Issue 35 | NOVEMBER 2011
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Adapting SBCC Programs and Activities in Sub-Saharan Africa

Of Interest…

C-Change launched the facilitated online C-Modules course in October 2011 in partnership with Ohio University. Twenty professionals from 11 countries in Africa and Latin America are developing and strengthening their competencies in planning, implementing, and monitoring and evaluating SBCC activities and programs. Based on the face-to-face training developed by C-Change, this course is facilitated, interactive, and tailored to individual professional interests. Information about the facilitated version and the no-cost, self-paced version is available here.

C-Channel 35 presents six articles on adapting HIV-related social and behavior change communication (SBCC) programs and activities to countries in sub-Saharan Africa. The first describes a program adapted for adolescent girls in Ghana, and the second outlines the adaptation of an evaluation model to Masaii settings in Tanzania. Two articles on Kenya follow: one on the incorporation of Islamic teachings into HIV prevention communications and one on the need to adapt multimodal texts for rural residents. When, how, and why HIV counselors in Malawi adapt Western testing guidelines is the subject of the next article, followed by one on U.S. positive prevention models that may be suitable for Mozambique.

C-Change adapted its Community Conversation Toolkit for HIV Prevention, developed in English in South Africa, to six other countries and cultural contexts. The recently released Swaziland adaptation is in the Siswati language. It uses culturally relevant artwork and local proverbs and includes components on male circumcision and condom use. All adapted versions are available on C-Hub: for Malawi in Chichewa; for Zambia in Kikaonde; for Zimbabwe in Ndebele; for Namibia in Lozi; for Lesotho in Sesotho; and for South Africa in Sotho and Zulu.


In this issue

1. Adaptation of a U.S. HIV prevention program for girls in Ghana.

2. Adaptation of the RARE model to the Masaii context in Tanzania.

3. Islamic teaching in HIV prevention in Kenya

4. Localization of HIV/AIDS discourse in a rural community in Kenya

5. Adaptation of Western testing norms by HIV counselors in sub-Saharan Africa

6. Adaptation of positive prevention interventions for international settings

1. Adapting a MultiFaceted U.S. HIV Prevention Education Program for Girls in Ghana

Authors: Fiscian V1; Obeng E2; Goldstein K3; Shea J3; Turner B3
Institutions: 1. JSA Consultants Limited, Accra, Ghana; Bristol-Myers Squibb, Princeton, N.J., and Community Services Foundation, Tema, Ghana; 3. Department of Medicine, University of Pennsylvania, USA.
Source: AIDS Education and Prevention 2009, 21(1):67-79


We adapted a U.S. HIV prevention program to address knowledge gaps and cultural pressures that increase the risk of infection in adolescent Ghanaian girls. The theory-based nine-module HIV prevention program combines didactics and games, an interactive computer program about sugar daddies, and tie-and-dye training to demonstrate an economic alternative to transactional sex. The abstinence-based study was conducted in a church-affiliated junior secondary school in Nsawam, Ghana. Of 61 subjects aged 10-14 in the prevention program, over two thirds were very worried about becoming HIV infected. A pre-post evaluation of the intervention showed significant gains in three domains: HIV knowledge (p =.001) and self efficacy to discuss HIV and sex with men (p <.001) and with boys (p <.001). Responses to items about social norms of HIV risk behavior were also somewhat improved (p =.09). Subjects rated most program features highly. Although short-term knowledge and self-efficacy to address HIV improved significantly, longer- term research is needed to address cultural and economic factors placing young women at risk of HIV infection.

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2. Promoting Health, Preserving Culture: Adapting RARE in the Maasai Context of Northern Tanzania

Authors: Birks L; Powell C; Thomas A; Medard E; Roggeveen Y; Hatfield J
Institution: Community Health Sciences, University of Calgary, Canada
Source: AIDS Care 2011, 23(5): 585-92


HIV/AIDS prevention strategies often neglect traditions and cultural practices relevant to the spread of HIV. The role of women in the HIV/AIDS context has typically been relegated to high-risk female groups such as sex workers, or those engaged in transactional sex for survival. Consequently, these perceptions are born out in the escalation of HIV/AIDS among communities, and female populations in particular where prevention frameworks remain culturally intolerant. We have attempted to address these issues by using an adapted Rapid Assessment Response and Evaluation (RARE) model to examine the impact of HIV/AIDS in the Maasai community of Ngorongoro. Our adapted RARE model used community engagement venues such as stockholder workshops, key informant interviews, and focus groups. Direct observations and geomapping were also done. Throughout our analysis, a gender and a pastoralist-centered approach provided methodological guidance, and served as value added contributions to our adaptation. Based in the unique context of a rural pastoralist community, we made recommendations appropriate to the cultural setting and the RARE considerations.

