From The Communication Initiative Network - where communication and media are central to social and economic development.
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In honour of World AIDS Day (December 1), this issue of The Drum Beat highlights reflections, perspectives, and guidance from the Joint United Nations Programme on HIV/AIDS (UNAIDS) and particularly from the UNAIDS Social Change Communication (SCC) Working Group. What follows includes a bit about the context of the current UNAIDS response and a focus on what the SCC Working Group considers to be the 10 key elements of social change communication, with supporting examples from HIV/AIDS programmes.
For additional reports, evaluations, and project examples, please also see The CI's HIV/AIDS Theme Site.
2007 United Nations General Assembly Special Session on HIV/AIDS (UNGASS) data revealed that over 150 countries show encouraging progress in the global AIDS response; however, the AIDS epidemic is not over in any part of the world. Examples of progress include: over 3 million people in low- and middle-income countries are receiving antiretroviral drugs (ARVs), with one million receiving access in 2007 alone; substantial increases in HIV prevention and treatment programmes, including a tripling of HIV prevention programmes for sex workers, men who have sex with men (MSM), and people who inject drugs; and in 7 of the most affected countries in sub-Saharan Africa, the percentage of young people who have had sex before the age of 15 has gone down. However, as the global epidemic has levelled off, it has levelled off at a terribly high level. An estimated 2.7 million people were newly infected with HIV in 2007; this represents 5 people newly infected for every 2 people newly receiving treatment. Thus, while much has been accomplished, there is still a long way to go. [UNAIDS 2008 Report on the Global AIDS Epidemic]
The UNAIDS programme is encouraging countries to "Know Your Epidemic and Response, and Act on it!" UNAIDS supports the global movement toward universal access to comprehensive HIV prevention, treatment, care and support that was called for and endorsed by UNGASS in 2006. [UNGASS 2006 High-Level Meeting on AIDS]
At the XVII International AIDS Conference in Mexico in August 2008, there was a renewed push to understand the persistent societal-level causes of HIV-related vulnerability and risk, such as gender inequality and HIV-related stigma and discrimination. A range of leaders made the case for combination prevention responses in the context of universal access, including biomedical, behavioural, and structural interventions, and for going beyond strategies that focus on individual knowledge, skills, and behaviour change to create more enabling environments for HIV prevention treatment, care, and support. For more information, please see:
- Behavior Change and HIV Prevention: (Re)Considerations for the 21st Century - Global HIV Prevention Working Group
- Structural Approaches to HIV Prevention - The Lancet, Volume 372, Issue 9637, August 2008
- The History and Challenge of HIV Prevention - The Lancet, Volume 372, Issue 9637, August 2008
- Biomedical Interventions to Prevent HIV Infection: Evidence, Challenges, and Way Forward - The Lancet, Volume 372, Issue 9637, August 2008
- "Know Your Epidemic, Know Your Response”: A Useful Approach, If We Get It Right - The Lancet, Volume 372, Issue 9637, August 2008
THE SOCIAL CHANGE COMMUNICATION WORKING GROUP
A renewed focus on societal conditions that make people vulnerable to HIV - and how to change them - has prompted reflection on the need to develop practical means to stimulate and support dialogue and community action for change. In 2007, UNAIDS convened an expert group to examine what is known about the concept known increasingly as "social change communication." That consultation helped UNAIDS to develop an expanded framework for communication for behavioural and social change [Report of the UNAIDS Technical Consultation on Social Change Communication]. The consultation also empowered sub-groups of volunteers to carry forward the discussion and planning. The resulting Social Change Communication Working Group (or, SCC WG) has been convened by UNAIDS over the past year to develop a technical update on Social Change Communication.
Central elements of the technical update were discussed with a range of delegates at the Implementers Meeting in Kampala, in June 2008 [click here for more info], and were presented in a poster session at the XVII International AIDS Conference in August 2008 in Mexico [click here for more info].
