Fwd: DB Click: HIV/AIDS - The Social Response to HIV/AIDS

August 12, 2008

DB Click: HIV/AIDS - The Social Response to HIV/AIDS

DB Click: The Social Response to HIV/AIDS

August 2008

DB CLICK: HIV/AIDS is designed for people seeking to address HIV/AIDS

issues and

opportunities. This is the 2nd of two issues of DB Click: HIV/AIDS compiled by

Warren Feek around the XVII International AIDS Conference in Mexico

City, Mexico

(August 2008). In the first we communicated the set of overall HIV/AIDS policy

themes developed through an online dialogue and review process by an extensive

group of HIV/AIDS communicators before the Conference (see

http://www.comminit.com/en/node/273615

).

Put forth following the Conference, the note below provides an introduction to

the prominent challenges, impact data, and strategic thinking that shaped the

dialogues in Mexico City. The content for this note was gathered by a group at

the Conference that included Sue Goldstein, Carol Larivee, Gray-Felder,

, Robin , and Warren. This work was supported by UNAIDS

through the good offices of Brazey de Zalduondo. The knowledge below

was also

fed into UNAIDS' knowledge gathering process at the Conference.

===

SOCIAL AIDS

If the Toronto AIDS Conference in 2006 could be called " the circumcision

conference " , then the XVII International AIDS Conference in Mexico

City was " the

social conference " . The term 'social' was breaking out in discussion everywhere

- social drivers, social complexity, social change, social mobilisation, social

movements, social stigma, socio-economics, socio-cultural factors, and social

phenomena (from homophobia to gender equity). This was a move back to an

effective long-term response: the social response. The notes that follow are

observations and highlights from the Mexico 2008 conference pertinent to an

increasing policy priority on, and investment in, a social

movement/change/norm/mobilisation

focus for more effective HIV/AIDS action.

These notes (which are available in an expanded version, here:

http://www.comminit.com/en/node/274190 ) should be read in conjunction with the

policy themes that were gathered online in advance of this conference

by a group

of HIV/AIDS communicators (see http://www.comminit.com/en/node/273615 ).

===

THE CHALLENGE

Even though UNAIDS data indicate SOME positive progress, it is clear that the

programmatic challenge remains huge. Geoffrey Garnett noted that, " if sexual

partners were

reduced by 50% and if circumcision was adopted then we would be

closer to keeping the epidemic under control " . The challenge: Both of these

elements have deep, sensitive cultural and social roots; they will not be

changed by traditional, individual behaviour-change-focused, information-based

initiatives. Another challenge concerns access to treatment: According to

Coutinho, " [f]or every 5 people infected three die without ever getting

treatment during their lifetime. " And Sepulveda, commenting on the fact

that the number of new infections is still hugely outpacing the growth

in access

to treatment, noted that " massive change is required if we are to reach this

turning point in the next few years " …massive change based on social norms,

social movement, and social mobilisation principles.

===

THE DATA

1. Prevention Overview

The August 2008 issue of the Lancet, which focuses on HIV prevention, data, and

conclusions, stresses themes such as the following: a long-term approach;

programmes that emerge from and respond to local contexts; the " political "

nature of the strategy and programming choices that are made; and the

imperative

for seeking change at the level of social norms. For example:

* " …change in housing status was associated with change in HIV/AIDS

related risk

behaviours...[including]...needle sharing and unprotected sex in

comparison with

individuals whose housing status did not change " [A

idala et al. - 'Housing

Status and HIV Risk Behaviours', " AIDS and Behavior " , 2005, Vol. 9, pp. 251-265]

* assessments of community solidarity strategies involving women sex workers in

the Dominican Republic " [r]eveal significant increase in condom use with new

clients (up from 75% to 94%); significant reductions in prevalence of [sexually

transmitted infections] STIs (29% to 16%); and significant increases in sex

workers verbal rejections of unsafe sex (50% to 70%). " [Kerrigan et al. -

'Environmental-Structural Interventions to Reduce HIV/STI Risk among Female Sex

Workers', " American Journal of Public Health " , 2006, Vol. 96, pp. 120-125]

* " ...the example of Uganda illustrates that national level social mobilisation

and policy efforts to involve local agencies and enable tailored structural

approaches to HIV prevention are possible. " [Rao Gupta et al. - 'Structural

Approaches to HIV Prevention', " The Lancet " , August 2008, p. 57]

2. Communication Programme Impact - 3 Examples

a. Soul City - South Africa

Soul City, a national programme using mass media and social mobilisation to

effect social change, described an evaluation of the 7th series of Soul City,

which dealt with antiretroviral therapy (ART), amongst other health issues. The

original study was a nationally representative survey of 1,500 adults over 16

years.

