Republic of Botswana: National Campaign Plan - Multiple Concurrent Partnerships

From the Executive Summary of this National AIDS Coordinating Agency Botswana (NACA) document:

"The practice of having two or more sexual partners over the same period of time - multiple concurrent partnerships, or MCP - is recognised as a key driver of HIV transmission in Botswana. The 'National Operational Plan for Scaling Up HIV Prevention in Botswana, 2008-2010' calls for Botswana to embark on a... multi-year behaviour change campaign, with MCP identified as the initial focus for the campaign. This document presents a nationally-agreed plan, ...the product of an intensive, multi-sectoral process, involving national- and district-level policymakers, managers and implementers from across the public sector and civil society, all under the guidance of the National HIV Prevention Technical Advisory Committee.

....One of the most important insights from the research [quantitative and qualitative findings relating to the nature and extent of MCP and the factors that drive MCP - available in the document annexes] is that MCP is not a single phenomenon but a complex and multi-faceted one driven by a combination of factors, both traditional and modern. Treating MCP as a uniform, monolithic behaviour obscures the variety of motivations that prompt individuals to have partners in addition to their primary ones, and the functions that these additional relationships fulfil....A typology that characterises the different forms that MCP takes is presented in the plan [chart on page 4], and this understanding of the complexity of the phenomenon underpins the approach taken in the campaign.

The campaign will address MCP in all its forms, but will have a strategic focus on young women [aged 18-24 (the median age of sexual debut for women is 18.2)] and adult men [aged 25-35]. Messages will address the key factors... that drive and motivate young women and adult men to engage in MCP. These include lack of knowledge about concurrency and HIV risk and related calculations that individuals make about the costs and benefits of having concurrent partners; consumerism; and gender, relationship, and peer-to-peer norms and values about sex and relationships. Another priority for the campaign will be the problem of inter-generational sex.... The campaign will combine approaches that create individual desire to adopt and maintain safe behaviours and those that create enabling environments for sustained behaviour change. Consumer-centred messaging will be developed to promote the relevant benefits of behaviour change and to shift the values and norms....

These messages will be disseminated through channels that prompt reflection, catalyze discussion and debate, role-play alternative behaviours and values, leverage supportive cultural norms and encourage those at risk to identify ways to overcome barriers to change. This will happen through a combination of standalone messaging (which will take a variety of forms, ranging from one-on-one discussions in communities and settings such as schools and churches to community theatre to radio and television spots) and the integration of MCP messages into existing HIV/AIDS and sexual and reproductive health activities (from HIV counselling and testing to support for adherence to antiretroviral therapy to life skills discussions with youth). Institutions and programmes that reach different populations who are at risk because of MCP will be assisted to mainstream MCP messages and adapt communications materials, enabling the campaign to reach youth and adults, males and females, rural and urban populations, poorer and more affluent people.

From the outset, there will be a focus on engaging leaders at national and community level and sensitizing and supporting partner institutions. Sensitization and advocacy efforts will be spearheaded by a team of ‘MCP Ambassadors’, acceptable, credible opinion leaders who can engage key individuals and institutions in the campaign to reduce MCP. The campaign will be characterised by a strong visual identity and a consistent central message, but specific messages for different target audiences will evolve as the campaign progresses, to maintain interest and provide solutions to the needs and challenges target groups face as they gain awareness, reflect and attempt to change and maintain behaviour...."

From the section Promoting Behaviour Change:
"The campaign’s approach to behaviour change will be based on premise that sustained behaviour change can only be achieved if there is a desire to change within the individual and if there is an enabling environment.... To create desire... within individuals, the campaign will adopt a consumer-centred approach.... Target audiences will be offered clear alternatives to their current behaviours, and these alternatives will be promoted, or positioned, by means of benefits that are relevant, attractive and important to people’s lives. At the same time, the campaign will shift perceptions of the risks and costs of MCP.... To create an enabling environment for adoption and maintenance of new behaviours, the campaign will focus on the values and norms that shape target groups’ lives. Behaviour change will be promoted via approaches that stimulate debate, drawing on cultural traditions of oral communications, dialogue and group interaction, and acting as a catalyst for target groups to generate their own ways of overcoming barriers to behaviour change. Communications will present and role-play alternative values, norms and scripts to those that are currently driving MCP in ways that are, while leveraging positive cultural norms and values, thus targeting the points of conflict about MCP that exist within the minds of target audiences. [Page 15 outlines the phases of behaviour change with a message focus and a communications objective for each phase.]

...A campaign symbol / slogan will be created that commands attention, creates momentum and belonging, and promotes a consistent central message. This central message will be prominently displayed on signage everywhere that MCP is being addressed (for example, banners in public places and posters in clinics, schools and churches). The campaign symbol will also be prominent in mass media communications and on all communications materials created for the campaign...."

The document concludes with sections on rolling out the campaign and on research, monitoring, and evaluation, as well as a logical framework that sets out the indicators against which the national campaign coordinating unit will report to NACA (through the National HIV Prevention Technical Advisory Committee [TAC]), and the information they will collect from districts and implementing partners.