C-Change Picks - Focus on HIV Prevention

C-Change Picks #9 - Focus on HIV Prevention
Information about Social and Behaviour Change Communication, sponsored by C-Change
September 8 2009

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

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 in the health sector - in particular HIV and AIDS, family planning and reproductive health, malaria, and maternal and antenatal health - and 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 #9 focuses on social and behaviour change communication (SBCC) strategies for HIV prevention. A mix of approaches to HIV prevention programming are highlighted within this issue, through research reports, case studies, and evaluations. The approaches include combination programming; integrating services; mass media strategies; interpersonal communication methods; and capacity building.

C-Change is working in Namibia to strengthen the capacity of partners and local NGOs to apply SBCC programming to their work in the prevention of HIV transmission. C Change developed a tool to assess an organisation's SBCC capacity in three core areas: planning and design, programme implementation, and monitoring, evaluation and research. (Click here to download the tool).

Using the tool, C-Change/Namibia has identified gaps among the organisations it has assessed that include: lack of programme focus on behavioural outcomes; lack of behavioural analysis of target audiences; lack of appropriate information, education, and communication (IEC) materials related to drivers of the HIV epidemic; inadequate training materials; and tools not updated to reflect current information about the drivers of HIV. As a result, C-Change has developed and implemented a systematic, stepped approach to strengthening organisations' capacities in the basics of SBCC and HIV prevention programming that meet standards of quality for SBCC, are evidence-driven, and are focused on the drivers of the epidemic. For more information, visit the C-Change website - click here.

In this Issue...

SPOTLIGHT ON SBCC TOOL

1. Social and Behaviour Change Communication (SBCC) Capacity Assessment Tool

FOCUS ON HIV PREVENTION

PROMISING PROGRAMMING FUSIONS

2. Promising Approaches to Combination HIV Prevention Programming
3. Evaluation of a Programme to Reach Transport Workers and CSWs in Ethiopia/Djibouti
4. Findings on South African HIV Prevalence, Incidence, Behaviour, and Communication

PROMISING CAPACITY BUILDING APPROACHES

5. HIV Prevention and Mitigation through Entrepreneurship in DRC
6. Expanding the Capacity of the Broadcast Media in Africa

INTEGRATING SERVICES: HIV/AIDS and FAMILY PLANNING

7. Integrating HIV Prevention and Counselling and Testing for HIV within Family Planning Services in South Africa
8. Integrating Counselling and Testing for HIV within Family Planning Services in Kenya

ASSESSING MASS MEDIA APPROACHES
9. Impact of a Regional Mass Media HIV Prevention Programme in Southern Africa
10. Impact of a Mass Media HIV Prevention Programme in Nicaragua
11. Evaluating the Trusted Partner Campaign in Four Sub-Saharan African Countries

REFLECTING ON INTERPERSONAL APPROACHES

12. Community Conversations to Address Harmful Traditional Practices and Reduce Stigma in Ethiopia
13. Thailand Turns to Education and Dialogue for Youth
14. Boosting Prevention through Interactive Games and Conversation

SPOTLIGHT ON SBCC TOOL

1. Social and Behaviour Change Communication (SBCC) Capacity Assessment Tool

This tool and an accompanying worksheet have been developed by C-Change for use in workshop and meeting venues in which an organisation and a facilitator work to determine an organisation's competencies in three areas:

• SBCC planning
• SBCC programme implementation
• SBCC research, monitoring, and evaluation

The intention is that by using this Tool, programme planners can identify the strengths and weaknesses of current programmes, and define activities to strengthen and refocus programmes to improve the overall quality of their SBCC efforts.

This Tool can be adapted for use across a wide variety of health areas, including: HIV and AIDS; malaria; family planning; and maternal, sexual, and reproductive health. Users are encouraged to adapt sections of the Tool or use the particular components that best address their needs in assessing capacities of organisations implementing SBCC programmes.

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FOCUS ON HIV PREVENTION

PROMISING PROGRAMMING FUSIONS

2. Approaches to Combination HIV Prevention Programming

Presented at the June 2009 HIV/AIDS Implementers' Meeting held in Namibia, "A Systematic Analysis of Three Promising Approaches to Combination HIV Prevention Programming" explores "combination HIV prevention", which includes a mix of strategies and risk reduction approaches that use current epidemiological and programmatic evidence to address different audiences with simultaneous behavioural, biomedical, social, normative, and structural interventions.

