The Drum Beat 309: MDG #6 - Combating HIV/AIDS, Malaria and Other Diseases

Millennium Development Goal (MDG) #6 seeks to halt and begin to reverse the spread or incidence of HIV/AIDS, malaria, and other major diseases, worldwide, by 2015. Indicators for this goal focus on high-risk groups and areas - for instance, HIV prevalence among pregnant women aged 15 to 24, ratio of school attendance of AIDS orphans to non-orphans aged 10 to 14 years, and proportion of the population in malaria-risk areas using effective prevention and treatment measures. Tuberculosis (TB) is another key emphasis, as evidenced by one indicator that focuses on the proportion of TB cases detected and cured under the internationally recommended control strategy (directly observed treatment, short-course - DOTS). For additional background on MDG #6 and the other goals, click here.

The CI website features a variety of summaries of experiences, strategies, trends, and resources that explore the use of communication to help reduce the morbidity and mortality associated with HIV/AIDS and the other diseases at issue in MDG #6. This issue of The Drum Beat highlights just a small sample of our many materials, honing in on the concrete impact that communication strategies and activities are having on the specific indicators associated with the Goal - and sharing a few insights about evaluating such impact.

Next month we will focus on MDG #7: Ensuring Environmental Sustainability. Please send your projects, articles, events, etc. to Deborah Heimann dheimann@comminit.com

 

CONTEXT

1. Six Million Dying of AIDS Amid Tsunami Largesse
At least 250,000 people died in the Dec. 2004 tsunami in south and south-east Asia; it took 3 weeks to raise nearly $6 billion for emergency relief and reconstruction. This is the same amount pledged to the Global Fund on AIDS, Tuberculosis and Malaria over 3 years. There are 6 million people on the planet dying of AIDS, 4.1 million of them in Africa. Each month 150,000 African children die from malaria.

2. Microbicide Awareness, Investment & Demand: Advocacy & Networking to Accelerate Microbicide Development & Availability
by Charlotte Watts, Anna Foss, Peter Vickerman & Lilani Kumaranayake
Five papers by the London School of Hygiene and Tropical Medicine find that the widespread use of even a low efficacy microbicide could have an important impact on HIV transmission. The paper indicates that the greatest gap in HIV prevention options is within primary partnerships, where abstinence is described as not an option, where women are often at risk from their partner's behaviour, and where condom use seldom exceeds 10%.

3. Net Gain - A New Method for Preventing Malaria Deaths
by Christian Lengeler, Jacqueline Cattani & Don de Savigny
Studies conducted in The Gambia, Ghana, and Kenya find "a 17-63% reduction in overall child mortality" as a result of insecticide-treated net (ITN) use.

4. C27 African Countries Break Pledges to Stop Taxing Insect Repellent Bed Nets
According to MassiveEffort.org, 70% of malaria victims are children and pregnant women, as reduced immune systems make them more susceptible to infection. African heads of state met in April 2000 and pledged to reduce or waive import taxes and tariffs on insecticide-treated nets (ITNs) meant to prevent the disease; of the 43 countries that signed this pledge, only 16 have complied. In Nigeria, taxes represent up to 70% of ITN retail value or 2 weeks' wages for many Africans living in poverty.

5. Where Do We Stand?
Every day in 2003, about 8,000 people worldwide died as a result of AIDS and more than 13,000 became newly infected; approximately 15 million children have lost one or both parents to AIDS. In Southern Africa, 24-39% of pregnant women aged 15-24 in capital cities were infected with the virus in 2002/03. Worldwide, malaria causes more than 300 million acute illnesses and at least 1 million deaths annually, and there is no evidence that it is diminishing. Sub-Saharan Africa is the most severely affected region; TB infection rates are also on the increase there. Worldwide, 2 million deaths resulted from TB in 2002; someone is newly infected every second.
Source: The Millennium Campaign

6. Working Toward Greater Equity in the Fight Against HIV/AIDS, Malaria & Tuberculosis: Statement by Participants in a November 2001 Bellagio Workshop
"Amongst teenagers in Kenya, HIV prevalence in 1999 was five to six times higher for girls than boys....In parts of rural Tanzania, the children from the richest fifth of the population are twice as likely to receive appropriate antimalarial treatment than those from the poorest fifth of the population....The cost of transport required to access test results for tuberculosis is 2-3 times the average wage of a day labourer in peri-urban Malawi."

