12,417 The Communication Initiative,HIV Communication: Focus on Evidence, Impact: The Drum Beat 688

The Drum BeatHIV Communication: Focus on Evidence, Impact: The Drum Beat 688
This issue includes:
LAUNCHING POINTS AND TOOLS FOR HIV SBCC EVIDENCE
EVALUATING STRATEGIES TO REACH ADOLESCENTS
EXPLORING EFFORTS TO REACH OTHER NICHE POPULATIONS
LOCAL AND MASS MEDIA IMPACTS
WHERE TO GO FOR MORE ON HIV COMMUNICATION
From The Communication Initiative (CI) Network – where communication and media are central to social and economic development.
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LAUNCHING POINTS AND TOOLS FOR HIV SBCC EVIDENCE
1. HIV Evidence
This group of materials from Health Communication Capacity Collaborative (HC3) and Johns Hopkins Center for Communication Programs is centred around an evidence database on strategically designed communication around HIV and AIDS, referred to as social and behavior change communication (SBCC) or health communication. This ongoing compendium of evidence to date is designed to demonstrate the impact of health communication on HIV-related outcomes.
2. HIV and Health Communication: Evidence Review
Connected to the resource above, this database is organised as a chart that lists articles of evidence in alphabetical order by author (including links to the documents) and gives a citation for each, a summary, an intervention description, area of HIV communication addressed, a country location, the communication intervention, and the study design. Both demand side (creating health-seeking behaviour) and supply side (improving delivery, such as in-service counselling) are served, as described here, by communication that motivates people to: test, use condoms, promote treatment access, and reduce stigma. Complementary roles are played by health communication and biomedical prevention and care programmes.
3. Propensity Score Matching (PSM): An HC3 Research Primer
PSM is a statistical technique that allows researchers to more accurately measure SBCC programme impact and to “make a strong case for causal attribution. Using the PSM approach increases the accuracy of impact measurement because it controls for unaccounted factors that might bias a person to respond favorably to a communication program.” This HC3 Research Primer describes the use of PSM for measuring SBCC impact, when it should be used, and what implementers should know.
4. How to Conduct Qualitative Formative Research
From Health COMpass, this resource explores the use of formative research to address health issues through SBCC strategies in culturally and geographically appropriate ways. Focusing on qualitative methods, it examines focus group discussions (FGDs) and in-depth interviews (IDIs) that are designed to: “gain insight into the health issue or behavior the project intends to address; relevant characteristics of primary and secondary audiences; communication access, habits and preferences; and the main drivers of behavior.” The resource outlines 11 steps, along with a list of resources, tips and recommendations, a glossary and list of concepts, and sources and citations.
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EVALUATING STRATEGIES TO REACH ADOLESCENTS
5. A Review of Interventions Addressing Structural Drivers of Adolescents’ Sexual and Reproductive Health Vulnerability in sub-Saharan Africa: Implications for Sexual Health Programming
by Joyce Wamoyi, Gerry Mshana, Aika Mongi, Nyasule Neke, Saidi Kapiga, and John Changalucha
This article provides a review of selected interventions in sub-Saharan Africa designed to address structural drivers of adolescents’ sexual and reproductive health (SRH) risk and to explore pathways of influence. “Comprehensive sexuality education and behaviour change communication (BCC) can help to influence social and gender norms, which are some of the key structural drivers of young people’s risk. Combining economic empowerment and social support, such as within families and through safe spaces, can also help to reduce risk. However, programmes that have a flexible design and phased approach that takes into account the various structural factors are likely to have the most impact. Moreover, monitoring and evaluation is vital for assessing impact and learning in order to make future programmes better.” [Reproductive Health Journal, Dec 2014]
6. Effective Strategies to Provide Adolescent Sexual and Reproductive Health Services and to Increase Demand and Community Support
by Donna M. Denno, Andrea J. Hoopes, and Venkatraman Chandra-Mouli
“This study is a descriptive review of the effectiveness of initiatives to improve adolescent access to and utilization of sexual and reproductive health services (SRHS) in low- and middle-income countries.” One finding: Community-based information, education, and communication (IEC) strategies showed mixed results, though an Indian study showed higher use of SRHS by girls associated with an empowerment programme. A Nepal study compared a participatory approach using activities such as youth clubs and street theatre to more traditional peer- and teacher-led education and found increased health seeking from the former approach. [Sep 2014]
7. Programa Geração Biz, Mozambique: How Did this Adolescent Health Initiative Flow from a Pilot to a National Programme, and What Did It Achieve?
