Health Promotion Journal of Australia, 2015, 26, 30–32

Health Needs and Behaviours

http://dx.doi.org/10.1071/HE14055

Love Bugs: promoting sexual health among young people

in Samoa
Emma Heard A,D, Leveti Auvaa B and Charlotte Pickering C
A
Research and Course Development Advisor, National University of Samoa, Lepapaigalagala Campus Toomatagi, Samoa.
B
Head of School, School for Nursing and Health Sciences, National University of Samoa, Lepapaigalagala Campus
Toomatagi, Samoa.
C
Clinical and Community Services Advisor, Samoa Family Health Association, Savalalo, Apia, Samoa.
D
Corresponding author. Email: emma.heard@uqconnect.edu.au

Abstract
Issue: This project addressed the sexual health and well being of youth in Samoa; a key at-risk group experiencing high rates
of sexually transmitted infections (STIs) and alienation from sexual health services.
Methods: Love Bugs included a health promotion event held at the National University of Samoa (NUS), exposing young
people to sexual health information and developing personal skills and building self-efficacy around healthy relationships,
communication and safer sex. A survey provided insights into participants’ knowledge and perceptions of sexual health, STIs
and healthy relationships. In response to survey results, six free condom dispensers were installed at NUS.
Results: Love Bugs exposed over 500 Samoan youth to positive sexual health information and provided an opportunity for
personal skill development with regard to protecting sexual health and well being. Condom dispensers were developed and
installed on the university campus for the ongoing access by students without concern of cost or embarrassment. Strong
partnerships were built between key community and government stakeholders that encouraged collaborative action towards
protecting sexual health and well being of Samoan youth.
Conclusions: Love Bugs was a successful initiative which addressed sexual health and well being of young people in Samoa.
A comprehensive evaluation should be undertaken.

So what? Love Bugs highlighted creative and culturally-appropriate ways to address sexual health in the Pacific. Rates of STIs
and unplanned pregnancies, particularly for youth, could be reduced through investment in the implementation and evaluation
of such initiatives.

Key words: community-based intervention, developing countries, sexually transmitted infections.

Received 11 September 2014, accepted 30 September 2014, published online 1 December 2014

Introduction
The sexual health of populations in the Pacific region is a key area
of concern with rates of sexually transmitted infections (STIs)
exceeding 25% in some countries; young people are an important
target group as rates appear highest among this group.1,2 While
comprehensive STI statistics in Samoa are limited, a high prevalence
is estimated; for example, one study shows 38% of women
attending antenatal clinics in Apia as having one or more STIs.3 Love
Bugs was a health promotion initiative implemented at the National
University of Samoa (NUS) that aimed to provide young people
with the necessary skills and resources to improve their sexual health
and well being. This paper will describe the Love Bugs initiative in
detail and offer some preliminary insights regarding the outcomes.
Background
Reproductive health services in Samoa predominantly target
married couples and offer pregnancy and contraception advice; thus,
young people are often alienated from such services due to
embarrassment, cost, transport and lack of confidentiality.4 Further to
this, young people in Samoa report low levels of exposure to family
planning messages.5 Only 36% of women aged 15–49 know of the
male condom as a form of contraception and only 1% have ever
used one; 15% of men (12% of married men) aged 15–49 report
having ever used a condom.5 Such statistics raise concern as
condoms are the only contraceptive method proven to reduce the
risk of all STIs.6 There is limited research exploring the low rates of
condom use in Samoa; however, it has been suggested that a lack of

Journal compilation Ó Australian Health Promotion Association 2015 CSIRO Publishing www.publish.csiro.au/journals/hpja
Young people’s sexual health in Samoa Health Promotion Journal of Australia 31

awareness and access to and acceptance of condoms, as well as a

lack of support from religious and community leaders for safer sex
education play a role.4,5
International literature shows key barriers to condom use, specifically
for young people, include the cost and embarrassment of obtaining
condoms.7,8 Free condom dispensers have been used around the
world as an effective means of addressing these barriers.7 Research
shows that dispensers in discreet, easily accessible places (including
university buildings) are particularly attractive to young people.7,9
Research into condom use in the Pacific region indicates that social
and cultural influences play an important role and thus, initiatives
addressing sexual health and condom use should be locally
designed and targeted.10 Love Bugs aimed to increase awareness
of STIs, promote healthy sexual relationships, develop personal
communication skills and effective condom use and provide access
to sexual health resources, including condoms for students at NUS. Fig. 1. A section of the ‘Love Wall’.

