Participation, power and accountability in HIV/AIDS communication

Tom Scalway gave an overview of Panos London’s learning from 20 years of HIV and AIDS communication work, which is documented in the report Missing the message?

Panos aims to build participation, ownership and accountability in HIV and AIDS work: the report is a step towards addressing the problems of HIV and AIDS communication through strategic work with policymakers, civil society and the media.

Although more interest and money than ever before is being mobilised in response to HIV and AIDS, it is questionable whether this builds on sustainable, locally owned responses. The high profile 15 billion dollars that the US recently promised comes with strings attached and supports particular agendas. An emphasis on rapid expenditure inevitably leads to short-term thinking and donor driven agendas. Scalway noted that the World Health Organization's 3 by 5 initiative – which aims to bring access to anti-retroviral therapy to three million people by 2005 – was considering bringing in a commercial advertising company to coordinate communication.

Ownership, participation and accountability are all evident in relatively successful responses to the pandemic. In Thailand, Uganda and Brazil, and in South Africa’s access to treatment campaign, common key things have been shown to work: having civil society at the centre of the response, a politicised community response that draws on local expertise and knowledge, local government leadership, and environments where dialogue can flourish. All of these things are difficult to measure and take time to achieve.

More sustainable approaches require long-term commitment with an emphasis on creating enabling environments for communication at a number of levels: media, civil society and national policy processes.

Discussion focused on the need for appropriate monitoring and evaluation and the importance of coordination of a range of methods. At the macro level, changes in the law and policy might be observed. At the micro level, some of the work being done by ActionAid with Stepping stones and Reflect points to ways to link the local interpersonal aspects of empowerment with wider advocacy agendas. An ongoing review of HIV and AIDS communication work by Healthlink Worldwide also looks at evaluation in this area.

Other contributors noted the important role of media partnerships, but also that the dominant agendas of commercial media make it difficult to get appropriate exposure for issues like HIV and AIDS. Media training and the capacity development of NGOs in this area is needed.

Questions about the role of social cohesion were raised: to what extent does social cohesion enable an effective response? One participant noted the work of Catherine Campbell, documented in "Letting them die" and other work in medical anthropology that has highlighted the cultural dimensions of responses to HIV and AIDS. (See Source Key list for details.) Social support could be the key to an effective response to HIV and AIDS. On the other hand, stigma and the ways cultural groups define their identities through exclusion could mean that one group's social cohesion becomes a problem for other people.

Participation, power and accountability in HIV and AIDS communication