Communications Framework for HIV/AIDS -- A New Direction
Collins O. Airhihenbuwa, Bunmi Makinwa, Michael Frith, Rafael Obregon
AIDS affects every country in the world, but it is in developing countries that it poses the greatest threat. This document presents a new framework to make HIV/AIDS communication more effective in developing countries. It is based on consultations synthesizing experiences from many regions including Africa, Asia, Latin America and the Caribbean.
The subtitle says it all: A New Direc-tion. Until now, most HIV/AIDS communications programs have been aimed at achieving individual-based changes in sexual and social behavior. While aspects of this approach are desirable and should be maintained, evidence from research and practice in many countries shows that existing approaches have major limitations. They are based on theories and models which are often not appropriate to non-Western cultures, where such contexts as family, group or community may play a greater role than individual will in decision-making. A broader focus is therefore necessary.
Under the leadership of the Joint United Nations Program on HIV/AIDS (UNAIDS), a new and more adaptable framework has been developed. It evolved through a consultative and participatory process that synthesized experiences from the African, Asian, and Latin American and Caribbean regions, along with that of the United States and Europe. UNAIDS, in collaboration with Pennsylvania State University, sponsored five consultative workshops. They were held in Geneva (November 1997), Abidjan (December 1997), Washington, DC (February 1998), Bangkok (July 1998), and Santo Domingo (January 1999). A Communication Framework for HIV/AIDS presents the result of this collective exercise.
A major conclusion from the workshop was that despite the great diversity of geographic and cultural settings, five domains are virtually universal and should be the focus in developing future communications strategies for HIV/AIDS prevention, care and support. The framework recognizes these interrelated domains as the dominant influences in an individual's behavior. The domains are:
- Government policy: policies and laws that may support or hinder intervention efforts;
- Socioeconomic status: collective or individual income that may allow or prevent adequate intervention;
- Culture: beliefs, customs, and practices that may promote or hinder prevention and care practices;
- Gender relations: the status of women in relation to men and their influence in sexual negotiations and decision making; and
- Spirituality: spiritual and religious values that may promote or hinder the translation of prevention message into positive health actions.
Each region was unanimous in identifying the five contextual domains in which prevention programs should operate. Yet each region also endorsed certain additional recommendations tailored to its specific needs.
Africa, for instance, faces a daunting reality: More than 60 percent of HIV cases (21 million) are in sub-Saharan Africa. Heterosexual transmission is the most common form of transmission. This explains why 80 percent of women infected with HIV/AIDS live in Africa and, similarly, why almost 90 percent of children infected with HIV/AIDS live in Africa. Out of the Abidjan workshop came the recommendation that future communications programs on HIV/AIDS should stress community-based approaches and regional cooperation. The relative success of Senegal, where HIV incidence is low, and Uganda, where it is declining, also highlight the role of government policy in creating an environment conducive to behavior change.
The Asian workshop recognized the impact that economic restructuring has had on social issues. It also noted that both drug use and commercial sex are prevalent in many areas. Participants also stressed the crucial role that spiritual leaders play as educators and care providers. The Latin America and Caribbean workshop emphasized the importance of needs assessment, advocacy and greater involvement of people living with HIV/AIDS in communications programs.
The last chapters of the book look to the future. They offer practical advice for "Translating the Framework into National Communications Strategies" and a check list gleaned from the collective wisdom and experience of the workshops.
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