is an attractive young woman whose marriage has been arranged to Kumaresan, the son of the village headman. Her family is elated because they are poor and to find a match for their daughter who is so much above their station is an honour and a stroke of luck beyond their dreams. Karpagam, however, is a bit concerned since Kumaresan has a reputation as something of a womaniser. Her family assures her that he will change once they are married. The marriage goes through and a year later when she is pregnant and goes to the clinic for some tests, the doctor, dismayed to find she is pregnant, tells her that her husband, Kumaresan is HIV-positive. This had come to light after a prolonged illness when Kumaresan underwent some tests. The doctor told Kumaresan's family, who had hidden the fact even from Kumaresan, so that he could get married and produce the heir they so desired. The doctor breached confidentiality by telling the parents and assuming they would tell Kumaresan. The parents didn't know that HIV could be transmitted from Kumaresan to his wife and then to the unborn child. The story highlights some of the realities that exist and puts up the issues for discussion.

Nalamdana, which means "Are you well?" in Tamil, was founded in 1993 with the sole purpose of using entertainment to address public health issues. Nalamdana's beginnings were in community theatre and the first one the team undertook was in one of the urban slums in Chennai, the state capital. The team's anxiety about attendance was quickly dismissed when a crowd of nearly 2000 people assembled to watch the show. The entertaining and gripping story had the audience rapt for the two-hour duration. At the end there was so much discussion, arguing and questions from the crowd that the team decided to come back the next day and do a follow up. This method of intervention and follow up has since been the main mode of Nalamdana's interventions.

Why drama?

HIV/AIDS is a sensitive topic. Not only does it have some stigma attached to it, the issue of sex that is associated with it is also a taboo topic for discussion in Indian society. People hate being lectured to, being the subject of such a sensitive discussion. In a drama, the story is about people like those in the audience (so they identify with them and empathise) and the plot is compelling enough to engage the viewer. The issue of HIV is handled sensitively and not in a way that would offend the cultural sensitivities of the audience. For example, even children are allowed to continue to watch the plays after the audience realises it is about HIV/AIDS. Yet, all the information is there and nothing is hidden. 

Built on the theories of strategic behaviour change communication, Nalamdana's interventions include street theatre, pop music, television films and a range of other communication products. The messages and the medium are carefully designed and extensively pre-tested among the intended audience. Nalamdana works closely with the State government, other NGOs and international organisations to further awareness of the socio-cultural issues that surround HIV/AIDS.
Nalamdana conducts pre- and post-intervention interviews with the audience and measures knowledge and attitude change. A study conducted in 1998 before and immediately after the intervention (street drama performances in HIV/AIDS) showed that overall, the proportion of correct knowledge responses increased from 71% to 97%. Accurate knowledge increased from 89% to 99% and knowledge concerning HIV/AIDS misconceptions increased from 54% to 95%. All results are statistically significant.

Next steps

One important lesson Nalamdana has learned in its eight years of work, is that you have to give audiences high-quality entertainment, even if it has got social messages, because we are competing with other forms of popular entertainment out there. If we want people to spend their time watching Nalamdana's play or TV film instead of something else, Nalamdana's work has to be as good, or even better than competing TV programmes. This is why Nalamdana's interventions are popular. Therefore, in the future, Nalamdana aims to use multiple media channels to reinforce similar messages. TV, radio and print used in conjunction in a very media-exposed environment, could yield the expected results. Also, Nalamdana realises the need to work more closely with existing government programmes and this requires some thoughtful and strategic advocacy.