Communications Practice and HIV/AIDS Prevention

Media campaigns and interpersonal communication complement each other in the development of communications interventions for HIV/AIDS prevention and care. The mass media can convey information efficiently and thereby provide effective support for face-to-face communication. The combination of mass media with interpersonal communication allows for addressing diverse individual and group concerns while honoring the delicate, private nature of human sexuality. One example of an effective interpersonal communication is oramedia - a term coined by Ogboaja to describe a traditional network of oral communication channels in the African context, which is equally applicable in several cultures of Asia and Latin America and the Caribbean.

Published materials on the success of interpersonal communications in HIV/AIDS are scarce. This is due in part to the relatively limited funding for interpersonal communication interventions. Funding has been limited primarily because interpersonal communication reaches fewer people than the mass media. However, many practitioners have found that interpersonal communication has been successful in addressing the sensitive issues of sexual behavior in Africa and Asia. Moreover, the costs and benefits of interpersonal communication have not yet been adequately assessed. Interpersonal communication results in behavior change that cannot be evaluated as easily as creating and maintaining awareness through the mass media.

Another problem is that mass media campaigns on HIV/AIDS prevention are criticized in part for unfounded claims by researchers and practitioners that behaviors were influenced when simple awareness was the only possible outcome. Although mass media campaigns, typically of limited duration, are necessary for promoting and maintaining awareness, behavior change requires sustained promotion among groups and individuals. This requires an interpersonal communication component.

Media campaigns are also useful in reinforcing interpersonal communication by, for example, focusing on gender roles in the family and the community. This has encouraged men to engage in the dialogue on HIV/ AIDS prevention, rather than placing the entire burden of decision making on women. The importance to men of their families and their protective roles in their families and community can be reinforced by the mass media.

Mass media campaigns can also help challenge the assumption that increased knowledge of HIV/AIDS alone leads to safer sexual behaviors. Targeting each segment of the community with appropriate messages is critical for reaching a population with diverse modes of knowledge production and acquisition. Also, cultures vary in their reliance on new knowledge as a motive for behavioral change. The strength of associations between and among knowledge, attitudes, and practices also differs from one culture to another. Understanding these cultural variations is essential for communications interventions. The traditional assumption that knowledge automatically leads to behavior change is no longer accepted.

Broadcast HIV/AIDS public service announcements (PSAs) have typically carried non-specific and uncontroversial safe sex information. In most cases, PSAs have been designed to increase knowledge rather than influence behavior. The promotion of condom use as a preventive health behavior message has appeared in less than a third of HIV/AIDS PSAs. So far, the majority of PSAs have been aimed at general audiences. They have generally provided vague, visually inexplicit material; avoided addressing barriers to behavior change; and have rarely provided specific recommendations. Almost without exception, PSAs have been limited to increasing the awareness of HIV/AIDS. This approach is inconsistent with the goals of HIV/AIDS prevention campaigns, which are to address contextual domains that could lead to behavior change.

Another factor to be taken into account is that HIV/ AIDS practitioners have begun to initiate community-based and community-wide programs. In contrast to typical communications campaigns, community-wide interventions are long-term, more complex, and by necessity, involve extensive community participation. While properly developed and well-implemented mass media campaigns can play a vital role in increasing knowledge and public awareness of the issues, more resources need to be invested in interpersonal communication. And it must be pointed out that communications campaigns alone cannot change community infrastructure, bring about and enforce policies, or increase resources (such as condoms or needle exchanges) and services (counseling, testing, or medical care).

In summary, the responses from countries represented in the consultative workshops highlighted the following key issues crucial to effective communications for HIV/ AIDS prevention, as well as other themes that remain somewhat problematic for HIV/AIDS prevention, care, and support programs:

· Integrate HIV/AIDS prevention with STD/ STI treatment, given the proven success of this strategy.

· Locate HIV/AIDS messages within the broader context of a country’s social economic reality, recognizing that HIV is both an economic and social crisis.

