Communication for HIV/AIDS: Challenges and opportunities

1. Communication for HIV/AIDS: Challenges and opportunities By Kindyomunda Rosemary M, Uganda AIDS Commission 4th Partnership Forum, 31 Jan 06

2. Presentation outline • Background – Communication contexts • Epidemiological, Programmatic • Why communicate? About what? • Communication approaches • Communication and knowledge management • Communication challenges • Opportunities for expansion • Proposals for way forward

3. Communication context:Epidemiological • Routes of transmission • Heterosexual contact >80%, Mother to child about 25%, blood borne <2% • Mature generalized epidemic • No longer driven by risk populations alone • Over 800,000 HIV+ - need care • Majority HIV free – but at risk, vulnerable and affected

4. Communication context:Epidemiological • Variations in HIV prevalence • Geographical, demographic • Differences in drivers of epidemic or causes of vulnerability • Un answered questions e.g. • The shift - when do adults get infected? • What happens to those infected through MTCT

5. Communication context:Programmatic • Multisectoral approach • Not a domain of a single sector • Approaches from different angles, levels • Health, social, economic, political • Ideological influences • Religious, cultural, etc • Differences in messaging and channeling • Social, economic status of audience • Determines the approaches

6. Why Communicate? • To influence behaviours • Prevent contracting/transmitting HIV • Enhance health care seeking behaviours • Enhance service uptake • Prevention, care and support • Health, social, spiritual etc • Lobby for scaled HIV/AIDS actions • Policy, programming, resources • Equity and quality service delivery

7. Communication to influence behaviours • Adopting safe Sexual behaviour • Abstaining – primary, secondary • Being faithful to one partner - knowledge of sero-status • Correct consistent condom use – casual partner, already infected • Preventing mother to child transmission (MTCT) • Awareness about MTCT, opportunities for preventing it • Preventing blood borne transmission • Awareness about routes, PEP, blood donation • Counter Myths, misconceptions, misinformation

8. Communicate about what? • Enhance health care seeking behaviours and service uptake (prevention & care) • Benefits of the various services – key promise • Availability of the services • Stigma and discrimination Communication for reduction of risk, vulnerability and impact mitigation

9. Communication approaches • IEC – Information, Education and Communication • Mass media: print, electronic, sermons, drama • BCC – Behaviour Change Communication (individual) • One to one, life skills dev’t, etc • Communication for individual and social change • Focus on the individual and environments • Policies, laws, socio-economic aspects, social norms, services, support systems etc

10. Communication and Information seeking behaviour theories • Information only sought/used when the individual registers a need • Risk perception • Info relevancy, applicability, timeliness • Information/exposure/experience act as triggers for an information need • Individual follows-up to satisfy need • Challenges of accessibility to timely, accurate info • Trigger can be +ve or -ve

11. Communication and Information seeking behaviour theories • Individual’s knowledge used to seek, evaluate source & info, process and utilize info • What builds individual knowledge • Indigenous knowledge: values, norms, beliefs, • Education status, • Previous experiences, etc • Information push and information pull • Opportunities and obstacles to communication • More attention on push than responding to need

12. Communication & the knowledge cycle • Bliss in ignorance • Individual not aware of need, low risk perception • IEC, experience etc triggers need • Conscious incompetence • recognizes need, seeks and evaluates info • Conscious Competence • Apply info (+ve or -ve), develop skills, change behaviour • Unconscious competence • Utilize skills instinctively, sustain behaviour

14. Challenges to communication:Situational/behavioral • Stagnation to increasing prevalence rates • Complacency Fatigue, ‘cure’, competing priorities Low risk/impact perception • High Couple discordance rates • When & how does the partner get HIV? • Limited service uptake e.g. for PMTCT • Message packaging, norms, beliefs, accessibility

15. Situational Challenges cont’d • Gender disparity • High prevalence in females • Poor male behaviour indicators • Rapidly changing environments • information age -Internet, DSTV, video halls • Exposure to new behaviours, practices • Competing & conflicting messages • Information goes stale very fast • Dynamics of the epidemic • Changing body of knowledge • Shifting epidemic – young pple to adults

16. Challenges to communication:Programmatic • Awareness rising Vs behaviour/ social change • Targeting the individual not situations • Behaviour influenced by situations • Blaming individuals • Stigmatizing messages & approaches • Information Inapplicability • Limited involvement of target audience in designing of messages & materials • Lack of local sources of information

17. Programmatic challenges cont’d • Lack of evidence-base • What fuels epidemic, what works better • Limited strategic focus • Limited linkages to services • Failure to act on messages • Unfulfilled demands • Balancing communication for prevention and care • Limited capacity • Lack of standards • Impact on message quality

18. Programmatic challenges cont’d • Fragmentation, limited coordination • Message inconsistency, duplication confusion • Competition, Conflict • Background of communicator • Level of investment - sustainability • No immediate results with communication • Communication a Life long investment

20. Opportunities for scaled action • The success story – ever worked & still working • Reductions among young people, increased ART uptake • Community knowledge and commitment • Conducive policy environment • Open dialogue at various levels – Think Tank • Input in Policy and strategy development • Comprehensive Communication Strategy • Prevention Policy Paper, ABC Policy guideline • Utilizing other services: • health esp. reproductive health • Social, economic, religious, business etc

21. Opportunities for scaled action • Build on existing knowledge base • Short and long term focus • Utilize entry points for social change • Vulnerability analysis report • Conceptual Framework for Communicating to young people • Risk behaviours, protective/harmful factors, domains within which they interact, key duty bearers • Participate in implementation of major communication campaigns • YEAH, PIASCY, ?

22. Young Empowered And Healthy • Bases on the agreed Conceptual Framework • Campaign for all owned by none • Promotes common thinking, common voices • Consistency, experience sharing, common priorities • Building partnerships in communication • Compliment strengths, wider reach, optimal utilization of resources/systems • From awareness to social change • beyond individual, Under and beyond ABC • Experiences in involving young people

23. YEAH Cont’d • Centered around Rock Point 259 drama • Over 4 million pple tuning in • Community participatory approaches • Phase 1: “Something for Something Love” (engaging in sex in exchange for favors, money or material goods) • Phase 2: “Be a Man” Changing male Gender expectations (Boys & men) • Common funding approaches • Wider coverage, social accountability Join YEAH Now, Tune in to Rock Point

24. Proposals for way forward • Situations have changed – adopt approaches • Make communication specific to situations • Shift focus from individual to social change • Enhance information push with equal focus on meeting information demands • Harmonize communication for prevention and care • Work in partnerships • Wider reach, learn from lessons etc • Utilize non-traditional partners • Research, document, share

25. HIV/AIDS Communication is the backbone of our response Reduce risk and vulnerability Reduce impacts