C-CHANGE
C-Channel:
Issue 38 | FEBRUARY 2012
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More than Individual Behavior Change: Social Change and HIV Prevention

Of Interest…

Through
C-Change's collaboration with the University of the Witwatersrand, its School of Public Health has become a center of excellence in SBCC. It is currently offering three short courses: one on applying SBCC theory to practice, one on research and monitoring and evaluation, and one on planning and implementing SBCC.

C-Channel 38 presents seven articles on HIV-prevention communication that targets social change. The first four articles examine communication for social change broadly; three of them offer models or frameworks that programs can follow. The fourth article reports on a multilevel intervention for sex workers in Brazil that sought to modify aspects of the social environment. The fifth article discusses the importance of mobilizing and integrating community responses and social capital for HIV prevention, and the sixth reports on a case study in three villages in Tanzania where social capital contributed to reductions in HIV-related risk behavior and HIV infection. The seventh article examines fear appeals in HIV prevention communication and whether these promote appropriate social behavior for different cultural and racial groups.

Capacity building in social and behavior change communication (SBCC) is a hallmark of C-Change. A capacity assessment tool called the SBCC-CAT is among several tools that serve this purpose. One version of the SBCC-CAT is used by organizations, and a second is used by donors and networks. A third version, an SBCC-CAT for individuals, will soon be published.

 

In this issue

More than Individual Behavior Change: Social Change and HIV Prevention

1. Social Change Communication: A Panacea for HIV and AIDS?
ONLINE FULL TEXT

2. Addressing Social Drivers of HIV/AIDS
ONLINE FULL TEXT

3. A Dynamic Social Systems Model for Considering Structural Factors in HIV Prevention
ONLINE FULL TEXT

4. A Multilevel STI/HIV Intervention to Change the Social Environment Among Sex Workers in Brazil

5. Social Capital and Effective HIV Prevention
ONLINE FULL TEXT

6. Social Capital and the Decline in HIV
ONLINE FULL TEXT

7. The Role of Fear, Efficacy, and Cultural Characteristics in Promoting Social Change


More than Individual Behavior Change: Social Change and HIV Prevention

1. Social Change Communication: A Panacea for HIV and AIDS? An Outlook of a Program Manager

Authors: Gopal R
Institutions: Gujarat State AIDS Control Society (GSACS), Ahmedabad, Gujarat, India
Source: Eastern Journal of Medicine 2011, 16: 133-136.

ABSTRACT

For about three decades of the pandemic of HIV and AIDS, need for an effective response has been felt very strongly. Human behavior being complex; widespread behavior changes are challenging to achieve. Understanding of the dynamics of HIV transmission cannot be separated from an understanding of the broader context of poverty, inequality and social exclusion which create conditions under which unsafe behavior flourishes HIV/AIDS is not a mere health issue: its occurrence is influenced by a number of socio-economic, cultural and ecological determinants. Thus social change communication incorporating the enhanced behavior change communication emerges as an inclusive way of responding to HIV/AIDS issues. Social change communication can tackle structural drivers of the HIV epidemic, with a particular focus on the drivers of gender inequality, stigma, discrimination and denial and human rights violations. Based on his understanding of social change communication as a practitioner and an AIDS control program manager, the author examines whether the issues related to social change communication make it an effective instrument for the containment of HIV and AIDS.

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2. Addressing Social Drivers of HIV/AIDS for the Long-Term Response: Conceptual and Methodological Considerations

Authors: Auerbach J1; Parkhurst J2; Cáceres C3
Institutions: 1 San Francisco AIDS Foundation, Research and Evaluation, San Francisco; 2 Department of Global Health and Development, London School of Hygiene and Tropical Medicine; 3 Institute of Health, Sexuality, and Human Development, Cayetano Heredia University, Lima, Peru
Source: Global Public Health 2011. 6(3): S293-S309. DOI:10.1080/17441692.2011.594451.

