Role of communication in HIV/AIDS prevention
Since HIV/AIDS first emerged globally, the role of communication has been recognized as critical to the control of the pandemic. The phrase “education is the only vaccine against AIDS” was commonly aired during the early years to control the epidemic.
Against this background, considerable efforts and energy were devoted to implementing communication programs to educate people about HIV transmission modes and prevention strategies. The underlying assumption of these early activities was that improving people’s knowledge about the infection and disease would lead to avoidance of risky behaviours.
Before designing a communication programme, it is important to understand the characteristic of the HIV epidemic in the target setting. In some countries, for example, in southern India and Afghanistan, the epidemic is mostly confined to a certain group of people, for example, sex workers in India, men who have sex with men (MSM), or injecting drug users (IDUs) in Central Asia. These types of epidemics are referred to as concentrated or non-generalized epidemics. In other countries (e.g., South Africa and Nigeria), the epidemic is affecting the general population rather than any specific sub-group. This type of epidemic is referred to as a generalized epidemic. The HIV epidemics in countries in sub-Saharan Africa are generalized epidemics.
Some of the proven HIVS/AIDs prevention strategies include the entertainment-education which has been identified as one that most effectively combines “best practices” elements by disseminating information through the media in a combination of entertainment and education. These approaches can be adopted by various entertainment modalities, ranging from professional to amateur street theater, from cartoons and comics to professional acting and drama performances.
Entertainment-education is both popular and effective as it focuses on emotional as well as cognitive factors that influence behaviour, and is closely aligned with the customs, norms, and narrative forms that the target audiences find familiar. There are many social factors that fuel the epidemic, including, but not limited to, gender, alcohol use, multiple partners, cross-generational sex, and transactional. There are many gender-related factors that are believed to fuel the spread of HIV. Some key areas that communication efforts can focus on to bring about positive change are gender equity and power imbalances in relationship.
About gender equity, there should be clear communication on the need for gender equity. This is because gender roles are socially determined and can therefore be changed. Communication can challenge these roles to provide a more equitable environment. On power imbalances in relationships, there should be communication (in a culturally sensitive manner) that power imbalances in a relationship increase HIV risk. Messages should address the power imbalances and the consequences of these imbalances and must emphasize that a man’s self-worth is determined by caring for his partner’s well-being.
Inclusion of men in communication efforts can bring about positive change because men have often been ignored in many programmatic gender interventions, including communication, and should be included as partners to fight against gender inequality. Gender-based activities are largely focused on women, or if they do include men, they separate targets by gender. Instead, communication efforts should seek to bring the two genders together to openly discuss gender norms.
Sex workers are predominantly women who trade sex for money and use sex as their primary means of income. They are different from women who have sex for transactional purposes, or those who engage in cross-generational relationships. Sex workers are particularly vulnerable to infection.Pregnant women who are HIV-positive are an important target for prevention of mother-to-child transmission (PMTCT) messages. By providing information on how a mother can prevent her unborn child from acquiring HIV, mothers are given the opportunity to protect them from the virus.
Youth represent a unique audience with special needs in regard to communication program design. Young people often believe that they are not vulnerable to HIV and, as a result, are more likely to put themselves at risk of contracting HIV than adults. Research shows that about half of all new infections occur in young people between the ages of 15 and 24, warranting the need to specifically address the behaviours of this population.
Apart from communicating to the specific groups commonly at risk, there is the need to communicate to the general public. Many people think that someone who looks healthy cannot possibly have the virus and therefore do not take precautions to avoid infection. Messages should also focus on risk behaviour. Seek to persuade those engaging in risky behaviour to change, instead of focusing on risk groups, as this can lead to stigma and discrimination. Communication should focus on the ABC three-pronged prevention strategy of abstinence, being faithful and correct and consistent condom use, along with a strategy for partner reduction. Messages should promote the available HIV/AIDS services, such as counseling and testing, care and treatment, and support groups. Communication should stress the availability and ease of use of these services.
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