The XVII International AIDS Conference (AIDS 2008) took place August 3-8 in Mexico City. In the lead-up to this event, over 500 HIV/AIDS communicators gathered online through The CI processes to suggest, debate, and formulate a set of policy ideas from a collective perspective on a more effective HIV/AIDS strategy. The space within which this online gathering took place is located here.

This issue of The Drum Beat highlights: a few of the contributions, from around the world, to the discussion; the draft policy ideas developed by the collective communication group; and some concluding notes we have been privy to since the conference. We hope you will review these contributions from fellow network members and submit your own comments through the page review processes related to the two documents referenced below.

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The Drum Beat 456 Contents:

• COMMUNICATION POLICY IDEAS from HIV/AIDS CI Network Members
• The CI's Mexico AIDS 2008 and HIV/AIDS Theme sites
• "The Real Stuff" - HIV/AIDS Communication POLICY RECOMMENDATIONS
• "Social AIDS" - DOCUMENTATION of a social movement/change/norm/mobilisation HIV/AIDS FOCUS
• New HIV/AIDS POLL

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COMMUNICATION POLICY IDEAS from HIV/AIDS CI NETWORK MEMBERS:

1. From ETHIOPIA:

"From African/Ethiopia perspective, the enigma of HIV & AIDS has paradoxical feature (Knowledge, IEC/BCC issues were de[a]lt across the nation, regional/local government states...). More than 85% of Ethiopians (including students) know about HIV, AIDS, its roots of transmission and its impacts. Yet, this knowledge is not really supported by actual changes in thoughts, perceptions, beliefs, most importantly behaviors. Still there are educated people exposed to HIV and dieing...

I thought and feel that HIV/AIDS education and its management programs must be mainstreamed across the society, sector....including faith-based institutions. Churches and mosques nowadays [are] doing commendable business here in Ethiopia. Schools have already begun mainstreaming. My college has already mainstreamed [a] gender and HIV/AIDS program.

But still it needs strong leadership, we have to fight first biased attitudes and thoughts like IKIK (I know it I know it perceptions of civil servants, academic staff). Anyways, i am currently working on my Ph D proposal to find out what is missing??

The major problem for countries like Ethiopia and universities/colleges here is financial and human resource[s]. I found HIV/AIDS is [a] really costly threat [to] development (MDGs [Millennium Development Goals] or Local/national devel[o]pment agenda). What do you think? What roles are expected from each of us (individually, professionally, nationally...?)"

2. From KENYA, Re: CAPACITY BUILDING:

"In my opinion I believe training and capacity development for all those who are in one way or another involved in the fight against HIV/AIDS is very vital. All health workers need to be up-to-date with current research in the area of HIV/AIDS. Let's take a case of ARVs [antiretrovirals] dispensing... how many of our small health centers have staff who are knowledgeable about ARV adherence and what advice to give to give to the patients who visit them?

How are the counseling skills [provided to] the health care providers, and in this case am looking at the skills of especially those who have to deal with those who are physically challenged in one way or the other...there ha[ve] been cases when visually challenged persons visit VCTs [voluntary counselling and testing centres] and the personnel there instead of helping them discriminate and stigmatize them because they are supposedly not to be sexually active... etc.

I believe training and capacity development will contribute to the effectiveness of BCC [behaviour change communication]."

3. Re: PAPUA NEW GUINEA and TRADITIONAL CULTURE:

"I am reading with great interest the various messages that are being sent to you. In many of them there is a mention of the importance of understanding the culture of the people among whom we want to raise HIV/AIDS awareness. However, I have not seen anyone suggesting that to ensure the success of any HIV/AIDS communication strategy it must based of an in depth understanding of the target society's traditional system of belief[s] and their mind frame. Many traditional belief systems do not have the notion that accidents, diseases etc can be prevented. Instead they explain these events post facto in terms of witchcraft or sorcerer' spells.

