AFRO-NETS> The Drum Beat - 122 - Effective HIV/AIDS Communication?

[Warren Feek <wfeek@comminit.com>]

The Drum Beat - 122 - Effective HIV/AIDS Communication?
-------------------------------------------------------

There is considerable debate and enquiry concerning the most effec-
tive communication strategies for addressing HIV/AIDS issues. James 
Deane, Executive Director of The Panos Institute, prepared a back-
ground paper on this theme for the recent Communication for Develop-
ment Roundtable <http://www.comminit.com/roundtable2>, held in Mana-
gua, Nicaragua, Nov 26 - 28 2001, and hosted by UNFPA. Links below 
are to the relevant sections of the paper. The full paper begins at: 
http://www.comminit.com/stcomdevround/sld-3440.html

We are interested in both your reactions and your perspectives on the 
most effective HIV/AIDS Communication. See the end of the issue for 
initial questions and how to contribute.


WHAT'S NEW, WHAT'S NOT?

1. The last 2 years have seen intense debate over different ap-
proaches to HIV/AIDS communication. In particular, there has been a 
growing questioning of social marketing and behaviour change oriented 
communication... two developments...have focused debate on this area, 
the...publication of a new framework on Communication produced by 
UNAIDS, [and]...the work of the Rockefeller Foundation [Communication 
for Social Change (CSC)]...
http://www.comminit.com/stcomdevround/sld-3445.html


2. The UNAIDS Framework calls for refocusing communication interven-
tions on the basis of 5 key contextual domains: (1) government pol-
icy, (2) socio-economic status, (3) culture, (4) gender relations, 
and (5) spirituality. [It] calls for moving away from individual-
level theories and models of preventive health behaviours...to more 
multilevel, cultural, and contextual explanations and interven-
tions...
http://www.comminit.com/stcomdevround/sld-3445.html#DB122-2
Also see - http://www.comminit.com/st2001/sld-3464.html


3. The principles and approach of CSC have been summarised as moving 
communication frameworks on HIV/AIDS...away from people as the ob-
jects for change...on to people as the agents of their own change; 
away from designing, testing and delivering messages...on to support-
ing dialogue and debate on the key issues of concern; away from a fo-
cus on individual behaviours...on to social norms, policies, culture 
and a supportive environment; away from technical experts in "out-
side" agencies dominating the process...on to the people most af-
fected by the issues of concern playing a central role.
http://www.comminit.com/stcomdevround/sld-3445.html#DB122-3
Also see - http://www.comminit.com/SocialChange/sld-2181.html


SO, IS THIS NEW & DOES IT MATTER?

4. Specific criticisms of these approaches tend to fall into 4 areas:

* Participatory, people centred communication has been at the core of 
most mainstream communication thinking and practice for many years...

* Some of these arguments are creating artificial boundaries between 
different approaches and schools of thought in communication...

* While the UNAIDS & Rockefeller...arguments have emerged largely 
from practitioners on the ground...they are weak when it comes to 
backing [them] up with rigorous academic analysis, modelling and the-
ory...

* Many of the ideas in documents such as the UNAIDS Framework are 
difficult to translate into practice on the ground, particularly 
within the setting of large institutions...
http://www.comminit.com/stcomdevround/sld-3446.html


5. Proponents acknowledge some of these criticisms. Nevertheless, 
they argue: 

* Both the UNAIDS & Rockefeller processes were centred on largely 
southern based, grassroots and civil society focused and driven de-
bates...[and] they appear to have revealed a "disconnect" between 
funding and some international agencies, and indigenous organisations 
working on the ground... 

* Systematically putting the principles of participatory communica-
tion into practice on the ground continues to be rare and much 
HIV/AIDS programming has been highly vertical... 

* Unless developing country societies and communities are setting and 
driving the underlying processes of change that are necessary to con-
front this epidemic...future progress...is unlikely to be sustain-
able...

* There is increasing interest in learning from and adapting the rig-
orous thinking that goes into behaviour change oriented interventions 
to communication for social change thinking...

* CSC is suggesting a major change in approach which involves insti-
tutions surrendering their agendas...

