|HIV/AIDS and Communication for Behavioural and Social Change: Programme Experiences, Examples, and the Way Forward (UNAIDS, 2001, 68 p.)|
|THE ROLE OF COMMUNICATION PROGRAMMING|
Workshop participants emphasised that AIDS can be viewed as a disease of ignorance and intolerance. Taboos surrounding HIV/AIDS often prevent recognition, discussion, or acceptance of safe practices. In the absence of a vaccine and therapeutic cure, communication programming represents a key ingredient in the social vaccine against HIV/AIDS (Population Reports, 1989. P. 1).
Workshop participants recognised communication programming as being a crucial factor in the implementation of the various UNAIDS priority areas, including:
· GIPA (Greater Involvement of People with AIDS), which is an essential communicative tool for community mobilization and advocacy. It makes HIV visible, contributing to the breaking of silence.
· Young peoples right to know about HIV/AIDS, especially AIDS orphans, child labourers, street children, young girls at risk for prostitution, and others.
· Drug therapy and vaccines, in which new challenges are emerging for communication programming in light of the discovery of new antiretroviral combination drug therapies, as well as media coverage of efforts to develop an HIV vaccine.
· Prevention, care, and support in which communication programmes must now address the entire HIV/AIDS continuum. A holistic approach to HIV/AIDS should therefore go beyond prevention (the previous mantra for communication programmes) to also include enabling mechanisms for the biological, psychological and social care and support of HIV/AIDS patients.
As HIV/AIDS takes a heavy toll on the existing medical services in countries of Sub-Saharan Africa, several innovative home-based care programmes have sprung up in South Africa, Zimbabwe, and other countries.
The Tateni Home Care Services was started by a group of retired nurses in Mamelodi, the black township of 1.5 million people on the western fringes of Pretoria, the capital of South Africa. In response to the growing needs for care and support among local HIV/AIDS patients, Tateni developed home-based care policy and training materials in cooperation with the local health authorities. Tatenis credo is based on the values of empathy, acceptance, hope, and the removal of discrimination against those infected or affected by HIV/AIDS.
Tatenis programme complements existing health care services rather than duplicating or competing with them. The family members of HIV/AIDS patients are trained to enlarge the base of primary care givers, thereby boosting the communitys internal capacity to handle HIVAIDS. Tateni was careful not to copy home-based care models from industrialized countries, where clients usually receive formal home-based health care, mostly in senior citizen homes or nursing home facilities. As African traditions emphasize complex family and community relationships of support, obligation, and consensus, cost-effective family-based home care is provided by Tateni in a way that is respectful of cultural norms and traditions. While Tateni mainly provides enabling palliative care, HIV/AIDS prevention, education, and surveillance are also an integral part of its work. Tatenis outreach workers teach home care using life-sized dolls made of foam rubber and cast- off clothes. They teach caregivers about how to take care of patients while guarding themselves against HIV infections (for instance, by wearing protective gloves, etc.).
The Chirumhanzu Home-based Care project in the central Midlands province of Zimbabwe, grew out of an initiative of hospital health workers, including senior nurses, Dominican sisters, and expatriate doctors. The home-based care project was launched because of three key reasons: overcrowded hospital wards, high costs of hospital care, and the wish of local AIDS patients to stay at home under the care of their families, up until the time of their death.
The Chirumhanzu project works closely with traditional village leaders, who are first invited to visit the local hospital or clinic to meet with the project staff. A video on home-care and HIV/AIDS is shown during this visit. Then the Chirumhanzu staff visits the village, where a public meeting is called by the local chief. The public meeting begins with a skit created by the Chirumhanzus drama troupe to entertain the public while providing relevant information on HIV/AIDS prevention, care, and support. The drama performance is followed by an interactive discussion on the effect of HIV/AIDS on the local community, usually facilitated by a respected nurse practitioner. The meeting usually ends with the chief, his advisors, and the local people showing interest in beginning home care services locally.
Source: UNAIDS (1999a, pp. 54-55).
There are many communicative challenges to HIV/AIDS prevention, care, and support. A glance at some of the key challenges will show that:
(1) Communication is a necessary but not a sufficient condition for either preventing HIV/AIDS or for augmenting care and support programmes.
(2) An individuals response to HIV/AIDS is strongly influenced and shaped by societal norms; by their gender and socio-economic status; by their faith, beliefs, and spiritual values; and by the prevailing governmental and policy environment for HIV/AIDS.
Communicative challenges to HIV/AIDS exist because:
A. HIV/AIDS is:
· invisible (for several years)
· silent (for several years)
· non-debilitating (for several years)
· multiple transmission modes
· non-discriminating (e.g. in terms of age, gender, geography, etc.)
B. HIV/AIDS deals with human behaviours:
· that often involve interaction between unequal parties (e.g. a paying client versus a poor commercial sex worker)
· that are shaped by deep-rooted socio-cultural traditions (e.g. patriarchy, circumcision)
· that are private and personal (e.g. sex, drug use)
· that are recurring
· that are pleasurable
· that satisfy physiological, psychological, and socio-affiliative needs
· that are considered taboo by society, therefore not easily discussed
· that are moralized by society
· that are stigmatised by society
· that are discriminated against by society
C. Efficacious responses to HIV/AIDS involves adoption of behaviours:
· that are dependent on compliance of more than one party (e.g. condom use)
· that are dependent on the availability of products (e.g. condoms) and services (e.g. HIV testing).
· that are preventive in nature (i.e. involve adopting a behaviour today to lower the probability of some future unwanted event)
· that involve benefits that are neither imminent nor clear-cut
· that result in a non-event (that is, nothing happens when one adopts; so motivation for maintaining behaviour change is low)
· that involve foregoing or reducing pleasure
· that involve foregoing or reducing adventure (Singhal 2000a)
D. HIV/AIDS deals with populations:
· that are often hard to reach by conventional media channels
· who are often marginalized by society,(for instance, gays, IV drug users, commercial sex workers)
· who are most vulnerable and powerless (for instance, women and children)
· who are of a lower socio-economic status
· who are on the move (migrants, truck-drivers) and not easy to target (Svenkerud, Singhal, & Papa, 1998)
In Japan, the number of HIV tests and the requests for HIV/AIDS counselling more than doubled between July and September, 1998, thanks largely to a popular melodramatic television series, Kamisama Mo Sukoshidake (Please God, Just a Little More Time), which told the story of a high-school girl who is infected by HIV while she engages in commercial sex work. This highly popular programme, which was broadcast over three months, addressed the issues of HIV/AIDS prevention, care and support, as also the issue of teenage prostitution in a culturally-sensitive manner, breaking the medias silence on the topic. Prior to the broadcasts of Kamisama Mo Sukoshidake, which amplified human emotions in confronting stigma, shame, guilt, fear, and anger, public awareness about HIV/AIDS had declined in Japan for five straight years, primarily because of medias reluctance to address the taboo topic. The television series earned the second highest ratings of all programmes broadcast during the summer of 1998 in Japan, moving a highly stigmatised topic to the domain of public discourse.
Entertainment-education programmes, such as Kamisama Mo Sukoshidake, represent an effective and viable weapon in the war against HIV/AIDS (Piotrow, Meyer, & Zulu, 1992). Such programmes utilize the popular appeal of entertainment formats (such as melodrama) to consciously address educational issues (Singhal & Rogers, 1999; Piotrow et al., 1997)). They earn high audience ratings, involve audience members emotionally, and spur interpersonal conversations among listeners on various topics.
Source: Watts (1998).