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3. Emerging Discourse: Islamic Teaching in HIV Prevention in Kenya

Authors: Maulana A1; Krumeich A2; Van Den Borne B2
Institutions: 1 Department of Health and Social Services, Nairobi, Kenya; 2 Faculty of Health, Medicine and Life Sciences, Maastricht University, The Netherlands
Source: Culture, Health & Sexuality 2009, 11(5): 559-569


Islamic values portraying sex outside of marriage as sinful are often believed to contribute to HIV transmission as they reject safe-sex practices. Moreover, stigma associated with sinful behaviour is frequently assumed to interfere with access to care for those infected. In contrast, adherence to religious values such as abstinence is viewed as an explanation for the relatively low incidence of HIV infection in Islamic populations. Inspired by this debate, a study was conducted into the possibilities of using Islamic texts as a starting point for health promotion addressing HIV infection and HIV/AIDS-related stigma in Lamu, a Muslim community in Kenya. The study also explored the potential role of Lamu's Islamic leaders in the delivery of that health promotion. In collaboration with Islamic leaders, texts were identified that applied to sexual conduct, health, stigma and the responsibilities of Islamic leaders towards their congregations. In spite of the association of HIV with improper sexual behaviour, Islamic texts offer a starting point for tackling HIV transmission and HIV/AIDS-related stigma. Under particular conditions, the identified Islamic texts may even justify the promotion of safer-sex methods, including condom use.

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4. Localizing HIV/AIDS Discourse in a Rural Kenyan Community

Authors: Banda F1; Oketch O2
Institutions: 1 University of the Western Cape, South Africa; 2 Maseno University, Kenya
Source: Journal of Asian and African Studies 2011, 46(1): 19-37


This paper examines the effectiveness of multimodal texts used in HIV/AIDS campaigns in rural western Kenya using multimodal discourse analysis (Kress and Van Leeuwen, 2006; Martin and Rose, 2004). Twenty HIV/AIDS documents (posters, billboards and brochures) are analysed together with interview data (20 unstructured one-on-one interviews and six focus groups) from the target group to explore the effectiveness of the multimodal texts in engaging the target rural audience in meaningful interaction towards behavioural change. It is concluded that in some cases the HIV/AIDS messages are misinterpreted or lost as the multimodal texts used are unfamiliar and contradictory to the everyday life experiences of the rural folk. The paper suggests localization of HIV/AIDS discourse through use of local modes of communication and resources.

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5. Working Outside of the Box: How HIV Counselors in sub-Saharan Africa Adapt Western HIV Testing Norms

Author: Angotti N
Institution: Dept of Sociology and Population Research Center, University of Texas at Austin, USA
Source: Social Science & Medicine 2010, 71(5): 986-993


The delivery of HIV counseling and testing programs throughout sub-Saharan Africa relies on the work performed by trained HIV counselors. These individuals occupy a critical position: they are intermediaries between the rule-making of international and national policymakers, and the norms of the communities in which they live and work. This paper explains when, how and why HIV counselors adapt Western testing guidelines (the "3Cs" consent, confidentiality and counseling) to local concerns, attempting to maintain the fidelity of testing principles, while reducing the harm they perceive may arise as a consequence of strict adherence to them. Data for this study come from Malawi: a poor, largely rural African country, where HIV prevalence is ranked 9th highest in the world. The analysis is based on 25 interviews with HIV counselors and a unique set of field journals, and captures local experiences and the moral quandaries that counselors in rural Sub-Saharan Africa face. The findings of this inquiry provide new insights into the implementation of HIV testing in rural African settings, insights that may guide HIV prevention policy.

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6. Adapting Positive Prevention Interventions for International Settings: Applying U.S. Evidence to Epidemics in Developing Countries

Authors: Rose C; Gutin S; Reyes M
Institution: Mozambique Positive Prevention Program, School of Nursing, University of California, USA.
Source: Journal of the Association of Nurses in AIDS Care 2011, 22(1): 38-52


HIV prevention efforts with people living with HIV are critical, and Positive Prevention (PP) interventions have expanded globally to address this growing need. This article provides an overview of U.S. PP literature addressing evidence-based interventions. It continues by looking at the prevention needs and care issues of people living with HIV in Mozambique and the larger African context, and then discusses which U.S. PP models may be best suited for adaptation and use in Mozambique. The research suggests that the lessons learned from these U.S.-developed interventions can be modified to develop theoretically sound interventions. These interventions must be culturally specific and include a collaborative approach for best results.

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