7. Non-Communicable Diseases (NCD's) Threaten World's Poor
Often thought of as "diseases of affluence", NCDs such as cancer, heart and lung disease, stroke, and diabetes are placing huge strains on the health systems of economically poor countries that are already struggling with HIV, malaria and TB. By 2020, NCDs are expected to account for 70% of deaths in lower-income regions. In 2020, deaths from tobacco use will surpass mortality from any single disease, including HIV.

ADDRESSING HIV/AIDS

* Please also visit our HIV/AIDS Window

8. Lesson for Life - Global
Each year on the occasion of World AIDS Day, the Global Movement for Children engages in a global effort to educate children about HIV/AIDS prevention and to spur them, their communities, and governments to accelerate action on behalf of HIV/AIDS-affected youth. In 2004, 4.3 million people from 67 countries used discussions, plays, dramas, and writing to learn about HIV/AIDS in both formal and non-formal education settings; the project gives children a leading role in teaching others the facts about HIV/AIDS and in taking action in their communities. Participants in an online Lesson for Life on UNICEF's Voices of Youth website exchanged ideas and change strategies. One young Malaysian wrote, "I now believe that the only way to eradicate HIV/AIDS is to stop the prejudice that society has towards people affected by HIV/AIDS".
Contact Kate Norgrove hivaids@gmfc.org

9. Evaluation of United Nations-Supported Pilot Projects for the Prevention of Mother-to-Child Transmission of HIV: Overview of Findings
by Naomi Rutenberg, Carolyn Baek, Sam Kalibala & James Rosen
Worldwide, approximately 800,000 children a year get HIV infection from their mothers during pregnancy, childbirth, or breastfeeding; 7 of each 8 live in sub-Saharan Africa and most of the rest live in South and Southeast Asia. In response, the UNAIDS Secretariat, UNFPA, UNICEF, and WHO launched an Inter Agency Task Team to undertake prevention of mother-to-child HIV transmission (PMTCT) projects in 11 countries. At sites in India, the proportion of pregnant women who knew how to avoid HIV infection increased from 50% to 85% after they had received counseling, and the proportion who knew how to avoid mother-to-child HIV transmission rose from 36% to 88%.

10. Lubuto - Eastern & Southern Africa & the United States
This project uses donated books to improve the literacy, language skills, and general knowledge of orphans and vulnerable children in eastern and southern Africa whose futures have been affected by HIV/AIDS. The programme grew out of the activities of volunteers who read to children at a shelter on a weekly basis. One of the volunteers arranged for the donation of a used shipping container, which was adapted to house a library containing thousands of books donated from the USA and the UK. The centre's Executive Director reported that many of the orphans passed secondary school entry examinations because of the knowledge they picked up from the library's materials.
Contact Jane Kinney Meyers mayazi@verizon.net

11. Impact Data - Teens on Smart Sex - Bangkok, Thailand
The Program for Appropriate Technology in Health (PATH), in cooperation with the Thai Ministry of Education, developed a curriculum consisting of 8 two-hour sessions conducted once a week for college students in Bangkok. The programme is based on the Theory of Reasoned Action behaviour change model, which suggests that people must first learn and practice behaviours in order to successfully use them at the appropriate time. Among males in the intervention group, mean HIV knowledge scores increased from 82.9 (out of 100) at baseline to 85.5 at T2; among females in this group, these scores increased from 81 at baseline to 83.7 at T2. In contrast, mean knowledge scores among males and females in the control group had declined at T2 and T3. At baseline, about 25% of sexually experienced females had used a condom at last sex; this figure increased to 33% for females in the intervention group at T2, but decreased in the control group to 16%.

12. Impact Data - Among Youth - Cameroon
To encourage abstinence, increase contraceptive use, and reduce sexually transmitted infection (STI) rates, Cameroonian researchers at the Institute of Behavioral Studies and Research (IRESCO), with support from the Population Council/FRONTIERS Program, trained a group of adolescents of both sexes in communication skills; they then informed their peers and advocated behavioural changes using interpersonal discussions and youth-produced information, education, and communication (IEC) publications. IRESCO also developed a series of media campaigns and organised theatre performances and sporting events. Condom use during last intercourse with a regular partner increased in the intervention site from 42% to 62% among boys and from 31% to 42% among girls. Condom use with the last occasional partner remained the same among control group girls (about 61%), but increased significantly among girls exposed to the intervention from 44% to 79%.

