The Karate Kids AIDS education project was famous in development circles, because it defied the conventional wisdom with its explicit sexual information for children, including the f- word. It was also famous because it went on to be translated into about 30 languages, and the video was distributed at street level all over the world. Produced in 1990, it is still in use today. I was a co-producer and Managing Director of the project, which included language versions, as well as editing and publishing books and comics with partners in many countries.
Karate Kids: Reaching The Unreached
Project Description 2
Health Promotion on Video 4
The Need for AIDS Health Education 5
Target Audience: Street Youth 7
Identifying a Common Culture 8
Children and AIDS 8
Adolescence, Street Life and High Risk Behavior 9
Risk Reduction and Condom Use 10
Strategy for a Hard-To-Reach Audience 11
Self-Confidence and Condom Use 13
Karate Kids and Family Planning 15
Critical Reactions 16
International Distribution to Community-Based Groups 18
Preliminary Evaluation of Impact 19
Future Monitoring and Evaluation 20
A – selected letters from the field
B – AHRTAG AIDS action street kids issue, August 1990
C – Childhope Fact Sheet on Street Children and HIV/AIDS, 1989
D – WHO Factfile November 1990
E – International Partners
Karate Kids: Reaching the Unreached
By Christopher Lowry, Managing Director, The Survivors Project,
Street Kids International
and Mark Connolly, M.P.H., Programme Consultant, Street Kids International
The Survivors Project is a cross-cultural AIDS health education programme featuring the adventure cartoon, Karate Kids. It is an international effort to educate and enhance the self-esteem of poor, out-of-school children and adolescents — street kids. The cartoon was co-produced by Street Kids International and the National Film Board of Canada and designed in consultation with street youth and educators in Nairobi, Manila, Colombo, Rio de Janeiro, Toronto and New York, with the technical assistance of the World Health Organization Global Programme on AIDS (WHO GPA) and the AIDS Unit of International Planned Parenthood Federation (IPPF) as well as a wide range of international health education and communications experts. The Karate Kids materials are designed to provoke discussion about sexual health issues including AIDS, sexually transmitted diseases (STD), and sexual exploitation of children and adolescents by adults. The Karate Kids animated cartoon, comic book, and training book are targetted at100 million street children.
The cartoon is intended as a discussion trigger video, and the training book, What We Need To Know About AIDS, can be used to train educators to answer the questions that the cartoon will provoke in young audiences. Karate Kids is a tool that is most effective in the hands of educators who are able and willing to talk about health, sexuality, and AIDS. The cartoon is designed to promote all three main aspects of adolescent sexual health: control of STD including HIV, family planning (specifically condom use), and the prevention of sexual abuse through awareness, peer loyalty and self-respect.
The primary “market” for the Karate Kids materials is poor, community-based outreach projects and street educators who often cannot afford to pay for the health education materials that they desperately need. Their work involves support and empowerment of poor children and youth in the slums and shanty towns of the world’s largest cities. The goal of the project is to achieve distribution of the materials to community-based groups all over the world.
The Survivors project was born in Sudan, where years of adversity have driven hundreds of children to the capital city of Khartoum in search of food, shelter, and work. From 1986 to 1987, Peter Dalglish, Executive Director of Street Kids International, worked with street children in Khartoum as Director of the Emergency Unit for UNICEF. Working with a local street outreach organization, he learned that the most common medical problems among street children in Khartoum, second only to cuts and bruises, were STD. It was clear that HIV/AIDS was a potential problem for the street children and adolescents in Khartoum, and for millions of street children at risk all over the world.
In January 1987 Dalglish borrowed an old Tom and Jerry cartoon from the American Embassy in Khartoum, Sudan and showed it to a group of street children. The children were fascinated by the images of mice being chased by cats, and they rushed back to the streets that day to tell all their friends what they had seen.
A simple idea was born: why not produce an animated film designed to teach street children about AIDS. Unlike most health promotion materials, the cartoon would be very entertaining — something that the children would want to see over and over again.
Dalglish returned to Canada and founded Street Kids International, a Canadian non-profit organization working to promote independence and self-respect among street children around the world. In consultation with international groups working with children, he conducted an informal survey to find out who are the most popular heroes among the world’s street children. Number one on the list in 1987 was Rambo, and number two was Ronald Reagan. Number three was Bruce Lee, whose karate movies are imitated with equal passion by kids in the streets of Bangkok, Lagos, and Rio de Janeiro. Bruce Lee was selected as the model for the hero of a karate adventure cartoon.
In 1988 Street Kids International and the National Film Board of Canada began work on Karate Kids in Toronto. The Director, Academy Award winner Derek Lamb, assembled a team which included some of the world’s best animators. In addition to Dalglish’s experience in Africa, the film makers researched the story among the street children of Mexico City and Guatemala City. Children’s preferences with respect to cartoons have been well documented over the years, and the style of the animation is based on this research (Dalglish & Scott, 1988). The animation in Karate Kids is simple, direct, and colourful, and the characters are energetic, humorous and likeable.