by Venkatraman Chandra-Mouli, Susannah Gibbs, Rita Badiani, Fernandes Quinhas, and Joar Svanemyr
“[T]he government’s five-year plan indicated that PGB was the model for addressing ASRH needs and preventing new HIV infections in adolescents.” This is one finding from a paper describing the inception and nationwide scale-up of Programa Geração Biz (PGB), a multicomponent initiative aimed at improving the sexual and reproductive health of adolescents in Mozambique. The researchers also analyse what helped and hindered the scale-up effort and set out the results achieved at the levels of the programme, health behaviours, and health outcomes. The objective of this analysis is to inform policymakers, programme managers, and international organisations operating in Africa and elsewhere about how the scale-up of this initiative was realised. [Feb 2015]
8. HIV-Related Discrimination among Grade Six Students in Nine Southern African Countries
by Brendan Maughan-Brown and Nicholas Spaull
This study examines stigma and discrimination of HIV-positive children by grade six students (n = 39,664) in Botswana, Lesotho, Malawi, Mozambique, Namibia, South Africa, Swaziland, Zambia, and Zimbabwe. Intervention designs that reduce stigma at an early age, minimise negative impacts on child health, and reduce discrimination that distances and excludes children may, as researchers indicate, improve health outcomes for children living with HIV. “Overall, our study points toward the need for early interventions (grade six or before) to reduce stigma and discrimination among children, especially in schools in rural and poorer areas. In particular, interventions should aim to correct misconceptions that HIV can be transmitted via casual contact with people living with HIV.” [Aug 2014]
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EXPLORING EFFORTS TO REACH OTHER NICHE POPULATIONS
9. Effectiveness of Behavior Change Communications for Reducing Transmission Risks Among People Living with HIV in 6 Countries in Central America
by Lung Vu, Benjamin Nieto-Andrade, Allison DiVincenzo, Jorge Rivas, Rebecca Firestone, Jennifer Wheeler, and Sussy Lungo
“The findings suggest that behavioral interventions in the larger context of a combination prevention program have positive effects on reducing HIV transmission risk among PLHIV.” This is the conclusion of a region-wide Central American study that aimed to estimate prevalence of HIV-related risks (sexual behaviour, HIV disclosure, number of sex partners, and violence) and factors associated with these risks, as well as to evaluate a BCC programme that intended to reach people living with HIV (PLHIV) in Belize, Guatemala, Panama, El Salvador, Honduras, Costa Rica, and Nicaragua. After 2 years of the Pan American Social Marketing Organization (PASMO) intervention programme, it was found that – amongst the men who have sex with men (MSM), transgender women (TW), female sex workers (FSWs), men at risk, and PLHIV who participated – condom use was high, most were adhering to antiretroviral treatment (A! RT) and monitoring CD4, and one-third were participating in a self-help group. An intervention channels analysis found that “mass media significantly increased the odds of condom use by 1.8 times, HIV disclosure by 1.5 times, and participation in a self-help group by 1.4 times. IPC [interpersonal communication] has made positive impacts on condom use and participation in self-help groups by an even larger magnitude compared to mass media intervention messaging…” [Oct 2014]
10. Reducing HIV Risk among Transgender Women in Thailand: A Quasi-Experimental Evaluation of the Sisters Program
by Duangta Pawa, Rebecca Firestone, Sindh Ratchasi, Olivia Dowling, Yaowalak Jittakoat, Alex Duke, and Gary Mundy
This evaluation explores the Sisters programme, launched in 2004 by Population Services International (PSI), in an effort to prevent HIV among TW in the city of Pattaya in eastern Thailand. The researchers share this communication-related finding: “Sisters has organized communications to raise awareness about the benefits of water-based lubricant and to discourage use of oil-based and other lubricants that can damage condoms. A combined package of condom and water-based lubricant was also introduced into outreach activities, replacing condom-only distribution. Evidence suggests that this approach is working. Sisters has achieved generally high levels of outreach coverage. With a transient population, it is important for the program to maintain coverage and frequency of outreach contacts. The outreach interaction itself – short messages plus condom and water-based lubricant distribution – is likel! y sufficient for this population with high levels of knowledge on condom use and HIV risks and motivated to use HIV prevention methods based on factors such as self-efficacy and positive attitudes…” [Oct 2013]
