By Fano Randriamanantsoa

Fanja, a 15–year–old girl in Madagascar, faces a difficult interpersonal conflict: her boyfriend is pressuring her to be intimate with him in a way that makes her uncomfortable. In the past, she didn't know how to get him to stop.

But this time is different. He only gets halfway through saying that if she loved him, she would have sex with him, when he halts abruptly, looks shocked, and takes a step back. She's given him a Red Card.

To prevent the spread of HIV/AIDS, AED turned to the signal soccer referees use to kick aggressive players out of a game. Red Cards are now the tool Malagasy girls use as an ice breaker to start conversations on sensitive topics and to stop risky and inappropriate behaviors at school, parties, their homes, and on dates.

As part of a larger health communications program, called C–Change, funded by USAID, Red Cards have been distributed to 1.5 million young women across the country.

“One big lesson we've learned from working on HIV/AIDS prevention is that nobody wants to deal with the tough issues,” said Peter Gottert, communication specialist in the AED Global Health, Population, & Nutrition Group. “But Red Card helps people do just that. It gets adolescents and parents talking, and lets girls call the shots.”

Eager to Participate
To kick off the initiative, AED ran television spots showing teenage girls in common, but difficult, situations. For example, one spot features a boyfriend who won't listen to a girl's polite, but insistent, refusals to drink alcohol at a party. Not knowing what else to say, she draws a Red Card from her pocket, shakes her head with confident disapproval, says, “I told you three times I just want a soda; why won't you listen to me?” and leaves.

As the initial series of four spots was airing, dozens of two–hour training sessions were held in schools and clubs and with sports teams so that girls could practice using Red Card.

The demand to attend these workshops has exceeded expectations. For example, one session was capped at 50 participants, yet additional girls snuck in each time the trainers were distracted.

Trainers asked the girls to explain Red Card to their parents once they got home. For many families, this conversation opened the door to discussing sexual harassment, alcohol use, and other risky behaviors.

Project staff continue to be surprised at how frequently many girls use the Red Cards. Most training participants, who normally might be seen as quiet or even a bit passive, have said they used Red Card within a week of the workshop.

Hitting Home
During the project's second phase, trainings took place throughout the country, directly reaching 30,000 teenage girls and sparking an exponential increase in the number of phone calls made to the national HIV/AIDS hotline—most of them asking for packs of 100 Red Cards. In addition, more than 2,000 Red Card clubs were formed, providing an opportunity for girls to talk about their experiences using the tool.

“Red Card has become a symbol of coolness among young women,” Gottert said. “It's not unusual to hear someone say, ‘That's a Red Card,' when a friend is off base. The program has tapped into emotions that were just below the surface.

“Plus,” he added, “it's so simple and scaleable.”

The strategy has proven easy to integrate into a variety of programs and contexts. For example, 50 national-level organizations and a multitude of local NGOs have purchased packs of 10,000 Red Cards for just $160. There is also evidence that parents are making their own Red Cards, which their daughters can take with them to parties or on dates.

“Red Cards alone are not the solution to the spread of HIV,” Gottert said. “But they clearly give young women a way to be heard, even if they can't find the right words.”

For more information, contact Peter Gottert at pgottert@aed.org.

Fano Randriamanantsoa is deputy country director and training specialist for C–Change, Madagascar.