Social change communication has been identified as a key strategy for National AIDS programme efforts to convey the risks of concurrent sexual partnerships, to address stigma and discrimination against people living with HIV and other key populations, as well as to build the social consensus that governments and communities must respect the human rights of all people - including the rights of women and girls, men who have sex with men, transgendered people, people who inject drugs, and people involved in sex work. Shifting social attitudes, laws, and policies towards inclusion, equality, transparency, and protection from violence is seen here as an important part of creating an enabling environment for people to access HIV prevention, treatment, care, and support.
For additional information about HIV/AIDS and human rights, please see:
- The UNAIDS Global Coalition on Women and AIDS
- The United Nations Development Fund for Women (UNIFEM) Say No to Violence Against Women Campaign
- UNAIDS - Men who have Sex with Men
- UNAIDS – People who Use Injecting Drugs
- UNAIDS – Sex Workers and Clients
- UNAIDS – Social and Behaviour Change
- UNAIDS - Reducing HIV Stigma and Discrimination: A Critical Part of National AIDS programmes - A Resource for National Stakeholders in the HIV Response - 2007 [PDF]
TEN KEY FEATURES OF SOCIAL CHANGE COMMUNICATION (SCC)
- based on the poster session from the XVII International AIDS Conference, August 2008, Mexico.
1. National AIDS programmes must identify societal causes of HIV risk and vulnerability, and mobilise communities to change harmful norms and structures.
Systemic social barriers involve multiple layers of causes - individual, relational, organisational, and societal - that need to be shifted in order to enable and sustain individual behaviour change to reduce HIV risk and AIDS impact. Identification and in-depth analysis of the problem that needs to be shifted is the first step of SCC.
Please see "Ecological Models".
2. The problem identification and its methodology must be owned by the affected people, within affected communities.
Ownership and participation are linked but not identical. Participation is key to many tools and approaches in the communication "toolbox" - from face-to-face methods of advocacy and counselling to uses of mass media for information and entertainment. But who generates and owns the issue or focus? Whether the spark comes from individuals in their home community level or from mass media, a key feature of SCC is the shift from linear information dissemination to two-way dialogue that engages affected people and spreads though natural channels of communication and influence.
- Since 2004, the Ethiopian Government's HIV/AIDS Prevention and Control Office (HAPCO), the United Nations Children's Fund (UNICEF) and the Communication for Social Change (CFSC) Consortium have been strengthening social change communication initiatives in Ethiopia. "Youth and Community Dialogue" participants highlight a range of achievements:
Better-informed communities and positive role models. ("We know how to behave, communicate, to be good role models for society.")
- Greater knowledge and empowerment, with wider impact: ("We pass ideas to community members... to parents, families and classmates. Society members then get true information."
- Multiple gains through girls’ and women's participation: ("In Ethiopian culture women are seen as inferior in society. Through this club we get empowered ourselves to speak! And we get support.")
- Benefits of sustained participation and camaraderie: ("We are a strong group with support and commitment, interest, motivation… We think more deeply about what we are doing, we have visions for the future.")
- A sense of achievement and more positive futures.
In addition, the programme has led to youth becoming voluntary teachers of orphans and vulnerable children, providing practical support for people living with HIV, and establishing successful income generation.
3. It is necessary to change many things and to intervene on multiple levels at the same time in order to shift or change the deeply entrenched beliefs and norms that impede HIV prevention, treatment, and care.
Soul City's carefully researched, multilevel communication initiative produced dramatic short-term results, and a longer term shift in attitudes about the legitimacy of gender-based violence in South Africa. After only a six month campaign there was a 10% increase in respondents disagreeing that domestic violence was a private affair and a 22% shift in perceptions of social norms on this issue. Qualitative data analysis suggests the intervention played a role in enhancing women's and communities' sense of efficacy, enabling women to make more effective decisions around their health and facilitating community action.
"I think Soul City inspired them to act against the abuse of their rights. When I see women standing up against the abuse, one can wonder who...inspired them to do this? Yeah, then I realise that Soul City is the source." (Rural Police Commander)
At a policy level, the evaluation concluded that the implementation of the Domestic Violence Act was largely attributable to the intervention.
For the Soul City Social Change Model, please click here.
4. Stakeholder analysis (social assessment) is a critical part of step one in SCC. Part of in-depth analysis is to determine all the stakeholders, at each level, who need to be reached and involved in order to bring about lasting change.
