|Communications Framework for HIV/AIDS: A new direction - A UNAIDS/PennState project (Best Practice - Key materials) (UNAIDS, 1999, 101 p.)|
The current reality of HIV/AIDS in Latin America and the Caribbean, where nearly 1.3 million people are living with HIV, shows different dimensions. On the one hand, it resembles the reality of industrialized nations, given that most infections occur among men who have unprotected sex with other men and among IV drug users. For instance, in Mexico, some studies show that nearly 30 percent of men who have sex with men are HIV-positive, while 311 percent of IV drug users are also infected with the virus. On the other hand, heterosexual transmission has increased over the past years. According to the UNAIDS/WHO 1998 Report, in Brazil, a decade ago, about 6 percent of all cases were detected among women. Today, that figure has jumped to 25 percent of all cases. In some countries, pregnant women with HIV have been detected at high rates. In Honduras, for instance, current estimates show that 1 percent of pregnant women are infected with the virus. In Haiti, back in 1993, nearly 8 percent of pregnant women were HIV-positive. The picture of treatment and care in Latin America and the Caribbean is also fragmented. Some countries have made great advances in guaranteeing provision of all available medications. However, accessibility and availability of HIV drugs are still irregular in most countries in Latin America and the Caribbean.
In the English-speaking Caribbean, no clear regional pattern emerges, given the presence of both high and low incidence rates in countries across the region. Most cases occur via heterosexual transmission, while transmission among men having sex with men accounts for 14 percent of the nearly 10,000 reported cases in the region. However, the doubling time for AIDS cases in the region is estimated at four to five years.
There was a two-fold basis for the discussions at the workshops. The first discussion was based on the report of the previous global consultative workshop in Washington, DC, which described the process of the project and conclusions reached up to that point. The second discussion arose from a presentation of a framework based on the five contextual domains (government policy, socioeconomic status, culture, gender relations, and spirituality) together with the observations and variations introduced during regional consultative workshops in Bangkok and Abidjan.
After the initial country reports, the development of the contextual framework was presented and discussed. There was consensus around the importance of taking into account the five domains when developing HIV/ AIDS communications programs, while retaining that which worked well in previous models and approaches. For instance, the strengths of past approaches lay in the methodology followed in communications programs. This methodology, no matter which model is used, must ideally include issues of needs assessment, planning, pretesting, implementation, evaluation, and feedback to planning. However, because some elements are missing from current communications programs and interventions (e.g., advocacy and greater involvement of people living with HIV), and given the increase of the epidemic, alternative models are urgently needed as the basis for more effective interventions.
While alternative approaches must be sought, the urgency of the disease needs to be kept in mind. This means that effective short-term programs must be developed at the same time that work proceeds on developing a new strategy. The capacities of organizations of people living with HIV and men having sex with men, NGOs, and others need to be strengthened, so they may be more effective in helping to control the epidemic.
The issues highlighted in the group discussions belonged to one or more categories of the five domains of the contextual framework. In addition, two interrelated methodological aspects of communications were also introduced. The first includes needs assessment, planning, pretesting, implementation, monitoring, and evaluation. Feedback must also be part of this aspect. The second methodological aspect includes issues of influence, including social pedagogy, mobilization, social advocacy, and government policy advocacy. Social pedagogy mainly relates to the increasing need to learn how to co-exist with the epidemic. Mobilization refers to issues of political will and commitment at the international, national, and local levels. Social advocacy was described as issues related to establishment of proper laws on HIV/AIDS (e.g., access to drugs and treatment) and human rights. Finally, government policy and advocacy refers to the role that UNAIDS must play as an advocate for political commitment from governments on HIV/AIDS issues.
As indicated above, these two methodological aspects are interconnected, showing that there is constant feedback between the two processes. Careful attention must be given to the fact that political and social advocacy affecting decision-making processes might be needed before any technical work (methodology), such as a communications campaign, is conducted. Political decisions often affect the types of messages that will be part of a communications campaign, which means that even if a communications campaign is methodologically sound, it may still be limited in impact, due to political issues and decision making.
This conceptual framework allows us to further show that communications should no longer be focused solely on issues of information and messages for behavior change alone, but also on every other aspect of the HIV continuum (prevention, care, and support).
In addition to the five contextual domains, two other key areas of interest were identified at the Latin America/Caribbean regional workshop. These are (1) advocacy, and (2) involvement of positive persons in communications programs.
· Advocacy is needed on different fronts throughout the region. For instance, issues of men who have sex with men tend to be ignored in some countries. Thus, advocacy must be conducted at local and national, as well as at international, levels.
· The need to strengthen support groups is increasing. Advocacy must play a critical role in this process. For instance, where necessary, access to basic health services must be advocated for people living with HIV/AIDS.
· Efforts must be made to develop strong partnerships among the media, government, and NGOs. However, this must be achieved through negotiation, sensitization of media owners, and proposal of sound communications strategies.
· UNAIDS must play a variety of roles in this process: as a facilitator of processes, to promote prevention, and to promote greater attention at the individual and family levels through advocacy before policy and decision-makers.
· The creation of a Latin American regional speakers bureau is one way to strengthen education and prevention programs. People living with HIV/AIDS might feel more comfortable sharing their experiences in countries other than their own, where there is little chance of being ostracized or discriminated against.
· At the ethical level, people involved in delivering HIV/AIDS programs must be self-critical and look inward to assess whether there is personal and organizational commitment to the work. Advocacy must be made to all audiences so as to gain political will and commitment.
· Issues such as violence, cultural values, human rights, education, spirituality, and law must also be taken into account in communications. However, on the issue of human rights, some participants believed that in Latin America this term might have, in certain contexts, a negative connotation. Thus, other terms such as human dignity or citizenship might be used to avoid greater resistance.
Involving HIV-Positive Persons in Communications Programs
· Persons living with HIV/AIDS must be involved in the planning, implementation, and evaluation of communications programs. In this regard, negotiation and consensus among government, international organizations, and other groups affected by the epidemic is crucial.
· HIV/AIDS has a close relationship to emotion and feelings. Behavior change does not occur in any one particular way. Entertainment, music, and humor are central elements of Latin American and Caribbean cultures and must be used in education and prevention programs.
· Communications campaigns are no longer limited to prevention messages, but should take into account the health continuum from prevention to care and support.
· Communications strategies must be localized, so specific groups and areas might be targeted (e.g., urban and rural populations and vulnerable groups). Programs must guarantee plurality and diversity and promote consensus (by keeping AIDS in the media and on social agendas).