In Papua New Guinea (PNG) the traditional beliefs in witchcraft and sorcery are accompanied by a traditional culture of promiscuity. These two traditional cultural features are reflected now not only in an increasing AIDS death rate but also in increasing numbers of elderly men and women being found brutally murdered because they were blamed for having caused these AIDS death[s]. These "witches" and "sorcerers" are usually tortured until they confess and are then brutally murdered. Almost all PNG citizens still try to identify the witch or the sorcerer after something bad happens to them or their kin. This is so in spite of the fact that 97 per cent of PNG citizens are devout Christians, who over many years now have been subjected to different kinds of HIV/AIDS awareness-raising communications. These strategies failed to take into account that the traditional culture of the target population did not include the possibility of using protective measures to prevent the occurrence of accidents, disease or death. If these are the pre-conditions to receiving messages that stress the importance of having protected sex it becomes obvious that different communication strategies will have to be developed to get the target population [to] begin being prepared to accept the possibility of protection against disease when this means a change of sexual relations, which are after all the most sensitive human relations. What I am trying to explain here is the importance of basing communication strategies on a sound understanding of the relevant aspects of the target population's traditional culture that will affect how the messages are perceived by the recipients."

4. Re: SOUTHERN AFRICA and FAMILY:

"I have worked for 7 years in Southern Africa using storytelling as a methodology for starting a conversation of change in the fight against HIVAIDS, and have found that we need to focus our efforts on how the disease affects family life, and decision making in communities. The family is the common thread which unites all people. Sharing the experience of how the disease affects family cross culturally is tremendously healing for all who participate. It also provides an interface for gender debate as well as in a [n]on threatening way helps us understand the different cultural views on human sexuality.

If we are wise we can in our conversations of change use this ghastly disease as the bridge to build the rift between the rich and poor because of the common thread, family.

Try it and use the family in your message as a starting point, you will stand amazed at how well it works."

5. From NICARAGUA, Re: IMPACT:

"If we can say something about impact (whatever action it is - or was the origin of the intended impact) I think we should learn about it. I agree...regarding the need of putting specialist at the head of communication strategies but I also think that the concept itself - of communication I mean - implies that a dialogue between different specialists take place to address a complex problem - and highly complex as the AIDS pandemic, even before conceiving any strategy for any purpose...

Fighting AIDS is a multi-factor multi-origin problem that occurs in different manner in different places...yes!!! I know this is well known but that is exactly my point. Most of the time we forget the basis and the need of consensus and op[p]ortune knowledge about the AIDS routes from different and complementary strategies/analysis and expertises in order to act...

I think that the point addressed by Alfonso that is difficult - for many of us indeed - to dissociate communication from mass media is maybe one of the biggest reasons to do "the same thousand things with the no so same but similar thousand messages". The communication understood as a change/evolutive/developing experience is not all the time in our heads while we are working on [these] strategies; and the fact/need/request of "creating/influencing/developing impact" sometimes refers to our most conservative concept of indicators of change and not exactly what should be consider as milestones on a longer process... Condom use and condom negotiation [within] violence relationships - like most sexuality behaviour around the world - or even stigma and discrimination, are just a couple of examples [of] how we think that communication strategies can help but how we don't do different messages and back up process and actions from a communication perspective because it may take longer of what is expected - or because we can lose the support if we do not have indicators on supporters' time.

I would also like to raise the problem of measuring impact of communication strategies - as you all could see it is something I consider as a weakness on our side as communication strategist/specialist/developers...and a need to work on."

6. From a RESEARCH PERSPECTIVE:

"From my research experience (mainly in Nairobi, Kenya, and a bit in Cameroon), the following are important issues to consider:

• Support systems (for testing, treatment, care) are essential. In some cases, community education programs are effective in encouraging people to be tested or otherwise change their behavior. However, the individuals who develop the education programs don't always have the facility or funding to also provide testing and treatment. There must be support networks in place.
• Approaches to HIV and AIDS work must be holistic. Too often AIDS is addressed as an isolated concern, when in fact it is deeply connected to other issues, e.g. poverty, gender issues, etc. Also, in some cases, funding is pulled from work on other issues in order to target AIDS. For example, funding may be pulled from organizations which do not only target AIDS orphans, but also care for orphans who have lost parents for other reasons. This puts organizations in a difficult position -- stop other work, be dishonest about what they do?
• As others have asserted, arts (music, dance, drama, puppetry, etc.) can play a vital role in preventative education programs. There are many reasons for this, including that communities may be tired of hearing about HIV and AIDS but may still be intrigued by innovative approaches to these issues (e.g. attracted to performances, willing to explore issues through creative means).
• Different stakeholders need to work together. For instance, it was emphasized to me by friends in Cameroon that Christian and Muslim leaders should communicate with each other and work together in communities.

