Author: Caroline Sugg, August 31 2016 - In the early days of HIV, communication was at the heart of many successful prevention efforts but has never been fully integrated into the global response. Caroline Sugg explains why this needs to change, by explaining how a focus on behavioural and social change can help tackle current challenges posed by HIV and AIDS.

The early days of HIV were dark indeed. Freshly made coffins lined the streets of African towns, stark symbols of communities ravaged by a new and little understood killer. The intense stigma faced by people living with the disease around the world cruelly compounded their suffering.

But in those frightening times, important clues on how to effectively fight HIV were already emerging. We should remember these clues today as the world wakes up to the fact that we are failing to prevent more than 2 million new infections a year.

Communication led to early successes

From the outset of the epidemic, while scientists rightly focused on developing treatments for AIDS, communication – in a variety of forms – was shaping what people knew, felt and did about HIV and AIDS. Robust data shows that when the epidemic was first emerging, Ugandans openly and frankly discussed HIV amongst friends and family, which made them less likely to have risky sex. Unlike neighbouring countries, Uganda saw HIV prevalence decline dramatically between the late-1980s and mid-1990s. In the Democratic Republic of Congo, local theatre and dance groups communicated the importance of using condoms, helping stop HIV getting out of control in Kinshasa.

In South Africa, media shows and community dialogue projects made people more likely to abstain from sex or use protection. A 2008 study comparing people living with HIV with those who were not suggests that such preventive measures helped avert 700,000 infections. Treating that many people with antiretroviral therapy would have cost more than $280 million – for just one year.

A sidelined solution

Yet, as a recent report by UNAIDS notes, these successes – and more besides – have not led to communication being prioritised in the response to HIV. While evidence from successful HIV communication programmes abounds, funding is scarce and communication sometimes feels as if it’s been side-lined as something a bit fluffy within a public health community dominated by biomedical professionals. This lack of commitment exists despite the fact that a respected UNAIDS–Lancet commissiondefeating-aids-advancing-global-health recognised that ‘behaviour change’ – which is inherently linked to communication – is one of six ‘basic programme activities’ needed to combat HIV, alongside the prevention of mother-to-child transmission, male circumcision and treatment itself.

Considering the current challenges posed by the AIDS epidemic, the failure to consistently integrate communication within HIV programmes is especially worrying. Young people around the world still lack the basic knowledge about how to protect themselves from the virus and risky behaviours are rife. There is also a lack of demand for tools to protect against HIV, a point made by Dr Bernhard Schwartländer, WHO Representative in China, referencing the low uptake of critical biomedical prevention measures like pre-exposure prophylaxis (PrEP).

Communication can be instrumental in tackling these problems. With social and behavioural change as the goal, effective communication interventions don’t just provide information to individuals. They aim to facilitate the types of discussion within societies that change social norms and established ways of doing things. They focus on the long-term, reflecting the fact that young people need advice beyond their first sexual encounter, as there’s no quick fix for a safe sex life. They recognise that supply alone – whether of condoms or PrEP medication – won’t achieve benefits unless people buy into them as something that’s worth their while.

What’s working today

At the beginning of this blog, I brought out some examples of successful communication approaches from the history books. Despite the tricky operating environment, great communication work, which seeks to achieve social and behaviour change around HIV, is still happening today. The Straight Talk Foundation continues its important engagement of young people in Uganda and South Africa’s Soul City Institute persists in combating HIV, with a new focus on social justice for women and girls. At BBC Media Action, we are working with young people in Zambia to encourage open discussion of safe sex (and hoping to ramp up our work on HIV further, building on past successes). I hope these projects provide fresh inspiration for those determined to bring down the number of new infections and end AIDS for good.

Caroline Sugg is Head of Special Projects at BBC Media Action. Caroline is an expert in health communication and the role of media in empowering women and girls. She has worked in media and communication for over fifteen years including in strategy consulting and for Channel 4 Television in the UK before joining BBC Media Action in 2003.

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Image credit: BBC Media Action

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