C-Change Picks - Focus on MCP and Gender Issues

C-Change Picks #12 - Focus on MCP and Gender Issues
Information about Social and Behaviour Change Communication, sponsored by C-Change
April 12 2010

From The Communication Initiative (The CI) and the United States Agency for International Development (USAID)'s C-Change programme.

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C-Change Picks is an e-magazine supported by C-Change and implemented by The Communication Initiative that focuses on recent case studies, reports, analyses, and resources on social and behaviour change communication (SBCC) in the health sector - in particular HIV and AIDS, family planning and reproductive health, malaria, and maternal and antenatal health - as well as in the environmental sector. If you have received this newsletter from a friend or colleague and would like to subscribe, please contact cchange@comminit.com

C-Change Picks 12 focuses on multiple concurrent partnerships (MCP), a major driver of HIV in Africa, and on gender issues in the context of HIV. It closes with a focus on faith-based responses to HIV prevention programmes that address MCP and gender-based violence.

C-Change completed the first of a multi-part capacity strengthening monitoring and evaluation training in Namibia in March 2010. The training strengthens the capacity of local partners and agencies to monitor outcomes and results of their SBCC programmes. Role playing and hands-on practice allowed participants to apply the skills they were learning, which included interview techniques, how to administer a questionnaire designed to measure outcomes, and how to use a corresponding database to store collected data. Participants will return for further C-Change training in June. See the C-Change website for additional information on C-Change’s capacity strengthening work around SBCC.

C-Change recently finalised and launched the C-Modules: A Learning Package for Social and Behavior Change Communication for facilitated, face-to-face workshops on SBCC. The C-Modules focus on essential SBCC competencies for each of the five key stages of developing an effective SBCC programme. The package includes a series of six modules with accompanying facilitator guides for communication practitioners working in development. This package is designed for staff of development programmes in small and medium-sized organisations with varying degrees of experience in planning or implementing SBCC programmes.

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The C-Change Capacity Strengthening Online Resource Center (CSORC) is now live and linked from the C-Change Picks website.

The CSORC is dedicated to providing the resources and opportunities needed to strengthen capacity in the important area of SBCC. It offers resources and practical tools - including links to the C-Modules mentioned above as well as other C-Change SBCC training tools.

Please visit the CSORC - click here!

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Please visit the C-Change Picks website for more resources and thinking recently highlighted by the C-Change programme.

You will find the current edition of the C-Change Picks e-magazine online.

For the archived issues of the C-Change Picks e-magazine, please click here.

C-Change Picks continues to seek new knowledge and experiences in social and behaviour change communication - your case studies, strategic thinking, support materials, and any other relevant documentation. Please contact cchange@comminit.com


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In this Issue...

GENDER ISSUES AND HIV

1. Masculinity, Rape, and HIV in South Africa
2. Multiple Concurrent Partnerships and Gender Power Dynamics

MCP AS A DRIVER OF HIV

3. Assessing Multiple and Concurrent Sexual Partnerships Among Basotho Men in Lesotho
4. The Language of MCP, Sex, and HIV and AIDS in Lesotho
5. Lessons from a Hard-Hitting Mass Media MCP Campaign in Swaziland
6. The Role of Sexual Dissatisfaction in MCP in South Africa
7. National MCP Communication Plan - Botswana
8. Understanding Why MCP
9. Southern African Policy Guidance for MCP Programming
10. Defining, Measuring, and Identifying a Future Research Agenda for MCP

SOME FAITH-BASED RESPONSES

Published by the Gender and Health Research Unit of the Medical Research Council (MRC) in June 2009, "Understanding Men's Health and Use of Violence: Interface of Rape and HIV in South Africa" is based on research in South Africa that sought to: clarify the prevalence of rape perpetration in a random sample of community-based adult men; understand factors associated with rape perpetration; and describe intersections between rape, physical intimate partner violence, and HIV. The authors note that high levels of rape are rooted in negative conceptions of masculinity. They argue that the problem cannot be addressed solely through criminal prosecution, but requires a broader approach that addresses these conceptions of manhood.


2. Multiple Concurrent Partnerships and Gender Power Dynamics

This poster presentation, exhibited at the 2009 meeting of the International AIDS Society in Cape Town, South Africa, examines MCP in South Africa's Eastern Cape Province. The presentation suggests that the practice of having multiple concurrent partnerships is culturally sanctioned in many parts of South Africa and is often inextricably linked to gender power differentials. Power imbalances in sexual relationships can hinder healthy couple communication and negotiation for safer sex, and may facilitate gender-based violence, which in turn can increase women's vulnerability to HIV. The presentation concludes by recommending that programmes seeking to reduce the prevalence of MCP in the country must also address issues of gender inequality and gender-based violence within relationships and should be designed for both men and women.

