HIV/AIDS - Social Shakes

Below is part of an overall paper called "SOCIAL SHAKES - rethinking the core principles for principled and effective development action" - the full Table of Contents is here.

HIV/AIDS

Did the global international Development organisations - bilateral governments, UN agencies, the big NGOs - fail to learn from the early, successful struggles to confront HIV/AIDS? As a result, did their actions, including their communication and media strategies, help contribute to the 15 years of HIV/AIDS hell that enveloped so many countries between 1990 and 2005 and that continue to this day for so many people, communities and countries? The data - for example, compiled by Roser⁴ - show the HIV/AIDS trends with which we are all too familiar.

The initial response to HIV/AIDS was driven by civil society actors - a combination of local community groups and individuals and networks of people living with HIV/AIDS in the South, and predominantly gay rights networks in the Northern countries. They put the issue on the agenda, had real "ownership" of HIV/AIDS as a major concern, and facilitated and undertook high levels of action. This dynamic was captured by the Panos Institute in its policy paper "Critical Challenges in HIV/AIDS Communication".⁵

That perspective was backed up by the data. For example, Uganda was doing so much better than other countries when HIV/AIDS incidence data were compared. Rates were lower than other countries. Everyone wanted to know why.

In 2004, the Population Health Evaluation Unit at Cambridge University in the United Kingdom, through CADRE, undertook a substantive research project examining the Ugandan approach to HIV/AIDS.⁶ That research resulted in this conclusion:

"Casual sex and HIV prevalence had dramatically declined in Uganda between the late-1980s and mid-1990s, a trend that was not observed in Uganda's neighbouring countries suffering from high HIV incidence. The authors hypothesised that horizontally communicating HIV-related matters through social networks would have positive impacts on population behaviour and HIV prevalence. Comparisons were made between Uganda and its neighbouring countries (Kenya, Malawi, South Africa, Tanzania, Zambia, and Zimbabwe) to discern the impacts of HIV-related communication patterns".⁷

A strong civil society process had begun in Uganda. The Cambridge research results linked the comparatively lower HIV infection rates in Uganda to the essence of the Ugandan strategy. This strategy was characterised by strong local and national civil society action that was embedded in and led by local people who raised and discussed the very sensitive issues that surround sex in established local community, district and national "spaces" (from family to parliament). It was these approaches - along with programmes that emerged from that consideration and the subsequent analysis - that had a positive effect in responding to HIV/AIDS – all through local social networking (pre-digital social networking!).

This was known at the time. Many people in the early 1990s, from their social communication perspectives, reflecting on the lessons learned from gay movements and the processes in Uganda, were almost literally yelling at policymakers and funders to please pay attention to this dynamic and to please support these localised communication actions that had demonstrated impact.

Rather strangely, the international reaction was to do just the opposite. The HIV/AIDS strategy was "internationalised" and "technified", even in Uganda. Into the complex, ultra-sensitive and dynamic ingredients that make up every culture's sexual soup, on which Ugandans had been working with their intimate knowledge of their culture and context in Uganda, for example, the focus instead turned towards epidemiological data, medical perspectives, a growing cadre of HIV/AIDS professionals, high-profile simple message advice, campaigns, the "targeting" of "key" populations, and a big attempt to market condoms.

The voice of HIV/AIDS became international bureaucrats and spokespersons, technical experts and scientists. Funding flows followed the same pattern. The people and organisations in the South who were doing such tremendous, and tremendously difficult, work became the "partners" (read: clients) of the big organisations. They had to follow their direction. Everything got flipped around.

There was little space for communicators to do what they did best. They were "encouraged" to undertake social marketing and campaign-style initiatives. The narrow epidemiological data (all incidence rates with no social, cultural or communication data at all) drove even narrower communication programmes. And ideology held sway for particular styles of communication programming. The ABC programme (Abstinence, individual Behaviour Change, Condoms - also known colloquially as "Anything But Condoms") reflected the ideology and social approach to sex of the country of its major bilateral funder, when the reverse should have applied.

It seems completely legitimate to posit that the failure to take a social communication approach to HIV/AIDS cost a very large number of lives and set back the HIV/AIDS response by at least 5 to 10 years. A comparison of Northern gay and Uganda infection rate trends in comparison with other populations and countries pre-1995, with overall global infection rates 1995-2005, would appear to provide the oxygen for that argument.

⁴ http://ourworldindata.org/data/health/hiv-aids/
⁵ http://panos.org.uk/wp-content/files/2011/03/critical_challengesc6mE7w.pdf [PDF]
⁶ http://www.comminit.com/global/content/social-communications-and-aids-population-behaviour-changes-uganda-compared-other-countr (summary)
⁷ http://www.comminit.com/global/content/social-communications-and-aids-population-behaviour-changes-uganda-compared-other-countr

The next section in this paper is CHILD HEALTH.

The previous section in this paper is POLIO.

Editor's note: Above is an excerpt from Warren Feek's paper "SOCIAL SHAKES - rethinking the core principles for principled and effective development action".

The full table of contents for this paper can be accessed at the bottom of the opening page.