The Drum Beat 146: Strategic Communication and PMTCT - UNICEF

THE UNICEF APPROACH TO STRATEGIC COMMUNICATION

1. THE MODEL

UNICEF's "Communication for Development" Model is based on the understanding that effective communication relies on the synergistic use of 3 strategic components:

• ADVOCACY to ensure resources and political/social leadership commitment at all levels
• SOCIAL MOBILISATION to engage civil society organisations (NGOs, Private sector, Religious organisations etc.) and ensure their participation in the development issue being addressed
• BEHAVIOUR DEVELOPMENT COMMUNICATION to encourage healthy behaviours and participation of individuals, families & communities.

2. THE PLANNING PROCESS

The ACADA Communication Planning Process - Assessment, Communication Analysis, Design, and Action. This process is utilised to develop a research based integrated communication strategy that considers individuals, families and communities within their environment and from their perspective; encourages and fosters community participation; and includes the identification of realistic, measurable objectives and related indicators.

3. THE TOOLS

Based on the Communication for Development model, and using the ACADA process, UNICEF has developed a set of tools for developing synergistic communication strategies for PMTCT, Polio Eradication and a variety of other programmes. These tools, while generic in content, allow each individual country to develop a tailored communication strategy addressing the unique needs of each country using a consistent and systematic approach to ensure quality. These tools can be used at the national, provincial/state, district or community levels.

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...taking the PULSE of international development...

Because it underpins all development issues, addressing economic poverty should be the only international development priority and programme.

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PREVENTION OF MOTHER-TO-CHILD-TRANSMISSION OF HIV (PMTCT)

4. The UN Inter-agency Task Team supports a 3-Pronged Strategic Approach for PMTCT:

ONE - Prevention of HIV in young people; prevention of HIV infection in women of childbearing age.

TWO - Prevention of unintended pregnancies in HIV-positive women.

THREE - Prevention of transmission of HIV, from an HIV-positive woman to her infant.

5. Some of the lessons learned from PMTCT communication interventions in Africa and Asia include:

• Community relevance is best ensured when strategic communication planning and overall programme design begins with participatory, community-based research.
• Capacity building and local ownership is key at all levels.
• Simple community dialogue tools can help communities to better identify and address stigma and discrimination, thus creating more caring and supportive environments for HIV-affected families.
• Interpersonal communication remains the most effective and powerful tool in addressing issues related to PMTCT.
• Involvement of male partners is key to women's acceptance of PMTCT services.

6. Conclusions drawn from these lessons:

• Increase variety of participants in communication planning, intensifying efforts to look at HIV/AIDS holistically and across all sectors, as a societal issue, not only as a public health issue.
• Begin drawing on rapid social research, incorporating results in programme design.
• Use community dialogue to help communities address stigma, care and support issues.
• Increase participation of men, youth and people living with HIV/AIDS (PLWHAs).
• Make couple counselling friendly for men and couples.
• Invest in interpersonal communication interventions.
• Increase understanding of basic HIV/AIDS transmission and prevention facts, including MTCT.
• Make more effort to research and understand community norms, values and practices related to PMTCT issues.

A Regional Consultation organised by PAHO/WHO, UNICEF, and Censida-Mexico on the use of Communications for the Prevention of the Mother to Child Transmission (PMTCT) of HIV/AIDS in Latin America and the Caribbean was held in Cuernavaca, Mexico, February 6-8 2002.


Reports and documents from this consultation are available:

Click here for English.

Click here for Spanish.

STIGMA & DISCRIMINATION

7. "Certain people are part of the problem...why do we give them sympathy? ...We know where the problem is. It lies with these girls flirting freely, spreading HIV...We should do away with human rights for such women...Arab states’ rules on women seem to be discriminatory but at least they control sexuality" - citizen of Zambia.

8. Despite vastly different cultural realities - experiences and research have identified similar aspects of discrimination and stigma throughout the regions of West, East and Southern Africa, South and SE Asia and Ukraine, including:

• the assumption that PLWHAs are members of a pre-determined group, regardless of whether they are or not...
• public's vulnerability to infection.
• the most marginalised and excluded groups in many societies - drug users, sex workers, men who have sex with men, and in general women - bear the brunt of stigma and discrimination.
• stigma related to HIV/AIDS is often layered on pre-existing stigmas of sexual conduct and drug use, thereby playing into and reinforcing existing social inequalities linked to power and domination within communities.
• derogatory name-calling.

9. The most extreme forms of stigmatisation being reported are in health care settings. They include:

• denial of drugs and treatment
• being left unattended in hospital and clinic corridors
• being dealt with last
• being labelled or called names in public areas of hospitals and clinics
• being subjected to degrading treatment
• breaches of confidentiality

10. "A woman will never decide to do the testing. If she finds herself HIV-positive she is signing three deaths: psychological death, social death & physical death. Don’t you think that is a lot?" - Woman, Burkina Faso.

Stigma surrounding MTCT prevents women from accepting testing and negatively impacts their quality of family life. In many cases, once a woman is diagnosed as HIV-positive, she faces rebuke or condemnation for wanting a child, and often is denied the right to make her own reproductive choices. The "M" in PMTCT can foster incorrect perceptions that a woman is solely at fault in transmitting HIV to her baby.

11. Main Causes of Stigmatisation:

• Continued misinformation about basic HIV/AIDS transmission and prevention creates fear, which in turn results in stigma.
• Many communities see mass media as largely responsible for both creating and reinforcing stigma, highlighting death and high-risk groups.
• In clinic settings poor, unsafe working conditions and a fear of infection are cited by health workers as contributing to their stigmatising behaviour towards PLWHAs.
• Other health workers identify their negative behaviours towards PLWHAs as the result of their inability to understand and manage HIV/AIDS. They see no remedy or solution to the despair surrounding the disease and many feel they don’t have the psychological resources to cope with somebody whose death is inevitable.

12. Recommendations for addressing stigma and discrimination include:

• Consider shifting the terminology "PMTCT" to more inclusive terms such as "PTCT - parent to child transmission", emphasising the responsibility of both parents in HIV transmission.
• Increase efforts to look at HIV/AIDS holistically, as a societal issue, encompassing the broader environmental and contextual factors that contribute to HIV transmission.
• Make more effort to research and understand community norms, values and practices related to PMTCT issues by beginning communication with rapid, participatory research and ensuring that results are incorporated into programme design.
• Increase participation of men, youth and PLWHAs in PMTCT.
• Assist communities in identifying realistic, feasible coping strategies for HIV/AIDS. Simple community dialogue tools have been developed and field-tested, proving that easy-to-use participatory tools can greatly assist and enhance community capacity to identify ways in which they can begin addressing HIV/AIDS and stigma, thus creating more caring and supportive communities...

Click here for access to the full study "Stigma, HIV/AIDS and prevention of mother-to-child transmission", commissioned to PANOS London by UNICEF.

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For general information on UNICEF's approach to strategic communication, contact Waithira Gikonyo wgikonyo@unicef.org

For information on strategic communication for PMTCT or the Tools developed by UNICEF,
contact Shari Cohen scohen@unicef.org

Many thanks to both Ms. Silvia Luciani and Ms. Cohen for their assistance with this issue.

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