as presented at the VIII International Communication for Development Roundtable, Nicaragua

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INTRODUCTION

Communication HIV/AIDS messages has been one of the corner stones of prevention strategies in the past two decades. The general assumption has been that general knowledge of HIV/AIDS information will lead to behavior change. For this reason, IEC has been promoted as a simple solution to a difficult problem. This assumption has led to unrealistic expectations about the power of communication as a critical means to behavior change.

Although communication and prevention messages have been conveyed to people, these messages have not translated into action as communicators had hoped would happen. The main purpose of communication messages on prevention is essentially to get people to change their behaviors in such a way that they are not at risk of HIV or if they already infected, not to be a risk to others.

So the question here is why has the provided not translated into the expected behavior? The answer is simply in the fact that the messages that people are hearing are not addressing their real needs. The majority of the people in Africa are people with very little resources and most of these people are first and foremost concerned about their basic needs, food, clothing, etc. If I do not have food to eat or a shelter, tell me in terms of priority where HIV will fall? My first need that I must satisfy is the basic essentials to help me survive after which I can maybe assimilate the prevention messages.

Essentially until we as communicators can address the basic needs of our target population, there is no way our messages of HIV prevention will translate into behavior change. Most poor people have greater problems just surviving that supersede the danger of HIV infection. The social structure is such that it favors men and without the necessary support, women cannot get out of these relationships.

The ultimate message is that unless communicators can meet the target population where they are in terms of their priorities i.e., if basic needs are what is important to me let us address that first and then let's address the HIV piece, then communication will failed in its effort. It is all about determining where the recipient is in terms of the messages which are being delivered. The majority of low-income people globally are not ready to deal with prevention messages instead their priority is accessing basic needs.

Let us as communicators understand this and start addressing not what we perceive the target audience needs but what there felt needs are. Otherwise we will continue to see little success in translation of our messages to action.

Communication weaknesses

Rather than conclude that communicating HIV/AIDS messages has been ineffective in the African set up, it would seem wise to develop approaches that respond to some of the limitations mentioned. The combination of testing plus single sessions of pre and post-test counseling along is unlikely to help and individual, sustain behavior change. However, several sessions of individuals, couples or group counseling, together with a variety of skills-based interventions, may reduce risk.

Recommendations

A significant of people at risk of HIV infection are likely to continue to shy away from HIV counseling and testing. Hence the need for health care providers to be well informed regarding the basic implications of HIV testing and test results. This include, reporting contact tracing requirements, confidentiality, and the basics of early interventions with ARV's.

What works at community level

Communities have their own coping mechanisms through which they communicate HIV/AIDS information and try to influence behavior change. These involve the care and prevention activities that are culturally appropriate to community needs.

• Messages with appropriate linguistic considerations
• Contexts of community HIV/AIDS information
• Beliefs and value systems on which to base AIDS information
• Mobilizing the cultural resources for care for those already infected

Taking a cultural approach in HIV/AIDS prevention and care means that any population's cultural references are resources (ways of life and the fundamental rights of persons) will be considered as key references in building a framework for strategies, policies and project planning, but also as resources and basis for building relevant and sustainable action reducing in-depth and long-term changes in peoples behaviors and giving full consistency to medical sanitary strategies and projects.

In promoting relevant IEC materials the following should be considered

• Acceptability and receivability of the proposed measures by the population.
• Priority given to combating the epidemic at the personal and group level.
• Mobilizing people's cultural resources, knowledge, know-how, self-confidence and energy.

There is an urgent need for communities programs to maintain peoples active commitment through IEC programs and procedures.

These will bring about and keep alive people's mobilization and significant change in their sexual behaviors under two conditions.

• Adaptation to peoples own language, intellectual systems and ways of life as well as to their own teaching and learning and communication methods.
• In line with people's specific interests, conditions and beliefs regarding life and survival for themselves, their families and community.

These aspects are expected to increase readiness and possibilities to discussing HIV/VID. Related problems risk in regular health education, formal or informal within the family, the community the work place and in other opportunities for public debate.

• Broader acceptance of medical and preventive actions like testing, counseling, peer education, visits to communities.
• Decrease in unsafe practices
• Growing mobilization among general population.
• Increased support to infected and sick people
• Medium term decreases in new infection figures.

Improvements in the following areas can facilitate prevention and behavior change

• Using pre test counseling ass a n entry to long term and more intensive interventions rather than as an end in it self.
• Actively linking clients to other HIV related preventions resources
• Developing and enforcing minimal standars for the quantity and quality of HIV communication and counseling interaction.
• Ensuring that communicators and counselor are well trained in terms of behaviour change approaches, resources development and referral and counseling skills.

Challenges

• Social paradigms: a hidering factor to behavior change among men than women.
• Illiteracy: high illiteracy rates among women in Kenia hinders access to information on HIV/AIDS
• Economic security: lack of economic security for women make them more vulnerable to HIV infection that men.
• Curriculum: national education curriculum lacking in issues related to gender in the Keyan society.
• Leadership: lack of meaningful roles in leadership positions, by women, at community and national level.

CONCLUSION

Behavior change has several motivating factors. These includes awareness of the need for and the benefits of change, practice in the skills for implementing new behaviors, in a variety of setting and confidence in the capacity to engage in and maintain new behaviors in light of changing circumstances and setbacks or failures.

Being aware of this complexity of factors should help HIV/AIDS communicators more precisely identify problems and select suitable interventions.