C-CHANGE
C-Channel:
Issue 43 | JULY 2012
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The Future of HIV-Prevention Communication

Of Interest…

C-Change's regional end-of-project dissemination meeting on June 18-19, 2012, in Johannesburg, South Africa, focused on the project's capacity strengthening in social and behavior change communication (SBCC) in southern Africa. Posters and presentations covered C-Change's capacity strengthening approach, toolkits, materials development processes, and contributions to the establishment of centers of excellence in SBCC, as well as findings of the research study in South Africa on using SBCC to address HIV prevention among adult women.

This issue presents eight articles on the future of HIV-prevention communication, its relationship to biomedical approaches, and the role of social mobilization and social change in responding to HIV. The first five articles emphasize the key role of the social sciences and behavioral approaches in the future success of biomedical interventions and new HIV-prevention technologies, and they point to need to learn from cost-effective behavioral programs that engage and mobilize individuals, networks, communities, and societies. Interventions of this kind in South Africa and Uganda are outlined in the sixth and seventh articles. The final article by a program manager recommends social change communication as an inclusive way of responding to HIV and AIDS issues and drivers such as gender inequality and stigma and discrimination.

cover of South Africa studyThese concerns are reflected in a recent C-Change publication, HIV Prevention Among Adult Women in South Africa: Opportunities for Social and Behavior Change Communication. It reports findings from a research study that focused on how to respond to high rates of HIV prevalence among women ages 25-35 and highlights the importance of community involvement and social mobilization for HIV-prevention policies and programs

 

In this issue

The Future of HIV-Prevention Communication

1. Time to strengthen social and behavioural approaches
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2. Effective HIV prevention: The indispensable role of social science
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3. Beyond the distinction between biomedical and social dimensions of HIV prevention
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4. Epistemic fault lines in biomedical and social approaches to HIV prevention
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5. Advancing biosocial pedagogy for HIV education
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6. Promoting critical consciousness and social mobilization: Lessons and curricular tools
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7. Addressing challenges in Uganda: Does social capital generation by NGOs matter?
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8. Social change communication: A panacea for HIV and AIDS?
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The Future of HIV-Prevention Communication

1. The rapidly changing paradigm of HIV prevention: Time to strengthen social and behavioural approaches

Authors: de Wit J1,2; Aggleton P1,3; Myers T4; Crewe M5
Institutions: 1 National Centre in HIV Social Research, University of New South Wales; 2 Department of Social and Organizational Psychology, Utrecht University; 3 School of Education and Social Work, University of Sussex; 4 Dalla Lana School of Public Health, University of Toronto; 5 Centre for the Study of AIDS, University of Pretoria.
Source: Health Education Research 2011 26(3): 381-392

ABSTRACT

A decade after the world's leaders committed to fight the global HIV epidemic, UNAIDS notes progress in halting the spread of the virus. Access to treatment has in particular increased, with noticeable beneficial effects on HIV-related mortality. Further scaling-up treatment requires substantial human and financial resources and the continued investments that are required may further erode the limited resources for HIV prevention. Treatment can play a role in reducing the transmission of HIV, but treatment alone is not enough and cost-effective behavioural prevention approaches are available that in recent years have received less priority. HIV prevention may in the future benefit from novel biomedical approaches that are in development, including those that capitalize on the use of treatment. To date, evidence of effectiveness of biomedical prevention in real-life conditions is limited and, while they can increase prevention options, many biomedical prevention approaches will continue to rely on the behaviours of individuals and communities. These behaviors are shaped and constrained by the social, cultural, political and economic contexts that affect the vulnerability of individuals and communities. At the start of the 4th decade of the epidemic, it is timely to re-focus on strengthening the theory and practice of behavioural prevention of HIV.

