UNAIDS HIV/AIDS Communication Framework - Health communication, HIV/AIDS

The purpose of health communication is to bring about some form of change, said Andrew Chetley, Director of the Exchange programme at the Exchange lunchtime discussion in London on the UNAIDS HIV/AIDS Communication Framework. That change might be in behaviour, policy, practice, conditions or attitudes, or in improved understanding or increased awareness.

A number of models and theories used in health communication were identified: health belief model, diffusion of innovation, social marketing, theory of reasoned action and social learning/cognitive theory. All have advantages and disadvantages, but one common disadvantage of these models, was the tendency to focus on the individual and be based on individual psychology, while most human beings live in situations that are family or community centred. In this way: 'We should not expect these models to be productive in explaining behaviour in social contexts where commonsense knowledge of the world takes a quite different form.' (Yoder 1997)

The issue of power is also relevant: sources and recipients of health information are usually not in the same relationship. The need for interaction between message ‘sources’ and ‘receivers’ was identified, as there appeared to be a clear issue of power relations here, and one that is not usually considered.

Warren Feek, Director, Communication Initiative outlined current thinking in communication circles. He pointed out two ‘tendencies’ in communication - previously dominant approaches and the current emphasis - which were in tension and driving debate at the moment. He began by reminding everyone of the HIV and AIDS statistics in Africa in particular and the fact that finding effective health communication approaches was therefore vital.

Speaking on how UNAIDS communication framework fits into broader communication strategies, Warren identified the need for contextual influences such as dialogue, knowledge and practice and emphasised that natural discourse and the nature of the individual culture are part of what make effective health communication.

He also noted that there is a tendency to do single focus activities such as condom distribution or mother-to-child transmission. He appealed to everyone in the health communication sector to start exploring the complexities rather than trying to distil everything to simple solutions.

Feedback from the small groups discussion

Three small groups discussed the following questions:

1. Discussing on field experience, a number of questions were raised about what drives the public profile of any particular approach or experience. The group suggested that essentially power and resources set limits on this for any particular approach. A lot of good work was being done, and it was often where there was successful work that documentation was being requested afterwards. Political will, media agendas and some religious agendas were all identified as having a bearing on how an approach fared. Other problems were associated with the time limits that came along with donor funding constraints and the demand to ‘scale-up’ projects, which was not always easy or appropriate. Also raised were questions about ‘the field’: What was it really? Whose was it and who defined it? All these were questions about the power of definition and who gets to set the priorities for research.

2. On the second question of culture, it was recognised that donors and governments have had a static picture of culture as a barrier in the past. A richer understanding of cultural context is needed to appreciate how communication works in different cultural settings. The notion of culture is misleading if it implies that only non-Western people have a culture. It needs to be recognised that everyone relates to some norms, beliefs and practices, and in this way, everyone has a culture. This includes those in the ‘North’ who are often depicted as being individuals outside of a social context. In this way culture should not be seen as something ‘they’ have over there, but something which is always an aspect of any social setting.

Issues were raised about development intervention where certain ‘cultural practices’ were seen as harmful. It was stressed that people had to determine their own solutions within particular cultures and that the most that should be done from the outside was to support particular voices that were asking important questions and recognise that this was being done. The example of ritual cleansing practices after death was discussed: in some places, jumping over relatives had been substituted for the traditional sexual practices. This showed that ‘traditions’ could be constructively engaged with to take particular health priorities into account.

There was also a broader recognition that most traditions are ‘invented’ in the sense of selectively drawing on existing cultural repertoires. Female Genital Mutilation was another example of an issue where condemnation from the outside was not enough. A hypothetical example illustrated the mixed blessing of externally driven agenda, which could be both productively challenging, but also inappropriate: the example was a group of concerned doctors from the Sudan coming to the UK to make sure they built extended family and community networks, since they were obviously lost without them.

3. Emerging from the discussion around putting the framework into practice, the group which had little detailed knowledge of the framework, looked at the five contexts and felt it would be hard to implement them. A perspective from a likely funder suggested the framework was unattractive to prospective donors, as it seemed like nothing new, and that it would be hard to ‘sell’ due to its complexity. Funders needed to be convinced that taking this approach would lead to more effective programmes, despite its complexity. There were convergences here with the way many corporations were taking more time to look at what made them more effective and to tailor their work to particular settings, and this might be persuasive to donors. It was also felt that the framework provided an opportunity to develop more responsive models to approach health issues in general.

In subsequent discussion a number of people felt that the principles contained in the framework - of taking context into account - were not new, since people had been saying this and acting on it at the grassroots level for many years. However the framework did provide a codified/written down/useable tool for project proposals with the added legitimacy of a large organisation like UNAIDS highlighting the importance of context. It was noted that the framework needed to be presented in a way that did not alienate those who had been working that way for a long time, emphasising this opportunity for recognition. It was perhaps not surprising, that the field of HIV and AIDS communication had brought issues of context to the fore, given the personal and social ripples caused by HIV and AIDS.

Feedback/evaluation

Twelve evaluation forms were returned (out of approximately 20 participants in discussions - three people only came to the presentations and lunch).

Key themes in the feedback were that the discussions were thought-provoking and informative and that people liked the small group discussions format and the range of participants from different backgrounds. A few people commented that the discussions could have been longer and the initial presentations a little shorter, but the overall concise two-hour format was also valued (one participant emphasised it should start promptly).

Suggestions for improvements included:

One participant suggested having lunch first so people weren’t hungry and distracted, though others thought the break for lunch was good so that people didn’t avoid it and only come for the discussion.

All wanted to come to similar events in future and a range of topics for discussion were suggested, some of which people offered to lead on (marked *) including: