Received date: February 6, 2019; Accepted date: March 9, 2019; Published date: March 19, 2019
Citation: Awasthi KR, Awasthi MS (2019) Behaviour Change Communication/Social Mar keting in HIV, AIDS. Health Syst Policy Res Vol. 6 No.1: 80.
Copyright: © 2019 Awasthi K R, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License,
which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited
This article reviews the importance of the role played by BCC and social marketing on preventing HIV. It explains the various Behavior Change Communication (BCC) movements through mass media which has become very effective in creating awareness and positive change of behavior to a large population over a short period of time. Materials were collected by a systematic search of the databases and the websites of national and international agencies. BCC is an essential part of a comprehensive HIV/ AIDS prevention, care and support program. The risk behaviors of getting HIV such as sharing needles, unprotected sex with multiple partners and sex workers increases the risk of HIV infection which can be prevented through different interventions that motivate individuals and communities to make appropriate choices about HIV prevention and care. Through social marketing, mass media, campaigns, health teaching, peer communication/ counseling, community outreach and technology, awareness can be raised significantly for successful HIV interventions thereby reducing the risk of HIV infection. As mass media campaigns are highly expensive, active participation of community, several stake holders, policy makers and a strong political and government leadership is adamant for the intervention to be both effective and sustainable on along term.
Behavior change communication; HIV infection; Social marketing; Health education
Social marketing in this present era is found to add further impetus in creating mass awareness in a population. This includes awareness of the population to practice use of safe behavior including use of contraceptives, and awareness of the importance of antiretroviral therapy which is provided free of cost through the public sector. Behavior Change Communication (BCC) campaigns through mass media can be a very effective tool to reach out to a large affected population over a short period of time . The ability to use various methods of media and campaigns to ensure that the messages are culturally and individually acceptable presents it with an added benefit in raising awareness. Nevertheless, as media campaigns alone have shown to be very less effective, as many studies have indicated, social marketing provides an additional benefit and better result. The most successful campaigns have been the ones that run media in conjunct with multiple channels such as peer communication, health education and availability of behavior changing facilities at an affordable price to bring about the desired change . The importance of need to change ones behavior is exemplified even more in certain diseases such as HIV AIDS. With a large population living with the disease and the possibility of a rapid growth in the incidence and mortality if left unattended, BCC plays a significant role in its prevention and control of spread especially for advocating use of condoms and new syringes among iv drug users.
This paper outlines the importance of the role played by BCC and social marketing on preventing HIV. It discusses some of the various successful BCC campaigns that have been run globally on controlling HIV, the factors that bring about its success and the potential barriers faced.
There is limited number of studies done on social marketing in HIV/AIDS. An extensive search of literature review was, therefore, conducted on research and review articles with the Key Words. Once the materials were collected on various successful interventions on social marketing to prevent HIV in Nepal and other countries, they were thoroughly reviewed. Extensive review from databases such as Google Scholar, PubMed, ProQuest, Cochrane database of Systematic Review and from the library database of Curtin University was done to obtain published works. The search was limited to articles dating between 1996 and 2013 using the key words: HIV, Mass media, Social Marketing, BCC interventions, Prevention.
The authors also searched gray literatures and reports published by the Government and non-Government organizations of Nepal and abroad. Literatures published in language other than English were excluded from the review. The authors then maintained an End Note (version X6) library to avoid duplication of the retrieved literatures. The authors read and reread the relevant literatures to extract the qualitative and quantitative information through note taking the major findings. This led the authors to narrate their findings under themes and sum themes as structured in his paper.
BCC campaigns and HIV AIDS
Health issue: An estimated 33 million people around the world are living with HIV AIDS . Even after three decades since the first case of HIV was reported, it still persists as a major disease burden globally. Although studies showed a significant increase in the number of HIV cases by 27% between 1999 and 2009, the number of deaths caused by it has decreased considerably in recent times . Even though women constitute nearly half of the total disease burden, studies have shown that 3.4 million children under the age of 15 years were living with HIV in 2010 which included 390,000 new cases [3,5]. The groups at high risk for HIV are sexual workers, drug injectors, homosexuals, and adolescents and adults involved in unprotected sex with multiple sex partners .
With such variation in the risk groups coupled with the magnitude of the disease burden, target group focused BCC campaigns can play a significant role in HIV AIDS control.
Successful BCC campaigns
Although several preventive and promotive campaigns for HIV AIDS started during the late 1990s, a majority of them have been ongoing on an extensive level since the last decade . Risk group focused BCC campaigns have been conducted in many countries. Where needle marketing campaigns in Bangladesh, Tanzania, USA and China were specifically targeted at intravenous drug users; other programs such as the Sonagacchi project in India, Soap operas in Tanzania, Louisiana, Philippines and Thailand Condom Social marketing programs targeted sexual workers practicing unprotected sex. Similarly, multimedia campaigns in Zimbabwe, South Africa, and Cameroon were aimed at adolescents and people involved in unprotected sex with multiple partners .
BCC over these years has evolved over the concept of social marketing which involves a multi-channel approach in addition to the conventional radio and television. The other channels include the use of internet, newspapers, street dramas, puppet shows, individual counseling, peer group discussions, use of role models in the form of singers, actors, people living with HIV for posters and billboards . Social marketing nowadays also incorporates the process of collection and distribution of preventive measures such condoms and syringes at a subsidized rate with easy access, voluntary testing, and treatment to care which has added further impetus to the existing media campaigns . The “100% Jeune” campaign conducted in Cameroon incorporated the afore mentioned social marketing principles. The campaign involved activities like peer education at multiple locations, a monthly magazine, information dissemination through an 18 episode drama and call in shows via the radio, television, billboards and establishment of user friendly condom outlets for users . Most of the focus of safe sex related education was centered on schools and youth outlets. The campaign in a year reached out to 165,000 youths via 50-80 shows while 320,000 magazines providing information on safer sex and protection were sold out in just 10 day . This exemplified how the campaign had successfully increased the interest level on HIV among the youths in Cameroon.
It has been found that HIV in urban and educated communities are attributed to negligence while in the rural communities it is largely due to low level of HIV awareness and strong socio cultural beliefs . BCC campaigns using entertainment education have been found to be a popular method to meet both these population. Some popular radio and television soap operas include “Soul City” in South Africa, “TwendenaWakati” in Tanzania, “TinkaTinakSukh” in India “Nshilakamona” in Zambia and “Kamaisama Mo Sukoshidake” in Japan. Along with the drama episodes and soap operas, condom blowing contests in Thailand, animation films and songs on HIV AIDS, rallies and soccer events have also been used for educating people on the deadly disease . The entertainment component of these campaigns and the use of role models have been well received by the community and have brought about a positive change in the behavior with regards to HIV AIDS. The concept of radio opera brought about a very interesting outcome. The operas on HIV aired in Tanzania on a regular basis triggered a communication behavior. The regular listeners of the opera were found to be frequently discussing about the disease with their friends and spouses. Out of the reported 61% opera listeners 55% discussed the episode and the disease with their friends while 37% did it with their spouses . The same evaluation also indicated a change in sexual behavior in the population as a result of the information obtained from the program.
For a BCC campaign to be successful it is necessary to actively involve the target group and promote local level ownership. The HEART campaign, a multi media campaign used to raise awareness about HIV AIDS amongst adolescents in Zambia exemplifies the effect of such programs. Local adolescents were recruited to be used as the frontrunners of the program and they were involved throughout the conceptualization, designing and implementation process of the campaigns . The involvement of similar age group people in the campaign helped develop messages that were relevant and acceptable in the target population.
Even though individual interventions aimed at controlling HIV AIDS are found to be more effective, it is less feasible due to the constraints of the required human and economic resources. Mass media campaigns require considerable amount of funds, therefore, involvement of multiple stake holders and preferably the government and policy makers is adamant. In China the mass media campaign was used as an advocacy tool aimed at public administrators, policy makers who neglected the issue of HIV revolving around drug injectors and sexual workers . Multiple issues on local newspapers, national and international media coverage on the infected plasma donors in one of the provinces prompted the government to address the issue of HIV AIDS which was hardly prioritized before the episode . Even in a country like China where prostitution and drug abuse face prosecution and is done hideously. The advocacy campaign resulted in implementation of HIV related education and social marketing at schools, availability of needle exchange centers at the nearest health centers. The involvement of local health workers to provide HIV related education and door to door needle exchange program to the identified drug users has decreased the HIV related stigma and has added further impetus to the disease control . Similarly, the Thai government realizing the threat of HIV due to the open sex industry in the country allocated a yearly budget of 1.5 million dollars for free distribution of condoms to the sex workers in the possible workplaces. The distribution was accompanied by mass awareness through peer education in universities and schools as well as a mobile van awareness campaign for the community [17,18].
Despite many success stories, social, cultural, political and economic barriers are often encountered while running BCC campaigns . At times the messages conveyed through BCC campaigns on HIV can be sensitive to a particular group or community and can make a negative impact to some traditional and cultural values. Though sex workers and drug users accounted to 50% of the population in 2005 in one of the provinces in China, these issues were illegal and not openly discussed in public so a mass media campaign on these issues in China was impossible . Similar resistance was experienced in Thailand when a condom promoting campaign targeting adolescents and young adults was launched using the slogan “Proud to Carry Condoms”. This campaign was heavily criticized and received negatively by conservative groups and parents citing it to be against the cultural values of the country . Media campaigns have not always worked in terms of HIV due to economic constraints. A mass media campaign could not be sustained in Louisiana in the United States due to the high expense incurred in creating and continuing it over a period of time . For developing countries factors such as availability of resources such as electricity, television, radios in rural settings play a significant role in the type of BCC campaign to be launched. The radio opera in Tanzania was a huge success where radio message were found to be preferred to the television advertisements due to the availability of radios in majority of households .
HIV AIDS has been a constant major health issue and still remains a challenge for policymakers and governments all over the world. However, over the years the use of BCC and social marketing campaigns has brought about a considerable decrease in the incidence of the disease and improvement in the quality of life of the population living with it. The high cost incurred in running BCC campaigns and the resistance faced due to traditional and cultural barriers has proven to be the major obstacles. With all these components, it is found that behavior change in a population is not an immediate process. It generally requires a longer period of time for people to believe, understand and use the knowledge of such campaigns in their regular practice. Another factor that plays a huge role in the success of campaign is the use of multiple channels for dissemination of information and key messages. The campaigns should also create a sense of ownership among the target groups through active community participation. The use of social marketing in ensuring availability and accessibility of resources such as condoms and syringes at an affordable price also plays a major role in bringing about positive behavior change. Successful BCC campaigns conducted in the past can always be used as an example and be replicated in other countries where HIV still persists as a major threat.