Part 1: Communication approaches and strategies on HIV/AIDS: what's new, what's not? (from the Background Paper for Communication for Development Roundtable)

The last two years have seen intense debate over different approaches to HIV/AIDS communication. In particular, there has been a growing questioning of social marketing and behaviour change oriented communication, and increased interest and debate focused in the field of Communication for Social Change, an approach to communication that focuses less on changing individual behaviours and more on empowering communities and societies to tackle the underlying issues of discrimination, poverty and marginalisation that are driving the epidemic in the first place. As these issues are closely related to the substance of the Roundtable, this section seeks to explain some of the main issues involved.

Two developments in particular have focused debate on this area, the first the publication of a new framework on Communication produced by UNAIDS, the second the work of the Rockefeller Foundation in this area.

UNAIDS New Communication Framework

This UNAIDS framework was published in December 1999 following an intensive process of detailed consultations in Asia, Africa, Latin America and the Caribbean and internationally. Its conclusions were that:

Based on a review of the literature and of experiences in the field, most current theories and models [of HIV communication programming] did not provide an adequate foundation on which to develop communications interventions for HIV/AIDS in the regions...

Participants at five consultative workshops (two global and three regional) noted the inadequacy and limitations of current theories and the models derived from them. Chief among the weaknesses identified were:

• The simple, linear relationship between individual knowledge and action, which underpinned many earlier interventions, does not take into account the variation among the political, socio-economic and cultural contexts that prevail in the regions.
• External decision-making processes that cater to rigid, narrowly focused and short term interests tend to overlook the benefits of long-term, internally derived, broad-based solutions.
• There is an assumption that decisions about HIV/AIDS prevention are based on rational, volitional thinking with no regard for more true-to-life emotional responses to engaging in sexual behaviour.
• There is an assumption that creating awareness through media campaigns will necessarily lead to behaviour change.
• There is an assumption that a simple strategy designed to trigger a once in a lifetime behaviour, such as immunization, would be adequate for changing and maintaining complex, life-long behaviours, such as consistent condom use.
• There is a nearly exclusive focus on condom promotion to the exclusion of the need to address the importance and centrality of social contexts, including government policy, socio-economic status, culture, gender relations and spirituality.
• Approaches based on traditional family planning and population program strategies tend to target HIV/AIDS prevention to women, so that women, rather than men, are encouraged to initiate the use of condoms.

The UNAIDS framework made a series of recommendations and set out a new framework for HIV/AIDS prevention. The conclusions of the framework were summarised very effectively in a paper prepared for UNAIDS by Arvind Singhal (2)>:

"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 control of individuals, have a significant influence on their HIV/AIDS-related health behaviours. In essence, the UNAIDS framework calls for moving away from individual-level theories and models of preventive health behaviours (health belief models, theory of reasoned action, stages of change, hierarchy of effects model, social cognitive theory, diffusion of innovations, and others) to more multilevel, cultural, and contextual explanations and interventions (McKinlay & Marceau, 1999; 2000)"

The Rockefeller Foundation Communication for Social Change Network: behaviour change depends on social change

The findings of the UNAIDS report strongly echoed the work and conclusions of a network facilitated by the Rockefeller Foundation which brings together communications actors and experts, ranging from grassroots and community based NGOs through to international NGOs and major multilateral and bilateral organisations. The Foundation's conclusions argue that while mass education campaigns aimed at changing individual behaviour play an essential role in AIDS prevention, they are highly unlikely to be successful or sustainable unless they are accompanied by deep-rooted social changes which will only result from internally driven change processes, including informed and inclusive public debate.

Many millions of dollars have been spent on individually targeted education campaigns, and many of these campaigns have had important impacts. Increasingly, however, concern is mounting that these campaigns are at best insufficient, in achieving the kind of long term, sustainable and rooted changes in society that are required for HIV/AIDS to be confronted.

The principles and approach associated with Communication for Social Change has been summarised as moving communication frameworks on HIV/AIDS...

• away from people as the objects for change...and on to people and communities as the agents of their own change
• away from designing, testing and delivering messages...and on to supporting dialogue and debate on the key issues of concern
• away from the conveying of information from technical experts...and on to sensitively placing that information into the dialogue and debate
• away from a focus on individual behaviours...and on to social norms, policies, culture and a supportive environment
• away from persuading people to do something...and on to negotiating the best way forward in a partnership process
• away from technical experts in "outside" agencies dominating and guiding the process...and on to the people most affected by the issues of concern playing a central role

Further details of this thinking can be found on The Communication Initiative (http://www.comminit.com) and Rockefeller Foundation (http://www.rockfound.org) websites.

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(2) Singhal, Arvind, HIV/AIDS and Communication for Behaviour and Social Change: Programme Experiences, Examples and Ways Forward, International Workshop, UNAIDS, Department of Policy and Strategy, July 2000