The AIDS Support and Technical Assistance Resources Project, Sector 1, Task Order 1 (AIDSTAR-One)'s Good and Promising Programmatic Practice (G3P) database was used to identify 25 promising combination programmes, 3 of which were selected to feature in this study: the AIDS, Population and Health Integrated Assistance Program (APHIA-II) Project (implemented in Kenya by Family Health International (FHI); the Avahan-India AIDS Initiative; and Alliance-Ukraine.

For each of the 3 interventions, a case study involving 2 weeks of field observation and a review of programme documents was conducted. Programmes were assessed along 3 dimensions, including the simultaneous implementation of: several risk-reduction options (behavioural, biomedical, and structural); activities to increase appropriate leadership and political support; and activities to increase community involvement.

Core components of combination prevention identified in this presentation are:

1. Know your epidemic - Track the epidemic, drivers, and underlying risk factors, changing the composition of the response - and the activities that compose it as the epidemic (or what we learn about it) changes.
2. A mix of activities that produces a maximum effect in a given setting - Add new activities, introducing innovative approaches to solve "old" problems and bringing in new areas of programming to tackle underlying factors that increase vulnerability.
3. A core commitment to strengthening civil society and the local response - The programme should engender confidence, skills, and commitment to community and pride in accomplishments among peers, staff, and participants.
4. Policy engagement and advocacy at all levels.

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USAID Ethiopia and Save the Children USA (SC/USA) together launched the High Risk Corridor Initiative (HRCI) in 2001 in both Ethiopia and Djibouti as a prevention programme to address the high HIV transmission rates among transport workers and commercial sex workers (CSWs) in 21 towns along a busy transportation corridor originating in Addis Ababa that has two separate routes to the border with Djibouti. Over its course, the HRCI programme expanded to link prevention efforts with strategies for care and support for PLWHA, and to broaden its prevention programme to additional intended audiences, especially in- and out-of-school youth who engage in high-risk activities.

As detailed in "Final Evaluation: USAID/Ethiopia High-risk Corridor Initiative", HRCI incorporated information dissemination (HIV/AIDS information centres), peer education activities, school- and community-based prevention outreach for young people, VCT service strengthening, community home-based care for PLWHA, and interactive drama. Core strategies detailed and evaluated in the document include: increase of prevention practices and demand for services; utilisation of the oral tradition that is embedded in Ethiopian coffee ceremonies; increase availability of and access to prevention and treatment services; provision of care and support services, including food support; and enhancement of livelihoods.

Recommendations for future planning include:

1. explore partnerships with larger private industries in Ethiopia (e.g., in the pharmaceutical industry) to mobilise more resources for responding to HIV.
2. explore partnerships with businesses along the corridor (e.g., tire manufacturers and spare parts businesses).
3. expand local partnerships (e.g., with hotels that give food to PLWHA) along the corridor.
4. build the palliative care knowledge and skills of HBCVs and nurse supervisors by linking with University of California San Diego (UCSD) and I-Tech.
5. add "care for the caregiver" trainings for HBCVs, family caregivers, nurse supervisors, and spiritual counsellors.
6. provide regular skilled support for volunteers who make home visits to sick clients.
7. include at-risk populations in the design of strategies and messages intended to change the risky behaviours.
8. ask community and religious organisations to fund lower-cost activities, such as coffee ceremonies and Community Conversations, which have proven successful in educating communities about HIV.

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This report is the third in a series of population-based HIV seroprevalence surveys, which started in 2002 and were repeated in 2005 and again in 2008. "South African National HIV Prevalence, Incidence, Behaviour, and Communication Survey, 2008: A Turning Tide Among Teenagers?" seeks to assess the national HIV prevention response in relation to the goals set in the HIV & AIDS and STI Strategic Plan (NSP), in particular, to reduce HIV incidence by 50% by 2011. The research found that although the overall situation remains dire, some solid progress has been achieved, especially among teenagers and children.

According to the report, a wide range of national and sub-national HIV/AIDS communication programmes exist in South Africa. These include national communication programmes conducted by government and non-governmental organisations (NGOs); programmes within schools, universities, and workplaces; provincial government programmes; sub-national programmes led by NGOs; and interactive communication, including community-level campaigns such as door-to-door activities, community theatre, and events. Specific findings on what South African prevention programmes have achieved are outlined and further challenges are identified.

Recommendations include:

• more carefully designed intervention programmes in some provinces;
• programmes to help people to have children without risking HIV;
• addressing high sexual partner turnover and intergenerational sex by focusing on changing norms at community level;
• implementing provider-initiated routine HIV testing at all health care facilities;
• increasing communication programme reach; and
• defining country-specific indicators including for most-at-risk populations.