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2. Effective HIV prevention: The indispensable role of social science

Author: Kippax S
Institution: Social Policy Research Centre, University of New South Wales
Source: Journal of the International AIDS Society 2012, 15:17357

ABSTRACT

This paper examines the ways in which HIV prevention is understood including "biomedical", "behavioural", "structural', and "combination" prevention. In it I argue that effective prevention entails developing community capacity and requires that public health addresses people not only as individuals but also as connected members of groups, networks and collectives who interact (talk, negotiate, have sex, use drugs, etc.) together. I also examine the evaluation of prevention programmes or interventions and argue that the distinction between efficacy and effectiveness is often glossed and that, while efficacy can be evaluated by randomized controlled trials, the evaluation of effectiveness requires long-term descriptive strategies and/or modelling. Using examples from a number of countries, including a detailed account of the Australian HIV prevention response, effectiveness is shown to be dependent not only on the efficacy of the prevention technology or tool but also on the responses of people-individuals, communities and governments- to those technologies. Whether a particular HIV prevention technology is adopted and its use sustained depends on a range of social, cultural and political factors. The paper concludes by calling on biomedical and social scientists to work together and describes a "social public health".

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3. Beyond the distinction between biomedical and social dimensions of HIV prevention through the lens of a social public health

Authors: Kippax S1; Stephenson N2
Institutions: 1 Social Policy Research Centre, University of New South Wales; 2 School of Public Health and Community Medicine, University of New South Wales
Source: American Journal of Public Health 2012, 102(5) 789-799 (doi:10.2105/AJPH.2011.300594)

ABSTRACT

Developing effective HIV prevention requires that we move beyond the historical but problematic distinction between biomedical and social dimensions of HIV. The current claim that prevention has failed has led to a strong interest in the role of treatment as HIV prevention; however, the turn to "biomedical prevention," "test and treat," and "combination prevention" instances pervasive confusions about prevention. These confusions arise from a failure to realize that all HIV prevention interventions must engage with the everyday lives of people and be integrated into their social relations and social practices. We challenge the claim that prevention has failed (illustrating this with discussion of prevention in Australia, Uganda, and Zimbabwe). We explain the enduring appeal of misguided approaches to prevention by examining how 1996 can be seen as a pivotal moment in the history of the global response to HIV, a moment marked by the rise and fall of distinct biomedical and social narratives of HIV.

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4. Epistemic fault lines in biomedical and social approaches to HIV prevention

Author: Adam B
Institution: Department of Sociology, Anthropology and Criminology, University of Windsor
Source: Journal of the International AIDS Society 2011, 14 (Suppl 2): S2

ABSTRACT

This paper raises the question of how knowledge creation is organized in the area of HIV prevention and how this concatenation of expertise, resources, at-risk people and viruses shapes the knowledge used to impede the epidemic. It also seeks to trouble the discourses of biomedical pre-eminence in the field of HIV prevention by examining the claim for treatment as prevention, looking at evidence constructed through the biomedical frame and through the lens of the sociology of science. These questions lie within a larger socio-historical context of lagging worldwide attention and funding to prevention in the HIV area and, in particular, neglect of populations at greatest risk. Much contemporary HIV prevention research relies on a population science divided over an epistemic fault line from the communities and individuals who must make sense of the intrusion of a life-threatening disease into their pursuit of pleasure and intimacy. There are, nevertheless, lessons to be learned from prevention success stories among sex workers, injection drug users, and gay and bisexual men. The success stories point to a need for a robust social science agenda that examines: the ways that people are socially organized and networked; the popular strategies and folk wisdoms developed in the face of HIV risk; sociohistorical movement of sexual and drug cultures; the dynamics of popular mobilization to advance health; the institutional sources of HIV discourses; and popular understandings of HIV technologies and messages.

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5. Advancing biosocial pedagogy for HIV education

Author: Davis M
Institution: School of Political and Social Inquiry, Faculty of Arts, Monash University, Australia
Source: Health Education Research 2011, 26(3): 556-562

ABSTRACT

This article develops the concept of biosocial pedagogy in HIV education for this era of expanding biomedical forms of HIV control. With reference to critical pedagogy and teaching and learning materials addressing HIV treatment and prevention, I explain how HIV education can problematize its own role in HIV control. I also discuss how educational practice can be informed by the ethical and political dilemmas that face people affected by HIV. I argue that through biosocially aware HIV pedagogy, individuals and communities can be assisted to act on the opportunities and drawbacks of biomedical HIV control.