A prototype film was created and pretested in Nairobi, Colombo, Manila, Rio de Janeiro, New York City and Toronto. The cartoon was presented to groups of kids by street educators in community-based projects. In group discussions, the children were asked thirteen basic questions about what they had learned from the cartoon. In every showing in the developing world the children enjoyed it as an adventure story reflecting their own lives, and their own values. The test cartoon consistently provoked laughter and excitement, and the children had many suggestions about how to improve the story. They wanted the female characters to be stronger; they needed clearer information about the passage of time between HIV infection and symptoms of AIDS; they said that the children should be barefoot, because many street kids don’t have shoes; they were frustrated that the villain did not die; and they wanted more information about condoms (Dalglish & Scott, 1988). Over the next twelve months, the story changed and expanded based on the suggestions of children, educators, and health authorities in many countries.
Final production began in October 1988, and the cartoon and comic book were premiered in English at the Second International Symposium on AIDS Education and Information in Yaoundé, Cameroon in October 1989. Additional funds were raised to publish the Karate Kids training book, written by Mark Connolly and David Werner. Since September of 1990 the cartoon, book, and comic book have been available in English, Spanish, and French, and the cartoon is presently available in 10 language versions.
Health Promotion on Video
The international popularity of the videocassette player (VCR) has made this project possible. Whereas film projectors are awkward and tend to be confined to institutions, the video player is portable, easy to use, and accessible to street workers in virtually every urban center in the world. Although few street outreach programs own VCRs, they can borrow or rent them when they want them. As one project director in Rio de Janeiro told Peter Dalglish, “I have 400 street kids in this program. If I tell them that we need a video player to watch a cartoon, don’t worry, someone will find one for me somewhere.”
The power of film, videotape, and television to educate has been widely documented. Well crafted audio-visual materials are emotionally engaging, and an engaged audience is ready to learn (Population Reports, December 1989). In order to capture the viewer’s imagination, a programme must do more than present information in an amusing context; it must tell a story. Storytelling functions in most cultural traditions as the primary means of transferring values and knowledge from one generation to another.
Karate Kids draws on the techniques and integrity of this universal human tradition. The storyteller/narrator in the Karate Kids cartoon uses humour, excitement, and sympathetic characters, the basic tools of storytelling, to engage the audience.
The Need For AIDS Health Education
The World Health Organization Global Programme on AIDS estimates that today between 8 million and 10 million people worldwide are infected with HIV. WHO estimates that since the start of the epidemic, over 1.3 million cases of AIDS have occurred worldwide, of which more than 300,000 are women. WHO projects that by the year 2000 as many as 20 million adults and 10 million infants and children will be infected. About half of the HIV infected people in the world are in sub-Saharan Africa, and new infections are increasing at an alarming rate, particularly in cities, throughout the developing world (WHO “In Point of Fact”, November 1990). In the United States, AIDS is most prevalent in urban minority areas, and the prevalence of the disease among the blacks and Hispanic communities is more than double that for white Americans. Researchers and community leaders alike look for effective preventive measures and counselling techniques in order to better educate people about how AIDS is transmitted, and how to protect themselves from infection (Fineberg, 1988).
In the event that a vaccine is developed with the potential to be available at low cost all over the world, we must not relax our efforts in the field of AIDS health education. It is the common hope of scientists, legislators, and people on the streets that a vaccine or a cure for AIDS will reduce the need for AIDS health promotion campaigns. The challenge of modifying sexual behavior on a global scale provokes both moral and economic objections. Sexual behavior is notoriously difficult to modify. Attempts to do so are bound to be controversial, expensive, and difficult to evaluate. A Canadian ecologist has wryly observed that “even people who recognize that AIDS is not a homosexual disease but is a biological problem of general concern often believe the battle can be won by medical technology. But a new vaccine alone will not end an epidemic. In spite of treatments for diseases such as malaria and vaccines for influenza, epidemics of these diseases regularly kill millions.” (Forsyth, 1987)
We have yet to discover vaccines for old, familiar sexually transmitted diseases such as gonorrhea and syphillis (Bandura, 1989). Even if it becomes possible to supply a magic bullet to immunize everyone in the world from HIV, the disenfranchised of the world will have to demand their share in the magic. We have a simple cure for hunger, yet millions continue to starve. As the burden of AIDS is now borne most heavily by the urban poor, access to AIDS health education, condoms, and the means to avoid intravenous transmission has become a social justice issue. “AIDS provides a unique and unprecedented opportunity to fight discrimination, to speak more openly about sexuality and to strengthen educational programmes for all. As a result of AIDS, in many societies, teaching and dialogue about sexuality has been permitted for the first time.” (Mann, 1989)
As we struggle with AIDS, the populations of cities in the developing world are surging. Urbanization is the most powerful force in Africa today. In Morrocco 12% of the national population now live in shanty towns. In Asia and Latin American the situation is much the same. By the end of the century Mexico City will have a population of 26 million people (Agnelli, 1986). By the year 2000, 77 percent of youth ages 15 to 24 in Latin America will live in cities (International Clearinghouse on Adolescent Fertility, 1989).
Regional AIDS experts in Africa now admit that in some population centers in east and central Africa, 30% of the adult population is infected with the virus (Toronto Star, “AIDS Update”, April 14, 1990). In Asia, in centers of sex tourism and the drug trade such as Bangkok and Manila, the rate of HIV infection on the streets is also rapidly increasing.