11. Findings from Encontros: A Multi-Level STI/HIV Intervention To Increase Condom Use, Reduce STI, and Change the Social Environment among Sex Workers in Brazil
by Sheri Lippman, Magda Chinaglia, Juan Díaz, Arthur Reingold, and Deanna L. Kerrigan
This study followed SWs in the Encontros intervention in Corumbá, Brazil, in order to gather findings on a multi-level intervention that included improved clinical care and community mobilising strategies to modify social-structural factors that shape sexual behaviour. The result: improved condom use and reduced incidents of sexually transmitted infection (STI). “[P]roject exposure was associated with a significant increase (of 0.3 standard deviations) in participation in networks, both in the entire cohort and among those reporting below median participation in [social] networks at enrollment. Additionally, participants reported a significant increase in perceived social cohesion as compared to non-participants among study subjects reporting below median perceived social cohesion at enrollment.” In their concluding remarks, researchers recommend: “[D]eeper investigation regarding the pathways of! effect – how participation changes the social environment to improve health – will improve our understanding of the community-level processes that shape behavior and inform future interventions.” [Mar 2012]
12. Findings from the SASA! Study: A Cluster Randomized Controlled Trial to Assess the Impact of a Community Mobilization Intervention to Prevent Violence against Women and Reduce HIV Risk in Kampala, Uganda
by Tanya Abramsky, Karen Devries, Ligia Kiss, Janet Nakuti, Nambusi Kyegombe, Elizabeth Starmann, Bonnie Cundill, Leilani Francisco, Dan Kaye, Tina Musuya, Lori Michau, and Charlotte Watts
Recognising that intimate partner violence (IPV) is an independent risk factor for HIV infection, researchers sought to assess the community-level impact of a community mobilisation intervention in Kampala, Uganda to prevent violence and reduce HIV-risk behaviours. The study is a cluster randomised controlled trial to assess the community-level impacts of SASA! Intervention staff in 8 sites supported over 400 activists, who led more than 11,000 activities including community conversations, door-to-door discussions, quick chats, trainings, public events, poster discussions, community meetings, film shows, and soap opera groups, reaching an estimated 260,000 community members. Selected impact outcomes: (i) Both women and men in intervention communities were more likely than their control counterparts to have progressive attitudes, meaning lower acceptance of IPV and more support of the acceptabilit! y of a woman refusing sex; (ii) past-year experience of physical IPV was substantially lower among intervention women compared to control women; (iii) among women reporting past year experience of physical and/or sexual IPV, the intervention was associated with a more than two-fold greater appropriate community response to this violence; and (iv) “[m]en in intervention communities were considerably less likely to report having had concurrent sexual partners in the past year compared to men in control communities, and this result was statistically significant…” [Jun 2014]
13. EMPowerment for ADvocacy: The EMPAD Policy Framework for National Advocacy by and with Key Populations
This theory of change is based on the following 5 strategies: strengthen alliances and advocate in support of key populations and a shift in social perceptions; increase the capacity of organisations of key populations to carry out advocacy; engage in national policy processes; link grassroots, national, regional, and global advocacy; and promote knowledge sharing among advocacy programmes and decision-makers. The guide illustrates the 5 strategies through the following case studies: improving the response to MSM in Senegal; addressing HIV in Latin America by advancing the rights of transgender people; and a regional platform for training national stakeholders on rights-based programming. [AIDS Alliance, 2014].