The hypothesis that high social capital would predict low stigma was partially

confirmed in that the items " feeling safe in

the community " and " participating

in an event " were related to lower stigma. Exposure to 2 Soul City media (among

other health communication programmes, such as Soul Buddyz) and

participating in

training or an event were associated with lower stigma, suggesting that the

media have a positive effect on reducing stigma. The research also highlighted

traditional beliefs, religious affiliation, race, and education as key

predictors of stigma. The implication is that increasing accurate HIV/AIDS

knowledge, implementing anti-stigma training in the outreach work of churches,

and improving voluntary counselling and testing (VCT) services will all assist

in decreased self-stigma, improved adherence, and, in the long run,

improved HIV

prevention.

* These data are from a poster session conducted by Soul City at the

Conference.

For more information, as a downloadable Word document, see:

http://www.comminit.com/files/SoulCitystudyin2006.doc

b. Puntos de Encuentro - Nicaragua

An evaluation of the Puntos initiative Somos Differentes, Somos Iguales (SDSI)

highlighted data on the effects of this mass media intervention in the

following

areas: scale, stigma, services, priority, and protection. For example, " 23% of

those respondents who said that they had talked to their partners about using a

condom in the past 6 months " ' and " 18% of those respondents who

reported using a

condom during their last sexual relationshi

ps with a casual partner in the past

6 months " attributed changes to SDSI.

** These data are from the Puntos Encuentros/SDSI poster session at the

Conference. For more information about Puntos de Encuentro and the evaluation,

see: http://www.comminit.com/en/node/269387

c. Straight Talk (STF) - Uganda

The Ugandan non-governmental organisation (NGO) STF draws on person-to-person

contact, radio, and printed materials to share information among, and foster

communication between, young people and influential adults about adolescent

sexual and reproductive health (ASRH), including issues related to

HIV/AIDS. For

more information on STF in Uganda, see:

http://www.comminit.com/en/node/266637/38

These data are based on STF's recently completed evaluation:

Impact on Youth: Researchers found that greater exposure to the materials is

significantly associated with higher ASRH knowledge, and each incremental

exposure is associated with increased knowledge. For more, see:

http://www.comminit.com/en/node/266577/38

Impact on Parents: About 62% of parents who had read Parent Talk (52 parents)

said that they took some type of action as a result of reading Parent Talk. For

more, see: http://www.comminit.com/en/node/267982/38

Impact of Mass M

edia Initiatives: Exposure to STF materials was found to have

improved adolescents' knowledge and attitudes about sexual and reproductive

health and helped them to adopt safer behaviours. However, among those parents

unable or unwilling to talk with their children about ASRH, two-thirds agree

that women should tolerate abuse from their husbands to keep a family together,

and one-third report that there are times when women deserve to be beaten by

their husbands. For more, see: http://www.comminit.com/en/node/266033/38

Evaluation of the School Environment Program (SEP): Teachers sensitised under

SEP were more likely to report feeling confident about talking to adolescents

about sex and growing up, but not more likely to actually do so. For more, see:

http://www.comminit.com/en/node/266614/38

Parent Survey: The study found that parents are an important audience for STF

materials - with about 60% having been exposed (mostly to local language STF

radio shows). However, organisers find that parents still need

considerable help

talking to their children about ASRH issues. For more, see:

http://www.comminit.com/en/node/266622/38

*** These data are from the Straight Talk Foundation poster session at the

Conference. They also relate to documents available on The CI website - see

links above.

3

.. National Implications - Data and Strategies

Though the starting point for this insight comes from the recent " corrections "

to HIV incidence rates in the USA - and particularly within the Black community

in that country - the response to that data highlighted what happens when the

family, community, state, and national dialogue on HIV/AIDS drops off the

priority table.

These quotes are from the Black AIDS Institute report " Left Behind " , which was

released at the Conference: " Standing on its own [as a country] Black

America...would rank 16th in the world in the number of people living

with HIV " ;

" AIDS remains the leading cause of death amongst Black women between

25-34 years

of age and the second leading cause of death in Black men 35-44 years of age " ;

" Blacks make up 70% of new HIV diagnoses amongst teenagers and 65% of HIV

infected newborns [in the USA]. "

The analysis of why this situation exists highlights government policy,

priority, and financial issues but stresses deep social norm and cultural

factors as being equally important - for example: " The SILENCE [our caps] that

masks the particularly high risk of HIV risk confronting men who have sex with

men in Africa and other highly impacted regions also exacerbates AIDS in Black

America " ; " As in many other parts of the world, many Black women in the US are

rendered vulnerable to HIV as a result of GENDER INEQUALITY [our caps]... "

The policy and programmatic pre

scription in this report begins: " Where national

AIDS responses have succeeded, communities have mobilised to fight stigma,

overcome prejudice and promote solidarity in the fight against the epidemic… "

===

Please participate in our current HIV/AIDS POLL:

[Note to Registered Users: when logged in, please vote then comment on your

choice in the form provided]

In an effort to contribute to efforts to meet Millennium Development Goal (MDG)

#6, schools should integrate HIV and AIDS prevention programming into their sex

education curriculum...

* Early - i.e., in primary/elementary grade levels.

* Around the time of puberty - i.e., in middle school.

* Later - i.e., when youth are nearing the end of undergraduate education.

* Never; it is the role of parents or others - not schools - to provide this

kind of information.