AIDS is becoming a disease of the urban poor, and disadvantaged adolesents are particularly vulnerable. The current rate of HIV infection among Brazilian street children is up to at least 8.9%, according to one Brazilian study (FEBEM São Paolo, 1989). HIV is spreading rapidly among Thailand’s estimated 100,000 injecting drug users; testing among some groups of Thai drug users in mid-1990 found that nearly 50% were HIV positive (Chin, 1990).
The grim reality is that most of the young adults who will develop AIDS over the next 5 to10 years have already been infected as adolescents. There is a growing awareness among policymakers in sub-Saharan Africa that now is the time to address AIDS health education to children and adolescents. If children have reached their fifth birthday, it is likely that they have not acquired the disease from their parents, and probably have not been infected by any other means. The pandemic is pushing back the thresholds of tolerance, and sex education has become a matter of survival. In many countries the debate about the propriety of educational messages to prevent HIV/AIDS continues, but it is encouraging to note that the Karate Kids materials are now being used in the developing world by a variety of groups, including both Catholic missionaries and Moslem doctors. Apparently they have decided that it is important to save lives while upholding the values of monogamy and abstinence.
Target Audience: Street Youth
One hundred million street children and working children worldwide live on the outermost fringes of human society (United Nations, 1986). This population is defined as children and youth between the ages of 5 and 18 who live, work, and sometimes sleep in the streets. They are often the lowest underclass of the urban poor. Few have access to education or health care; most survive by scavenging, begging, stealing and occasional employment.
The Karate Kids programme provides sexual health education for marginalized audiences. The most receptive viewers of Karate Kids are poor, non-white children and adolescents with little or no formal education.
Their mother tongue may not be the dominant language of literacy in the streets where they are fighting to survive. While the target audience for this project is out-of-school youth, the cartoon has been used effectively with community groups that include both adults and children. The cartoon and print materials are also used by people working with illiterate adults, as well as government agencies including ministries of health, education, youth and social welfare.
The cartoon has also been shown to “general audiences” on television, and this powerful medium has exposed tens of thousands of people to Karate Kids outside of discussion groups. Some TV presentations in Canada and the Dominican Republic have included interviews and commentary showing only selected clips of the film. When broadcasters acquire the rights to the programme, the producers strongly recommend that Karate Kids be shown in the context of educational activities with trained community health workers.
Identifying a Common Culture
It is widely accepted that HIV/AIDS risk-reduction campaigns need to be tailored to socioeconomic, racial and ethnic differences in value orientations (Bandura, 1989; Shafer, 1988). Karate Kids takes this understanding a step further. Research for the storyboard revealed common elements in the lives of poor urban children all over the world. In producing health education materials we need to be sensitive to racial and ethnic differences in values. However, once a focus on a specific socioeconomic target group has been determined, such as poor urban youth, we can identify risk behavior, as well as values and pleasures, that are shared by poor urban youth throughout the developing world. Economic marginalization, the formation of youth gangs in the face of family breakdowns and the socioeconomic dysfunction of slum life, mistrust of authorities, and the basic human values of friendship, courage, ingenuity and self-respect are key aspects of the ‘common culture’ of the children and adolescents depicted in Karate Kids. This common experience is attested to by the street children themselves, and the success of the cartoon in capturing the spirit of this commonality is clearly indicated by the responses given to the final question during the pretest of the Storyboard for the cartoon. Children in Rio de Janeiro, Manila, Nairobi, and Colombo were asked the question, “Where does the cartoon take place?” They all answered that it was a marketplace in their own city. (Dalglish & Scott, 1988). It is encouraging to note that in field test screening of Karate Kids, youths often call each other by the names of the characters in the cartoon, identifying closely with Karate and his friends.
Children and AIDS
When we think of children and AIDS, the media tends to direct our attention to the ‘innocent victims’ — children who are infected at birth or from an infected blood transfusion. While the incidence of perinatal transmission of HIV is increasing rapidly, we should recognize that this issue can be used to distract our attention from the difficult subject of adolescent sexuality. Part of the difficulty is that people often refer to adolescents as children, and the terms “street kids” and “street children” are used to decribe both the five year old scavenger in the Guatemala City dump and the seventeen year old hustler on Sunset Strip in Hollywood, California. In fact, both of these individuals may be sexually active, but only one of them is technically a child.
Before he confronted AIDS, C. Everett Koop, the former Surgeon General of the United States, had quite conservative views on sex education. As he learned more about the nature of AIDS, he reversed the attitudes that had helped to get him appointed under Ronald Reagan. He proposed that AIDS health education should begin in kindergarten. Why? Dr. Koop became aware that adolescent hormones are more powerful than the fear of punishment or even death.
Sexual exploitation and of children and adolescents by adults is a universal human problem, and it is even accepted to some degree in some cultures. In addition to the problem of sexual abuse, they are often forced into prostitution by poverty and/or dysfunctinal families. For millions of the world’s youth, the message “just say no” is a joke, and for those who have no choice, it is an insult.
