Shari CohenMay 2003

1
Communication forPMTCT ? An
OverviewJHU/CCPBaltimore, MDMay 6, 2003
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The UN Four-Pronged Strategy for PMTCT
I
II
III
IV

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

• Prevention of HIV in young people
• Prevention of HIV infection in women of
  childbearing age (including their partners)

• Prevention of unintended pregnancies in
  HIV-positive women

• Care support for the mother and her family

3
Historical Overview

• 1998-2000 Countries implement PMTCT pilot
  projects Communication components vary in
  quality - mostly ad hoc communication
  responses
• March 2000 Global PMTCT meeting in Gaborone
  reveals progress, gaps, and need for
  communication assistance To support VCT,
  infant feeding counselling, care/support
  components, community mobilisation
  strengthening of HIV primary prevention
• May 2000 - present UNICEF HQ responds to
  communication field needs by providing
  concentrated technical assistance to PMTCT
  programs in the development of evidence-based
  communication strategies at country levels, and
  the development of global tools that can be
  adapted for any region

4
Communication accomplishments

• As of February 2003, UNICEF-sponsored field
  support has been provided directly or indirectly
  to the following regions countries to prepare
  for, develop or review/revise communication
  strategies for PMTCT
• ESAR Botswana, Rwanda, Zambia, Uganda, Malawi
  South Africa
• EAPR Myanmar, Cambodia Thailand
• ROSA India
• TACR Regional consultation with government
  colleagues, in collaboration with PAHO Guyana
  planning visit
• WCAR Nigeria The Gambia
• CEE/CIS Preparation participation in regional
  planning retreat

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PMTCT Communication Toolbox

• Global PMTCT tools currently being finalized
  field tested
• Communication Assessment Tool
• Sample research tools for quantitative and
  qualitative narrative community-based research
  on PMTCT issues
• already field tested and in-use
• Universal framework for development of PMTCT
  communication strategies work plans (the
  one-week strategy workshop)
• already field tested and in-use
• Community Dialogue tool to assist communities in
  creating caring supportive environments for
  HIV-affected families
• already field tested and in-use
• QA guide on infant feeding HIV for use by
  service providers
• ready for field testing
• PMTCT talking points guide for service providers
• ready for field testing
• Health worker sensitization training sessions

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Communication for Development Model
Advocacy Advocacy
Advocacy
Social Mobilisation
Behaviour Development
Community Participation
healthier individual, family community
behaviours
partnerships with NGOs CBOs civil society
political /social commitment support
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Communication for Development ModelWhat is it?

• a strategic approach that uses community-led
  evidence as its foundation and is based on the
  understanding that effective communication is
  strengthened when the synergistic use of three
  strategic components are combined
• advocacy to ensure resources and political/social
  leadership commitment at all levels
• social mobilization to engage ensure
  participation partnership with civil society,
  NGOs CBOs
• behavior development communication to encourage
  healthy behaviors, improved knowledge, attitudes
  practices and participation of individuals,
  families communities

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Communication for Development ModelWhat it is
not...

• This approach is not based on IEC messages
  materials
• Communication materials messages are used only
  when there is demand from the target audience
  members (the community, health workers, etc.) and
  audience members are integral in designing such
  materials in collaboration with health
  communicators
• This approach is geared to affect more meaningful
  behavior development by engaging society -
  communities, families individuals - in a
  variety of locally appropriate methods, ideally
  identified by those communities themselves.

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ACADA Communication Planning Process
Assessment
Evaluation

• Situation Report

Communication Analysis

• Problem Analysis/Statement
• Behaviour Analysis
• Participant Analysis
• Communication Channel Analysis

Action
Research Monitoring

• Implement Plan

• Communication Objectives
• Evaluation Indicators

Design

• Message Material development
• Pre-testing Revisions
• Materials Dissemination Training plan
• Monitoring Evaluation plan
• Plan of Action

Strategy Plan

• Advocacy
• Social Mobilisation
• Behaviour Development
• Communication

Select/Determine

• Strategies/Activities
• Partners/Roles
• Channels
• Approach, Appeal, Tone

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• The result of this strategic planning process
  is the development of an integrated
  communication strategy
• that is built on community-based led research
• that considers individuals, families and
  communities within their environment from their
  perspective
• that encourages fosters community participation
  empowerment
• with realistic, measurable objectives
  indicators
• with culturally relevant approaches and messages
  that match the existing levels of KAPBs

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Key lessons learned in supporting communication
for PMTCT

• Include a wide variety of PMTCT-related
  stakeholders in the planning stages, including
  men, youth, PLWHAs, CBOs, NGOs INGOs,
  counselors, epidemiologists, communication
  specialists, nutritionists, BFHI/HIV/STD/ANC/RH
  managers, traditional leaders
• In those countries where emphasis has been placed
  on capacity building local ownership at all
  levels, momentum has increased in moving
  communication strategies forward
• Clarifying roles responsibilities for
  communication implementation in the planning
  stages, keeps strategies moving forward in a
  timely manner
• Advocacy visits have been key to the success of
  developing PMTCT strategies, enabling local
  players to actively participate in planning
• Regional/global sharing of lessons learned is
  invaluable

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Lessons learned continued...

