Panos Global AIDS Programme
In this 30-page report, Robin Vincent argues that effective HIV and AIDS communication is central to the achievement of universal access to HIV prevention, treatment, care and support. In his assessment, the 2005 call by G8 governments, the African Union, and the United Nations to come "as close as possible to" universal access by 2010 will remain elusive without a paradigm shift in development and communication practice. This report reviews lessons learned from the response so far and suggests that there is an urgent need to strengthen communication approaches that look beyond narrow, short-term interventions focused on individual behaviours.
Communication challenges include: the effective coordination of the response; sustained advocacy to tackle the underlying drivers of the epidemic; and the
specific communication needs of prevention, treatment and care initiatives that require grassroots ownership and social mobilisation. In addressing these barriers, it is vital, Vincent suggests, that the focus turn toward developing and implementing strategies drawing on communication which engages those most affected by HIV and AIDS - that is, participatory communication which "go[es] beyond delivering 'messages' to particular groups of people to change their attitudes and behaviour, focusing instead on a two-way process of dialogue and participation, and the broader social context and set of enabling factors and resources that support communication in any setting." This claim is based on his observation of factors which have contributed to efforts to move toward universal access, which include:
- "political leadership: played a major role in tackling the epidemic in Uganda,
Thailand, Senegal and Brazil
- civil society mobilisation: the combined actions of non-governmental
organisations (NGOs), women's groups, communities, faith-based organisations (FBOs),
and others underpinned successful wide-scale social responses in Senegal and Uganda
- open dialogue: in Uganda, discussion and knowledge-sharing in personal communication networks made people feel that HIV and AIDS affected them
personally, promoting changes in behaviour
- the media: raised awareness and promoted dialogue and debate in Thailand,
Brazil and Uganda
- country-driven responses: drawing on local expertise, a home-grown set
of approaches and priorities were produced by government in partnership
with civil society in Senegal, Uganda and Jamaica
- multisectoral responses to prevention and care: including multiple government
ministries; involving of all levels of society from national to community level matching the response to the stage and character of the epidemic: combining
efforts aimed at the majority population and those focused on high-risk groups
- targeted large-scale interventions, combined with a range of prevention approaches
- effective monitoring of the epidemic and risk behaviours, and using the findings to support improved policies and programmes."
Reflecting on these factors, Vincent urges that communication can meet the important need to effectively address social barriers to universal access, in the following ways:
- stigma and discrimination
- lobbying to ensure that policy and laws do not perpetuate discrimination
- enacting policies in institutional contexts like schools, workplaces and
- promoting accurate information and frank dialogue with communities and households
- presenting human interest stories through the media
- gender inequity
- engaging in advocacy and social mobilisation to remove legal barriers and address social challenges such as gender violence, poverty and migrant labour
- supporting equitable policies in different institutional contexts, such as schools
- fostering existing networks and women's efforts to organise for gender equity
- designing gender-sensitive participatory communication approaches to tackle harmful
gender norms and practices
- developing gender indicators to track progress on the above in country plans
for universal access, and ensuring that plans are consistent with existing international
Vincent points to a broad range of participatory approaches that have attempted to take social context - such as notions of morality, sexuality and identity, and disease and death - more seriously, recognising the need for a sustained effort to build communication capacity at local levels so that communities and individuals can lead their own change processes. The idea is that, rather than begin with externally defined messages (many of which are based on what Vincent describes as the faulty assumption that individuals make rational choices about their behaviour), the emphasis must be placed on a process of dialogue and negotiation of change at many levels that is closely attuned to the needs and perspectives of people most intimately affected by HIV/AIDS.
One of the many communication approaches that have drawn on grassroots ownership and social mobilisation that Vincent describes here is communication for social change (CFSC) programming, which centres around generating informed and inclusive local-level debate as a basis for engaging in wider social change. For instance, in Ethiopia the CFSC process has worked through a large network of youth clubs in a process that "stimulated dialogue within existing networks and groups, and amplified the voices and concerns of young people and their communities through a variety of media to stimulate discussion at district and national levels." In addition to such peer-based approaches, Vincent also points to the engagement (and, possibly, re-working) of existing cultural practices as a potentially effective means of deepening participatory communication approaches. The key is to avoid co-opting people into powerful, pre-set development agendas under the guise of "authentic" local participation.
Communication, dialogue, and negotiation, Vincent argues, are central to coordinating the wide range of stakeholders working towards universal access, and developing the accountability, transparency, and meaningful involvement of people living with HIV/AIDS (PLWHA). He identifies a number of strategies for, and examples of, building effectively on existing responses and initiatives in communities most affected by HIV and AIDS, as well as supporting country-driven processes and the wide involvement of stakeholders.
The report concludes with a series of recommendations, which are excerpted here:
"Mainstreaming communication for effective coordination of the response
- Ensure that country plans for universal access have a communication strategy that clearly identifies priorities for communication around each of prevention, treatment and care, and the necessary resources and expertise to put it into practice
- Maximise accountability and transparency of the HIV/AIDS response through country-level plans developed with meaningful input of those most affected, and their involvement in monitoring national and international commitments, policies and funding processes
- Promote simple and manageable monitoring and evaluation that strengthens learning for more effective practice on the ground, and facilitate networking to share lessons learned
- Support networks of PLWHA and inclusive social movements to strengthen their communication capacity, and to mobilise around universal access to prevention, treatment, care and support
- Work with the most affected and at-risk groups to ensure communication around prevention, treatment and care interventions is focused on the character of local epidemics and does not neglect prevention and care.
- Promote a large-scale, purposeful dialogue on the underlying and core causes of HIV and AIDS - first with the most affected groups and subsequently with wider groups of stakeholders in the response
- Promote advocacy and social mobilisation to tackle social barriers to universal access such as poverty, gender inequity, stigma and discrimination, and inadequate health systems, through: supportive laws and government policies; supportive institutional policies; and community dialogue, debate and action
- Promote dialogue and debate at all levels on the long-term social impact of HIV and AIDS on social infrastructure, communities and households, to inform policies and initiatives that will mitigate such impact.
- More systematically strengthen the role of the media and new information and communication technologies in promoting awareness, dialogue and debate, and to amplify the voices and experiences of those most affected
- Raise awareness of the importance of interactive and participatory communication approaches that look beyond ‘messaging’ and social marketing
- Further develop and fund participatory communication for social change approaches to strengthen civil society and community communication capacity, and to enable innovative, relevant and locally owned responses
- Build on existing community communication capacities and responses, such as inclusive social movements and creative cultural practices."
Email from Robin Vincent to The Communication Initiative on November 30 2006; and Panos website.