Adolescence, Street Life and High Risk Behavior
Adolescents are particularly vulnerable to HIV infection and particularly resistant to prevention efforts. While experimentation is essential to adolescent development, sexual activity and drug use are all too often the arenas of experimentation in many cultures (Garrity, 1989). A recent study of adolescent sexual experience in Latin America found that from 12 to 26 percent of 15-19 year old girls and from 43 to 73 percent of 15-19 year old boys reported premarital sexual experience. About one-fourth (26-27 percent) of sexually experienced males in Mexico City and Santiago, 31 to 45 percent in other Latin American cities and countries and 72 percent in Jamaica report their first sexual experience before age 15. In Jamaica, 30 percent of females report having their first premarital intercourse before the age of 15 (Morris, 1989). A survey of unmarried youth aged 14 to 25 in Ibadan, Nigeria shows that half the girls and nearly four-fifths of the boys have had sexual relations by the time they are 18 years old . A 1984 study of unmarried youth aged 14 to 21 in Monrovia, Liberia found that 69 percent of the females and 82 percent of the males have had premarital sex. Available data from clinics and surveys demonstrate a high incidence of STDs among adolescents in many African countries (Gyepi-Garbrah, 1985).
HIV infection worldwide is most prevalent in the 20 to 40 year old age group. 20 percent of people with AIDS worldwide are in their 20s (WHO, 1989). Because the virus incubates in the body for up to10 years, many of these people may have been infected with the virus when they were teenagers. This disturbing trend is likely to continue (International Clearinghouse on Adolescent Fertility, 1987).
Street children are by nature survivors; adversity has taught them how to cope with a hostile environment, and how to get by with very little. The challenge for organizations working with street children is to build on their ingenuity and resourcefulness so that they will leave the streets.
Beyond the basic fact that adolescents lead risky lives, the behavior of street children and adolescents puts them at particularly high risk of HIV infection. Poverty is the enemy of innocence, and poor children are desperate children. In Brazil, for example, where there are more street children per capita than in any other country, sexual promiscuity is taken for granted by street kids. Theirs is a violent universe where physical force prevails (Oliveira, 1989). Poor children and adolescents may engage in unprotected sex with multiple partners out of economic necessity (survival sex), in the peer group (comfort sex), and in the shanty-town community (child and adolescent sexual abuse). Street children will sometimes do anything to survive, and for many of them selling their bodies is the only way to ensure that they have a full stomach at the end of the day. They turn to prostitution not by choice, but out of economic necessity. While intravenous drug use is less common among street youth in the developing world than in the developed world, other forms of blood-to-blood transmission such as mutual tattooing are more common all over the world. Use of drugs such as marijuana and alchohol, as well as glue and gasoline sniffing, are widespread among street youth. Drugsimpair judgement and significantly reduce a person’s ability to practice safe sex. “When a kid is high, concern over safety is low.” (Larkin Street Youth Center, 1990)
Risk Reduction and Condom Use
The risk of becoming infected with AIDS, like many health risks, is associated with behavior. Furthermore, the risk behaviors associated with HIV infection may also expose the individual to other health risks including STD. Population groups that are at high risk for sexual transmission of HIV are in most cases also at risk for STD, and infection with other STD increases the risk of HIV transmission (Paalman, 1990).
WHO now estimates that by the year 2000, 75-80% of all HIV infections will be transmitted by heterosexual intercourse (WHO “In Point of Fact”, November 1990). The balance of HIV infections are transmitted by other forms of unprotected sexual activity, unclean intravenous injections, and by passive infection through contaminated medical procedures and perinatal transmission. While there is a need for many culturally specific medical and humanitarian messages about HIV/AIDS, there is a great ongoing need for materials and campaigns that focus on how to avoid the sexual transmission of HIV/AIDS. Since the HIV/AIDS pandemic shows no signs of levelling off, this urgent need is not likely to diminish in the near future.
In order to achieve a significant reduction in the spread of HIV/AIDS, sexually active people all over the world must reduce the risk of infection through proper use of the only barrier method known to prevent the transmission of HIV during sex — the condom. The lack of popularity of the condom in most cultures and communities makes condom promotion one of the greatest public health challenges of our age. It is extremely difficult to modify habitual behavior in adults, especially in the highly sensitive realm of sex. It is more likely that we will significantly effect the level of condom use in a population if we can reach children and adolescents before they become sexually active and before they have developed prejudices against condom use.
A great strength of the Karate Kids package is that it allows for flexible use by educators, by providing the opportunity to discuss other aspects of street survival and values. It is useful even if condoms are not readily available, because it is not just about AIDS and condoms — it is about sexual health and the human values of empowerment, self-respect, and independence. This is very important, because in some communities there may be chronic shortages of fresh, inexpensive condoms. Aside from the moral objections that are often raised against condoms by both Christian and Moslem officials, it has also been argued that condom promotion fosters dependency on a sophisticated product supplied unreliably by the agencies of developed nations. At present, condom supply is considered to be extremely difficult in some communities due to chronic problems with supply, storage, distribution, and resistance by dominant authorities.
