HIV/Aids Messages Not Getting Through

“The message is out there, everyone has heard the message, but they haven’t heard it” says Pat Francis, director of South African HIV/AIDS group Wola Nani. Communication strategies on HIV have failed miserably and continue to fail, she points out: “The message is just not getting through, and we don’t know what message is going to make people hear it…we’ve got to a stage where teachers are tired of doing classes on HIV/AIDS, they want to drop it because they are bored of repeating it, and yet - can people negotiate condoms or abstinence? – No! We can see from the rate of incidence that the message still isn’t getting through”.

This sums up the frustration that many professionals working on HIV/AIDS feel.
In “Missing the Message? 20 years of learning from HIV/AIDS” a report issued for World AIDS day, Panos evaluate HIV/AIDS communication to date and argue that it is time for nothing less than a fundamental reappraisal of HIV communication strategies.

Though it is widely reported that the strength and vision of national political leadership in the cases of Uganda, Senegal, Thailand and Brazil have been crucial to successfully combating HIV/AIDS, those successes also have other lesser-known ingredients such as open public debate. This open debate, with local, public participation and ownership is crucial. “What works” say Panos “is when the energy, anger and mobilisation of civil society have been at the forefront of our responses. Too little in today’s response to AIDS foster these dynamics.”

From Message to Voice

“Approaches should move from putting out messages to fostering an environment where the voice of those most affected by the pandemic can be heard. This shift from message to voice is much more effective. While HIV/AIDS information and key health message remain crucial, it is important to look beyond these messages – no matter how empowering and context-sensitive they might be – and help to develop environments where vibrant and internally derived dialogue can flourish”.

The central conclusion of the report is that the most effective responses to HIV/AIDS are those which emerge from within societies; tending to be long-term, complex and difficult to evaluate – which is precisely the sort of strategy that donors find hardest to support.
The report stresses the importance of strategies being long-term because of the nature of the pandemic - symptoms can take up to ten years to appear, it is directly related to sex and sexuality, there is stigma, prejudice and discrimination, and it is related directly to poverty and to inequality. All of these require a long-term approach and therefore long-term engagement.

Communication for Social Change

Drawing on the UNAIDS Communication Framework for HIV/AIDS and The Rockefeller Foundation Communication for Social Change Network the report identifies that most current theories of HIV communication programming have many weaknesses including:
-The assumption that decisions about HIV/AIDS prevention are based on rational, volitional thinking with no regard for true-to-life emotional responses to engaging in sex
- The focus on condom promotion to the exclusion of the need to address the importance and centrality of social contexts, including government policy, socio-economic status, culture, gender relations and spirituality.

Emphasis should be changed to go beyond individual behaviour to social norms, policies, culture and the supporting environment. The importance of Faith-Based Organisations in realising these goals is recognised. Emphasis should shift from persuasion and the transmission of information from outside technical experts to dialogue, debate and negotiation on issues that resonate with members of the community.

Urgent attention should be given:

At policy level, particularly among donors, these include longer-term engagement, greater inclusiveness in consultation, more participatory decision-making and greater transparency.

Within the media, these include the beginnings of a critical reappraisal of media training, and also the importance of working on media structure, legislation and regulation.

Within Civil Society, there is a need to increase emphasis on advocacy and on more sophisticated relations with the media.

Not much of this is easy to implement but as time goes on there is the serious danger that responses continue to be ‘business as usual’ especially as expectations of HIV/AIDS communication work are so low.

The liberal model of privatised deregulated, globalised media (advertising -
driven, commercial, prone to sensationalism and sometimes highly sexualised) can be very damaging. However, for example, stories told by HIV-positive people sympathetically treated on a radio programme can have far more impact than more conventional communication messages, and there are many given examples of this happening. Relatively little support is given to such interactive forms of media compared to the support given to media that merely disseminates information.

Much greater benefit may be had from a media which accommodates pluralistic discussion, vibrant debate and critical policy commentary.

 The role of the media in setting agendas is also highly valuable - it’s shown that where AIDS is put on the policy agenda, this has often been preceded by strong media engagement with the issues.

As standard HIV/AIDS communication programming continues to be a low-achiever, community media is an area which is clearly identified as deserving far greater support.

For a copy of the report you can find a pdf version online at www.panos.org.uk or you can write to Lina Funk by e-mail at linaf@panoslondon.org.uk