Communications Framework: The Locus of Change

A NEW DIRECTION

Rationale for a new framework

• 90% of new cases of HIV occurs in Africa, Asia, Latin America, and the Caribbean
• Approach to prevention, care, and support based on context of these regions.
• Changing context of response to HIV/AIDS - treatment drugs and vaccine trials, economic, social and development impact, and expanded response from UNAIDS

Communications Framework for HIV/AIDS: A New Direction

GOAL: To develop an improved framework for communications for HIV/AIDS prevention, care and support.

Objectives

Review existing approaches on HIV/AIDS communications

Proposed guidelines in development of regional and national strategies

Identify program exemplars from the regions and countries as examples in the new framework

Consensus

Current theories and models of behavior change do not provide adequate contextual approach to HIV/AIDS prevention in the regions

Focusing on the Context

Government & Policy

Socioeconomic

Culture

Gender Relations

Spirituality

Theories and Models Used in HIV/AIDS Communications

• Health Belief Model
• Theory of Reasoned Action
• Social Learning/Cognitive Theory
• Diffusion of Innovations
• Social Marketing
• Hierarchy of Effects
• Stages of Change
• AIDS Risk Reduction Management

Limitations of currents theories & models

• Focus on the individual and exclude context
• Assume that HIV preventative decisions are based on rational volition and not enough emotion
• Assume that knowledge leads to behavior
• Ignore the differences between single action (i.e., Immunisation) and continuous life-long activities (i.e., condom use)
• Focus on condom promotion alone (i.e., "condomisation of HIV/AIDS)

Context & the new framework

Five Domains:

• Government & Policy
• Socio-Economic Status
• Culture
• Government & Policy
• Spirituality

Government & Policy

• Policy and supportive enviroment
• Role of government in setting policies
• Role of government in setting agenda including ethnics in research
• Government support for issues of tourism, migration, violence and rape of women

Socio-Economic Status:

• HIV/AIDS as a social problem
• Issues of accessibility of health care
• Issues of affordability of clinical interventions and drugs

Culture

• Elasticity of language
• Family & community relations
• Centrality of family in decision making
• Individual beliefs vs. community norms
• Caregivers and their role in a culture

Gender Relations:

• Imbalance of power
• Unequal access to info. and education
• Sexuality, control and negotiation
• Vulnerability and risk of HIV
• Women and mothers
• Images and representation of women in media

Spirituality:

• Non-judgment attitude toward all religions
• Partnership with religious leaders
• Understand spirituality as broader than religion
• Religion and spirituality: entry point to communities
• Humanizing persons living with HIV/AIDS
• Relate prevention to care
• Different values about the dead

Operationalizing the Framework: The locus of change

Ethiopia; Malawi; Lesotho, Swaziland and Ghana

Workshop on HIV/AIDS Communications for behavior and social change: Programme Experiences, Examples and the way forward

UNAIDS/UNICEF Workshop on Communications Programming

Policy and government:

• laws and legislations
• political will and commitmenet
• funding, and funding policies of donors
• program strategy and policy
• resource allocations

Socio-economic status:

• education and training
• unemployment
• income generation and remunerations
• poverty malnutrition
• inheritance, marriage, divorce

Culture:

• norms and attitudes of society
• strengths in cultures
• oral media and performance
• tradition and values

Gender relations:

• social habits; expectations
• rules and other social constructs
• economic dependance of women
• role of men in society

Spirituality:

• religion and faith
• churches, mosques, prayer sites
• belief
• death, life and fatality
• influence of faith healers, religious leaders

Recommendations

• Address the full HIV/AIDS continuum of prevention, care, and support.
• Integrate a cross-disciplinary approach drawing upon knowledge of epidemiology, anthropology, sociology, information science, psychology, and community development.
• Promote provision access, and use of various services and products.
• Plan and implement a sustained, coherent, and for long-term.
• Address regional, country, and community specificity.
• Research, monitoring and evaluation are essential for HIV/AIDS communication programming to be effective.
• Increase advocacy for, and the visibiltiy of, communication initiatives and their contributions among UNAIDS co-sponsors, donors and others.

The UNAIDS Communication Framework: A Call to Focus on the Forest, Not the Tree.

Most past and present strategic planning for HIV/AIDS communication programming usually begins with ascertaining the problematic knowledge, attitudinal, and practice factors among individuals in the target audience.

The "new" UNAIDS communications framework urges HIV/AIDS program implementers to reorient their approach to instead ascertain the role of socio-cultural influences (socio-economic status, gender relations, cultural norms, and spirituality) and environmental influences (government policy, access to services, occupational risks) in shaping individual behavior.

The UNAIDS framework calls for refocusing communication interventions on the basis of five key contextual domains: (1) government policy, (2) socio-economic status, (3) culture, (4) gender relations, and (5) spirituality. These contextual domains, while they lie outside the skin of individuals, have a significant influence on their HIV/AIDS-related health behaviors.

Thanks you. Muchas gracias.