December 2001

Prepared by Sabine Michiels
in collaboration with
The Extension, Education and Communication Service
FAO Research, Extension and Training Division

Draft for Discussion

Part 2 of 2

1 2

3. Developing a national strategic communication plan for HIV/AIDS.

Communication programmes and activities are most successful when they are based on participatory research and planned systematically and strategically. Often the haphazard and ad hoc use of communication activities leads to top-down design and implementation and has a high chance of not effectively reaching the intended audiences simply because they have not been involved.

The following nine-step process demonstrates how a communication plan for HIV/AIDS could be developed, bearing in mind that it needs to be developed in close collaboration with all major "stakeholders"¹¹ (present at each and every design phase) and that they are merely a set of "guidelines".

The HIV/AIDS Communication Strategy will be developed with due consideration to culture, gender relations, power structures, religion/spirituality, individual and government economic status. (UNAIDS/Penn State, 1999).

Step 1. Defining the research gaps

Some interesting qualitative research studies, carried out mainly amongst specific target groups in the field of HIV/AIDS, shed light on the complex issue of the systemic effects of the disease on people's lives in Sub-Saharan Africa, but clearly point to the need for more qualitative action research to build a sound understanding of vulnerability¹² and susceptibility¹³ to HIV/AIDS (Topouzis 1998:4). Qualitative information is also needed for message design and appeals development, as well as for focused materials production.

It is important that programme managers and professionals working in the field of agriculture, health, education, rural development, etc. join forces with communication specialists, social scientists, media workers, community leaders, PLWHA and members of affected households, to identify the information they need to plan for coherent, sustainable, problem-solving communication plans. This requires information to define their audiences, to identify psycho-cultural realities and constraints, to conceptualise and produce a variety of culturally appropriate audio-visual and scripto-visual materials. Participatory processes and methodological approaches are essential for guaranteeing the success of communication strategies and plans.

The following sequencing of activities is suggested:

1. a comprehensive (country) literature review on HIV/AIDS and its impact and the coping mechanisms and strategies developed to deal with its impacts (review: including epidemiological data review, social, economic and agricultural impacts assessments)



2. a multi-sectoral, multi-disciplinary participatory workshop to share the findings of the review, to identify the research gaps and to determine study methodologies and approaches

During this exercise, particular attention should be paid to those anthropological, ethnographic and sociological studies assessing the effects of HIV/AIDS morbidity and mortality at the individual, household and community level and the coping mechanisms and strategies of the children left behind.

Step 2. Undertaking qualitative research

There is a need for a collaborative action research effort that is participatory in nature and involves programme staff, communicators, researchers, community leaders, PLWHA, members of farm-households, and many more (e.g. traditional and religious leaders, extension workers, women from single-headed households or widows, teachers, NGO staff, health agents, etc.) throughout the process of the study. This multi-level and multi-disciplinary research process will allow those involved to identify the multiplicity of problems and take advantage of the discussion forum to share knowledge and exchange ideas as well as to be proactive in the problem-solving process.. The research forum itself becomes an important catalyst for change. Experience has shown that this is a learning process that enables people to reassess their own attitudes and behaviour and to learn from each other as well as from people interviewed.

FAO's work and experience in communication for development has shown that communication interventions are most effective when they are research-based and when they directly address the target population.¹⁴ Hence, the first step to designing effective and socially appropriate communication programmes, strategies and materials for HIV/AIDS prevention and education, would be to analyse and explore (1) the behaviours, attitudes, practices, feelings and needs of different participants; (2) the communication factors (i.e.: listening habits, language(s), access to information/education, media preferences); (3) the institutional response capacity and available infrastructures; and,(4) the dynamics of HIV/AIDS (including the relationship between AIDS, agriculture and food security).