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6. Promoting critical consciousness and social mobilization in HIV/AIDS programmes: Lessons and curricular tools from a South African intervention

Authors: Hatcher A1; de Wet J2; Bonell C3; Strange V4; Phetla G5, Proynk P6, Kim J7, Morison L8; Porter J9; Busza J 10; Watts C 11; Hargreaves J 12
Institutions: 1 Department of Obstetrics, Gynecology, and Reproductive Sciences, Bixby Center for Global Reproductive Health, University of California; 2 Department of Sociology, University of Cape Town, 3 Department of Public Health and Policy, London School of Hygiene and Tropical Medicine; 4 Social Science Research Unit, Institute of Education, London; 5 School of Public Health, University of the Witswatersrand; 6 The Earth Institute, Columbia University; 7 HIV/AIDS Practice, Bureau for Development Policy, UNDP, New York; 8 Department of Psychology, University of Surrey; 9 Department of Global Health and Development, London School of Hygiene and Tropical Medicine; 10 Department of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine; 11 Department of Public Health and Policy, London School of Hygiene and Tropical Medicine; 12 Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine
Source: Health Education Research 2011 26(3): 542-555

ABSTRACT

The development of critical consciousness is seen as a key stage in communities increasing levels of dialogue about priority problems and effecting structural change for health. However, relatively little research identifies concrete methods for programmes to build critical consciousness. We examined how a South African structural intervention used critical consciousness as a tool for prevention of intimate partner violence and HIV infection. We collected qualitative data in the form of in-depth interviews with managers, trainers, and participants of the Intervention with Microfinance for AIDS and Gender Equity intervention (IMAGE) in rural South Africa. The data were analysed through a coding structure developed in QSR NVivo. We draw practical lessons from IMAGE to guide other HIV programmes aiming to promoting critical consciousness and social mobilization. This research suggests that specific curricular tools can work towards critical consciousness and that mobilization efforts in future programmes can be strengthened by including individual and collective efforts by participants.

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7. Addressing HIV/AIDS challenges in Uganda: Does social capital generation by NGOs matter?

Authors: Muriisa R1; Jamil I2
Institutions: 1 Faculty of Development Studies, Mbarara University of Science and Technology, Uganda; 2 Department of Administration and Organization Theory, University of Bergen, Norway
Source: Journal of Social Aspects of HIV/AIDS 2011, 8(1): 2-12

ABSTRACT

HIV/AIDS has had devastating impacts in many countries, Uganda in particular. However, Uganda is depicted as one of the most successful countries in fighting HIV/AIDS. Among others, Uganda's success story is attributed to the open general environment which allows open discussions surrounding HIV/AIDS when other countries such as South Africa and Kenya denied the existence of the disease in their countries. In addition, the success is attributed to the policy which allowed many actors to participate in the fight against the disease. The primary focus of this article is to map the process of social capital generation by NGOs and how social capital benefits enhance mitigation of HIV/AIDS challenges in Uganda. The key to social capital is nurturing relationships. In this regard, HIV/AIDS NGOs play a central role in the way individuals, groups and communities interact, and how various kinds of social relations are forged with people living with HIV/AIDS and especially for those who are HIV infected. NGOs' success in reducing the number of HIV/AIDS cases in Uganda is based on their abilities to generate social capital. This involves inclusion and building social networks and empowerment at the individual and community levels, and disseminating information to reduce social stigma as well as discrimination. We used a mixed-method strategy to collect data for this study. We used a structured questionnaire having quantitative and qualitative question sets which focused on different social capital measurement indicators. We used observations and in-depth face-to-face interviews. A major finding of the study is that the ways individuals and groups are connected and interact with each other are important mechanisms for alleviating HIV/AIDS challenges in Uganda.

To link to the full text of this article online, click here. Access the journal website here.

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8. Social change communication: A panacea for HIV and AIDS? An outlook of a program manager

Author: Gopal R
Institution: Gujarat State AIDS Control Society, Ahmedabad
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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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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