VOTE - http://www.comminit.com/en/hiv-aids.html (see " Poll " heading on the top

right side).

===

STRATEGIC OBSERVATIONS

a. Modes of Transmission - Presentations from Lesotho and Uganda reflecting on

the UNAIDS Modes of Transmission Study raised the issue of " message " not being

effective or appropriately targeted as a gap area in communication.

For example,

a presenter from Lesotho highlighted the need to spur a broad social

campaign or

" movement " to foster community discussion of the underlying issues of HIV/AIDS

risk

and alcohol use.

b. Women and Prevention - Kim, from the University of the

Witwatersrand in

South Africa, reported on the IMAGE study, which looks at structural

interventions such as microfinance that are providing a safer space

for dialogue

on risk behaviours and prevention options. This study suggests that 1) there is

a need to go beyond randomised controlled trials (RCTs) and think differently

about what is effective data collecting, and 2) that behaviour change

programming is working in many situations.

c. Participative Communication and Research Design - One session at the

conference highlighted how the failure of a research organisation to consult

with a people living with HIV/AIDS (PLHA) group in Thailand undermined the

efficacy and accuracy of their trial for a new drug. The failure to engage with

this group - to hear and consider their ideas for improving the research design

based on their local knowledge and insights - led to passive

resistance (such as

unreported non-compliance) resulting from their lack of trust of the

researchers. The results of the study were corrupted.

d. The Marriage of Prevention, Care, and Treatment - HIV prevention, consisting

of combination prevention " married to " treatment and care, is a central focus -

if not the dominant theme - of the Mexico AIDS conference. Presenter

Myron Cohen

said that prevention and treatment have been " engaged " for 25 years; they " need

to get married " , and to20do it today. He cited and Stover's

modeling that

indicated that this " marriage " could avert 28 million new HIV infections and 10

million deaths by 2015. He stressed that combination prevention was essential,

and cited behavioural and structural intervention strategies as parts of the

package needed to get proven barrier methods and future vaccine-based and

ARV-based prevention strategies into actual use.

e. The Global Prevention Working Group (WG) - The key message: HIV

prevention is

difficult, but doable. If known and effective prevention strategies

were brought

to scale, a dramatic decrease in new infections could be achieved; however,

without a dramatic increase in effective combination prevention, new infections

will continue to outstrip treatment gains.

f. HIV-related Stigma and Discrimination (S & D) - Recognition that HIV-related

S & D blocks access and participation was evident in conference pre-meetings,

including Living 2008, the Ecumenical pre-conference, and the men who have sex

with men (MSM) meeting, as well as during the conference itself - e.g., the

march against homophobia and a wide range of plenaries and sessions. Ten years

ago the AIDS community could say we knew S & D were important but we didn't know

what to do about them. Today, we see they are still as important, but we have

new programme models and strategies to combat them, and tools for

monitoring and

evaluating these programmes to show what progress t

hey are making.

CONCLUSION

The emphasis on social analyses and socially driven responses to HIV/AIDS to

emerge from the Mexico Conference stresses the vital importance of

communicatioon approaches for effective action. It is the communication-based

approaches outlined in " The Real Stuff " (

http://www.comminit.com/en/node/273615

) that provide the policy and strategy direction to advance the

requirements for

a social approach to HIV/AIDS.

Thanks - hope that this was helpful. If you have feedback or ideas please use

the peer review forms at the bottom of all links above to send us your commemts

and ideas. This concludes the 2-part special DB Click: HIV/AIDS series - normal

service resumes soon!

===

See also the HIV/AIDS Theme Site - Where communication and media are central to

HIV/AIDS - http://www.comminit.com/en/hiv-aids.html

===

Access all information on the issues you choose through a Theme Site on The CI:

HIV/AIDS - http://www.comminit.com/en/hiv-aids.html

Early Child Development - http://www.comminit.com/en/earlychild.html

ICT4D - http://www.comminit.com/en/ict4d.html

ICT Policies and Studies - http://www.comminit.com/en/ictpolicies.html

Democracy and Governance - http://www.comminit.com/en/demandgov.html

Polio - http://www.comminit.com/en/polio.html

Natural Resource Management - http://www.comminit.com/en/nrm.html

Avian Influenza - http://www.comminit.com/en/avianinfluenza.html

===

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===

from The Communication Initiative...where communication and media are

central to

social and economic development...

Partners: ANDI, BBC World Service Trust, Bernard van Leer Foundation,

Calandria, CFSC Consortium, CIDA, DFID, FAO, Fundación Nuevo Periodismo

Iberoamericano, Ford Foundation, Healthlink Worldwide, Inter-American

Development Bank, International Institute for Communication and Development,

s Hopkins Bloomberg School of Public Health Center for Communication

Programs, MISA, PAHO, The Panos Institute, The Rockefeller Foundation, SAfAIDS,

Sesame Workshop, Soul City, Swiss Agency for Development and ation,

UNAIDS, UNDP, UNICEF, USAID, WHO, W.K. Kellogg Foundation

..

Website: http://www.comminit.com

August 12, 2008