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MCP AS A DRIVER OF HIV


3. Assessing Multiple and Concurrent Sexual Partnerships Among Basotho Men in Lesotho

Published by C-Change in July 2009, "A Baseline Survey of Multiple and Concurrent Sexual Partnerships Among Basotho Men in Lesotho" presents the findings from a survey conducted by C-Change in March 2009 in order to collect population-based data related to the MCP knowledge, attitudes, and practices of Basotho men and to consider appropriate communication channels for HIV prevention messages. The report suggests that in designing media campaigns, messages do not need to concentrate on the protective benefits of condoms or the dangers of MCP, per se, recommending more nuanced messages that discuss the need to use condoms with steady partners, the high risk when MCP and intergenerational sex are combined, and the need to balance having fun with the risks associated with MCP. In addition, the study recommends increasing awareness of where men can obtain condoms, as well as encouraging the practice of carrying condoms, as this may be a cause of the relatively inconsistent condom use.


4. The Language of MCP, Sex, and HIV and AIDS in Lesotho

Also published by C-Change in July 2009, "The Language of Multiple Concurrent Partners, Sex, and HIV and AIDS in Lesotho: Opportunities for Dialogue Promotion Research Report" analyses formative research carried out by C-Change to understand how culturally-embedded communication about HIV and AIDS and sexual behaviour contributes to sustaining the practice of MCP in Lesotho. According to the report, the findings from qualitative research along with a review of existing research is informing message development for a short-term communication campaign in Lesotho focusing on HIV prevention through the promotion of dialogue about MCP. The report suggests that opportunities for intervening in language, promoting dialogue, and community mobilisation should pay attention to the fact that dialogue about sex and MCP using open and direct language runs counter to indigenous concepts of respect and social status and risks provoking a backlash.

5. Lessons from a Hard-Hitting Mass Media MCP Campaign in Swaziland

This September 2009 AIDSTAR-One case study, "Secret Lovers Kill: A National Mass Media Campaign to Address Multiple and Concurrent Partnerships," is about a national media campaign in Swaziland which focuses on HIV prevention, with a specific focus on MCP. Launched by the government's National Emergency Response Council on HIV/AIDS (NERCHA) in 2006 with controversial and blunt messages about the practice of "secret lovers", the campaign sparked passionate national debate in the media and in communities about the practice of makhwapheni. According to survey data, the number of men reporting two or more partners dropped by 50% immediately after the campaign began. However, the campaign was suspended due to objections raised about the stigmatising effect of what was termed fear-based advertising. This case study shows that if direct and hard-hitting campaigns are being designed, attention must be given to ensuring that groups within the community are not stigmatised as a result of unintended messages.


6. The Role of Sexual Dissatisfaction in MCP in South Africa

"The Role of Sexual Dissatisfaction in Driving Multiple Concurrent Partnerships," presented by Soul City Institute for Health and Development at the 4th South African AIDS Conference in 2009, looks at the role of sexual dissatisfaction and lack of partner communication in driving MCP in South Africa. The overall aim of the research was to gain insight into the audience's understanding, attitudes, and practices around sexual relationships in the context of HIV prevention. The author argues that sexual dissatisfaction and partner communication around sex must be addressed as part of a strategy to decrease MCP.


7. National MCP Communication Plan - Botswana

"Republic of Botswana: National Campaign Plan - Multiple Concurrent Partnerships", published in March 2009 by the National AIDS Coordinating Agency Botswana (NACA), outlines a multi-year behaviour change campaign, with a focus on MCP as a key driver of HIV transmission. One insight from the research that underpins this plan 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. According to this plan, 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 and this understanding of the complexity of the phenomenon underpins the behaviour change approaches taken in the campaign.

8. Understanding Why MCP

In "Why Multiple Sexual Partners?" published in August 2009 in The Lancet, James D. Shelton examines behavioural components of MCP. As stated by Sheldon: "Understanding why people have multiple partnerships is key to efforts to change behaviour, with the realisation that behaviours range from polygamy itself, to longer term quasi-polygamy (sometimes described as having a 'small house'), to sporadic sexual encounters." Shelton provides a brief review of one campaign to address MCP in Botswana: "O Icheke - Break the Chain - campaign," led by the NACA with help from Population Services International and other partners. He concludes by suggesting that behaviour change projects on MCP, along with the promotion of male circumcision and use of condoms, especially for high-risk sex, appear to be the most promising way forward for preventing hyper-epidemic HIV transmission.


9. Southern African Policy Guidance for MCP Programming

A 2-day meeting on "Addressing MCP in Southern Africa: Developing Guidance for Bold Actions" which was co-hosted by the AIDS Prevention Research Project (APRP) at Harvard University, the World Bank, and the Joint United Nations Programme on HIV/AIDS (UNAIDS), brought together various organisations working in the southern Africa region with the aim of establishing a common vision and agenda to guide interventions and strategies addressing MCP. Key principles for future MCP programming are outlined here, including that programming "must be based on sound evidence regarding the epidemic and the existing responses and unmet needs. It needs to be a coherent strategy and to operate at different levels, but with the specific solutions and messages to be community-driven. Both social transformative and individual behaviour change approaches are required, and there must be consistency and complementarity between them and in the approaches taken by the various stakeholders."