The FAO Communication for Development Group has gained a significant amount of experience in experimenting, applying and adapting the methodologies and approaches available to do communication research. There has been an important move from extractive, exogenous, top-down and quantitative research to qualitative, endogamous and participatory research such as Participatory Rural Appraisal (PRA), Rapid Rural Appraisal (RRA), the Farming Systems Development (FSD) approach, the Focus Group Discussion technique¹⁵ and more recently Participatory Rural Communication Appraisal (see Box 1 for more details).

Today, there is a mix of participatory audience-friendly methods and approaches available that no longer depend on literacy and secondary schooling and can be applied to discover the problems, needs, fears and desires of rural people, and at the same time make room for processes that prompt locally based solutions.

Box 1: How PRCA is unique and different (SADC-CCD/FAO 1998:50)

Step 3. Linking research findings to communication planning

This process involves the identification, prioritisation and in-depth analysis of all communication problems as well as the diagnosis of what causes the gap between existing and desired behaviour. It allows for setting precise communication objectives at diversified levels of information, conscientisation or behavioural change and includes the following group activities:

• building a common knowledge base
• information analysis
• prioritisation of issues.

Step 4. Developing a communication plan

The communication planning process is part of a systematic process that includes exploring knowledges and planning a strategy and preparing for the field. It is important that a multi-disciplinary group of programme stakeholders plan for their communication master plan and claim ownership over its planning and implementation.

Once the research findings have been broken down into manageable categories describing themes, sub-themes, issues and communication problems, the planning process can begin. This implies the development of a coherent, integrated, problem-solving, location-specific communication system, which links each communication problem to a set of communication objectives, specific target audiences, messages and appeals, and a specific institutional communication channel and/or media channel and format. What follows is a description of the technical sequencing of the 5 major activities involved in the development of a communication plan for HIV/AIDS.

Five steps to a Communication Plan for HIV/AIDS¹⁶:

1. Defining the communication problem(s): Analysing the problem (disaggregated research and analysis), the situation and the communication factors [e.g. through participatory action-research (PAR) and/or participatory rural communication appraisal (PRCA¹⁷ )
   
   What causes the gap between existing and desired behaviour? Is it that people do not know? Is it that they do not care? Or is it that they do not do? Who is aware of the problem? Who needs to be made aware of the problem? Who is aware of the solution(s)? Who needs to be made aware of the solution(s)?



2. Setting the communication objectives: Analysing the data, building a common knowledge base, setting the priorities (focus on inspiring measurable changes in behaviour).
   
   If people do not know, they need information. If people do not care, they have to be made critically aware. If audiences do not do, communication objectives will have to pass through the stages of information and critical awareness creation to arrive a setting an objective at the level of behaviour change.



3. Refining the audiences: Audiences are not uniform, and they need to be defined and involved in the process.¹⁸ During this phase of planning, the participants themselves identify the primary and secondary audiences, the latter being those groups that critically influence the behaviour or decision making of the primary audiences. Once these are identified, the group then refines them further (i.e. women, rural women, rural women at the reproductive age, rural illiterate women, etc.). In the case of HIV/AIDS prevention, the communication strategy would need to cater to the specific, yet different needs, of all "stakeholders"¹⁹ including extension agents, school teachers, rural youth, women, male migrants, local government officials, policy makers, traditional leaders and many more.



4. Building major message lines and appeals: Develop content that reflects what the target population needs; use appropriate language (as identified in the research phase) in communication materials to suit audiences; use a multiple communication channels to reinforce messages.²⁰ Major themes and appeals are identified. The participants are trained in how to select appeals that are culturally appropriate and audience-specific. They are then guided into distinguishing various ways of appealing to the target audiences and how and when to choose emotional vs. rational appeals, positive vs. negative, mass vs. individual, etc.



5. Choosing the communication channels: Institutional channels (formal and informal) and media channels (mass, group, interpersonal, traditional, print); and involve other competent partners.
   
