HIV Prevention Communication Training: New evidence, new thinking

1. HIV Prevention Communication Training: New evidence, new thinking Kevin Kelly, Laura Myers, Zuzelle Pretorius HIV Capacity Building Partners' Summit Johannesburg, 19 March 2013

2. BLC Project Overview: • BLC supports local and regional institutions to improve health care and HIV prevention services by strengthening both technical leadership andmanagement capacity • Regional and country activities • 6 countries • Regional organizations • Key Program Areas • Capacity Building, • Care & support for OVC • HIV prevention • Community-based care

3. BLC Project: HIV prevention • BLC supports the SADC HIV Unit to strengthen its strategic leadership role for HIV Prevention and build the HIV prevention capacity of member states. • Partnership with SADC HIV Unit and Centre for AIDS Development Research and Evaluation (CADRE) • Target group: HIV program managers in Government • ( Ministry of Health, Education), National AIDS • Council, and CSO partners • Pilot in Swaziland prior to roll out in the region

4. New evidence – new thinking • Based on extensive review of literature and existing materials • Facilitation processes and communication materials piloted in five trainings in Tanzania, Zimbabwe, and South Africa • 115 individuals involved representing 50 CSOs, international NGOs, and government departments • Modularized training curriculum with 10 half-day presentations and workshop processes with exercises

5. What have we learned about existing prevention capacity? • Significant gaps and missed opportunities: HIV care and support, HBC, OVC programs, family planning, HCT • Widespread difficulty in grasping more abstract concepts: partial protection, targeting general population, sero-discordance • Significant variation by country • Little diffusion of understanding of new thinking to local levels and little evidence of learning from or sharing of experiences

6. What have we learned (Cont) • Direct community prevention interventions are usually project-based rather than strategic or continuous • Low dose, opportunistic, event-focused HIV prevention efforts with little consideration of local dynamics of transmission, selection, or targeting • Largely information based; little understanding or use of communication or social and behavioural methodologies, multilevel or combination strategies, results-based management, orlocal level collaboration or long-term strategic thinking

7. Foundations of prevention thinking in the training program • Oriented and focused on: • Theory of change, combination prevention, social ecology framework, results-based management approaches • Addressing modes anddynamics of transmission • Role of communication in social and behavioral change • Evidence-based thinking at local level (KYE, KYR) • ‘Options’ for prevention and offering combination prevention options • Basic science of HIV/AIDS

8. Format • Participants seated at tables of four people to allow for small group discussion at key moments in the presentations • Each presentation is followed by a practical exercise conducted in small groups to localize, contextualize, and develop practical understanding of key concepts • Each day begins with a review of overnight questions and ends with a reflection on the day’s learning experiences

9. Structure • BLOCK 1 – Know your epidemic - Know your response • Module 1: Know your epidemic - Big picture and country picture • Module 2: How HIV works • Module 3: Reviewing prevention options - Know your response • BLOCK 2 – Plan your response • Module 4: A social ecology approach to prevention planning • Module 5: Communication for HIV prevention • Module 6: Combination prevention • Module 7: Managing for outcomes • BLOCK 3: Targeting key drivers of infection • Module 8: Addressing dynamics of generalized epidemics • Module 9: Addressing the needs of high-risk populations • Module 10: PHDP

10. • the big picture – epidemic update • BLOCK 1 – Know your epidemic - Know your response • reviewing prevention options• know your response • • how HIV works •

11. •combination prevention • • a social ecology model approach to prevention planning• BLOCK 2 – Plan your response • managing for outcomes • • Communication for prevention •

12. · addressing dynamics of generalized epidemics · ·PHDP · BLOCK 3: Targeting key drivers of infection •addressing the needs of high risk populations• Image: Faraja Trust

13. Challenges • National strategic frameworks may reflect new advances in HIV prevention, but may not outline how advances may be incorporated in implementation plans at a programme, project and community level. • Need for concerted efforts to translate new evidence about HIV prevention needs and effectiveness into practice • This may require departure from standard approaches; and the need to ‘reboot’ in some areas (paradigm shift) rather than ‘infuse’ new understanding • Approach may require some departure from existing commitments and programmatic approaches and this can prove challenging to secure.

14. Solutions • Adapt the program in each country, keeping with local HIV dynamics and implementation conditions or opportunities • Allow for considerable lag-time before capacity building efforts to support the approach are adopted by most- relevant country-level agencies • Approach appears to be best supported by existing plans to implement combination prevention and existing communication frameworks which cut across a range of implementing agencies • Social ecology approach allows bridging the gap between developmental and ‘topical’ approaches to prevention in country level prevention approaches