Southern and Eastern Africa Region Male Circumcision Communication Meeting: A Joint UNAIDS & PEPFAR Coordinated Meeting, September 22-24, 2010

From the United States Agency for International Development (USAID), the President's Emergency Plan For AIDS Relief (PEPFAR), and the Joint United Nations Programme on HIV/AIDS (UNAIDS):

This report records the experience of the UNAIDS-PEPFAR Southern and Eastern Africa Region Male Circumcision (MC) Communication Meeting that brought together 117 health professionals from 14 countries in East and Southern Africa and international experts from Europe and North America. The meeting aimed to advance knowledge and to share promising experiences and communication materials for adolescent and adult MC in three key areas: demand creation, client counselling, and advocacy.

During the plenary sessions, several key points were discussed: countries are at different stages of their MC communication programming; behaviour change communication tools can be modified for MC; epidemiological projections indicate that an MC scale-up is urgently needed; and achieving the scale-up will require a communication strategy tailored to each country context and audience segment, addressing existing and potential barriers and providing persuasive and accurate information.

On the first day of the conference, a Materials Marketplace was held to give participants an opportunity to share printed materials, videos, and other communications materials on MC. A sampling is included in the appendix of this report.

Working sessions covered a range of topics including:

• Advocacy for Scale-up of Male Circumcision
• Demand Creation Strategy: Importance and Content - This session emphasised strategic communication for behaviour change (including for MC), which “generally draws on the social ecological framework within which individual behaviour occurs under multiple layers of influence: partner and family relationships, community, and society. Thus, communication interventions must promote change simultaneously at these different levels. 
  • Strategic communication [focuses on] an identified audience and identifies other groups that influence the target audience in relation to a defined set of outcomes or objectives, such as peers, family members, or community leaders. It combines a series of elements: data, planning, stakeholder participation, creativity, high-quality programming, and linkages with other program areas. It uses mass media (television, radio, print, and mobile and outdoor media), interpersonal communication (community mobilization), and advocacy in an ongoing effort to promote behavioral and social change and increase service uptake.....
  • Formative research as well as audience segmentation (primary and secondary audiences) drives strategic communication. Program planners should use SMART objectives (specific, measurable, achievable, realistic, and time-bound) to describe what the program expects to achieve. Participatory approaches to designing messages result in more effective communications that promote change, reinforce positive behaviors, and promote service uptake. Monitoring and evaluation demonstrate the extent to which the communication program meets its objectives.”
  • MC messages need to: draw on the evidence; provide a call to action; address the context, draw on realities of the intended audience; use the visual and verbal language of the audience; entertain and educate; and be clear and consistent. “Communication programs use both mass media, which reaches large numbers of people at a low cost per unit, and interpersonal communications, which allow face-to-face dialogue and greater interaction. Entertainment-education involving drama, sports, or interactive sessions can be highly effective in bringing about a personal reflective moment. Interpersonal approaches include peer education, in-clinic facilitation, community events, telephone helplines, counseling, home visits, and workplace programs....Advocacy falls within the broader realm of communication. It works to strengthen community response through community dialogues and media dialogues.”
• Counselling - During this session, participants made several recommendations to increase uptake of HIV testing and counseling (HTC) including to employ and expand provider-initiated testing and counselling (PITC). 
• Developing a Communications Toolkit for Male Circumcision - This session identified “high priority audiences, key barriers and influences that the toolkit will need to address, and effective channels for disseminating the toolkit. Information on the Kenya MC communication toolkit and its relation to the national and regional communication strategies are provided in Appendix C” of the reprot.
• Case Study on Swaziland: Scaling up Male Circumcision to Reach an Entire Country
• Programme Evaluation: Formative Research, Pre-testing, and Monitoring Service Utilisation

Overall, the meeting emphasised the need for well-designed communication interventions that will create the demand for adolescent and adult MC, especially among non-circumcising populations. It also stressed the importance of applying MC lessons learned by the public health community from communication strategies for family planning, HIV prevention, and malaria control, for example. Evaluations of the initial scale-up efforts were recommended to inform the expansion of MC programming in selected countries.

Appendix C highlights communication materials from the meeting. For example, in Kenya, subsequent to the development of the national communication strategy for voluntary medical male circumcision (VMMC), C-Change - in partnership with the Nyanza Male Circumcision Task Force - developed a VMMC Communication Guide for Nyanza province. A broad range of VMMC communication materials were designed in accordance with the strategy, including radio spots, billboards, posters for men (including posters specifically to be posted in men's bathrooms), video vignettes, and brochures and booklets designed to reach men. Other materials included a booklet and poster designed to reach women, a post-operative brochure and poster, and a supermarket TV screen. For service providers, the communication sub-committee of the National and Nyanza MC Taskforce developed flipcharts and posters for service delivery points. Community mobilisers were provided with guides and community dialogue cards. A series of brochures designed to reach key influencers (faith leaders, business leaders, and community leaders) were also developed. Samples of these materials are included in the report.