   Participants are taken through a process of distinguishing formal and informal institutional channels and of designing the right combination of media. The use of traditional and popular media and their application at village level should be fully explored. In full respect of context and ritual meaning, local cultural expressions such as poems, dances, drama could be effectively used for HIV/AIDS communication.²¹
   
   At the end of this exercise the participants have at their disposal a coherent tool for the planning of all communication interventions and a framework for action. Consequently, the communication team can see how radio programme A will carry message X to target audience Z, which will enable them to reach communication objective Y and address the problem they decided to tackle.

Step 5. Developing a series of action plans

During this phase, a series of sub-action plans are developed in concert with the main communication plan. These can include a media production plan, a training plan, field implementation and monitoring and evaluation.

Step 6. Producing multi-media communication materials

Once the media mix is planned for and the media production plan is developed, a series of material production activities can be launched simultaneously. In general, four types of communication materials can be distinguished, as they require specific production techniques:

• scripto-visual materials (print and other visual such as comic strips, wall charts, posters, bill boards, flash cards, etc.)
• radio, including rural radio and audio cassettes for use in listening groups
• audio visual production including TV and video
• traditional and popular media including community-based cultural resources, drama and popular expressions
• new internet-based communication technologies for the creation of electronic information networks (e.g: e-mail and web sites).

Special attention should be paid to production approaches and methodologies as process(means) rather than actual outcome (end product). A growing body of evidence suggests that participatory production methodologies, based on sharing knowledge and experiences with segments of the audiences concerned, are far more effective as they cater immediately to their needs, their psycho-socio-cultural reference frame, their life-goals and aspirations, their problem and their constraints.

Meaningful social change takes time. Producing with audiences, whether young people, village women or men, religious leaders or traditional chiefs, increases the chances for sustainable communication activities. They bring in their traditional and indigenous knowledge and the wisdom of a lifetime experience. (See Box 2)

Step 7. Conducting field training/capacity building

Only when the training programmes are designed and when the communication materials are produced, can training activities be undertaken. Given the urgent need for a multi-sectoral and integrated response to HIV/AIDS, it is important to engage all the necessary and often overlooked stakeholders, across sectors, in the training programme. This would include training PLWHA, extension workers, health workers, educators and other (potential) front-line communicators including NGOs, in the use of communication materials and in interpersonal communication skills.

Step 8. Implementing field activities

Once the field workers and their supervisors are trained, field communication activities can begin in full coordination with all partners involved, including pretesting the communication materials.

There is a tendency to favour the easier, short-run type of communication campaigns over the in-depth, longer-term communication activities in villages and communities. However, only those communication activities that base their strength in communities and that allow for the building of communication networks and partnerships, guarantee ownership and are sustainable in the long run.

Step 9. Monitoring and evaluation

"The success of any intervention will depend to a large extent on the appropriateness of what has been done. Every intervention occurs within a specific context, and local context as well as the stage of the epidemic must be taken into account when planning, designing and implementing HIV prevention programme. It is also critical to remember that interventions at multiple levels are nearly always needed in order to encourage people to adopt and sustain safe sex practices, as well as to establish the enabling and supportive environments necessary for reducing vulnerability to HIV infection. (Innovative approaches to HIV Prevention, UNAIDS 2000)

A close monitoring and evaluation scheme, including record keeping and impact evaluation should be designed to allow for a review of progress and problems and for a consecutive redesigning the field programme, as required.

UNAIDS (2001) has identified several criteria for the evaluation of HIV prevention programs that should be taken into consideration, they include: (1) social relevance, (2) efficiency, (3) impact, (4) sustainability and (5) ethical soundness.

Box 2: Artists as experts²²

Conclusion

The most important factors to take into consideration when developing a national communication plan relate more to the overall approach and context than to the development of the plan itself. These include:

• Combination of long-term and short term interventions. HIV/AIDS prevention communication activities cannot take place in a vacuum, rather they should be accompanied by immediate assistance, like food aid or credit injecting initiatives, and long-term sustainable development aiming to reduce poverty. Relief-oriented initiatives should be combined with investment-oriented strategies to ensure that when funds are finished, projects are able to continue. Long-term strategies should continue to address the underlying problems that make rural households vulnerable to the impact of HIV/AIDS. The main focus should be on enabling households and communities to avoid irreversible coping strategies particularly those that reduce future income-earning potential and destroy their productive capacity.
  