Strategy for a Hard-to-Reach Audience
Street children are a difficult audience to reach. They rarely belong to traditional organizations, clubs or teams. Knowing that society has turned its back on them, they become part of the urban underworld, making their own rules, speaking their own language, and creating their own heroes.They resent most authority figures, including policemen, soldiers, politicians and teachers. Years of indifference and neglect on the part of families and institutions have destroyed their self-respect. Dreams of glory have been replaced by the constant struggle to fend off hunger, and to have a warm place to sleep at the end of the day. The fear of death does not move them because their world has become cold and faceless (Dalglish & Scott, 1988).
One of the biggest problems in preventing HIV/AIDS is how to reduce risk behavior among populations that are resistant to conventional messages and traditional public health campaigns. Harvey Fineberg, Dean of the Harvard School of Public Health, has identified various obstacles to effective AIDS education. “Sexual practices and drug use are biologically based, socially complex behaviors. Both derive from biological impulses that are hard to resist.” (Fineberg, 1988) Moreover, to avoid infection over the long-term requires extreme changes in risk-taking behavior. Albert Bandura of Stanford University has observed that information alone is inadequate. He proposes that the most effective health promotion will both inform and empower people to exercise influence over their own motivation and behavior (Bandura, 1989). What is required is a shift of emphasis from trying to simply scare people into healthy behavior, as in the “Grim Reaper” style of AIDS health education favoured in many countries during the 1980s, to “empowering them with the tools for exercising personal control over their health habits… Detailed factual information about AIDS must be socially imparted in an understandable, credible, and persuasive manner.” (Bandura, 1989) While, as Fineberg points out, individual long-term protection from infection requires rather extreme behavior changes, agencies concerned with public health have no other choice but to accept this challenge.
The Karate Kids materials have been designed to influence the sexual behavior of a particularly hard-to-reach group. In a non-judgemental “voice”, with empathy and compassion, the project addresses people who are involved in high risk activities. In the context of a karate adventure story, the cartoon teaches children what HIV/AIDS is, how it is sexually transmitted, and how infection can be prevented. It suggests that they can protect themselves from AIDS, that they should be loyal to their friends, and that their lives have value. It offers the example of street performance as a viable alternative to sex work and picking pockets. Karate Kids can be used to take advantage of the unique opportunity presented by the transition toward sexual activity (“sexual debut”) during adolescence (Schafer, 1988). It is a social development programme intended to reduce the level of risk behavior in target populations by reaching children and adolescents before or during the time when they become sexually active, before they have developed any deep prejudice against condoms, and before they have developed the high-risk sex and drug habits that will expose them to HIV.
Adolescents around the world share a sense of invulnerability to disease, and it is very difficult for them to accept any link between immediate gratification and the possibility of sickness in the distant future. On the other hand, many street children feel that they will die violently before they become adults. In Guatemala, Brazil, and Colombia street children are assasinated by extrajudicial forces know as “death squads”. The risk perception of street youth may be complicated by both the natural adolescent feeling of immortality and a profound fatalism based on experience.In general, people tend to make their assessments of risk based on potentially misleading social and physical appearances (Bandura, 1989). The Karate Kids cartoon directly addresses this problem of risk perception in the first argument between Karate and Mario.
Mario: “Why did you do that?”
Karate: “Because that man wanted to fuck you, and maybe you would get sick with AIDS.”
Mario: But how do you know that man has AIDS?”
Karate: There is no way to know. Some people carry AIDS inside their bodies for many years before they start to look sick.”
Mario: “Aw, I won’t get AIDS!”
Karate: “Yes you can! Anyone can get AIDS!”
Street youth have less fear of death than other kids, but they are extremely apprehensive about sickness. In the ethic of the street, weakness caused by illness can often result in abuse and abandonment. The idea of being disfigured by lesions and sores, weakened and dirty from chronic dysentery is far more disturbing to a street youth than the prospect of an early death. The cartoon appeals to this anxiety but at the same time counsels the audience to be kind to people with AIDS. Mario’s friends feed and care for him until he dies, following Karate’s counsel that “he is our friend and he needs us. No one can get AIDS from just touching him.”
Innovative programmes serving homeless youth in the United States tend to downplay the fact that there is no cure for AIDS, instead offering the hope of chronic treatment and living with AIDS (Larkin Street Youth Center, 1990). While this is important in the developed world, it is inappropriate in the developing world where street youth cannot hope to receive any expensive palliative care or drug treatment.
Self-Confidence and Condom Use
The Karate Kids programme is about empowerment, independence and self-respect. Viewers are compelled on an emotional level to identify strongly with these attributes, long before they are presented with any health information about AIDS or proper condom use. As Bandura has emphasized, self confidence is an essential precondition of health promoting behavior. “Perceived self-efficacy can effect every phase of personal change — whether people even consider changing their health habits, how hard they try should they choose to do so, how much they change, and how well they maintain the changes they have achieved.” (Bandura 1989)
Adolescent resistance to condom use has been well documented in many cultures (Larkin Street Youth Center, 1990; International Clearinghouse on Adolescent Fertility, 1989; Gyepi-Garbrah, 1985). However, the importance of peer modelling, peer education, and group loyalty among street youth can be used to overcome this resistance. Karate Kids uses the role model of a healthy, confident Karate hero, and the peer group model of a group of kids who are loyal friends, to convey the message that condom use is a demonstration of peer loyalty. The Karate hero suggests to them that if they are sexually active, they can protect themselves from AIDS by using condoms. Karate says: “Anyone can get AIDS. So we must all protect ourselves and protect our friends.”