ABSTRACT

A key component of the shift from an emergency to a long-term response to AIDS is a change in focus from HIV prevention interventions focused on individuals to a comprehensive strategy in which social/structural approaches are core elements. Such approaches aim to modify social conditions by addressing key drivers of HIV vulnerability that affect the ability of individuals to protect themselves and others from HIV. The development and implementation of evidence-based social/structural interventions have been hampered by both scientific and political obstacles that have not been fully explored or redressed. This paper provides a framework, examples, and some guidance for how to conceptualise, operationalise, measure, and evaluate complex social/structural approaches to HIV prevention to help situate them more concretely in a long-term strategy to end AIDS.

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3. A Dynamic Social Systems Model for Considering Structural Factors in HIV Prevention and Detection

Authors: Latkin C 1; Weeks M 2; Glasman L 3; Galletly C 3; Albarracin D 4
Institutions: 1 Department of Health, Behavior and Society, The Johns Hopkins Bloomberg School of Public Health, Baltimore; 2 Center for Interdisciplinary Research on AIDS, Yale University,; 3 Center for HIV Prevention Research, Medical College of Wisconsin,; 4 Department of Psychology, University of Illinois, Champaign Urbana
Source: AIDS Behav 2010, 14(2): 222-38. DOI: 10.1007/s10461-010-9804-y.

ABSTRACT

We present a model for HIV-related behaviors that emphasizes the dynamic and social nature of the structural factors that influence HIV prevention and detection. Key structural dimensions of the model include resources, science and technology, formal social control, informal social influences and control, social interconnectedness, and settings. These six dimensions can be conceptualized on macro, meso, and micro levels. Given the inherent complexity of structural factors and their interrelatedness, HIV prevention interventions may focus on different levels and dimensions. We employ a systems perspective to describe the interconnected and dynamic processes of change among social systems and their components. The topics of HIV testing and safer injection facilities (SIFs) are analyzed using this structural framework. Finally, we discuss methodological issues in the development and evaluation of structural interventions for HIV prevention and detection.

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4. Findings From Encontros: A Multilevel STI/HIV Intervention to Increase Condom Use, Reduce STI, and Change the Social Environment Among Sex Workers in Brazil

Authors: Lippman S1; Chinaglia M1; Donini A1; Diaz, J1; Reingold, A2; Kerrigan D3
Institutions: 1. Population Council, Brazil Office Campinas; 2 Division of Epidemiology, University of California, Berkeley; 3 Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore
Source: Sexually Transmitted Diseases 16 November 2011. doi: 10.1097/OLQ.0b013e31823b1937

ABSTRACT

Background: Sexually transmitted infection (STI)/HIV prevention programs, which do not modify social structural contexts that contribute to risk of STI/HIV may fail to bring about improvements in health, particularly among groups who experience discrimination and exclusion from public life. We conducted a multilevel intervention with sex workers, including improved clinical care and community-mobilizing strategies to modify social structural factors that shape sexual behavior, to improve condom use and reduce incident STI.
Methods: We followed 420 sex workers participating in the Encontros intervention in Corumba, Brazil, between 2003 and 2005. We estimated the effect of the intervention on incident chlamydia and gonorrhea infections and condom use using generalized estimating equations and inverse probability weighting by comparing those who actively engaged in the intervention activities (exposed) with those who were less engaged (unexposed). We also determined the association of participation on reported social cohesion and participation in networks.
Results: Exposed participants had significantly higher odds of reporting consistent condom use with regular clients (odds ratio [OR]: 1.9, 95% confidence interval:1.1-3.3) and nonsignificantly increased odds with both new clients (OR: 1.6, 0.9-2.8) and nonpaying partners (OR: 1.5, 0.9-1.5). The odds of an incident STI were nonsignificantly reduced for exposed participants compared with unexposed (OR: 0.46, 0.2-1.3). Participation was significantly associated with increased perceived cohesion and participation in networks.
Conclusion: This prospective study provides evidence that multilevel interventions with mobilizing strategies to modify aspects of the social environment can improve condom use, reduce STIs, and increase social cohesion and participation in networks among sex workers.

