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Contextual Domains: Creating an Enabling Environment for Behavior Change
Coordination and Implementation Modality for HIV/AIDS Communication Framework
The goal of this communication framework is to reduce the prevalence of HIV/AIDS and provide appropriate care and support to the infected and affected through comprehensive communication programs.
The General objective is to provide a comprehensive contextual, societal as well as personal behavior related information to serve as a tool for the development of a communication guideline in different scopes and levels.
The specific objectives are to:
This framework, unlike earlier approaches, focuses on social and environmental contexts rather than solely on individual behavior. Within this framework, five contextual “Domains” are identified as universal factors in communication for HIV/AIDS preventive health behavior. These five domains are government policy, socio-economic status, culture, gender relations and spirituality. These inter-related domains formed the bases of the framework to be used as a flexible guide in the development of HIV/AIDS communication interventions.
In order to create an enabling environment for individual and social changes, a communication framework needs to examine the issues that either support or hinder this change process. In attempting to change behaviors of individuals through IEC/BCC process, various conceptual issues play a significant role.
It is important to keep in mind that all the Domains are independent yet interrelated. Identified issues can touch upon different issues. For example, when low school enrollment of girls and its impact on the spread of HIV/AIDS is considered, it first tends to be addressed in the Gender domain. In terms of Gender this point represents a gender gap. The socio-economic domain helps in addressing the issue from the point correlating low enrollment of girls in school with their decreased ability and capacity to earn a living and enjoy equal employment opportunities. On the other hand, this issue examined from the policy domain, can highlight the existing or non-existing policy in place maintaining low enrollment or policy in place aiming at increasing low enrollment, it is also reflected in the subordinate position that females hold in the family and society due to cultural values, and can be dealt with under the cultural domain (please refer to attached Diagram).
The domain of Policy and Law is one of the areas identified in supporting or hindering HIV/AIDS Communications in terms of Prevention, Care and Support. Acknowledging the role of government and recognizing the magnitude of its role aims to addressing the existing issues to be addressed as well as to formulating the desired change in Policy and Law. The success of sustainable policies such as HIV/AIDS Policy, Health Policy, Education Policy, etc. will be determined by the capacities of the society, community as well as individuals to face up to the realities of the epidemic.
UNAIDS has identified several key issues to be taken into consideration when analyzing the role of government in establishing policies at both national and regional levels out of which the following are applicable to Ethiopia:
In terms of HIV/AIDS Communication, it is important to look at how policy makers in government and at all levels of the society support or hinder the effectiveness of behavior and social change. Some issues to be evaluated are as follows:
Research points to the correlation between lower socio-economic status and the increased susceptibility of such population to many diseases, including HIV/AIDS. In many cases, people in poor health have been known to develop AIDS soon after being infected with the virus. Thus, socio-economic is a crucial domain in the success of HIV/AIDS Communications. In light of that, the following issues, drawn from the issues identified by UNAIDS, must be considered in the implementation of the framework in the Ethiopian context:
Culture has been defined as the collective consciousness of a people. It is shaped by a sense of shared history, language and psychology. There is no right or wrong culture. Culture evolves over time and although some aspect remains unchanged, other aspects of it tend to change in time.
Western train of thought regarding culture tends to view the Self as a product of the individual to a varying degree. Many other cultures, however, view the self as a product of the family, of the community and other environment influences.
Health practitioners and communicators have to recognize culture and its communication channels in order to be effective. Yet often it is apparent that there is little attempt to convey understanding through viable channels of local beliefs and practice. Instead, these channels are used to disguise imported knowledge by presenting it in local idioms. Beliefs of illness and traditional health practice should become the substance of local messages and interventions.
Unfortunately, culture has been equated with negative rather than positive beliefs and practices. It is crucial for health communicators working on HIV/AIDS and using this framework to examine thoroughly not only negative behaviors, but also contextual and individual values.
The following points were selected from the key points identified by UNAIDS. These selected points were found to be relevant to the Ethiopian Context and should be considered regarding the impact of culture on HIV/AIDS Communication in the new framework:
Gender is defined as the opportunities, roles, responsibilities, relationships, and personal identities a particular society prescribes as proper for women and men. These attributes are socially constructed and learned by both individually and collectively. Gender roles are influenced by many other determinants, such as race, culture, community, time, ethnicity, occupation, age, and level of education. While sex may be biologically determined, gender is socially defined.
Gender based responses aims to enable both sexes to protect themselves against HIV/AIDS, to access proper care and cope with the epidemic. A gender-based approach does not mean that men and women will become the same. It means that opportunities in the lives of men and women will not depend upon their sex and that equal weight is given to the knowledge, experience, and value of both women and men to increase the quality and the duration of their lives.
Issues in terms of Health Care and Health Systems, women and adolescents do not benefit from Health Services as much as they should. These issues are often due to the lack of supportive and progressive management as well as issues with the systems itself. Women often do not show health seeking behavior because the system is not inviting.
Another especially strong issue affecting the perception of women is how media presents women., especially in the advertising of commercial material. Women are portrayed un-necessarily in a derogative manner. What steps can be taken in order to achieve effective communication for HIV/AIDS to alleviate this challenge. Who should be addressed within our context? Unfortunately, programs aiming to change the behavior of men tend not to challenge the contextual determinants of their behavior. Attention must be given to the roles and responsibilities of men. Rather than focusing only on women, programs should include all the different social roles and norms that affect and could affect the sexual behavior of men and women.
The key element in discussing the goals of communication in HIV/AIDS is to increase gender equity by strongly discouraging negative gender stereotypes within the target context. The foundation of HIV/AIDS prevention is based upon promoting responsible and respectful sexual behavior for both men and women.
The following key issues regarding gender relations should be considered in operational zing the framework:
Spirituality is grounded in the belief that, there is a supernatural force that regulates the interaction of living beings with their visible and non-visible environment. Spirituality is a much broader and more inclusive concept than religion, although the two terms are often used interchangeably. It encompasses belief and value systems ranging from organized religion to individual and collective values whose embrace represents a guiding principle on which meanings are based. Increasingly, scientific literature is reporting the link between spirituality and positive health behavior.
Religious leaders are important partners and key players in HIV/AIDS Prevention and care. They can provide a supportive environment for people and families of people living with HIV/AIDS. As well as appeal to the moral code of their followers. With this in mind, in addressing the issues emerging from the Spiritual domain, it is important to consider in working with and implementing this HIV/AIDS Communication Framework in Ethiopia:
Promote the value that we must humanize persons living with HIV/AIDS.
The HIV/AIDS Communication Framework involves a broad range of IEC/BCC and advocacy activities and a variety of communication channels and approaches. It also calls for the active participation of a number of actors and stakeholders both at federal, regional and grass root levels. Therefore, the overall coordination for the implementation of the framework will be the responsibility of the National HIV/AIDS Council secretariat. The Ministry of Health will be the key collaborating institution during implementation process due to its special mandate in the development of health promotion and owning health infrastructures at the federal and regional levels. Relevant government and non-government organizations at all levels will be active actors in the implementation.
PACT Ethiopia that initiated the formulation process of the document will be responsible for accomplishing the remaining activities like planning key roles in the implementation of the framework, development of the guidelines including follow up research in-order to refine the framework. PACT will also collaborate with other key stakeholders in the country that are involved in HIV/AIDS communication.