· Develop HIV/AIDS communications strategies with due consideration to culture, gender relations, power structure, religion/spirituality, individual and government economic status, and the individual and collective roles of these dimensions in HIV/AIDS prevention and care.

· Promote community participation by planning and carrying out people-centered programs that induce broad-based participation.

· Use mass media and interpersonal messages either independently or jointly in communications strategy.

· Recognize the role of alcohol consumption in the spread of HIV. This is particularly important given that some societies favor alcohol consumption.

· Support the availability of condoms as well as teaching their proper use.

· Advocate for communications to address the importance of laws prohibiting violence against women, including domestic violence and rape by men in the military.

· Encourage communication with and between parents and siblings so that HIV/AIDS can be discussed in whatever manner the culture and family support parent-sibling discussion.

· Collaborate with private sectors and recognize the important role of non-governmental organizations, so their roles and capabilities are strengthened.

· Develop targeted programs for specific populations, such as taxi drivers.

· Use participatory and qualitative research, so the beneficiaries of programs are involved in planning, implementation, and evaluation. This type of research has allowed several countries to identify problems and audiences that had originally been overlooked during planning of communication interventions.

· Identify the differences within a country or region, for example, rural vs. urban and lowland vs. highland.

· Recognize the importance of human rights as they relate to the legal protection of persons living with HIV/AIDS, including such communications strategies as disclosure in vaccine trials, prevention of mother-to-child transmission of HIV, and access to treatment drugs, including anti-retrovirals. Each of these poses ethical issues.

· Develop programs for specific populations, such as curriculum integration for school-based HIV/ AIDS education programs and workshops for worksite-based HIV/AIDS education.

· Maintain awareness through the mass media - such as by addressing existing misconceptions about HIV/AIDS - while recognizing the limitations of sole reliance on the media to spur action.

· Recognize the implications for men having sex with men. This continues to be ignored in some countries’ HIV/AIDS prevention programs.

· Use evaluation as a strategic element in all communications strategies. Pretesting must also be emphasized in all communications programs as a crucial component of effective message and material design. Moreover, the epidemiological context of HIV/AIDS must be understood through systematic research in order to design more effective communications programs.

· Promote the openness to explore new ideas and approaches to influencing audiences. Early school education on HIV/AIDS prevention might be an effective way of addressing a problem in some places. However, political will and commitment are needed, which means that advocacy work must be directed to ministers of education and other decision-makers.

Recommendations

In the context of HIV/AIDS, both short-term solutions and long-term change are needed to alleviate the impact of AIDS. The contextual domains present some challenges to be addressed, since they do not lend themselves to linear intervention strategies directed to solving problems without reference to the causes. It is critical to identify relevant social, cultural, and behavioral norms that could be encouraged or changed to reduce risk situations that tend to favor the spread of HIV/AIDS. Following are some of the key issues for achieving the goals and objectives related to the five domains of context. These recommendations are grouped into interpersonal communication, mass media, and program intervention.

Interpersonal Communication

· Identify the role and function of interpersonal communication strategies. For example, identify the potential of entertainment education by using humor in AIDS messages and discussions about sexuality to promote open discussion among couples, peers, and friends.

· Create opportunities for communities to discuss issues through interpersonal communication.

Mass Media

· Define the role and function of communications interventions, including social mobilization and advocacy.

· Train personnel and participants, whether from within or outside the targeted social context, in the use of effective mass media strategies.

· Assess the information environment, particularly in light of the competition between health and other communications priorities for media space and time.

Program Intervention

· Make a distinction between planned communications and news items that are not within the purview of health interventionists.

· Identify what is meant by cultural meaning, so the understanding and appreciation of “culture” is not limited to individual beliefs.

· Use indigenous resource persons, such as opinion leaders and traditional healers, to serve as facilitators for communications planning.

· Use flexible approaches to intervention, rather than one-size-fits-all formulas.

· Cover the continuum from prevention to care in communications strategies.

· Treat communities as holistic, but segmented, targets of information, rather than as single audiences.