Promoting HIV Prevention in Lesotho


Published on

A Behavior and Social Change Communication Approach

Published in: Health & Medicine
  • Be the first to comment

  • Be the first to like this

No Downloads
Total views
On SlideShare
From Embeds
Number of Embeds
Embeds 0
No embeds

No notes for slide
  • Partners for Health and Development Communication, or PHDC, is a new five-year $175 million global health and development communication initiative supported by USAID.
  • Promoting HIV Prevention in Lesotho

    1. 1. Promoting HIV Prevention in Lesotho A behavior and social change communication approach Presented by: Carol Larivee Deputy Director, C-Change
    2. 2. C-Change Partnership <ul><li>Lead partner: </li></ul><ul><li>Regional partners: North American Partners: </li></ul>
    3. 3. Catalyze System-Wide Change <ul><li>Improve the effectiveness and sustainability of communication: </li></ul><ul><li>Start interventions at scale </li></ul><ul><li>Influence underlying individual and social norms </li></ul><ul><li>Tap into social capital </li></ul><ul><li>Involve media as partners </li></ul><ul><li>Build communication competencies </li></ul>
    5. 5. Concurrent Partnerships
    6. 6. Definition <ul><li>Two partnerships are sexual concurrent if they overlap in time. </li></ul>Same contact rate (5/yr), but the sequence of start and end dates is different Current Partner Count Slide from Dr. Martina Morris -- U. of Washington 1 2 3 4 5 time 1 01 01 0 1 0 1 0 1 2 3 4 5 time 1 2 3 2 1 2 10 1 0
    7. 7. Important features of concurrency <ul><li>Intensity of overlap </li></ul><ul><ul><li>How long does the concurrency last (duration) </li></ul></ul><ul><ul><li>How frequent is the back and forth between partners </li></ul></ul><ul><li>Gender asymmetry </li></ul><ul><ul><li>Do men report concurrency more often than women? </li></ul></ul><ul><ul><li>Not an issue of reporting error </li></ul></ul><ul><ul><ul><li>Always more men than women with no partners, so this balances </li></ul></ul></ul><ul><ul><li>This changes the connectivity of the network </li></ul></ul><ul><ul><ul><li>Asymmetry will lead to less connectivity </li></ul></ul></ul>Slide from Dr. Martina Morris -- U. of Washington
    8. 8. Implication : Concurrency has threshold impacts on network connectivity Bicomponents in red Hubs and superspreaders are not required for network connectivity Slide from Dr. Martina Morris -- U. of Washington In largest component: In largest bicomponent: 2% 0 41% 5% 64% 15% 10% 1% Mean: 1.74 Mean: 1.80 Mean: 1.86 Largest components Mean: 1.68 Number of Concurrent Partners
    9. 9. Cultural Setting
    10. 10. “ Everything you discuss here is just the tip of the iceberg” Participant at Swaziland HIV/AIDS Partners’ Forum, 2008 Historical, political, economic processes, and contemporary trends Slide from Suzanne LeClerc-Madlala, U. of Kwa Zulu Natal
    11. 11. Southern African societies are traditionally polygamous, patrilineal and patrilocal Many norms and values rooted in these social arrangements persist and shape the assumptions, expectations and meanings that people bring to relationships. Suzanne LeClerc -- Madlala
    12. 12. Formative Research Soul City One Love Regional Campaign
    13. 13. Regional Programme country partners Slide from Harriet Perlman, Soul City, Regional Programme <ul><ul><li>Botswana </li></ul></ul><ul><ul><li>Lesotho </li></ul></ul><ul><ul><li>Malawi </li></ul></ul><ul><ul><li>Mozambique </li></ul></ul><ul><ul><li>Namibia </li></ul></ul><ul><ul><li>South Africa </li></ul></ul><ul><ul><li>Swaziland </li></ul></ul><ul><ul><li>Tanzania </li></ul></ul><ul><ul><li>Zambia </li></ul></ul><ul><ul><li>Zimbabwe </li></ul></ul>
    14. 14. Themes across all countries <ul><li>MCPs are common practice </li></ul><ul><li>Sexual dissatisfaction </li></ul><ul><li>Emotional and physical dissatisfaction </li></ul><ul><li>Culture and social norms influence MCPs </li></ul><ul><li>Money and material possessions </li></ul><ul><li>Alcohol and MCP </li></ul><ul><li>Men cannot control sexual desire </li></ul><ul><li>Pressure </li></ul><ul><li>Male domination and abuse </li></ul><ul><li>HIV and AIDS risk and fatalism </li></ul>Slide from Harriet Perlman, Soul City, Regional Programme
    15. 15. Regional Messages
    16. 16. Campaign Positioning <ul><li>A positive campaign. </li></ul><ul><li>Get people talking about sexual choices they make. </li></ul><ul><li>Create awareness of risky sexual behaviour without blame or shame. </li></ul><ul><li>Create a conversation about social norms and MCP </li></ul><ul><li>Challenge gender stereotypes and cultural norms that reinforce MCP, and put people at risk. </li></ul>Slide from Harriet Perlman, Soul City, Regional Programme
