Approaches to HIV and AIDS communication strategies

Background materials
Discussion paper - PANOS strategy (RTF format 85 KB)

PANOS communication in Lusaka (RTF format 75 KB)

Full report:Exchange lunchtime discussion 20 March 2002

James Deane, Director of PANOS, described how he used the debate at the Communication for Development Roundtable (CDR) to emphasise the need for new approaches to HIV and AIDS communication. CDR is a biennial event organised by UN agencies to identify trends and map out strategic priorities in communication and development.

Summary of the presentation by James Deane

New approaches are needed to halt the remorseless spread of HIV and AIDS. There have been many successes, but also failures due to lack of resources, insufficient political will, or inappropriate communication and prevention strategies.

Key question: Does the fact that communication has principally been used to address the symptoms of the HIV and AIDS mean that it has little to offer in addressing the causes of the epidemic?

It is not the first time such questions had been asked. Similar questions were raised in consultations that led to the UNAIDS HIV and AIDS communication Framework and to the Rockefeller Foundation’s Communication for Social Change programme.

When such questions are posed in debates in the South, the response has always been similar: a deep-seated unease concerning the appropriateness, effectiveness and sustainability of many current HIV and AIDS communication interventions.

Three distinct approaches to communication are:

• behaviour change communication, including social marketing and information, education and communication (IEC) interventions 
• social change communication 
• advocacy communication 

Behaviour change communication is results oriented, science-based, project oriented, client-centred, cost effective, based on a belief that urgency of the epidemic necessitates a high degree of focus on behaviour, tries to encourage people to make informed choices. 

Social change communication can include a focus on seeing people and communities as agents of their own change, emphasises community empowerment, creates an environment of change, is process oriented, provides a voice for communities and opportunities for dialogue and debate rather than focusing on products and messages, is based on a belief that behaviour change is dependent on social change and is a long term process. 

Advocacy communication is organised attempts to influence the political climate, policy and programme decisions, public perceptions of social norms, funding decisions and community support, and strengthens voices in communities and societies to effect change socially and politically.

It can be argued that any distinction between behaviour change, social change and advocacy communication is artificial:

'In good programmes, they are usually combined… In the long run, behaviour change programmes cannot depend on monologue or dictation from outside, they must depend on dialogue and informed choices by individuals and within communities.'
Professor Phyllis Piotrow, Johns Hopkins University 

At the CDR there was:

• widespread agreement that behaviour change depends on social change 
• significant agreement that most behaviour change programmes are not integrated into wider development strategies, are often self contained and leave little behind in terms of community or social empowerment 
• concern about the fundamental questions of ownership, accountability and rootedness of communication intervention 
• recognition that social change programmes are difficult to evaluate and fund and require a long time to demonstrate impact. 

Although resources to deal with HIV and AIDS are being increased, they are still inadequate and there is a low level of confidence that using current strategies will contain the spread of HIV and AIDS. There is also little evidence that wider development processes, for example poverty reduction strategy papers (PRSPs), connect with HIV and AIDS communication strategies that are driven from within developing countries.

The CDR called for a coordinated and a concerted multisectoral international and in-country communication response among all partners to tackle the spread of the epidemic. This means involving governments, NGOs, religious leaders, donors, the private sector and particularly those living with HIV and AIDS.

James Deane concluded with a brief description of the work of the PANOS AIDS programme and the principles it follows to stimulate informed analysis of HIV and AIDS issues from developing countries.

A question was raised about the success of communication efforts in Uganda. James Deane attributed the success to its political leadership and an indigenous, internally respected research capacity and authoritative analysis of the epidemic. He explained that Uganda created a climate where sex and sexuality could be discussed publicly and increasingly freely. This was supported by a multisectoral strategy that tackles both the causes and symptoms of the epidemic.

Small group discussion

After the presentation, participants broke into three small groups to discuss three questions:

• What are the main differences between Behaviour Change Communication, Communication for Social Change, and the UNAIDS framework? How do these approaches empower people to take ownership of the response to the epidemic?
• To what extent do donors and international AIDS communications organisations prioritise activities which follow the principles behind the UNAIDS, or Communication for Social Change approaches (who sets the agenda and the response to AIDS)?
• How can AIDS Communication Programmes working within the UNAIDS, or Communication for Social Change be evaluated, given they do not limit themselves to changing individuals' behaviour, but instead address the contextual factors shaping individuals' attitudes and behaviours?

The group that dealt with the first question looked at the main difference between behaviour change and social change and the question of ownership of strategies to deal with HIV and AIDS. The group discussed:

• the need for a supportive environment to lead to behaviour change 
• the role of social change in creating opportunities for behaviour change 
• the need to listen more to grassroots organisations and to work from the bottom up rather than impose frameworks from the top 
• The short-term nature of donor funding that encourages approaches such as behaviour change, rather than providing the longer term funding to enable social change to occur 
• the need for community organisations to have the freedom and flexibility to adapt communication strategies and frameworks to the local context 
• the need to pay attention to issues of power and control that influence ownership. 

The group looking at the second question recognised that donors had to spend money, often on a large scale, and that this introduces constraints to spend it quickly. This group also emphasised the need for an enabling environment. It focused on the importance of the process of deciding on which approach to use. Attention to accountability and involving a broad constituency would determine who was setting the agenda for work on HIV and AIDS.

The group that discussed the third question noted that it was difficult to evaluate social change programmes. Several factors played a role including the usual low budget for evaluation activities and the lack of a reasonable baseline to be able to track change. If the change was focused at the policy level, it could be even more difficult to identify what was causing the change and why one approach worked and another did not. The group felt that it was also important to recognise that social change needs to consider the diversity in any community or group and recognise that some individuals respond to approaches in different ways.

Discussion conclusion: Further discussion on HIV and AIDS communication is needed. Exchange agreed to arrange a further session, later in the year to explore the issue in more depth. This may be linked to a forthcoming report from PANOS on HIV and AIDS due out in late summer 2002.

Evaluation

Feedback from the participants was almost universal in praise for the excellent and comprehensive presentation and in the lack of sufficient time to discuss the issues raised. Several people noted that having the background papers in advance helped

Suggestions for improving these sessions included narrowing the focus of the topic and the questions relating to it, limiting the feedback session from small groups to only two or three key points, and aiming for more specific outcomes (for example, a learning/training outcome).

Topics that people suggested for future lunchtime discussions included:

• Practical case studies/real projects/what works 
• How to integrate HIV and AIDS work into other programmes 
• How to bridge the gap between HIV and AIDS, sexual and reproductive health and family planning 
• Monitoring and evaluation of communications (including usefulness of publications) 
• Social marketing – from products to behaviour change 
• Communication for child health 
• Relationship between donors and recipient communities.

more on HIV and AIDS communication