Results of a Baseline Peer Study for the Design of the Social Marketing Intervention for HIV Prevention in the Bateyes

This 64-page study from the Dominican Republic (DR) examines data collected through participatory ethnographic interviewing of men and women on condom use, partner social and sexual patterns, and social marketing of HIV/AIDS prevention and reduction programming. The data were used in a participatory workshop to develop stronger behaviour change communication (BCC) strategies.

From the document:
"The PEER (Participatory Ethnographic Evaluation and Research) study was conducted between March and May 2006 in four bateyes (originally communities of Haitian migrant workers formed around the sugar cane industry) in Santo Domingo and Barahona. PEER is a qualitative method based upon training members of the target group (peer researchers [PSI]) to carry out in-depth qualitative interviews among their peers....PSI identified the following key themes as the main areas of interest for the focus of the PEER study:

Social context of the bateyes:

• How is cultural identity (e.g. Haitian/Dominican identity) defined by people living in the bateyes?
  
• How is identity of the batey perceived in relation to wider Dominican society?
• What are the sources of employment for the bateyes and what are the patterns of migration in relation to work?
• How are gender and marital relations experienced and defined? 
• What are the norms with respect to fidelity and number of partners?
• How are different types of partners perceived or classified by both men and women?
• What types of exchange exist between different partners?
• What is the perception of risk with different partners?
  

Condom Use:

• What are the current levels of knowledge of AIDS and how is AIDS perceived and experienced?
• What is the locus of control – i.e., what control do men and women have over prevention?
• What are the perceptions of condoms and norms surrounding condom use?"
  

Findings indicate cultural values and norms that reinforce the practice of multiple sexual partners, social exclusion of those thought to have AIDS, a strong understanding among both men and women of condom use as protection, gender inequality in that women will not suggest condom use to a partner, and an association between condom use and lack of trust. The main recommendations resulting from the research indicate that: "Partner reduction strategies should focus on reducing those partners who are already defined as not trusted and risky partners. Condom messages need to de-link condom use and use with non-trusted partners. Condom messages need to de-link condoms with negative images of preventing infection / protecting oneself against infection. Messages need to link condoms with core positive values such as ‘being healthy’, ‘being attractive’, ‘being a man’, ‘trust a man who uses condoms.’ Multiple coordinated messages need to be directed to each population segment [that represents a set of values and behaviours.]” Messages at the community level need to be mutually reinforcing, to change the current stigma against condoms and condom users into a stigma against condom non-users.

The document further details the implications for messages and next steps in BCC message formulation:

1. Cultural positioning and language - Messages need to be equally appealing to the Dominican and the Haitian culture without distinguishing between Haitian and Dominican identity, so as not to stigmatise one culture or the other.
2. Segmenting the populations - Messages need to coordinate with the motivations and aspirations of different categories of men and women - the " responsible man" and the "chulo" (macho or attractive man), as well as the married and the unmarried woman.
3. Motivation and intention to use condoms - These differ depending on whether a man wishes to conform to the role of a responsible family man or an attractive and eligible man and whether a woman wants to appear faithful to her family or to secure a home, children, and financial support.
4. Barriers to condom use are the trust issue, perceptions of pleasure reduction, desire for pregnancy, and the wish to appear healthy and free of AIDS.
5. Positioning messages - Replace the formula that condoms = non-trusted partners and infection, with a positive connection linking health, attractiveness, and responsibility to condom use.