13. Impact Data - Balbir Pasha HIV/AIDS Campaign - Mumbai, India
Population Services International (PSI) India geared this HIV/AIDS mass media campaign toward urban men aged 18-34 in the lower socioeconomic groups in Mumbai. Balbir Pasha sought to dispel myths, increase risk perception, generate discussion, and motivate people to access telephone hotlines and voluntary counseling and testing (VCT) services. The bedrock of the campaign was the principle that people can learn by observing the behaviour of others; a fictional "alter ego", Balbir Pasha, was created for the TV campaign. The aim was to use an entertaining, engaging character to increase perception of HIV/AIDS risk from unprotected sex with non-regular partners by personalising the message and creating empathy through identifiable real-life situations. Sales of condoms in the red light district tripled after campaign launch.

14. Impact Data - "Stop AIDS Love Life" Campaign - Ghana
Launched by the First Lady of Ghana, this campaign works to foster compassion toward those with HIV/AIDS, as well as to increase perceived risk and reduce social barriers to preventive behaviours among 15- to 35-year-old Ghanaians. Local artists and producers donated their time and talent to create a song and video that aired on radio stations and on M-NET, an Africa-wide satellite TV station. The Ministry of Communications subsidised TV and radio spots that focused on the ABCs of prevention: sexual Abstinence, Be faithful, and Condom use. Phase II, "Caring Communities", emphasised community participation in HIV/AIDS prevention. Even after controlling for a number of socio-economic characteristics, sexually active men and women exposed to the campaign were more likely than the unexposed to have used a condom at last sex. While only 10% of male non-viewers used a condom at last sex, 34% of men with high campaign exposure had done so.

15. HIV/AIDS Prevention in the Cross Border Areas of the Greater Mekong Sub-region - South East & East Asia
This initiative by UNESCO, the Asian Development Bank, and Southeast Asian Ministers of Education Organization (SEAMEO) addresses key factors contributing to the spread of HIV/AIDS in Cambodia, the Lao People's Democratic Republic, Myanmar, Thailand, Viet Nam, and Yunnan Province of China. UNESCO worked with minority groups in highland areas to develop radio soap operas in an effort to arm girls and young women with information about HIV/AIDS. Focus groups helped establish initial themes and storylines based on actual women's experiences with migration. The programmes are in local languages (Hmong, Lahu, and Jingpo), by native speakers, and make use of traditional and locally composed music. Broadcast began in autumn 2004; in March 2005, UNESCO began distributing cassettes and CDs village-level awareness-raising campaigns.
Contact Carmelita Villanueva c.villanueva@unescobkk.org

16. Breaking Down Barriers: Lessons on Providing HIV Treatment to Injection Drug Users
Published by the Open Society Institute (OSI), this report presents examples of innovative HIV treatment programmes for injecting drug users (IDUs) in a wide variety of countries, including Argentina, Brazil, France, Hong Kong, Russia, Spain, and the United States. Drawing on these success stories, the book seeks to refute negative assumptions about IDUs' ability and desire to be treated for HIV infection.

17. A Guide to Indicators for Monitoring & Evaluation National HIV/AIDS Prevention Programmes for Young People
Since young people have had a relatively short time in which to become infected with HIV, this guide recommends that most of the indicators be collected with youth aged up to 24 years. Prevalence in this group can be a good measure of the rate at which the epidemic is progressing and can show where prevention programmes are making a difference. The recommended methodology of data collection is a national or regional household survey of young people.

 

ADDRESSING MALARIA, TB, AND OTHER DISEASES

* Please also visit our Polio Window

18. Challenges in Communicating About Malaria
Two articles are summarised here based on conclusions from the Malaria Knowledge Programme (MKP) at the Liverpool School of Tropical Medicine, in the UK. In "Communicating Malaria Research," MKP details strategies for working across disciplines and sectors to increase the impact of its research. For instance, MKP organised a workshop in South Africa to bring together policymakers, researchers, and grassroots organisers from a variety of fields (mosquito control, epidemiology, medicine, social science, agriculture, water, sanitation and the environment) to explore strategies for averting the increasing impact of malaria in urban areas. What emerged from the workshop was an international network that is sharing understanding and expertise in an effort to influence policy and practice.