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PROMISING CAPACITY BUILDING APPROACHES

5. HIV Prevention and Mitigation through Entrepreneurship in DRC

This report is the result of a rapid assessment conducted by Education Development Center, Inc. (EDC) in collaboration with Family Health International (FHI) in Bukavu, Democratic Republic of Congo (DRC), in August 2008. This research builds upon the Regional Outreach Addressing AIDS through Development Strategies (ROADS) programme, which is an HIV/AIDS prevention initiative created by USAID/East Africa and currently implemented by FHI in 26 vulnerable communities along the transport corridors of 8 countries in East and Central Africa.

Since 2005, ROADS has been working at 3 Bukavu sites with 23 indigenous youth associations that form 3 Youth Cluster groups consisting of both in-school youth from 22 local secondary and tertiary institutions and out-of-school youth, including street youth, AIDS orphans and vulnerable youth, ex-combatants, teenage mothers, and sex workers. The clusters mobilise youth for HIV prevention using participatory theatre and other methodologies, promoting counselling and voluntary testing, undertaking home visits for persons living with HIV and AIDS, sensitising community members on gender-based violence (GBV) and alcohol abuse, providing condom distribution outlets, and referring persons to local HIV/AIDS services.

The proposed capacity-building project will start with initial and basic orientation training in entrepreneurship for 100 young people who are currently involved in some level of economic activity, and will include a business simulation game. Those 100 young people will be invited to submit a description of a business idea. Of these, 60 will be selected based on market relevance, representation of group involved (e.g., at least 60% girls as entrepreneurs), and potential for growth. The youth submitting the 60 selected ideas will enter a training and coaching process designed to help them refine the business ideas and develop a business plan for implementing them. The 60 participants will submit their business plans for assessment; those 20 whose business plans are selected for further support will attend more formal entrepreneur workshops. A number of other activities will include all 100 participants in order to help them build their ideas, skills, and knowledge in small and micro business development.

This document describes in detail the proposed project plan, activities, and monitoring and evaluation strategy.

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6. Expanding the Capacity of the Broadcast Media in Africa

The African Broadcast Media Partnership Against HIV/AIDS (ABMP) is a pan-African coalition of broadcast companies created to reinvigorate and increase the effectiveness of broadcast media's contribution to the fight against HIV/AIDS. In February and March 2008, a study was conducted on the implementation of the ABMP and its impact in a select number of participating broadcast companies. The research took place in seven African countries (Kenya, Madagascar, Mozambique, Nigeria, Senegal, Swaziland, and Tanzania) with 18 broadcasting companies and 36 external stakeholder organisations surveyed, resulting in a data-set of 100 face-to-face interviews. The aims of the survey were to: assess the extent to which the key objectives of the ABMP are being implemented; find out how surveyed countries perceive the benefits and challenges of participating in the ABMP; examine institutional opportunities and limitations; and gauge perceived contribution to national HIV/AIDS efforts of the sample broadcasters. This resulting report, entitled “Implementation of the African Broadcast Media Partnership Against HIV/AIDS and its Impact in a Select Number of Participating Broadcast Companies,” found that the ABMP contributed to national HIV/AIDS campaigns and that broadcasters also benefited from improved technical capacity.

The survey found that there are five broad types of impact that the ABMP has made on participating companies: fostering collaboration, learning, increasing HIV/AIDS as a programming focus, targeting the youth, and increasing viewership. Most respondents indicated that the ABMP has prompted increased coordination between broadcasters and governments and between broadcasters and organisations. Some also noted that it has helped improve or market their own content. Some respondents found that it increased social responsibility and consciousness. The survey found that respondents learned a lot about HIV/AIDS and about producing high quality creative programming. One respondent also noted that the coalition facilitated organisational learning. For many respondents, a major impact of the ABMP is its ability to make stations incorporate more HIV/AIDS issues in their programmes in a more creative way.

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INTEGRATING SERVICES: HIV/AIDS and FAMILY PLANNING

7. Integrating HIV Prevention and Counselling and Testing for HIV within Family Planning Services in South Africa

The two models studied within "Feasibility, Acceptability, Effectiveness and Cost of Models of Integrating HIV Prevention and Counseling and Testing for HIV within Family Planning Services in North West Province, South Africa," published in September 2008, are the Testing Model - which educated family planning (FP) clients about HIV and AIDS counselling and testing (C&T) and offered C&T within the FP consultation by an FP provider - and the Referral Model - which educated FP clients about C&T and then referred interested clients for testing and post-test counselling to a specialised C&T service. Key interventions included: (a) holding sensitisation meetings at the national, provincial and district levels; (b) reviewing and developing training materials; (c) application of the Balanced Counselling Strategy Plus (BCS-Plus) approach; (d) modification of registers for collection of FP and C&T statistics; and (e) training of health providers.

