C-Picks 19 - Addressing HIV Vulnerability in Comprehensive Ways

Addressing HIV Vulnerability in Comprehensive Ways

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ADDRESSING HIV VULNERABILITY AMONG YOUNG ADULTS AND YOUTH

1. HIV-Related Knowledge, Attitudes, Beliefs, and Practices of Young People in Cross River State and Kogi State, Nigeria

2. HIV Prevention Messages for Radio and TV Programs Popular with Youth in DRC

STRATEGIES THAT ADDRESS THE HIV RISK OF ALCOHOL CONSUMPTION AND GENDER-BASED VIOLENCE

3. Alcohol and HIV Picture Codes Developed by C-Change Namibia

4. Alcohol Consumption and HIV Risk: A Peer Education Strategy for Bar Patrons

5. Preventing Gender-Based Violence & HIV: Lessons from the Field

INTEGRATED SERVICES AND STRUCTURAL APPROACHES TO HIV PREVENTION

6. Integration of Family Planning and HIV Services: Programs in Ethiopia and Kenya Lead the Way

7. The Avahan-India AIDS Initiative: Promising Approaches to Combination HIV Prevention Programming in Concentrated Epidemics

8. Structural Interventions: An Overview of Structural Approaches to HIV Prevention

ADDRESSING STIGMA: LESSONS FROM AFRICA

9. Integrating Stigma Reduction into HIV Programming: Lessons from the Africa Regional Stigma Training Programme

10. Food Secure and HIV-Positive in Ethiopia (the Breedlove Project)

11. Stigma in the Balance: Ensuring the Roll-Out of ART Decreases Stigma

HIV PREVENTION FOR YOUNG ADULTS AND YOUTH

1. HIV-Related Knowledge, Attitudes, Beliefs, and Practices of Young People in Cross River State and Kogi State, Nigeria

C-Change issued a recent report on HIV-related knowledge, attitudes, beliefs, and practices of young people in two states in Nigeria, based on focus group discussions and in-depth interviews with more than 1,200 secondary and university students and out-of-school youth. Interviews and discussions centred on youth lifestyles and risky behaviours, information and misconceptions about HIV, media habits, and recall of youth-focused HIV prevention messages and programmes. The report notes risk factors that need to be addressed and makes recommendations on communicating with youth about HIV prevention.

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2. HIV Prevention Messages for Radio and TV Programs that Target Youth in DRC

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STRATEGIES THAT ADDRESS THE HIV RISK OF ALCOHOL CONSUMPTION AND GENDER-BASED VIOLENCE

3. Alcohol and HIV Picture Codes Developed by C-Change Namibia

C-Change Namibia contributed to the development of a flip chart on alcohol and HIV, used by field workers and volunteers to create conversations on alcohol as a driver of HIV and promote behaviour change. The flip chart can be used as part of a comprehensive HIV behaviour change curriculum or as a stand-alone tool. Each page has a photo on the front and text on the back. After showing one of the photos to a small group or an individual, the facilitator asks open-ended questions and leads the conversation, referring to the text and summarised talking points. The flip chart and a fact sheet on the campaign can be downloaded from C-Hub.

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4. Alcohol Consumption and HIV Risk: A Peer Education Strategy for Bar Patrons

From October 2010, this case study explores the process and impact of the Collaborative HIV/STD [sexually transmitted disease] Prevention Trial, a 5-year research intervention that sought to study alcohol consumption and risky sex among male patrons of wine shops in the city of Chennai, in South India. The behaviour change communication (BCC) initiative involved identifying, recruiting, and training peer outreach workers called Community Popular Opinion Leaders (CPOLs), who communicated messages about safer sexual behaviour through informal, yet structured, one-on-one conversation with their peers, with the hope of preventing HIV. The case study includes details about what worked well in this project - for example, messaging focused on risk reduction rather than risk elimination, and peer-led delivery of personal messages ("I statements") to encourage change - as well as challenges that were encountered. Recommendations and future programming directions are presented. For more information about the Collaborative HIV/STD Prevention Trial, please click here.

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5. Preventing Gender-Based Violence & HIV: Lessons from the Field

This October 2010 brief describes the strategies of two organisations that have tackled the challenge of combining HIV and gender-based violence (GBV) prevention: Puntos de Encuentro in Nicaragua and Raising Voices in Uganda. An integrated strategy to address GBV in the context of HIV involves strategies such as advocacy and interpersonal communication (e.g., training providers to identify women living with violence and to respond with appropriate care and referrals). Lessons learned include:

• To change attitudes, the issues of GBV and HIV must become real for people. In other words, to internalise the links between GBV and HIV, one must perceive and critically think about the benefits and consequences for him- or herself and the surrounding community, rather than think about them as distant societal problems.
• Get people to focus on what they can do instead of what they cannot do - looking at the strength in people and the assets in the community, rather than focusing on the problem alone.
• One source - be it a television show or workshop - is not enough to get people to take action. Both Puntos de Encuentro and Raising Voices support activists to spread messages about human rights in relation to sexual health, including GBV, in schools, in the media, in religious institutions, and in venues in the community on a long-term basis.