  "The basic goal being to help create the conditions in which both infected and non-infected individuals can live with dignity and security even in highly affected areas. Meeting the immediate food and other basic needs of destitute households is essential. Halting risky sexual and social behaviours, including, for example, the trading of sexual favours for food, goods and services, is crucial to this goal. This particular example is especially important as the poverty arising from HIV/AIDS spreads and creates greater destitution among adolescents and young adults who must then look for ways to survive." (Excerpt from the 27th session of the Committee on World Food Security, Rome, May 2001)



• Partnerships for combined efforts. No single action can make a meaningful and lasting impact on the AIDS crisis. Development agencies whether national or international, governments, civil society, NGOs, CBOs, academic institutions, religious authorities, private sector, farmers and teachers, all stakeholders need to combine efforts to fight against and alleviate the impact of AIDS. They should work collaboratively and contribute to providing an integrated, multi-sectoral response to the epidemic.²³



• Sensitive approach. Prevention and mitigation programmes need to take into account the production systems, agro-ecological zone, mobility patterns, household types, gender relations, cultural and social norms and values. The strategies should also deal with the fact that needs is an ever-changing category. Whatever will be identified as an urgent need today may no longer be urgent or the same tomorrow.



• Greater involvement of PLWHA and others directly affected. Foster active participation of people living with and affected by HIV/AIDS, communities and households in processes of problem and needs identification, problem-solving and implementing responses. PLWHAs can be teachers for the community at large on HIV/AIDS.