• PMTCT messages must be clear, realistic and
  simple, especially regarding infant feeding
  options, and in countries where caution has been
  exercised in developing messages, realistic,
  easy-to-understand messages are being developed
  more easily
• Countries using an extended counseling training,
  including using lay counselors, have experienced
  higher uptake of VCT, increased male involvement
  less reported stigma of VCT PMTCT services
• In countries where emphasis has been placed on
  community participation preparedness - before
  services are available - uptake has been notably
  higher stigma has been noticeably less
• PMTCT communication should be complementary to,
  and integrated within existing HIV/AIDS, ANC RH
  interventions

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Lessons learned continued...

• Activities support materials aimed at creating
  supportive community environments and fighting
  stigma are a critical component of PMTCT
  communication activities and should be based on
  community research guided by community
  participation
• Countries engaging in narrative community-based
  led research have had stronger community
  commitment to involvement and support of PMTCT
  programming
• this refers to the recent South Africa
  research approach that is based on a narrative
  story-telling approach, including additional
  qualitative quantitative research prongs
• In countries where local government has
  supported a holistic approach to PMTCT,
  communication results have been more dynamic and
  successful
• this refers to the recent national PMTCT
  communication approach in South Africa, which
  uses PMTCT to bring together cross-cutting issues
  related to PMTCT, VCT, RH, MCH, Gender, Stigma,
  Traditional Healers, etc.

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What are the challenges?

• PMTCT is still seen in most countries as a
  vertical special HIV program, which is causing
  stigmatisation of the program, with low uptake as
  one of the results
• Marketing of PMTCT at country levels could begin
  focusing on the expanded ANC services aspects
  of PMTCT - that it is a new stream of ANC
  services - rather than placing all the focus on
  the HIV aspects
• Many countries still view PMTCT as only the
  service package, viewing primary prevention and
  other aspects of PMTCT as part of other HIV
  programs
• Community stigmatisation and partner rejection of
  HIV-positive women still not yet properly
  comprehensively addressed
• Inadequate implementation and use of research on
  community and audience perceptions of
  PMTCT-related issues, including stigma

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Challenges continued

• Still a tendency to expect behavior change
  results based on
• ad hoc IEC communication interventions (e.g.
  posters, brochures, mass media, etc.)
• Communication interventions rarely address health
  workers attitudes, HIV-negative women, men
• Continued confusion about infant feeding
  protocols - Largely due to lack of
  research/evidence on infant feeding protocol
  for HIV mothers, and health worker attitudes
• Lack of fulltime national PMTCT teams slows down
  program progress, particularly in communication
  activities
• Recent successful global practices are leaning
  towards identifying non- traditional
  communication players to take up key roles
  responsibilities for communication-related
  interventions that, in the past, were confined
  to more traditional IEC communication players

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Challenges continued...

• Gender gap still exists between youth - globally,
  more girls reporting lack of knowledge/skills on
  basic primary prevention of HIV
• Large percentage of women girls still feel they
  are not at risk of becoming infected with HIV
• Is it denial or lack of information? Only
  research will clarify

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Primary HIV prevention is still a priority...
Information Gap Percentage of boys and
girls (aged 15-19) who did not know any
way to protect themselves against
HIV/AIDS
The data emphasises the need to reach all
youth, especially girls
Source DHS, 1994-1999.
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• Percentage of sexually active girls (aged 15-19)
  who do not see themselves at risk of becoming
  infected HIV, compared with HIV prevalence
• At the time of survey as measured among pregnant
  women (in surveillance studies, 1994-1999).
  Source DHS, 1994-1999.

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Conclusion...Communication interventions for
prevention of MTCT are most successful when
Integrated within existing ANC, MCH, RH HIV
programming Built on community-led research
Include on-going involvement from all segments
of community with particular emphasis on male
partners, grandparents traditional leaders
Communities are provided with simple tools
to help them identify realistic feasible ways
to begin addressing community stigma Invest
in interpersonal communication