Methods the day along with information and demonstrations on how to

use them. The number of condoms, contraceptive kits and ABC
Love Bugs included a health promotion event, a sexual health survey
lollypops distributed was recorded, as were the number of messages
and the installation of free condom dispensers at NUS. In 2013, NUS
contributed to the ‘Love Wall’. Staff observed and reported on the
had a total number of 2884 students (1582 females and 1302 males)
number of students watching the live demonstrations and engaging
enrolled across its eight faculties. All students live off campus, most
with other aspects of the event.
in family homes.

Health promotion event Survey

At a Love Bugs event held at NUS, students were exposed to sexual
health information via flyers, posters and a multi-media presentation.
The material was developed using a strengths-based approach to
health promotion focusing on positive emotion; meaning that all
information was presented in a non-confrontational manner.11 The
Youth Development Sector at the Samoan Government Ministry of
Women, Community and Social Development (MWCSD) were
consulted throughout the development of the material to ensure
the material was contextually appropriate for Samoan youth. The
number of flyers distributed was recorded and staff observed and
reported approximate numbers of students who engaged with the
posters and presentation.
The event included the ‘Love Wall’, a space where participants
wrote personal, positive sexual health messages. This was
showcased on a large billboard in the NUS foyer for the
following week, increasing student exposure (Fig. 1). Lollypops
carrying the ABC message (A-abstinence, B- be faithful ((only have
one partner)) and C-condoms) were distributed; and staff, including
a range of health promotion practitioners from the university,
Government sectors and non-government organisations, engaged
participants in conversation, answered questions and offered further
information; where necessary participants were referred to Samoa
Family Health Association (SFHA) for further services. The playing of
popular music and a live condom mascot created an open,
friendly and fun environment that encouraged public participation.
Condoms and contraceptive kits were freely available throughout
Short surveys were made available for participants to complete
voluntarily. The survey consisted of multiple choice and short
answer questions aimed to gauge respondents’ knowledge and
perceptions of healthy relationships, STIs and safe sex measures.
The survey was developed with special consideration given to the
fact that sex is a taboo topic in Samoa,4 and the public nature of
the event; thus, the questions were brief and impersonal.
Free condom dispensers
Six free condom dispensers were installed at NUS. Dispensers were
built in collaboration with Red Cross Samoa from a locally-developed
method using recycled plumbing pipe. The involvement by 100
students from the schools of Arts, Education and Carpentry in the
styling, promotion and installation of the dispensers enhanced
student ownership of the project. These students also participated in
sexual health workshops that provided information on STIs and
healthy relationships, offered brief counselling and question time.
Condoms were supplied by SFHA.
Results
During the health promotion event, 300 flyers, 120 ABC lollypops,
200 contraceptive kits and 500 condoms were distributed. 200
students contributed to the ‘Love Wall’ and ~100 students viewed
‘how to use a condom’ demonstrations (groups of 20 students
participated in 5 demonstrations throughout the day). A total of
~400 students participated in one or more aspects of the event,
32 Health Promotion Journal of Australia
including viewing and engaging with the posters and the multi-
media presentation.
The survey was completed by 48 students (31 females, 15 males
and 2 unidentified). Results highlighted that most respondents
understood key aspects of healthy relationships including: trust
(90%), respect (83%) and honesty (95%); 46% of respondents listed
condoms as being important for a healthy relationship. Most
respondents knew what STI stood for (67%) and that condoms were