The study found that both models increased the numbers of people aware of C&T and the numbers of people interested in testing. Increases in discussing the client's HIV serostatus changed from 5-6% at baseline to 62-81% at endline. Both models used the BCS-Plus Toolkit, developed by FRONTIERS, effectively to integrate HIV prevention activities, including education about prevention, dual protection, and counselling and testing within FP services. Providers acknowledge that the training capacitated them with the ability to discuss sexual issues with their clients freely, and it assisted in improving client-provider relation. Lastly, provider experience with clients raised a need for further training on new themes to be included in the BCS for better client services.

The document proposes the following recommendations:

• Counselling of all FP clients about sexually transmitted infection (STI)/HIV/AIDS risk behaviours and prevention can address common misconceptions, and provides the opportunity to engage with clients about their sexual behaviour and interest in HIV testing.
• Client preference for location of HIV testing should be respected and clients should be able to access services in the facility where they receive FP services or through referral.
• To assure the quality and effect of integrating services at the district level, it is important that records are kept and reported that describe the HIV services provided during FP consultations.

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8. Integrating Counselling and Testing for HIV within Family Planning Services in Kenya

The same two models - the Testing Model and the Referral Model - are studied within this July 2008 report, with a focus on the same types of interventions, but in Kenya. Seventy-five health providers were trained at a residential training of five days for the referral model and nine days for the testing model, which included an additional four days for training in HIV C&T and conducting and interpreting rapid HIV tests. Participants developed implementation action plans. Planning for and procurement of key supplies were undertaken with district-level mechanisms for sourcing, storage, distribution and replenishment of supplies. Routine data collection on FP and voluntary counselling and testing (VCT) services was strengthened. To better understand patterns of VCT utilisation, clients in both models were given a set of VCT vouchers during their FP visit. The vouchers had two parts; the front part contained information about the referring institution, while the back side contained information about the receiving institution. Once completed, the voucher was handed over to the midwife in charge of the FP clinic who then filed it. Information on the number of vouchers received was compiled on a monthly basis.

Specific sites were studied with pre-post intervention research without a control group, through facility assessments, focus group discussions with FP providers and with FP clients, observations of provider-client interactions, and client exit interviews, as well as a cost analysis.

Findings in this report, "Feasibility, Acceptability, Effect and Cost of Integrating Counseling and Testing for HIV within Family Planning Services in Kenya," showed that:

• Integrating counselling and testing for HIV into FP services is feasible and acceptable.
• Quality of family planning counselling improved.
• Quality of counselling on sexually transmitted infection (STI)/HIV issues improved.
• Counselling on condoms and dual protection and their use improved.
• Counselling on HIV C&T increased during FP consultations from 39 percent overall at baseline to 88 percent of all consultations at endline. Discussions of the client serostatus increased from 24 to 81 percent of consultations.
• Clients who were offered and obtained HIV C&T increased.
• Incremental costs for integrating C&T into FP services are affordable.

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ASSESSING MASS MEDIA APPROACHES

9. Impact of a Regional Mass Media HIV Prevention Programme in Southern Africa

This is a May 2008 evaluation of the Soul City Regional Programme (SCRP), an HIV/AIDS communication project which involves 8 southern African countries and combined the adaptation of local communication materials with a largescale capacity building programme. The Soul City Institute for Health and Development Communication identified local partners in each of the 8 countries who, with support from Soul City, set up their own health communication programme: Choose Life! in Botswana, Phela in Lesotho, Pakachere in Malawi, Nweti in Mozambique, Desert Soul in Namibia, Lusweti in Swaziland, Kwatu in Zambia, and Action in Zimbabwe. These country programmes produced a total of 20 titles in the 5-year period from 2002 to 2007. Approximately 20 million copies of these were distributed in the region. In addition, the SCRP produced a total of 11 radio drama series and 14 television documentaries/talk shows. The aim of this evaluation was to investigate the impact of the local communication interventions in each country on individuals and communities. The results of a series of surveys (baseline in 2002, mid-term in 2004, final impact in 2007) are summarised here in "Soul City Institute Regional Programme 2002 - 2007 Impact Evaluation Summary."

