Communication Challenges in HIV Prevention: Multiple Concurrent Partnerships and Medical Male Circumcision

This four-page briefing note, published by Panos' Global AIDS Programme, presents a summary of findings from a pilot research project in Uganda in 2009. The broad objectives of the research were: to examine how contemporary communication approaches on HIV prevention, specifically multiple concurrent partnerships (MCP) and medical male circumcision (MMC), address social and structural drivers; and to stimulate debate on some of the key communication challenges around HIV prevention. The findings suggest that there is a need to complement any roll-out of programmes on MCP and MMC with social communication programming that addresses the structural and social drivers of HIV. Technical interventions which do not take into account these social dimensions of HIV may not be very effective.

Data for the study was collected via focus group discussions with community members; interviews with community and opinion leaders who were likely to influence the decision-making process in the community; and a review of existing documentation on MMC and MCP including national policies and programmes.

The study found that most respondents were able to articulate clearly what they understood by MCP, and generally recognised the role MCP plays in driving the spread of HIV. Respondents gave a number of reasons why people engage in MCP including: it is a sign of masculinity; it is part of the culture; it is retaliation for a partner's infidelity or abuse; poverty may make women turn to commercial sex; women and girls seek higher economic status which sometimes leads to cross-generational sex; and complacency about HIV, specifically in the younger generation.

The document explains that several national campaigns have encouraged young people to abstain and married couples to be faithful, but few have addressed MCP head on. Only one campaign by the Uganda Health Marketing Group seeks to encourage people to reduce their number of sexual partners. It uses community mobilisation, radio, television, and printed materials. However, most of the campaign is limited to the capital, Kampala, and urban areas. Also, the two radio spots in local languages focus on fidelity and not partner reduction. According to the report, addressing practices that are deeply rooted is challenging and many respondents were pessimistic about whether changes in people's attitudes would be long-lasting.

The briefing report also includes findings on male circumcision. According to the research, all respondents knew of the importance of MMC in HIV prevention, and the practice is gaining popularity in Uganda. Other reasons for circumcision included: fulfilling religious duties; increasing sexual pleasure; hygiene and preventing/curing sexually transmitted infections; and cosmetic reasons. According to the report, some misconceptions and fears around circumcision still remain, including: that male circumcision fully protects against HIV; that the procedure may not be safe; and that it could lead to impotency, infertility and loss of libido.

The research showed that most rural community members received information about circumcision through community outreach efforts, radio programmes, health workers, and health centres. A communication strategy around safe circumcision has been created in partnership with the government, the Health Communication Partnership, and the World Health Organization (WHO), though it has yet to be implemented.

The report includes some key lessons learned, including:

• respondents felt current messages were not effective in changing behaviour;
• messages on MCP are not reaching rural areas in accessible languages and formats;
• MCP and MMC policies, programmes, and communication do not take into account the traditional norms and perceptions surrounding masculinity that shape individual attitudes; and
• campaigns and communication need to be accompanied by adequate services and supplies for MMC.

The brief also notes that it is important to address prevailing myths and misconceptions around MMC. More research is needed to understand communities' perceptions of communication campaigns, as well as to understand the social and structural drivers of HIV, including culture, masculinity, and gender, with particular reference to MCP. More research is also needed to explore how participatory approaches could best address MCP and MMC, particularly with people who have less power and access to information. More attention also needs to be paid to communication in rural communities and how these communities prefer to communicate.