Strategic Communication Framework for Hormonal Contraceptive Methods and Potential HIV-Related Risks

Given the World Health Organization (WHO)'s recommendation that women should receive correct and full information to enable an informed choice regarding their method of contraception, the Health Communication Capacity Collaborative (HC3) developed this strategic framework to assist governments in developing a communication strategy and to guide the development of social and behaviour change communication (SBCC) materials and activities focused on the potential risks certain hormonal contraceptives (HCs) such as progestogen-only injectables may (or may not) have for women at risk of HIV. It is designed to help country-based stakeholders tailor to the local context and then disseminate information pertaining to HC and HIV risk with a variety of audiences, including providers, women, and their partners at regional, national, and local levels. To date, Malawi's and Swaziland's Ministries of Health have adapted the framework to their country contexts and have subsequently developed SBCC materials on this topic.

The framework presents a step-by-step process to guide country-level adaptation:

• Step 1: Understand the most recent evidence base on different methods of HC and their relationship with various HIV-related risks - e.g., the 2014 WHO guidance recommends no restriction on the use of any HC method for HIV-negative women or for women living with HIV.
• Step 2: Contextualise the evidence within broader sexual and reproductive health (SRH) programming principles - involves reviewing the epidemiological context of a given country, balancing potential risk of HIV against lifesaving benefits of effective contraceptive methods, and seeking to establish policies, guidelines, and operating principles that facilitate full access to family planning (FP) services and informed choice (e.g., by fostering a coordinated response through connections among different parts of the health sector and with other public sector actors, including police, social services, the legal sector, women's rights organisations (contraceptive users), networks of women at risk of or living with HIV, young people's organisations, religious groups, non-governmental organisations (NGOs), and the media).
• Step 3: Adapt the Strategic Communication Framework to develop a country­-specific strategy - involves: conducting a situation analysis, which examines the social and behavioural drivers that facilitate or act as barriers to uptake of desired behaviour(s); audience segmentation, which is guided here by the Social Ecological Model (see page 13) to help ensure that activities are tailored to be as effective and appropriate as possible for relevant audiences and that messages and materials are highly customised according to that audience's needs; strategic design, which consists in an audience profile, objectives, positioning, key messages, and strategic approaches; and monitoring and evaluation (M&E), which can help ensure the programme is reaching women with information and services to meet their needs for contraception and HIV prevention and care.
  • The bulk of the resource elaborates here on Step 3, beginning with an overview of strategic approaches that can be used in demand generation (see Table 1 on page 17), including advocacy, counseling, digital media, distance learning, interpersonal communication (IPC)/peer communication, mass media, and print media. Pages 18-42 offer detailed illustrative content of a communication strategy for country adaptation, with several examples in the form of charts and tables.
• Step 4: Prepare for implementation - "It is recommended that the adaption of a country communication strategy on HC methods and potential HIV-related risks be implemented through a consultative process with a range of stakeholders at the country level, including government representatives, service providers and civil society....Participation of individuals and/or groups directly affected is crucial from the start. To be most effective, communication efforts should also be matched with efforts to expand and increase access to FP and HIV services, and train and equip providers."