effective in reducing risk of transmission (88%). Just over half (54%)
of respondents identified safe sex as important for ‘protecting
your and your partner’s health’, ‘preventing unwanted pregnancies’
and ‘reducing the risk of getting an STI’. The survey was voluntary
and the low response rate may reflect the ongoing perception of
sex as taboo, and participants may have been uncomfortable
completing the survey.4
The condom dispensers held ~100 condoms and were installed
with promotional posters designed by students and information on
how to use condoms. After one month, three of the dispensers had
been torn down and stolen. Despite this, the remaining three were
refilled approximately every eight weeks for the following year; a total
of 3900 condoms were dispensed during this time.
Although this report was limited by the use of staff observation in lieu
of concrete numbers of participants plus the relatively small sample
size of the survey, results indicate the reach of Love Bugs was
significant and provides some exploratory insights into the current
knowledge of sexual health and the challenges experienced by
young people in Samoa.
Conclusion
Preliminary results show that Love Bugs exposed 500 young people
to positive sexual health messages and information (through both
the health promotion event and workshops held as part of the
condom dispenser development and implementation). Personal
www.publish.csiro.au/journals/hpja
E. Heard et al.
skills and self-efficacy were enhanced through condom
demonstrations and the initiation of communication with regard to
sexual health. Access to condoms and sexual health information
was provided through the development and implementation of
free condom dispensers and locally-designed sexual health
promotion materials.
The extent of the impact of this project is yet to be investigated and a
comprehensive impact evaluation should be undertaken in order to
truly understand the outcomes and reach of the project.
References
1. Cliffe SJ, Tabrizi S, Sullivan EA. Chlamydia in the Pacific Region, the silent epidemic.
Sex Transm Dis 2008; 35(9): 801–6. doi:10.1097/OLQ.0b013e318175d885
2. World Health Organisation Regional Office for the Western Pacific. HIV and sexually
transmitted infections in the Western Pacific Region: 2000–2010. Manila
(Philippines): World Health Organisation Press; 2012. Available from: http://www.
wpro.who.int/publications/2012/document_hiv_and_sti_2000-2010.pdf [Verified
6 June 2014].
3. World Health Organisation Regional Office for the Western Pacific Region.
Western Pacific country health profiles: 2011 revision. Manila (Philippines): World
Health Organisation Press; 2011. Available from: http://www.wpro.who.int/health_
information_evidence/documents/CHIPS/en/. [Verified 6 June 2014].
4. Lata S. Decisions and dilemmas- reproductive health needs \assessment for
adolescent girls in Samoa. Pac Health Dialog 2003; 10(2): 53–61.
5. Ministry of Health. Samoa domestic health survey 2009. Apia (Samoa): Government
of Samoa; 2010.
6. World Health Organisation. Position statement on condoms and HIV prevention.
Geneva (Switzerland): World Health Organisation Press; 2004. Available from:
http://www.unfpa.org/webdav/site/global/shared/documents/news/condom_
statement.pdf. [Verified 6 May 2014].
7. Burtney E, Fullerton D. A review of the national and international research literature
on condom promotion and distribution. Dunblane (Scotland): Insights Health and
Social Research; 2009.
8. Bell J. Why embarrassment inhibits the aquisition and use of condoms: a qualitative
approach to understanding risky sexual behaviour. J Adolescence 2009; 32(2):
379–91. doi:10.1016/j.adolescence.2008.01.002
9. Sixsmith J, Griffiths J, Hughes J, Wren J, Penfold S, Natusch H. Accessibility of
condoms to young people in Manchester, UK. J Fam Plan Reprod H 2006; 32(4):
219–25. doi:10.1783/147118906778586534
10. McMillan K, Worth H. The impact of socio-cultural context on young people’s
condom use: evidence from two Pacific Island countries. Cult Health Sex 2011; 13(3):
313–26. doi:10.1080/13691058.2010.529945
11. Hastings G, Stead M, Webb J. Fear appeals in social marketing: strategic and ethical
reasons for concern. Psychol Market 2004; 21(11): 961–86. doi:10.1002/mar.20043