From a Sheffield (UK) perspective, I'd add that young people and others often don't see HIV and AIDS as concerns, since medication is now available. They don't realize how much lives can change due to HIV even if medication is available."

7. From MALAWI, Re: LEPSA APPROACH:

"In Malawi, the Learner-centred, Problem posing, Self discovery and Action oriented approach (LePSA) to dealing with behaviour change challenges associated with HIV and AIDS. The approach involves engaging communities in deep reflection and analysis sessions that eventually generate a drive for action at individual as well as group level. The approach has evolved from Paulo Freire (Brazilian writer)'s transformative writings. The approach recognises that change is a result of a conscious decision one has to make based on deep reflection over life and not merely knowledge acquisition. As a Communication for Development Consultant, I have noted that most change based initiatives are merely addressing knowledge dissemination objectives and are not challenging enough to engage learners more critically to facilitate commit[t]ed decisions. Practitioners don't seem to invest much time in dialogue with people to achieve critical understanding of the effects and causes of issues happening around them. This seems to be the reason why a lot of knowledge has flown around about HIV and AIDS but with little impact on behaviour change. Most IEC initiatives might need to be reexamined to see how they can engage learners in deeper reflection at individual level beyond mere knowledge acquisition. Practitioners might also wish to adopt new skills and attitudes to better cope and address the needs of learners, both the literate and illiterate as it seems behaviour change is a challenge affecting both cadres."

8. From UZBEKISTAN:

"I believe that we should encourage policy makers to develop communication policies that:

1. Are holistic in addressing both societal needs for safety and individual needs for recognition. By this I mean balancing the need to educate and support behavioral change in a wide range of setting[s] that include education, workplace and health systems and helping those who are marginalized by the mainstream to have a voice in terms of access and support.
2. That are in a clear and understandable language and are transparent in terms of resource allocation, benchmarks of success to include benefits to society and what negative consequences could occur if the policy fails and are in the form of living documents that help people understand the who, what, why and how of HIV/AIDS policies.
3. That includes cultural sensitivity but not at the cost of protecting society from dangers brought by the effects of HIV/AIDS in terms of loss of life, economic degradation and the destruction of communities.

These would go a long way to improving the process of addressing the core issue of reducing the spread of HIV/AIDS and supporting those with the disease in getting access to drugs and services that allow them to live productive positive lives. In turn I hope that we in this community begin to learn what the challenges that policy makers face in terms of special interests (including our own) in developing policies and legal frameworks that may not be popular but are essential to...generating behavioral changes that are needed to control and stop the spread of HIV/AIDS, in order for us as a professional social movement to better assist policy makers and society at large in addressing the core challenge of eliminating HIV/AIDS from the greater society."

9. Re: INTEGRATION and MEDIA:

"I would add 3 things to the policy document. I think that to remember that communication is not only about social change but any technology including ART [antiretroviral therapy] and vaccines need communication integrated into the implementation plan. The achievement of communication to increase knowledge about ART in a very Short time is rarely recognised - an example is the booklet on ART that was jointly produced by Soul City and Khomanani. It reached 50% of the population and increased knowledge about a range of issues related to ART among those expose[d] compared to those not exposed.

I think the second issue is that I strongly feel that local is good yes, but we do not want to Ghettoise the south and encourage only small group under the tree interventions - people in the south also need sophisticated mass media (locally developed).

Finally the issue of the international media's content is playing a role in communication - in South Africa. One of the most watched TV programmes is the Bold and the Beautiful. In one episode they talked about how a woman can pass TB on to her unborn child! Apart from the consumer and questionable sexual values we are bombarded with this misinformation - [this] is problematic - I don't know how these are translated into policy?"