Overall, the 5-year evaluation of the SCRP has shown substantial reach and impact of local media interventions on individuals and communities in the 8 southern African countries. According to the report, a striking finding was a clear shift in HIV testing in all countries from 2002 to 2007, with exposure to Soul City partner interventions associated with testing in all settings. Similarly, in all 8 countries the media interventions were clearly associated with knowledge about antiretroviral treatment (ART) including knowing that one can still transmit HIV while on ART, knowing that a person can live longer on ART, and knowing that ARVs do not permanently cure AIDS. This indicates that the HIV testing and AIDS treatment messages were particularly effective in the media interventions in the region. In all of the 8 countries, stigma reduction associated with one or more of the media interventions was measured suggesting the messages were effective in shifting attitudes.

This report outlines the findings for each country.

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10. Impact of a Mass Media HIV Prevention Programme in Nicaragua

Somos Diferentes, Somos Iguales (SDSI) is a communication for social change initiative implemented by Puntos de Encuentro that aims to prevent future HIV infections in Nicaragua by means of mass communication actions, including entertainment-education (edutainment) programmes, local capacity building, and the development of links, coordination, and alliances within communities.

"Catalyzing Personal and Social Change Around Gender, Sexuality, and HIV: Impact Evaluation of Puntos de Encuentro's Communication Strategy in Nicaragua," published in June 2008, presents the results of the SDSI impact study. The purpose of the evaluation was to explore the intervention's impact on a representative group of young people, on collective processes, and on the local environment. In particular, it measured SDSI's impact on the following areas: gender equity, stigma reduction, personalisation of risk perception, knowledge and use of services, interpersonal communication, HIV prevention practices, and personal and collective efficacy for HIV prevention.

Evaluation of SDSI included household surveys, as well as in-depth interviews and focus group discussions with participants, non-participants, and key stakeholders The survey findings indicate that greater exposure to SDSI led to positive changes on a population level - all of which are detailed in the report. Broadly, the intervention resulted in a significant reduction of stigmatising and gender-inequitable attitudes, an increase in knowledge and use of HIV-related services, and a significant increase in interpersonal communication about HIV prevention and sexual behaviour. Qualitative findings indicate that SDSI played an important role in promoting community-based dialogue on key topics, strengthened youth leadership, and fostered alliances between organisations.

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11. Evaluating the Trusted Partner Campaign in Four Sub-Saharan African Countries

This September 2008 document summarises the findings of an evaluation of the Trusted Partner Campaign, a regional project implemented by Population Services International (PSI). According to this report, qualitative research conducted in urban areas of sub-Saharan Africa has found that youth may initially use condoms with a partner, but they stop condom use once they believe they can trust their partner. The Trusted Partner Campaign was developed to alter the misconceptions that resulted in a heightened sense of trust and subsequent lower consistent condom use. The campaign involved 4 television spots that focused on profiling young people whose characteristics were appealing to the opposite sex and deemed responsible and trustworthy. The end of each spot, however, showed that looks and perceptions can be deceiving, as it is revealed that each "trustworthy" person is HIV-positive. Similar storylines were used in 5 radio spots and supporting print materials for posters and billboards. All spots were run in various languages in Lesotho, Mozambique, Uganda, and Zambia.

Cross-sectional surveys of youth aged 15-24 were conducted before and after the Trusted Partner Campaign aired in Lesotho, Mozambique, Uganda and Zambia. The surveys measured three aspects of trust (caution, interpersonal trust, and received assurances) as well as condom use for youth who reported having a regular partner.

Exposure to this campaign was only associated with consistent condom use in Mozambique, and the impact was only felt among those with the highest levels of exposure to the campaign. The results of this evaluation also indicate that more intense exposure may be necessary to achieve impact. However, regional campaigns appear to be a cost-effective way to reach large numbers of youth and further research with more consistent measures of exposure should be pursued.

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REFLECTING ON INTERPERSONAL APPROACHES

12. Community Conversations to Address Harmful Traditional Practices and Reduce Stigma in Ethiopia

Community Conversation (CC) is an interactive process which brings people together and engages communities to discuss and explore underlying causes fuelling the HIV and AIDS epidemic. CC was initiated in Ethiopia in 2002 by the National HIV/AIDS Prevention and Control Office (NHAPCO). CARE International's Health Improvement and Women Owned Transformation (HIWOT) programme adopted the approach, initiating 105 CC groups in 14 districts on issues related to HIV and sexual and reproductive health between 2006 and 2007. CC recognises that people have capacities, knowledge, and resources to transform individually and collectively once they perceive ownership of a problem.