19. Impact Data - Tanzania Essential Health Interventions Project (TEHIP) - Tanzania
TEHIP is a partnership between Tanzania's Ministry of Health and Canada's International Development Research Centre (IDRC). To test the feasibility and impact of an "evidence-based" approach to health planning, TEHIP uses participatory research and implementation strategies to give local people a say in the causes of child and adult mortality, drawing on personal contact, radio, and computers to build health systems' capacity. A 2005 evaluation found that average clinic visits per child increased from 2.8 to 5.8 per year. More children were treated for malaria, more early cases of worms were spotted, more eye infections were caught, more AIDS messages were shared, and more mothers were exposed to family planning information. Over 5 years, child mortality fell in the 2 districts by more than 40% and adult mortality dropped by about 20%, even as AIDS was beginning to spread. During this period, districts not using the TEHIP plan experienced virtually no change in their death rates.

20. Evaluation of the "Puye" Vaccination Campaign in Colombia
As part of "Puye", the Ministry of Social Protection, UNICEF, the Pan American Health Organisation (PAHO), and the National Health Institute invited parents, neighbours and friends, and authorities to "puyar" children's vaccination. "Puyar" means both the action of injecting vaccines and the Colombian expression that means to demand, to hurry up, or to press for. The media was deeply involved; RCN Radio and Caracol Radio offered a presence for the campaign in 11 radio stations (national coverage) and 48 radio stations (regional coverage) in the municipalities in which posters would be displayed. The Church was also considered an ally: The Minister of the Social Protection sent letters to mayors and parish priests expressing his support and asking for their collaboration. Whereas an average of 77% of the municipalities where the communication strategy was applied improved (in terms of vaccine coverage) during a 5-month period, an average of only 48% of areas with no intervention improved.

21. Health Communication Insights: The Role of Communication in Vietnam's Fight Against Tuberculosis
by Do Huu Thuy, Nguyen Thi Mai Huong, Youssef Tawfik & Cathleen Church-Balin
This report examines Vietnam's use of health communication in its successful efforts to turn back a mounting TB epidemic. The World Health Organization set a global target of detecting 70% of infectious cases and curing 85% of those by the year 2005 through the use of DOTS; Vietnam achieved nationwide DOTS coverage in 1999, and, between 1997 and 2002, detected 82% of the estimated number of new infectious cases and cured more than 89% of cases. Health communication was designed to change people's misperceptions (some Vietnamese considered TB incurable and hereditary) by providing accurate information and by strategically using advocacy, mass media, community mobilisation, and interpersonal communication and counseling. A 2002 survey found high levels of awareness among the public and health care providers; 80% knew that TB is a communicable disease and could list the basic symptoms and 100% knew that a person with TB should go to a health facility for medical care rather than buying drugs.

22. Health Communication Insights: The Role of Communication in Peru's Fight Against Tuberculosis
by Fernandez Llanos-Zavalaga, Patricia Poppe, Youssef Tawfik & Cathleen Church-Balin
The TB incidence rate reached 243 cases per 100,000 before Peru's National Tuberculosis Control Program (NTCP) turned the trend around. Communication activities were developed to respond to the barriers (e.g., deep stigma) operating in the Peruvian context. NTCP aired television and radio spots to raise community awareness, correct common misconceptions, motivate patients to seek care, and encourage the public to participate in Peru's fight against TB. One strategy was to use the word "free" to appeal to low-income groups. The consistent and widespread use of the NTCP logo on TV and in printed media (in local Quechua and Aymara languages) amounted to "branding", which "led to wide recognition that helped the public easily identify TB service sites." The number of patients who began and then abandoned treatment dropped from 12.1% in 1991 to 2.8% in 2000. According to WHO, Peru fell off the list of high burden countries in 2000 and TB cases are now falling at a rate of 6% per year.

 

This issue was written by Kier Olsen DeVries.

 

The Drum Beat seeks to cover the full range of communication for development activities. Inclusion of an item does not imply endorsement or support by The Partners.

Please send material for The Drum Beat to the Editor - Deborah Heimann dheimann@comminit.com

To reproduce any portion of The Drum Beat, see our policy.

To subscribe, click here.