10. Re: CAPACITY BUILDING:

"While I completely agree that local voices, dialogue, discussion and action [are] critical, I think it is also important that local discussions take place within a broader communication strategy that is evidence based and grounded in the key issues of the local epidemic. I think we need to collectively think through how we can support national initiatives to develop communication strategies that allow for local initiative and action around a common framework. [There are m]ixed messages and conflicting message abound HIV programming.

A number of countries are now pulling together national communication strategies, but the ability to implement these strategies is lacking both in technical and financial resources. Most larger-scale communication efforts are funded from external donors with external technical support. It is critical that as a global community we work with countries to develop a critical mass of skilled communication practitioners who can move from the data to innovate communication programs for behavior and social change at scale. If we go to any MOH, we will find an underfunded and understaffed team at the Health Promotion Units who [put] most of their budget and efforts on WADs [World AIDS Days] in the same fashion used for the other health days, [and the] resources usually [do] not have any impact on health indicators. Resources for communication are usually in the hands of the technical program manager for HIV or TB. A major target population for our advocacy efforts needs to be those program managers, usually clinically trained, who do not see the "evidence" to support putting resources into comprehensive communication programs.

So I would like to see added a section on capacity building, comprehensive communication strategies that can form a framework for concerted local efforts and a discussion on targeting technical program managers for our advocacy efforts."

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Please click here to visit The CI's pre-AIDS 2008 communication gathering space.

And also see The CI's HIV/AIDS Theme site.

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HIV/AIDS COMMUNICATION POLICY RECOMMENDATIONS

11. THE REAL STUFF! Towards more principled and effective HIV/AIDS policy and investment action

This is the draft of collected policy ideas from the HIV/AIDS communication group convened through The CI processes:

Derived from their direct, day-to-day, in-country and community, work experience and analysis of the HIV/AIDS pandemic, the community of people and organisations using communication and media strategies to address HIV/AIDS strongly encourages HIV/AIDS policy makers and funders to adopt the following common themes and objectives as integral to their strategic direction and financial investments.

These policy and investment proposals are also derived from substantive programme experience, lessons learned from addressing other relevant, major development issues (e.g., the civil rights and the women's movement), and evaluation and research data on these approaches.

Read the full policy draft by clicking here.

Provide your critique, stories, and insights in support or to dispute this policy approach either within the page review form or simply reply to this issue of The Drum Beat (we will insert your comments, anonymously, for you).

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SOCIAL MOVEMENT/CHANGE/NORM/MOBILISATION HIV/AIDS FOCUS

12. SOCIAL AIDS

This note provides an introduction to the prominent communication challenges, impact data, and strategic thinking that shaped the dialogues at AIDS 2008 in Mexico City. The content for the note was gathered by a group at the Conference and was supported by the Joint United Nations Programme on HIV/AIDS (UNAIDS).

"If the previous International AIDS Conference in Toronto in 2006 could be called "the circumcision conference", because of its predominant focus on that possible programming response, then the XVII International AIDS Conference in Mexico City was the social conference. "Social" was breaking out in discussion everywhere - social drivers, social complexity, social change, social mobilisation, social movements, social stigma, socio-economics, socio-cultural factors, and social phenomena (from homophobia to gender equity). This was a move back to the fundamentals for an effective long-term response - the social response..."

These notes are observations and highlights pertinent to an increasing policy priority on, and investment in, a social movement/change/norm/mobilisation focus for more effective HIV/AIDS action.

Read the full draft by clicking here.

Provide your critique, stories, and insights in support or to dispute this policy approach either within the page review form or simply reply to this issue of The Drum Beat (we will insert your comments, anonymously, for you).

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VOTE in our NEW HIV/AIDS Poll:

In an effort to contribute to efforts to meet Millennium Development Goal (MDG) #6, schools should integrate HIV and AIDS prevention programming into their sex education curriculum:

• Early - i.e., in primary/elementary grade levels
• Around the time of puberty - i.e., in middle school
• Later - i.e., when youth are nearing the end of undergraduate education
• Never; it is the role of parents or others - not schools - to provide this kind of information.

VOTE - click here - (see "Poll" heading on the top right side).

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