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5. Social Capital and Effective HIV Prevention: Community Responses

Authors: Low-Beer D; Sempala M
Institutions: Global Fund to Fight AIDS, TB and malaria
Source: Global Health Governance 2010, 4(1).

ABSTRACT

Most work on health governance has been concerned with global and national coordination; this paper assesses the governance challenge of building HIV prevention programs on community responses. It analyzes situations where HIV prevention has been successful, suggesting they developed multi-level governance integrating the national program with the community response. This ensured national HIV programs were built on the basic governance unit of the community. This governance approach allowed HIV programs to mobilize the important resources for HIV prevention which reside in social networks as social capital. The paper first assesses the links between governance and social capital, following which case reviews of HIV program data are used to highlight the importance of community level responses in effective HIV prevention. Finally, detailed community interview data are analyzed to identify key governance barriers and linkages to better integrate community responses into national HIV programs (from the Communicating AIDS Needs Project). As with the growing understanding of aid and development, HIV prevention programs need to leverage a much greater source of resources than exist in programs in order to deliver population health outcomes. This requires a wider view of governance, which can build national HIV prevention programs on the basic unit of community responses.

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6. Social Capital and the Decline in HIV Transmission - A Case Study in Three Villages in the Kagera region of Tanzania

Authors: Frumence G 1; Killewo J 2; Kwesigabo, G 2; Nyström L 3; Eriksson M 3; Emmelin M 3
Institutions: 1 Department of Development Studies, Muhimbili University of Health and Allied Sciences, Tanzania; 2 Department of Biostatistics and Epidemiology, Muhimbili University of Health and Allied Sciences, Tanzania; 3 Department of Public Health and Clinical Medicine, Epidemiology and Global Health, Umeå University, Sweden.
Source: J of Social Aspects of HIV/AIDS 2010, 7(3): 9-20.

ABSTRACT

We present data from an exploratory case study characterising the social capital in three case villages situated in areas of varying HIV prevalence in the Kagera region of Tanzania. Focus group discussions and key informant interviews revealed a range of experiences by community members, leaders of organisations and social groups. We found that the formation of social groups during the early 1990s was partly a result of poverty and the many deaths caused by AIDS. They built on a tradition to support those in need and provided social and economic support to members by providing loans. Their strict rules of conduct helped to create new norms, values and trust, important for HIV prevention. Members of different networks ultimately became role models for healthy protective behaviour. Formal organisations also worked together with social groups to facilitate networking and to provide avenues for exchange of information. We conclude that social capital contributed in changing HIV related risk behaviour that supported a decline of HIV infection in the high prevalence zone and maintained a low prevalence in the other zones.

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7. HIV/AIDS Marketing Communication and the Role of Fear, Efficacy, and Cultural Characteristics in Promoting Social Change

Authors: Terblanche-Smit M; Terblanche NS
Institutions: Department of Business Management, University of Stellenbosch, South Africa
Source: Journal of Public Affairs 2011, 11: 279-286. doi: 10.1002/pa.420.

ABSTRACT

The HIV/Aids pandemic is a major concern in Africa, and South Africa's major marketing communication campaigns do not seem to be producing the expected results. This study investigates whether the use of fear appeal marketing communication increases the likelihood of adopting appropriate social behaviour, and if different cultural or racial groups vary in their perception of different fear appeals, namely high, medium, and low fear, pertaining to HIV/Aids marketing communication. The role of fear and efficacy beliefs is analysed by using experimental research techniques to ascertain the influence of different levels of fear appeals. The findings indicate differences amongst cultural or racial groups pertaining to levels of fear and efficacy experienced after exposure to high fear appeals compared with lower fear appeals.

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This publication is made possible by the generous support of the American people through the United States Agency for International Development (USAID) under the terms of Agreement No. GPO-A-00-07-00004-00. The contents are the responsibility of C-Change, and do not necessarily reflect the views of USAID or the United States Government.

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