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close this bookHIV/AIDS and Communication for Behavioural and Social Change: Programme Experiences, Examples, and the Way Forward (UNAIDS, 2001, 68 p.)
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View the documentCase: Child Courts in Zimbabwe
View the documentCase: Sincere Community Centers in Malaysia
View the documentCase: Buddhist Principles to Cope With AIDS


At the outset, it was acknowledged that the new UNAIDS communication framework is not an alternative theory, but rather a guided flexible approach to addressing HIV/AIDS prevention, care, and support issues globally, with attention to regional and local specificity. Workshop participants were urged to look at the UNAIDS communication framework not as a readymade prescription, but rather as a flexible guide, an approach which would facilitate local ownership in operationalizing and implementing communication programmes.

Workshop participants noted that the process of operationalizing the UNAIDS communication framework has already begun in Ethiopia, which will likely lead to some further guides for in-country implementation. Also, UNICEF’s West and Central African Region (WCAR) has created an HIV/AIDS communication strategy for local responses and partnerships, drawing upon the UNAIDS communication framework. The UNAIDS framework was provided to the programme implementers as a “road map”, but not with instructions on how to navigate it (This was left to in-country teams). Based on this flexible approach, UNICEF’s WCAR has created an integrated communication initiative to address HIV/AIDS issues by incorporating components of media and political advocacy, social mobilization, and communication for behaviour change.

Workshop participants provided several useful recommendations as possible next steps in trying to operationalize, unpack, and implement the UNAIDS communication framework:

1. Communication specialists and programme implementers should revisit their current initiatives to see how the five contextual domains can influence their programme strategies.

2. A new mode of operationalizing is needed for the five contextual domains, going beyond the involvement of communication planners. Most past communication interventions have been designed by communication researchers and planners. For operationalizing the five contextual domains, communication planners must pull together a multi-disciplinary team, create multi-sectoral partnerships, and a plan for multi-institution capacity-building.

3. In operationalizing the five contextual domains, it may be useful to ask (for each of the domains) the following sets of questions: Who are the key actors? Who is the target group? What might be the key activities? What institutional mechanisms are needed to implement the key activities? What resources (human and material) are needed for the activities? How can these resources be raised locally, regionally, nationally, and internationally?

Further, workshop participants provided specific suggestions for next steps in operationalizing each of the five contextual domains of the UNAIDS communication framework, as follows:

#1. Government Policy: With respect to the contextual domain of government policy, it may be useful to understand:

· What is the government’s present political stance with respect to HIV/AIDS? What more could it do? How?

· What is the government’s present role in establishing the media and public agenda for HIV/AIDS? What more could it do? How?

· What is the government’s present role in promoting participation of civil society institutions in HIV/AIDS prevention, care, and support, including the private sector? What more could it do? How?

· What are the government’s policy, laws, and regulations with respect to the tourism, commercial sex work, domestic violence, and other domains which impact HIV/AIDS prevention, care, and support initiatives? What more could it do? How?

Case: Child Courts in Zimbabwe

The Zimbabwean government deserves credit for modifying its legal and judicial proceedings to protect the rights of sexually assaulted children. Prior to the establishment of the child-friendly courts, children faced hostile questioning in regular courtrooms, face-to-face with their adult abusers. Intimidated by the courtroom atmosphere, they often broke down, refused to speak, or had great difficulty in describing the sexual act. Without their testimony, the accused were often acquitted.

Today, when a sexual offence complaint is initiated on behalf of a child, the Zimbabwean police and social welfare officers work with the child to reduce their physical and emotional trauma. Children now give courtroom testimony sitting in a separate room through close-circuit television, removed from the gaze of their abuser. A trained intermediary relays the court’s question to the child in a gentle language that the child can understand. The child can also use male and female dolls to demonstrate the sexual act without describing it.

In 2000, every province in Zimbabwe has at least one child-friendly court. The child-friendly courts represent a culturally-sensitive government intervention to protect the rights of the young people.

Source: UNAIDS (2000a, p. 53).

#2. Socioeconomic Status: With respect to the contextual domain of socioeconomic status, it may be useful to understand:

· What role does poverty play in exacerbating local vulnerability to HIV/AIDS?

· What may be certain local mechanisms to alleviate poverty and vulnerability for those at risk for HIV/AIDS?