Developmental theory as formulated by Piaget and others provides the basic explanatory model of adolescent decision-making that underlies the pedagogical strategy of Karate Kids (Piaget, 1967). Applied to the issue of condom use in adolescents, the theory would suggest that a transformation from an egocentric worldview to recognition of mutual responsibility is necessary for young people to begin to use condoms or other available contraception (Reis & Herz, 1989; Shafer, 1988). The message at the heart of the film promotes this transformation in the young viewer. Karate says, “We must all protect ourselves and our friends”, and this message is reinforced through acts of friendship and solidarity throughout the cartoon. Not only does this statement link condom use to legitimate (egocentric) self-interest, but it also promotes mutual responsibility for condom use in the context of a deep primary value of street youth — peer group loyalty.
AIDS education materials for adolescents must focus on immediate outcomes and should involve peer support if possible (Larkin Street Youth Center, 1990). Viewers of the Karate Kids cartoon learn that the immediate reward for condom use is peer approval and respect. In the discussion that follows the screening, educators have an opportunity to provoke the kids to reinforce this among themselves.
The decision to include frank, non-judgemental information about condom use in the cartoon was supported by all of the technical advisors involved in the project, and was also demanded by street youths who viewed the less explicit storyboard video during pretesting (Dalglish & Scott, 1988).
There is a strong precedent for the effectiveness of this approach in the history of educational campaigns against STD. During World War Two, the US military initiated a massive educational campaign against STD. The campaign simply reminded soldiers that diseases could be prevented through the use of condoms, which were widely distributed. The military sold or distributed freely as many as 50 million condoms each month during the war, and between 1940 and 1943 (before the introduction of penicillin) the rate of STDs in the US Army fell from 42.5 to 25 per thousand (Fineberg, 1988). Unlike most health education campaigns in the era of AIDS, this program recognized that sexual behavior could be modified, but that calls for outright abstinence were likely to fail. As one medical officer explained it, “It is difficult to make the sex act unpopular.” (Brandt, 1988) The central message of Karate Kids is based on this understanding. Recognizing that if the kids are sexually active, they risk HIV infection, Karate tells them, “Condoms are safe. They can protect you and your friends from getting AIDS.”
The challenge to the animation team was to create a sequence that would not be widely banned due to frontal nudity, yet would not cause confusion. In the pretest cartoon, Karate demonstrated condom use by putting one on his fingers, but this was confusing to some youths and the producers decided that the sequence would have to be more explicit (Dalglish & Scott, 1988). The final cartoon includes a sequence which dissolves from a picture of a couple embracing in a “thought balloon” to a blue-tinted close-up of two hands putting a condom on a stylized phallus. It lacks realistic contours or pubic hair but clearly conveys the essential information about pinching the end of the condom and rolling it onto the full length of the penis.
Karate Kids and Family Planning
Family planning programs are by definition progressive and tend to take risks in challenging the status quo. The efforts of family planning advocacy groups and community workers must be highly praised by anyone concerned with the problems of teen pregnancy and other aspects of reproductive health. The AIDS Unit of International Planned Parenthood has produced pioneering materials to promote the integration of AIDS education and family planning work (Gordon & Klouda, 1988), and they continue to do very innovative work. However, traditional family planning programs present deep-rooted impediments for the promotion of adolescent sexual health in general, and AIDS health education in particular. There is a well-founded belief among family planning workers in many parts of the world that their work should not be associated with STD control, because people will not visit a clinic associated with the stigma of sexual disease.
Family planning has been medicalized, so it is not only possible but acceptable for counsellors to explain birth control methods, including condoms, without talking about sex at all. Traditional family planning programs tend to reach women who come into contact with family planning counsellors or clinics, in the context of birth control instruction. Often, marriage is a pre-requisite for access to family planning counselling and supplies. Programs are oriented toward the people in the community who are least likely to be involved in STD risk behavior, although their husbands may be exposing them to considerable risk through unprotected extra-marital sexual activity.
Thus women are encouraged not only to change their own habits, but to challenge the habits, self-image and cultural conditioning of the men in their lives. Generally, the men in their lives will resist condoms. They will say that condoms are only for ‘dirty’ women and men, they are uncomfortable or unmanly, they can’t be trusted, etc. By the time adolescents become sexually active, they may already have negative attitudes to condoms. In a recent study conducted in Washington, D.C., inner-city teenagers suggested that condom use implied the assumption of the presence of disease in the condom user, making the suggestion of condom use very difficult (Center for Population Options, 1989).
Karate Kids attempts to reach children and adolescents before they develop these prejudices. By teaching young people that sex without a condom is dangerous, it addresses the basic mandate of traditional family planning programs. If the project is successful, it will increase condom acceptance and use in target populations.
