Communication for HIV/AIDS: Challenges

and opportunities

By Kindyomunda Rosemary M,

Uganda AIDS Commission

4th Partnership Forum, 31 Jan 06

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

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

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

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

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

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

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

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

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

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

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

Status Bliss in ignorance

Conscious Incompetence

Conscious to Unconscious Competence

Communication activity(for against)

-Mass media (print, electronic, public fora)- Exposure to situations (-ve/+ve)

- One to one-Linking to services- Talk shows,-Link to Life skills devt

-Community participatory approaches- Counseling-Skills dev’t & enhancement

Outcome Awareness,

(trigger need)

Confusion/

Uncertainty

Knowledge

Change & maintain Behaviour

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

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

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

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

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

Status Bliss in ignorance

Conscious Incompetence

Conscious to Unconscious Competence

Communication activity

IEC thru - mass media (print & electronic

- One to one-Linking to services- Talk shows-Link to life skills devt

-Community participatory approaches- Counseling-Skill dev’t

Outcome Awareness

Trigger need

Uncertainty /

Confusion

Knowledge

Change & maintain Behaviour

Obstacles -Lack of info

-Irrelevant messages

-Poor packaging

-Message conflict Peer pressure -Rapid changes- Myths, beliefs, norms-Stigma-Unmet demands

-Peer pressure-Lack of support services-Info conflict-Stigma

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

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, ?

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

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

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

HIV/AIDS Communication is the backbone of our response

Reduce risk and vulnerability

Reduce impacts