There is considerable debate and enquiry concerning the most effective communication strategies for addressing HIV/AIDS issues. James Deane, Executive Director of The Panos Institute, prepared a background paper on this theme for the recent Communication for Development Roundtable, held in Managua, Nicaragua, Nov 26 - 28 2001, and hosted by UNFPA. Click here for the full paper.

We are interested in both your reactions and your perspectives on the most effective HIV/AIDS Communication. See the end of the issue for initial questions and how to contribute.

WHAT'S NEW, WHAT'S NOT?

1. The last 2 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... two developments...have focused debate on this area, the...publication of a new framework on Communication produced by UNAIDS, [and]...the work of the Rockefeller Foundation [Communication for Social Change (CSC)]...

2. The UNAIDS Framework calls for refocusing communication interventions on the basis of 5 key contextual domains: (1) government policy, (2) socio-economic status, (3) culture, (4) gender relations, and (5) spirituality. [It] calls for moving away from individual-level theories and models of preventive health behaviours...to more multilevel, cultural, and contextual explanations and interventions...

3. The principles and approach of CSC have been summarised as moving communication frameworks on HIV/AIDS...away from people as the objects for change...on to people as the agents of their own change; away from designing, testing and delivering messages...on to supporting dialogue and debate on the key issues of concern; away from a focus on individual behaviours...on to social norms, policies, culture and a supportive environment; away from technical experts in "outside" agencies dominating the process...on to the people most affected by the issues of concern playing a central role.

SO, IS THIS NEW & DOES IT MATTER?

4. Specific criticisms of these approaches tend to fall into 4 areas:

• Participatory, people centred communication has been at the core of most mainstream communication thinking and practice for many years...
  
• Some of these arguments are creating artificial boundaries between different approaches and schools of thought in communication...
  
• While the UNAIDS & Rockefeller...arguments have emerged largely from practitioners on the ground...they are weak when it comes to backing [them] up with rigorous academic analysis, modelling and theory...
  
• Many of the ideas in documents such as the UNAIDS Framework are difficult to translate into practice on the ground, particularly within the setting of large institutions...

5. Proponents acknowledge some of these criticisms. Nevertheless, they argue:

• Both the UNAIDS & Rockefeller processes were centred on largely southern based, grassroots and civil society focused and driven debates...[and] they appear to have revealed a "disconnect" between funding and some international agencies, and indigenous organisations working on the ground...
  
• Systematically putting the principles of participatory communication into practice on the ground continues to be rare and much HIV/AIDS programming has been highly vertical...
  
• Unless developing country societies and communities are setting and driving the underlying processes of change that are necessary to confront this epidemic...future progress...is unlikely to be sustainable...
  
• There is increasing interest in learning from and adapting the rigorous thinking that goes into behaviour change oriented interventions to communication for social change thinking...
  
• CSC is suggesting a major change in approach which involves institutions surrendering their agendas...
  
• Many communication initiatives are overly focused on the symptoms of the HIV/AIDS pandemic (sexual behaviours), rather than the underlying causes (discrimination, marginalisation, disempowerment, inequality).

A CHANGING ENVIRONMENT

6. Although communication technologies have dominated the discourse around recent developments in information and communications, there have [also] been fundamental changes in the wider communication environment...

• New technologies, principally in the form of the internet and mobile telecommunications, are creating new opportunities for disseminating information...
  
• A major liberalisation of the media in the developing world, transforming...print and broadcast media from a largely government owned, monopolistic and uncreative environment to a more dynamic, popular, democratic, creative and complex one...
  
• Liberalisation has led...to the emergence of [a] consumer led...urban centred communication infrastructure, one...less interested in the concerns of the poor, and...decreasingly interested in providing news and information to its audiences...
  
• State run broadcasting systems have found it difficult to transform...into public broadcasting entities...
  
• Globalisation and transnational ownership of the media is resulting in...increasing numbers of mainstream developing country media institutions being bought by transnational conglomerates...
  
• Women continue to suffer marginalisation in and from communication networks...

HIV BECOMES POLITICAL AGAIN: TREATMENT, STIGMA, MEN

7. Since the beginning of the epidemic... civil society and AIDS support organisations in developing countries have struggled to make their voice heard internationally... [and unlike those formed around issues of women's rights, an] international HIV/AIDS civil society coalition has not emerged...perhaps because there was not a clear issue around which concrete demands for action could be made...

8. At the end of the 1990s, that issue potentially emerged in the form of access to treatment for HIV/AIDS. Arguably for the first time, organisations in the South were able to set their own agenda, demands and priorities... Millions of people in South Africa, Brazil and elsewhere who...formerly regarded the issue of HIV/AIDS as one of public health and sexual behaviour have been drawn into a debate marking it out as an issue of economic justice and human rights. International lobbying has led to...concessions by international pharmaceutical companies to reduce the prices of ARVs and...to...concessions over intellectual property rights at the WTO.

9. A growing movement to confront HIV/AIDS related stigma is taking on a new profile and energy. UNAIDS has designated the issue as the focus of the next World AIDS Campaign.

CHALLENGE: IMMEDIATE ACTION OR NECESSARY REFLECTION?

10. 2 responses are facing communicators:

• The "emergency" response - the epidemic is now so devastating that we need to rapidly scale up the time, resources and energies putting the strategies we've already developed into action on the ground, and less time theorising...
  
• Reflection leading to long term strategic action - it is the demand for quick, measurable results that has created a field made up of large, donor driven, top down communication interventions which have...proved both unsustainable in securing behaviour change and have not addressed the underlying causes of the epidemic...and, that the increasing complexity of developing country societies, prompted by greater liberalisation, and more complex media systems and horizontal communication patterns in society demand fresh thinking and approaches.
  

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SHOULD WE ACCELERATE AN EMERGENCY RESPONSE? OR IS IT TIME TO ASSESS THE STRATEGIES USED SO FAR?

SHOULD WE CONTINUE WITH A PREDOMINANTLY BEHAVIOURAL APPROACH WITH AN EMPHASIS ON SEXUAL BEHAVIOUR? OR SHOULD WE EXPAND THE CULTURAL AND CSC BASED STRATEGIES PROPOSED BY THE UNAIDS & ROCKEFELLER NETWORKS?

DOES THE CHANGING COMMUNICATION ENVIRONMENT IN MOST COUNTRIES DEMAND A CHANGE IN STRATEGY? OR CAN WE ADAPT THE PRESENT STRATEGIES TO THAT NEW ENVIRONMENT?

SHOULD HIV/AIDS COMMUNICATION STRATEGIES BECOME LESS OR MORE POLITICAL?

Have you discussed these issues within your organisation? We would like to know your thinking. Please send insights to Warren Feek wfeek@comminit.com

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