* Many communication initiatives are overly focused on the symptoms 
of the HIV/AIDS pandemic (sexual behaviours), rather than the under-
lying causes (discrimination, marginalisation, disempowerment, ine-
quality).
http://www.comminit.com/stcomdevround/sld-3446.html#DB122-5


A CHANGING ENVIRONMENT

6. Although communication technologies have dominated the discourse 
around recent developments in information and communications, there 
have [also] been fundamental changes in the wider communication envi-
ronment...

* New technologies, principally in the form of the internet and mo-
bile telecommunications, are creating new opportunities for dissemi-
nating information...

* A major liberalisation of the media in the developing world, trans-
forming...print and broadcast media from a largely government owned, 
monopolistic and uncreative environment to a more dynamic, popular, 
democratic, creative and complex one...

* Liberalisation has led...to the emergence of [a] consumer led... 
urban centred communication infrastructure, one...less interested in 
the concerns of the poor, and...decreasingly interested in providing 
news and information to its audiences...

* State run broadcasting systems have found it difficult to trans-
form...into public broadcasting entities...

* Globalisation and transnational ownership of the media is resulting 
in...increasing numbers of mainstream developing country media insti-
tutions being bought by transnational conglomerates...

* Women continue to suffer marginalisation in and from communication 
networks...
http://www.comminit.com/stcomdevround/sld-3449.html


HIV BECOMES POLITICAL AGAIN: TREATMENT, STIGMA, MEN

7. Since the beginning of the epidemic...civil society and AIDS sup-
port organisations in developing countries have struggled to make 
their voice heard internationally... [and unlike those formed around 
issues of women's rights, an] international HIV/AIDS civil society 
coalition has not emerged...perhaps because there was not a clear is-
sue around which concrete demands for action could be made...
http://www.comminit.com/stcomdevround/sld-3447.html


8. At the end of the 1990s, that issue potentially emerged in the 
form of access to treatment for HIV/AIDS. Arguably for the first 
time, organisations in the South were able to set their own agenda, 
demands and priorities... Millions of people in South Africa, Brazil 
and elsewhere who...formerly regarded the issue of HIV/AIDS as one of 
public health and sexual behaviour have been drawn into a debate 
marking it out as an issue of economic justice and human rights. In-
ternational lobbying has led to...concessions by international phar-
maceutical companies to reduce the prices of ARVs 
and...to...concessions over intellectual property rights at the WTO.
http://www.comminit.com/stcomdevround/sld-3447.html#DB122-8


9. A growing movement to confront HIV/AIDS related stigma is taking 
on a new profile and energy. UNAIDS has designated the issue as the 
focus of the next World AIDS Campaign.
http://www.comminit.com/stcomdevround/sld-3447.html#DB122-9


CHALLENGE: IMMEDIATE ACTION OR NECESSARY REFLECTION?

10. 2 responses are facing communicators: 

* The "emergency" response - the epidemic is now so devastating that 
we need to rapidly scale up the time, resources and energies putting 
the strategies we've already developed into action on the ground, and 
less time theorising...

* Reflection leading to long term strategic action - it is the demand 
for quick, measurable results that has created a field made up of 
large, donor driven, top down communication interventions which 
have...proved both unsustainable in securing behaviour change and 
have not addressed the underlying causes of the epidemic...and, that 
the increasing complexity of developing country societies, prompted 
by greater liberalisation, and more complex media systems and hori-
zontal communication patterns in society demand fresh thinking and 
approaches.
http://www.comminit.com/stcomdevround/sld-3448.html#DB122-10


***

Should we accelerate an emergency response? Or is it time to assess 
the strategies used so far?

Should we continue with a predominantly behavioural approach with an 
emphasis on sexual behaviour? Or should we expand the cultural and 
CSC based strategies proposed by the UNAIDS & Rockefeller networks? 

Does the changing communication environment in most countries demand 
a change in strategy? Or can we adapt the present strategies to that 
new environment? 

Should HIV/AIDS communication strategies become less or more politi-
cal? 

Have you discussed these issues within your organisation? We would 
like to know your thinking. Please send insights to 
Warren Feek <wfeek@comminit.com> 

***

The Drum Beat seeks to cover the full range of communication for de-
velopment activities. Inclusion of an item does not imply endorsement 
or support by The Partners.

Please send material for The Drum Beat to 
The Editor
Deborah Heimann <dheimann@comminit.com>

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