10. Defining, Measuring, and Identifying a Future Research Agenda for MCP

"Consultation on Concurrent Sexual Partnerships: Recommendations from a meeting of the UNAIDS Reference Group on Estimates, Modelling and Projections held in Nairobi, Kenya, April 20-21st 2009" outlines recommendations that emerged from a meeting that brought together experts who worked to: reach consensus on a standard definition of "concurrent sexual partnerships", recommend methods for measuring concurrency in a population, and set out a future research agenda around the study of concurrent sexual partnerships and its association with HIV transmission. The report closes with a detailed description of a future research agenda which includes methodological, epidemiological, and "innovative" research designs.

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SOME FAITH-BASED RESPONSES


11. Religious Leaders Mobilize a Faith-based Response to HIV in Kenya

This September 2009 brief, prepared by USAID's Health Policy Initiative, shares strategies and lessons learned from the Health Policy Initiative's work to help support the Kenya Network of Religious Leaders Living with or Personally Affected by HIV/AIDS (KENERELA+). This group seeks to equip, empower, and engage religious leaders living with or personally affected by HIV and AIDS to live positively and openly as agents of hope and change. “Finding Courage in Faith: Religious Leaders Challenge Stigma and Mobilize a Faith-based Response to HIV in Kenya” states that one of the keys to KENERELA+'s success has been the cultivation and support of strong individual champions. In addition, KENERELA+ says that successful implementation and delivery at the grassroots level is more effective than centralised action.


12. MCP Attitudes and Perceptions of Community Leaders of Faith

Published by the Pan African Christian AIDS Network (PACANet) in January 2009, this report shares findings from a survey that sought to access churchgoers' perceptions about MCP and the church's response to these relationships, with a view that church leaders must understand the attitudes and perceptions surrounding these relationships in order to develop effective interventions. "Multiple Concurrent Partnerships and the Church: Assessing the Attitudes and Perceptions of Community Leaders of Faith," which collected data across denominations, found that members of evangelical churches in Africa were less likely to perceive MCP as a problem within their congregations. Additionally, most tended to explain MCP by drawing on gender stereotypes, saying that women participated in such partnerships for economic reasons while men's "natural and social impulses" drove them to seek multiple partners.


13. The Role of Religious Communities in Addressing Gender-Based Violence and HIV

This August 2009 report summarises a USAID Health Policy Initiative project which was designed and implemented in Africa by Futures Group International and Religions for Peace. Recognising the importance of collaborating to prevent and reduce gender-based violence (GBV) and HIV among women and girls, the initiative partners worked to improve the capacity of religious leaders and faith-based organisations to respond to GBV and its links to HIV. This report details the project’s process and identifies lessons learned.

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UPCOMING EVENTS

14. HIV/Culture Confluence: Changing the River's Flow – April 12-13 – South Africa

15. XVIII International AIDS Conference (AIDS 2010) – July 18-23 – Austria

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Communication for Change (C-Change), implemented by AED, is USAID's flagship programme to improve the effectiveness and sustainability of social and behaviour change communication programmes, activities, and tools. C-Change works with global, regional, and local partners to incorporate knowledge about the social determinants and underlying causes of individual behaviours and takes into account research and lessons learned from implementing and evaluating activities. Employing innovative and tested methods, C-Change works to meet the continuing challenges posed by evolving health issues that require a behaviour change communication approach. C-Change also works to strengthen the capacity of local organisations to plan, implement, and manage programmes, thus ensuring sustained local knowledge and skills. Please visit the C-Change website. To contact C-Change, please email cchange@aed.org

The Communication Initiative (The CI) network is an online space for sharing the experiences of, and building bridges between, the people and organisations engaged in or supporting communication as a fundamental strategy for economic and social development and change. It does this through a process of initiating dialogue and debate and giving the network a stronger, more representative and informed voice with which to advance the use and improve the impact of communication for development. This process is supported by web-based resources of summarised information and several electronic publications, as well as online research, review, and discussion platforms providing insight into communication for development experiences. Please see The CI website .

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This publication is made possible by the support of the American people through the United States Agency for International Development (USAID) under the terms of Agreement No. GPO-A-00-07-00004-00. The contents are the responsibility of the Communicative Initiative and the C-Change project, managed by AED, and do not necessarily reflect the views of USAID or the United States Government.


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The CI Partners: ANDI, BBC World Service Trust, Bernard van Leer Foundation, Calandria, CFSC Consortium, CIDA, DFID, FAO, Fundación Nuevo Periodismo Iberoamericano, Ford Foundation, Healthlink Worldwide, Inter-American Development Bank, International Institute for Communication and Development, Johns Hopkins Bloomberg School of Public Health Center for Communication Programs, MISA, PAHO, The Panos Institute, The Rockefeller Foundation, SAfAIDS, Sesame Workshop, Soul City, Swiss Agency for Development and Cooperation, UNAIDS, UNDP, UNICEF, USAID, WHO, W.K. Kellogg Foundation.
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