    17. 17. Core campaign messages for Region <ul><li>Having multiple and concurrent relationships puts you and your loved ones at risk. A safe relationship means: </li></ul><ul><li>There are no secrets and lies </li></ul><ul><li>Communicating effectively with each other </li></ul><ul><li>Challenging cultural practices that support MCP </li></ul><ul><li>There is respect for and between men and women </li></ul>Slide from Harriet Perlman, Soul City, Regional Programme
    18. 18. Lesotho
    19. 19. C-Change Partners in Lesotho
    20. 20. Annual New Infections
    21. 21. HIV Prevalence in Adults
    22. 22. HIV Prevalence by Marital Status
    23. 23. C-Change Formative Research in Lesotho
    24. 24. Main Question <ul><ul><li>How does communication about HIV/AIDS, sex, and culture contribute to multiple concurrent partners in Lesotho? </li></ul></ul>Slide from Veronica Sigamoney, Social Surveys ?
    25. 25. Methodology <ul><ul><li>Qualitative research </li></ul></ul><ul><ul><li>24 in-depth interviews </li></ul></ul><ul><ul><li>Key informants: traditional healers, youth leaders, health-care workers, volunteers involved in HIV/AIDS/ reproductive health work, local area chiefs, church leaders </li></ul></ul><ul><ul><li>Fieldwork in 4 districts: Berea, Leribe, Mafeteng and Maseru </li></ul></ul>Slide from Veronica Sigamoney, Social Surveys
    26. 26. In Lesotho Silence & Secrecy as Respect Slide from Veronica Sigamoney, Social Surveys Secrecy Silence HIV/AIDS Sex, MCP HIV/AIDS Sex, MCP Shame Respect Social Norms Indirect Communication
    27. 27. Strategy
    28. 28. Elements <ul><li>Stimulate dialogue through mass media and community networks </li></ul><ul><li>Leverage existing networks and resources </li></ul><ul><li>Support stakeholders to develop and implement national communication program. </li></ul><ul><li>Specific messages for Lesotho </li></ul>
    29. 29. Engage Existing Community Groups <ul><li>Structured program and tools </li></ul><ul><li>Menu of best practices from which communities can select </li></ul><ul><li>Leverage existing networks </li></ul><ul><ul><li>NAC Village Councils </li></ul></ul><ul><ul><li>World Vision </li></ul></ul><ul><ul><li>CRS </li></ul></ul><ul><ul><li>U. of Lesotho </li></ul></ul>
    30. 30. MCP Issues that will be Addressed <ul><li>Basic Risks of MCP </li></ul><ul><li>Social and community norms: How have they changed – how must they change? </li></ul><ul><li>Sex and emotions: How are they related? </li></ul><ul><li>Alcohol: What role does it really play? </li></ul>
    31. 31. MCP Issues that will be Addressed <ul><li>Gender: W hat role do abuse and violence play? </li></ul><ul><li>Communication skills: Negotiation, assertiveness, conflict resolution, sensitive issues </li></ul><ul><li>Specific issues: Faithfulness, peer and parental pressures. Others? </li></ul><ul><li>Choices: Taking the first step, getting through the day, the week </li></ul>
    32. 32. Magnifying Change Through Media <ul><li>Feature changed communities and provide legitimacy for local action through: </li></ul><ul><li>Radio Spots </li></ul><ul><li>Radio Talk Shows </li></ul><ul><li>Billboards </li></ul><ul><li>Inserts </li></ul><ul><li>Media </li></ul>
    33. 33. Monitoring and Evaluation <ul><li>Evaluation with quantitative and qualitative components using state of the art measures of concurrency </li></ul><ul><ul><li>Nine key questions used to determine prevalence of concurrency – Ask the following of the three most recent sexual partners: </li></ul></ul><ul><ul><ul><li>When did you first have sex? </li></ul></ul></ul><ul><ul><ul><li>When did you last have sex? </li></ul></ul></ul><ul><ul><ul><li>Do you expect to have sex in the future? </li></ul></ul></ul>
    34. 34. Messages <ul><li>Looking for the right balance between provocative and culturally sensitive AND doable action …… </li></ul><ul><li>“ We need a social movement!” Mr. Motlapula Khobotlo, NAC </li></ul>
    35. 35. C-Change Lesotho Team <ul><li>In Lesotho: </li></ul><ul><li>Palesa Ndabe, CARE </li></ul><ul><li>Nicol Cave, AED </li></ul><ul><li>Hope Dolo, Phela </li></ul><ul><li>Limpho Mokhochane, Phela </li></ul><ul><li>Clive Ashby, CARE </li></ul><ul><li>Ken Storen, CARE </li></ul><ul><li>Support from US and Region </li></ul><ul><li>Peter Gottert, AED </li></ul><ul><li>Shereen Usdin, Soul City </li></ul><ul><li>Harriet Perlman, Soul City </li></ul><ul><li>Carol Larivee, AED </li></ul><ul><li>Kwamy Togbey, CARE </li></ul><ul><li>Veronica Sigamoney, Social Surveys </li></ul><ul><li>Bev Russell, Social Surveys </li></ul>