In the Community Conversation approach, community facilitators with leadership competencies are identified and approached to lead CC discussion groups of 50-60 volunteers from diverse backgrounds. According to the authors, after 12 months, the following changes were noted in communities:

• Some CC groups condemned early marriages in their communities, committing themselves to protecting school girls from discontinuing their education due to forced marriage.
• Other CC participants decided to stop Female Genital Cutting (FGC) in their areas or penalise traditional circumcisers (frequently traditional birth attendants) who do not use new razor blades for each girl they circumcise. In some places, participants discussed harmful traditional practices apart from HIV/AIDS (i.e. milk teeth extraction), and passed by-laws to stop FGC in their locality.
• Some CC participants reached a consensus to avoid practicing risky behaviours that predispose to HIV infection, such as going to night clubs and drinking alcohol, which is very common in the community, as well as practices like widow inheritance.
• Researchers found the sessions have helped reduce stigma and discrimination towards people living with HIV (PLWH), with some CCs providing care to people living with HIV and AIDS or forming HIV/AIDS clubs.

This report identifies challenges, and lessons learned, and common outcomes of CC in practice.

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13. Thailand Turns to Education and Dialogue for Youth

"Protecting Youth against HIV: Education and Dialogue for Adolescents in Thailand," published in August 2008, describes a 5-year project through which the Program for Appropriate Technology in Health (PATH) is facilitating HIV/AIDS and sexuality education for 11- to 18-year-old youth in Thailand. PATH staff developed a comprehensive 16-hour sexuality education curriculum based on the premise that young people will make good decisions when they have complete and accurate information; it is also tailored to students' needs, abilities, interests, and learning styles. The project includes supervised extracurricular activities, such as camps that incorporate sexuality education into computer games and drama. In addition, the Teenpath website reinforces content from the curriculum and provides a place for peers to talk about the challenges they face.

Working with regional partners, PATH identifies schools interested in implementing the Teenpath curriculum and then trains school administrators and teachers (who then train fellow educators) in both content and methodology. The Teenpath team also works with 10 universities throughout Thailand to teach sexuality-education methods to aspiring teachers.

To empower youth to educate their peers and model healthy behaviours, Teenpath has held more than 50 camps for young people. Campers have developed a social marketing condom campaign, surveyed adult attitudes toward condom sales at secondary schools, and forged networks of youth leaders to encourage advocacy for sexual and reproductive health and rights.

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14. Boosting Prevention through Interactive Games and Conversation

Published in September 2008, this publication describes an adaptable HIV prevention tool and the results of its use to date in more than 18 countries. Initially developed by the German Federal Centre for Health Education (BZgA), the "Join-In Circuit on AIDS, Love, and Sexuality" takes the form of a workshop with 5 or more stations, at which trained facilitators help participants learn critical information about HIV through interactive problem-solving, games, and conversation. Throughout each 75-minute session, facilitators engage participants in dialogue about how HIV is transmitted, how to talk about sexuality and love, condom use, non-verbal communication, living with HIV, and so on - all the while emphasising 3 main messages: "Be informed; protect yourself and others; show solidarity."

By the end of 2007, the Join-In Circuit had been adapted and used in HIV prevention in Bangladesh, Mongolia, and Nepal; the Russian Federation and Ukraine; Mozambique, Zambia, and Zimbabwe; and Ecuador and El Salvador. The report presents a number of findings gleaned from the experiences of adapting the Circuit in these different contexts. On the whole, evaluators found that "Most organizers and facilitators agree that the Join-In Circuit is an effective tool for HIV prevention among young people. Though primarily viewed as a vehicle for providing information, subjective evidence suggests that the Circuit has a positive influence on people's attitudes (towards people living with HIV, for example) and helps people to change their behaviour (use condoms, etc).”

A number of challenges are encountered, however, and are outlined here. For instance, effective interpersonal communication can be a particular challenge, especially in countries with authoritarian communication structures. This applies not only to facilitators, but also to the participants, who may not be accustomed to being asked for their opinion. Several concrete suggestions are offered for overcoming challenges.

For more information about the Join-In Circuit approach, please click here.

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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 social and behaviour change communication approach. C-Change also works to strengthen the capacity of local organisations to plan, implement, and evaluate 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 visit The CI website.

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.