Endnotes

¹This approach is in line with the "Call for Action for the children left behind by AIDS " drafted by UNAIDS, UNICEF and the BLCA in December 1999 in occasion of World AIDS DAY.
²Agricultural education and training policies need to take into account the gender implications and socio-economic impact of the epidemic on rural households and communities.
³In reality these are merely guiding themes of analysis and research. Inevitably they will vary from country to country depending on the priorities and needs.
⁴Similarly to the research recommendation, the objectives of the Communication strategy will be designed in each country according to needs and priorities.
⁵See "FAO and the socio-economic impact of HIV/AIDS on Agriculture" (updated 1998) for a history of FAO activities and research in the area of HIV/AIDS. In 1993-1994 FAO conducted a first set of studies in East Africa to determine the impact of the HIV/AIDS epidemic on agriculture: "The effects of HIV/AIDS on farming systems in East Africa" (FAO 1995). This paper can also be found on the internet: www.undp.org/popin/fao.faohome.htm
⁶Similarly, the Rockefeller Foundation states that there is a need to move "away from a focus on individual behaviours... to social norms, policies, culture and a supportive environment" (Rockefeller Foundation, 1999:15).
⁷Communities can be grouped in pre-impact incidences of infections but the impact is not yet visible; early-impact: the impact is visible but community and household coping strategies are still effective; and full-impact: breakdown of socio-traditional coping strategies. (Baier FAO: 1997)
⁸In Africa, 23 countries fall into this category. "HIV in these countries remains predominantly in groups whose behaviour places them at high risk but has the potential to spread rapidly to the general population. " ( World Bank 1999)
⁹For more information on prevention see the recommendations listed in a Paper prepared by UNAIDS: "HIV/AIDS prevention in the context of new therapies" , Report of a meeting organised by UNAIDS and the AIDS Research Institute of the University of California at San Francisco, UNAIDS 1999.
¹⁰Source: HIV/AIDS prevention in the context of new therapies. Report of a meeting organised by UNAIDS and the AIDS Research Institute of the University of California, at San Francisco, Geneva February 1998.
¹¹"Stakeholders" have here been defined as all the people somehow affected (directly or indirectly) by HIV/AIDS as well as all the professionals, community members, leaders, government and ministry officials, public figures, musicians and communication specialists engaged in prevention, care and support efforts.
¹²"Vulnerability refers to a risk environment in which biological, socio-cultural, economic and political factors make it likely that a society or groups of that society will be rendered particularly susceptible to HIV infection and to the likelihood of experiencing the impact of the epidemic." (Topouzis 1998:4)
¹³Susceptibility refers to "the likelihood of a society to experience the epidemic". (Whiteside 1996:9 cited in Topouzis 1998:4)
¹⁴This applies to all media whether it's traditional or folk media, rural radio, participatory video or the Internet.
¹⁵The Focus Group Discussion technique lends itself to action research, to participation, to learning. If carefully planned and competently engineered and guided, this is an excellent tool to demystify research as well as a basis for planning and implementing a coherent communication intervention. (For more information on the FGD see Guidelines for studies using the group interview technique, by J. Aubel, International Labour Organisation and United Nations Population Fund (1994).
¹⁶Another approach is that developed by Family Health International: the Communication Pyramid (see website: www.fhi.org/en/aids/aidscap/aidspubs/handbooks/effcom.html
¹⁷For further information see "Participatory Rural Communication Appraisal: Starting with the people" developed by the SADC Centre for Communication for Development in collaboration with FAO (1998) (see also the website: www.fao.org/waicent/faoinfo/sustdev/cddirect/default.htm
¹⁸The audiences to reach in the case of HIV/AIDS in rural areas would be: rural men and women, teenage boys and girls, out-of-school boys and girls, decision-makers (local leaders, community leaders, religious leaders), along with special target audiences such as commercial sex workers, truck drivers, extension workers, army and police).
¹⁹"The characteristics of all stakeholders are to be determined during the research process. Any programmes or initiatives that use externally identified stakeholders are limited and bound to "A comprehensive analysis provides strategic guidance, valuable baseline information, a timetable for action, and a basis for future advocacy. It must be seen as the start of an ongoing process not an end in itself. The more accurate, insightful, and thorough the initial analysis, the more uses it can serve over the long term in many different ways." (Piotrow et al.: 1997)
²⁰There are three basic approaches in AIDS Communication: stick to your known partner, protect yourself (condom) and refrain from sex (abstinence). The challenge will be to move away from fear building to empowerment (e.g. from "AIDS kills" to "You can keep AIDS out of your life"). Clearly FAO will not undertake the task itself but rather in collaboration with those organisations qualified and experienced in the field of AIDSCOM such as UNAIDS, WHO and the various specialised centers for communication.
²¹Source: adapted from the design, implementation, monitoring and evaluation process proposed by the Johns Hopkins School of Communication (Piotrow et al. 1997) and from unpublished materials from A. Decock 1998. In addition, these steps are also contained in other FAO Communication for Development publications such as: Artists as Experts: a participatory methodology to produce traditional and popular media (FAO 1996), Applying DSC methodologies to population issues: a case study in Malawi (FAO 1994), La communication pour le developpement rural: instructions et directives a l'intention des planificateurs du developmment et des elaborateurs de projets (FAO 1998).
²²The Artists as Experts training kit aims to assist communication trainers in building a team capable of working with traditional and popular artists in a participatory workshop. It proposes one possible approach on how to produce songs, dances, poems, theatre plays and other forms of cultural expression used as communication channels in development programmes.
²³In Zambia, for instance, different ministries have made specific commitments to addressing HIV/AIDS. The Cabinet Office has developed HIV counselling services. The Office of the President has encouraged inclusion of HIV prevalence messages in all speeches of the country's top political leaders. The ministry of Defence has developed a plan for creating an orphan's fund to help upkeep education of orphans of officers and men of defence forces. The Ministry of Agriculture, Food and Fisheries has proposed to train extension workers in social mobilisation techniques for HIV/AIDS prevention and mitigation, and in coping mechanisms for rural populations.

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