One of the strengths of the project is that it has no overt family planning message. It does not mention that the condom is a contraceptive. Karate simply tells the kids that condoms are safe, and that they are effective tools for self-defense.
Some critics of the project, particularly officials claiming moral authority in parts of Africa and southeast Asia, have suggested that the cartoon is unacceptable for various reasons. a/ it promotes condoms; b/ it contains explicit language and images; c/ it presents sexual activity outside of marriage; d/ it presents a peer group leader who cohabits with his girlfriend; e/ it depicts sexual exploitation of a boy by a man;
f/ it contains scenes of petty crime that are not punished; and g/ it has a slapstick chase scene that makes the audience laugh at a policeman. All of these elements were included in the plot of the pre-test video, and they are in the final film because they all contribute to the authenticity, and thus to the popularity of the cartoon with its primary audience.
Other critics, particularly AIDS activists in Canada and Europe, have charged that the cartoon is too violent, that it is technically inaccurate, and that it promotes homophobia. These charges are serious, and should be responded to in some detail. They suggest that the villain may be perceived by the audience as a sterotypical middle-aged homosexual, and that the cartoon condones violence against homosexuals. While the producers of the cartoon have been sensitive to this risk, their main concern has been to respect the experience of the street children and adolescents and the street educators for whom the cartoon was made. In pretesting of the cartoon, every street youth, male and female, recognized the Smiling Man not as a middle-aged gay man, but as a man who exploits children and adolescents. They understood that in the shanty towns and red light districts where they live, their experience of adults with money is exploitive and often violent. In the test cartoon, the Smiling Man didn’t die, but returned at the end. Street girls in Manila insisted that the producers should not bring the finished cartoon back to them unless the Smiling Man was killed. The decision to include karate and some violence in the cartoon was, again, based on the fact that Bruce Lee and Rambo are the most popular film stars among street youth around the world (Dalglish & Scott, 1988). Violence is a fact of everyday life for street youth, and Karate Kids is true to that reality.
With respect to technical accuracy, the cartoon has a clear non-medical tone and focusses only on sexual transmission of HIV. It states simply how to use a condom. Karate says that there is no cure for AIDS, and insists that the gang must take care of the boy who is infected. This film is intended to be used as a discussion trigger by educators who can talk about the subject beyond the simple messages of the cartoon. It is accompanied by a simple but detailed training book, and the video sleeve is also a basic instruction sheet for the user.
The sensitivity of gay activists in the West to the content of AIDS health education materials is justified, given that their community has been devastated by the disease. However, the transmission of HIV globally has little to do with sexual orientation, and the film is neutral on this issue. The boy who gets AIDS is not criticized by his friends because he had sex with a male. He is warned not to compromise himself with a man who only wants to use him. Karate has two motives when he tells the kids to avoid the Smiling Man. First, to avoid a sexual encounter where condom use is highly problematic, and second, to avoid the emotional and physical abuse of sex work at a young age. This first incident with the Smiling Man is not the time for Karate to talk about condoms — in terms of the technique and art of storytelling, the audience of the cartoon is not yet ready to absorb the technical ‘safe sex’ message.
Karate defends his young friends against adults who exploit them sexually. Through Karate’s actions, the cartoon suggests that adults who have predatory sexual relations with boys and girls are bad people. The moral messages about sex in the cartoon are “protect yourselves, protect your friends” and don’t let yourself be used sexually by anyone. Street children and adolescents have the right to act up against yet another form of exploitation.
International Distribution to Community-Based Groups
The materials are being distributed to street educators, health workers, and various kinds of community-based programmes at little or no cost. Projects can order the Karate Kids package directly from Street Kids International (one video in local format and language, two copies of the training book in English, French, or Spanish, and 6 sample copies of the comic book; comics available in packs of 144) . To date, materials have been distributed in this way to projects in over 50 countries. Orders have been stimulated by widespread coverage in publications produced by Appropriate Health Resources & Technologies Action Group (AHRTAG), WHO, Red Cross and Red Crescent Societies, International Planned Parenthood, World Assembly of Youth (WAY), Johns Hopkins University, the PANOS Institute, and other agencies. Organizations that are currently collaborating in the distribution of the materials include the Ministries of Health in Mexico, the Dominican Republic, Honduras, Thailand, and Canada, ENDA in West Africa, as well as several members of the League of Red Cross and Red Crescent Societies, members of the Save The Children Alliance, OXFAM-Canada, Terre des Hommes, as well as regional offices of WHO, Pan American Health Organization (PAHO), UNICEF, CARE, and GTZ-Germany.
The programme has been designed in close consultation with street workers, and it relies on their efforts to reach its audience. This grassroots approach generally has a greater long-term impact than the influences applied by outside ‘experts’ for a limited time. The Karate Kids project takes into account that “In the social
diffusion of new behavior patterns, indigenous adopters usually serve as more influential exemplars and persuaders than do outsiders. Moreover, behavioral practices that create widespread health problems require group solutions that are best achieved through community-mediated efforts.” (Bandura, 1989)
Preliminary Evaluation of Impact
The project has received initial feedback from community-based projects that are using the Karate Kids package. This participatory evaluation by educators indicates that the materials are a flexible, dynamic set of tools that serve the purpose of the user whether they want to talk about HIV/AIDS, or include discussion of other STD, child abuse, or condoms as a form of birth control.