· What mechanisms may stimulate local income-generating activities?

· What local mechanisms can ensure equal access of all citizens to job opportunities, educational services, and care and support facilities?

· What is the role of key governmental, civil society, and private actors in vocational training, education, and employment generation?

#3. Culture: With respect to the contextual domain of culture, it may be useful to understand:

· What is the nature of relationships between people in families (including husband-wife, parent-child, extended kinship networks, and intergenerational dynamics)?

· What is the nature of relationships between people in neighbourhood communities?

· What types of oral and visual media are used in the community, especially traditional media forms?

· What is the role of cultural gatekeepers in community information flows?

· What are the positive and negative attributes of the local community’s culture with respect to HIV/AIDS?

Case: Sincere Community Centers in Malaysia

Pink Triangle Malaysia (PTM), a non-governmental organization, operates an innovative outreach programme targeted at intravenous drug users (IDUs) in Chow Kit, a poor red-light community in Kuala Lumpur, the nation’s capital city.

The use of a culturally-sensitive research protocol to assess the clients’ needs, prior to launching the programme, strongly pointed to the importance of creating an Ikhlas (“sincere”) Community Center (ICC), a “safe space” where the IDUs would feel comfortable dropping-in. The Ikhlas Community Center provides meals to IDUs, medical care and treatment, referrals to hospitals and drug treatment centers, counselling and psychological support, access to condoms and other risk-reduction services, and referrals to job placements. Clean bathroom and toilet facilities are also provided so that IDUS can bathe, wash clothes, and maintain basic hygiene.

The IDUs are involved in running the various ICC activities: They cook and clean, serve as outreach workers and volunteer counsellors, and conduct administrative tasks. Such participatory involvement helps them take “ownership” of the project, and builds their self-esteem. The IDUs of the ICC now routinely liaison with volunteer groups from hospitals, nursing schools, the corporate sector, and colleges, and thus feel more accepted by the general community. Their active involvement also makes the Pink Ikhlas programme highly cost-effective and effective.

Source: UNAIDS (1999a, p. 42).

#4. Gender Relations: With respect to the contextual domain of gender, it may be useful to understand:

· What are the roles, relationships, opportunities, and expectations of both men and women in the family, community and society?

· What may be some ways in which men and women in the community can be engaged in facilitating more equitable gender relationships?

· What are the men’s culturally-driven perceptions of family relationships, spousal relationships, child care, and others?

· What are the cultural strengths of the community which promote men as fathers, husbands, care givers, concerned heads of households, and responsible members of the community?

#5. Spirituality: With respect to the contextual domain of spirituality, it may be useful to understand:

· What are the various types/denominations of religious, spiritual, and secular organisations in the local community?

· What are the communication channels (mass, interpersonal, and group) used by religious and spiritual organisations to communicate with their audiences?

· What types of influence is wielded by local religious and spiritual leaders (including traditional healers, voodoo priests, and others) in the local communities?

· What are the mechanisms through which spiritual and religious organisations engage with governmental, private, and civil society organisations, for example, educational institutions such as Bible colleges and Islamic Madarsa Schools, and with other women, youth, and other voluntary associations?

Case: Buddhist Principles to Cope With AIDS

Spiritual care is an integral part of the Sanpatong Home-Based Care project in Thailand, where Buddhist principles of kindness, compassion, altruistic joy, and equanimity help the afflicted to cope with AIDS. Buddhist monks teach meditation to help people find tranquility, boosting their mental strength to continue with life. Spiritual guidance is provided on how to protect oneself from suffering and how to see the natural hand in the human cycle of life and death. Discourses cover how to come to terms with one’s mortality, or that of a loved one. Those suffering from HIV/AIDS often spend week-long retreats at Buddhist Wats (temples), where they meditate, re-examine their spiritual beliefs, and benefit from a regimen of healthy diet and exercise.

People in six out of the 10 ASEAN (Association of South East Asian Nations) countries subscribe to Buddhist principles, suggesting some important guides for designing communication programmes for HIV/AIDS prevention, care, and support in this region. Buddhist principles forbid the taking of life (i.e. do not infect others) or consumption of substances to alter the natural body state (i.e. do not consume alcohol or inject IV drugs),thus providing an effective spiritual platform to address high-risk behaviour.

Source: UNAIDS (1999a, p. 71).