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LOCAL AND MASS MEDIA IMPACTS
14. Effectiveness of Mass Media Interventions for HIV Prevention, 1986-2013: A Meta-analysis
by Jessica M. LaCroix, Leslie B. Snyder, Tania B. Huedo-Medina, and Blair T. Johnson
This study analyses mass-media-delivered HIV interventions defined as those “wherein the intervention message is delivered in a natural setting through a mass media channel to which individuals may or may not attend (e.g., radio, television, newspaper, magazine, or mass distribution or mailing of printed materials).” It explores campaign duration and channels, date of data collection, country of campaign, level of country development, and message and sample characteristics predicted effect size magnitude, “using meta-analytic techniques (ie, pooling effect sizes and analyzing possible moderator variables of effect size magnitude)….In summary, the present results provide strong testimony to the power that mass media campaigns can have for people living in nations most at need for HIV prevention and other health promotion interventions. Results also suggest that such campaigns generally lack effe! ctiveness in relatively developed countries…”
15. Engaging Local Media in VMMC Scale-Up: A Case Study from Kenya
by Ida Jooste, Silas Achar, Nicholas Mbugua, and Elizabeth Gold
This case study discusses how media can play a positive role in promoting voluntary medical male circumcision (VMMC) as part of HIV prevention efforts or can fuel fears and discourage VMMC through sensationalist, inaccurate, or negative coverage. Government, non-governmental organisations, and media organisations all collaborated to support media outreach activities such as conducting roundtables, briefings, and media tours, as well as providing experts and training spokespersons in strategic communications. “Such collaboration helped ensure that the stories were based on real field experience and expert analysis of communication gaps in the community.” It also helped ensure that stories complemented public service announcement (PSA) campaigns and other communication efforts. The media training to strengthen reporting on VMMC involved a small cadre of more experienced health journalists. They par! ticipated in a series of workshops followed by story production and mentoring. Other media engagement strategies included hosting expert radio forums and roundtable discussions, sponsoring a VMMC category in Kenya’s StoryFest media awards, and distributing the Male Circumcision Consortium (MCC) News publication to journalists, as well as offering one-day media relations workshops for health workers. [Oct 2013]
16. A Kenyan Newspaper Analysis of the Limitations of Voluntary Medical Male Circumcision and the Importance of Sustained Condom Use
This analysis of Kenyan media treatment of condom use has the objectives of: (i) investigating promotion messages in a popular online newspaper to determine how the limitations of male circumcision are represented and whether condom use is still being promoted; and (ii) gaining insight into popular understandings of the limitations of this new procedure through newspaper reader comments. As stated here, “[i]t is critical that messaging about VMMC be informative, accurate, and culturally sensitive and emphasize that VMMC does not afford full protection against HIV infection….” This study searched the independent East and Central African newspaper the Daily Nation, using a qualitative thematic analysis. Researchers recognised the need to use “gain” framing language to encourage participation in VMMC but recommended emphasis on the need for including information about additional protection, especi! ally condom use.
17. A Role for Health Communication in the Continuum of HIV Care, Treatment, and Prevention
by Cecilia Tomori, Kathryn Risher, Rupali J. Limaye, Lynn M. Van Lith, Susannah Gibbs, Marina Smelyanskaya, and David D. Celentano
The authors “provide illustrative examples of the specific roles that health communication can play in bolstering the continuum of care in low- and middle-income countries… and draw on …reviews …and studies … [of] interventions that incorporate health communication components” in order to approach health communication’s potential to improve outcomes across the continuum of care through supporting development of a framework “that translates health communication theories and practices into specific interventions to address each step in the treatment cascade.” Included within the discussion of communication interventions that might be incorporated into the treatment continuum are: mass media, school- or workplace-based education, or entertainment modalities (e.g., street theatre). [Aug 2014]
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WHERE TO GO FOR MORE ON HIV COMMUNICATION
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This issue of The Drum Beat was written by Kier Olsen DeVries.
The Drum Beat is the email and web network of The Communication Initiative Partnership – Partners: ANDI, BBC Media Action, Bernard van Leer Foundation, Breakthrough, Calandria, Citurna TV, DFID, Eldis, FAO, Fundación Imaginario, Fundación Nuevo Periodismo, Heartlines, Iberoamericano (FNPI), IFPRI, Inter-American Development Bank, Johns Hopkins Bloomberg School of Public Health Center for Communication Programs, MISA, Open Society Foundations, Oxfam Novib, PAHO, The Panos Institute, Puntos de Encuentro, The Rockefeller Foundation, SAfAIDS, Sesame Workshop, Soul City, STEPS International, UNAIDS, UNDP, UNFPA, UNICEF, USAID, The Wellcome Trust, World Health Organization (WHO), W.K. Kellogg Foundation.

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