In the Copperbelt Province of Zambia, Dr. Chandra Mouli uses the Karate Kids cartoon as the audio-visual component of a week-long life skills course for out-of-school youth (Mouli, Phiri, and Rao, 1990). Dr. Mouli reports that the cartoon’s “perfect balance of entertainment and information” provides a positive context of trust and good humour for the entire five-day course. He estimates that he showed it 60 times in a four-month period in 1990.
Dr. Jay Wortman has used the materials extensively with aboriginal communities in northern British Colombia. The cartoon has been so successful as an ice-breaker for community group discussions of AIDS that Health and Welfare Canada recently commissioned an English language aboriginal storyteller version of the cartoon for distribution to 650 aboriginal communities across Canada. In health workshops with northern native communities, Dr. Wortman finds that “the adults and elders are as fascinated by the video as the kids. I plan to incorporate the video into all my future presentations to adults as well as younger audiences.” Dr. Wortman’s research colleague in Vancouver, Canada, has also written that “the cartoon is considered a very effective took by our street outreach nurses. Other health educators have mentioned to me how useful they have found Karate Kids for assisting them in teaching students learning English as a second language about AIDS.” (Sandra Chan, Research Officer, Division of STD Control, Ministry of Health, British Columbia, Canada)
Enthusiastic reports have been received from both urban and rural projects in Africa. “The material has been of tremendous help. It is stimulating, informative, educating (sic) and easy to understand.” (Dr. Olusegun A. Atibioke, Atibioke Medical Clinic, Osogbo, Nigeria) “Really it works well with our program. So far we have not missed a day without showing to the school, clubs, and private meetings.” (Hussein H. Ahmed, Paramedic, Dar-es-Salaam, Tanzania). A selection of eight letters from educators who are using the materials in Latin America, the Caribbean, the Middle East, and sub-Saharan Africa are attached as Appendix ‘A’.
Future Monitoring and Evaluation
An evaluation study of the Karate Kids package (Los Niños Karatecas) is planned for Santo Domingo, Dominican Republic in April-May 1991 in association with the STD Programme, Ministry of Health (PROCETS), International Development Research Centre (IDRC Canada), and the Education Technology Department at Concordia University, Montreal. The project will enhance the ability of local researchers to conduct further study, collaborating with trained Dominican street educators. The purpose of the evalution is to study the immediate effects of the Niños Karatecas materials on the knowledge, attitudes, and risk perception of Dominican street youth. The research team will evaluate the separate and combined merits of the training book, video, and comic book in order to produce guidelines that will help educators anticipate and discuss with audiences the questions that the package may generate. The project will provide training to field workers in the skills of educational media evaluation and usage, and enhance the ability of local researchers to conduct further study.
A comparative study of the effect of the materials on knowledge, attitudes and behavior of street youth in six inner-city communities in the United States and the Caribbean is also planned for 1991. This project will use electronic means of data collection involving video playback and hand-held viewer response units. While eliminating the need for written questionnaires, it will have strong appeal for street youth who enjoy video games. It is hoped that the methodology developed in this comparative study will be very adaptable for cross-cultural evaluation of Karate Kids and other videos in the future.
The Karate Kids programme encourages young people to feel good about themselves, and to help one another. It is being used by eductors who are actively working to improve the self-esteem and health of street youth and other groups.
The relentless progress of HIV has convinced many health workers in the developing world that moral messages requiring monogamy and abstinence render public health campaigns ineffective. Karate Kids answers the international need for compelling, straightforward sexual health education tools targetted at low-literacy audiences. The non-judgemental tone of the cartoon invites the empathy and attention of people who are involved in high risk activities, and may provoke them to use condoms as an affirmation of self defense and peer loyalty.
Karate Kids is being shown widely in contact centers, clinics, schools, and from the back of video vans in over 50 countries. If this cartoon and other condom promotion programmes are effective, the global demand for condoms will increase. The challenge for National AIDS Programmes and AIDS-related non-government organizations now is to anticipate this need. As children and adolescents in Dakar, Santo Domingo, and Manila begin to learn that sex without a condom is dangerous, they deserve better street-level access to low-cost condoms.
Targetted primarily at youth who are not yet infected with HIV, and who have not yet produced their own children, the Karate Kids programme is for future generations, for children who are not born yet.
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Bandura, Albert. “Perceived Self-Efficacy in the Exercise of Control over AIDS Infection”, in S.J. Blumenthal, A. Eichler, & G. Weissman (Eds.) Women and AIDS, Washington, D.C. American Psychiatric Press, 1989.
Brandt, Allan M., “AIDS in Historical Perspective: Four Lessons from the History of Sexually Transmitted Diseases”. American Journal of Public Health, 78 (1988) 4 (April) p. 367-71.
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Mouli, V. Chandra, Phiri, J.C., Rao, K.N. “A Week’s Crash Course in Survival Skills: A new approach to reaching street kids in the Copperbelt Province, Zambia.” Copperbelt Health Education Project, Kitwe, Zambia, 1990.
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