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INTEGRATED SERVICES AND STRUCTURAL APPROACHES TO HIV PREVENTION

6. Integration of Family Planning and HIV Services: Programs in Ethiopia and Kenya Lead the Way

This March 2011 case study from the United States Agency for International Development (USAID)'s AIDSTAR-One programme explores integration of family planning (FP) and HIV services as a promising strategy to prevent transmission of HIV - with a focus on how this strategy has been realised in Kenya and Ethiopia. Things that have worked well in terms of integration include: facilitated referrals (e.g., use of referral forms by community health workers), health worker training, the linkage of clinic- and community-based services, and government support. One core recommendation is to address male norms and behaviours - for example, by (in Kenya), holding "Men's Clinics" on weekends, where men are educated about HIV and other health issues and are given the option to be tested for HIV. "Though the integration models used in programs observed in Kenya and Ethiopia are different, what they have in common is a holistic understanding of an individual's health needs. This understanding is passed on to frontline workers who take the time to ask, listen, and act on a client's health needs, both expressed and observed."

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7. The Avahan-India AIDS Initiative: Promising Approaches to Combination HIV Prevention Programming in Concentrated Epidemics

This March 2011 case study describes the behavioural, biomedical, and structural components of the Avahan-India HIV prevention programme, launched by the Bill and Melinda Gates Foundation in 2003 as part of a plan to work with existing government interventions in 6 Indian states. Avahan "has successfully built a comprehensive prevention program that combines the most effective responses to the multiple and complex needs of most-at-risk populations (MARPs)", including female sex workers, men who have sex with men (MSM), transgender people, injecting drug users (IDUs), and truckers and their helpers. Interventions include: peer-led outreach to promote behaviour change, clinical services to treat sexually transmitted infections (STIs), condom social marketing and distribution of free condoms, distribution of clean needles and syringes, support for community mobilisation, and advocacy to reduce structural barriers to safer sexual practices. Over the entire project, more than 80% of male clients of female sex workers reported condom use at last sex with a sex worker; as of May 2007, that represented a 35% increase from a year earlier. The case study concludes with recommendations for implementers, such as securing good evidence for programming and addressing the social and cultural context that may contribute to or hinder a project's success.

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8. Structural Interventions: An Overview of Structural Approaches to HIV Prevention

This March 2011 resource provides information about, and links to, research and tools for those seeking to find what works in HIV prevention. The introductory section explains that structural approaches reduce an individual's HIV-related vulnerability by creating the conditions in which people can adopt safer behaviours. Strategies for categorising structural approaches detailed here include: (i) Social change: These approaches focus on factors affecting multiple groups (e.g., a region or country as a whole), such as legal reform, stigma reduction, and efforts to cultivate strong leadership on AIDS; (ii) Change within specific groups: These approaches address social structures that create vulnerability among specific populations, such as men who have sex with men, mine workers, young women, or economically poor women. Examples include efforts to organise and mobilise sex workers, and interventions to change harmful male norms; and (iii) Harm reduction or health-seeking behaviour change: These approaches work to make harm-reduction technologies available to those in need and to change rules, services, and attitudes about these technologies.

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ADDRESSING HIV STIGMA: LESSONS FROM AFRICA

9. Integrating Stigma Reduction into HIV Programming: Lessons from the Africa Regional Stigma Training Programme

This April 2011 document illustrates lessons learned from implementing the toolkit "Understanding and Challenging HIV Stigma across Africa". The most common approach has been through the incorporation of stigma exercises into training courses or workplace and community activities. However, there are also examples of how stigma reduction has been integrated into policies, throughout programmes, and how it has led to national government interventions to understand structural issues around stigma. The overall results show that creating opportunities for greater awareness and understanding of stigma is the first step to changing it; strategies to then scale up the change, through integration at different levels, can have real impact.

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10. Food Secure and HIV-Positive in Ethiopia (the Breedlove Project) - Ethiopia

The Breedlove Project integrates HIV programming (treatment and prevention of mother-to-child transmission (PMTCT) of HIV) with nutrition programming to address short-term and long-term needs of families and households in Ethiopia. The monthly coffee ceremony aspect of the project might take place in, for example, the antiretroviral therapy (ART) unit of a hospital in Addis Ababa. As women arrive for the discussion, they note that the reception area is transformed - condoms and pamphlets are swept off the table to make way for a colourful tablecloth, a bowl of flowers, and a pot of coffee. The group discusses issues such as stigma and the lies people tell to their own neighbours and family members to avoid the shame and discrimination of living with HIV in Ethiopian society.

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11. Stigma in the Balance: Ensuring the Roll-Out of ART Decreases Stigma

This policy briefing paper, published in April 2011 by Evidence for Action, draws on findings from qualitative research carried out against the backdrop of a longitudinal cohort study in a semi-rural area of North Tanzania. It explores the impact of ART on stigma and outlines recommendations for decreasing stigma during ART roll-out, such as: increasing visibility of people living with HIV to help increased "normalisation" of HIV and reduce self-stigma, training, reducing fear-related stigma, and involving all key stakeholders.

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C-Picks and SBCC

Please visit the C-Picks website for more resources and information about social and behaviour change communication (SBCC).

C-Picks continues to seek new knowledge and experiences in SBCC - case studies, strategic thinking, support materials, and other relevant documentation. Please contact cchange@comminit.com

FHI 360 has acquired the programmes, expertise, and assets of AED.

This publication is made possible by the 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 The Communication Initiative and the C-Change project and do not necessarily reflect the views of USAID or the United States Government.