For example, the Caribbean Vulnerable Communities (CVC) Coalition works to mobilise affected communities in the Caribbean to unpack the social, cultural, and economic dynamics that contribute to HIV transmission and barriers to treatment for individuals who are engaged in sex work, who use drugs, who are in prison, and who are men who have sex with men. The CVC has achieved results through:
- Dialogue with gatekeepers and policy makers, for example on the harmful impact of punitive approaches to drug use on Caribbean societies and on people who use drugs
- Mobilising members of the communities themselves, such as sex workers and sexual minorities, to analyse the factors that lead to social exclusion and drive members of their communities away from services
- Helping communities to form national and regional coalitions for demanding and strengthening service provision
- Advocating at national and regional levels on policy issues and engaging in debates.
5. Once the social barrier or need for change is analysed and stakeholders are identified, SCC involves four more steps including:
- Engagement of key stakeholders - to ensure "ownership";
- Alignment among sectors and partners in a unified strategy;
- Implementation and amplification (scale and scope); and
- Evaluation and reporting back.
6. SCC invites and requires us to think in partnership, rather than project mode.
SCC involves recognising the different options and groups that are at work, and working with them to align their efforts toward common goals.
For example, the Uganda AIDS Commission's programme to reduce vulnerability and risk of young people coordinates 400 implementing groups across the country to intervene on four levels: individual, service delivery; community; and social/political.
Please see the Vulnerability Analysis conducted by the Uganda AIDS Commission.
7. Leadership at all levels for ongoing dialogue and coordination is critical to help stakeholders to stay on course.
Challenging deeply entrenched norms and expectations is likely to make some people uncomfortable; this is clear when the subjects are gender inequality, HIV-related stigma and discrimination, and efforts to promote human rights - as all of these involve reflecting on power relations and social justice. Respectful but persistent leadership and support can help keep people to have difficult but important conversations, staying focused on common goals.
8. A SCC programme to shift deeply entrenched social norms should have a long-term plan and road map (5 years or more) that includes activities to influence all the components and layers identified in the analysis stage.
When aligned, coordinated, and sustained, diverse efforts and partners can produce major, cumulative results over time. However, communication in national AIDS programmes today is fragmented and project oriented. A larger, longer term vision is needed with more investment at local levels.
9. Monitoring and assessing the progress of AIDS communication toward social change is complex and should follow these basic principles.
- Use diverse and complementary approaches, methods and tools
- Explicitly address power dynamics
- Document and analyse underlying drivers
- Engage diverse stakeholders in assessing multi-level, multi-component responses over time
- Ground work in the specifics of cultural contexts
- Work in partnerships
- Utilise holistic, systemic approaches
Several monitoring and evaluation guidelines and tools are available, and a broad framework that encompasses all of these is under development.
10. Capacity development is needed at every level to get best results from an SCC strategy.
From facilitating community dialogue to analysis and measurement of attitudes and norms, to joint planning and coordination of communication partners, SCC goes beyond traditional information, education, and communication (IEC) and individual-focused behaviour change communication (BCC). It requires a range of people and skills, and training to meet the technical, political, and management challenges involved.
SCC WORKING GROUP CONTACTS
Please contact the SCC Working Group with your comments and contributions at firstname.lastname@example.org
Current members of the Working Group include:
Joint United Nations Programme on HIV/AIDS (UNAIDS)
Communication for Social Change Consortium (CFSCC)
Johns Hopkins Bloomberg School of Public Health Center for Communication Programs (CCP)
Soul City Institute
Management Sciences for Health (MSH)
Caribbean Vulnerable Communities Coalition (CVC)
Academy for Educational Development (AED)
World Health Organization (WHO)
Zambia Centre for Communication Programmes (ZCCP)
United Nations Population Fund (UNFPA)
Please VOTE in The CI's HIV/AIDS POLL!
If culturally delicate HIV/AIDS factors such as male circumcision or fewer multiple concurrent partners are to be effectively addressed which communication strategies are most required?
- Individual/partner counselling
- Education campaigns
- Social marketing
- Private dialogue
- Public debate
- Media focus
- Skills training
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