A Critical Assessment of Theories/Models Used in Health Communication for HIV/AIDS
Airhihenbuwa, C.O and Obregon, R.

Most theories and models used to develop HIV/AIDS communication are based on social psychology that emphasizes individualism. Researchers including communication and health scholars are now questioning the presumed global relevance of these models and thus the need to develop innovative theories and models that take into account regional contexts.  In this paper, we discuss the commonly used theories and models in HIV/AIDS communication. Furthermore, we argue that the flaws in the application of the commonly used “classical” models in health communication are due to contextual differences in locations where these models are applied. That is to say that these theories and models are being applied in contexts for which they were not designed.  For example, the differences in health behaviors are often the function of culture. Therefore, culture should be viewed for its strength and not always as a barrier. The metaphorical coupling of 'culture' and 'barrier' needs to be exposed, deconstructed, and reconstructed so that new, positive, cultural linkages can be forged.  The HIV/AIDS pandemic has served as a flashpoint to either highlight the importance or deny the relevance of theories and models, while at the same time addressing the importance of culture in the development and implementation of communication programs.

Social and Economic Factors in an Integrated Behavioral and Societal Approach to Communications in HIV/AIDS
Melkote, S.R., Muppidi, S.R. and Goswami, D.

An integrated sociobehavioral approach to communication in human immunodeficiency virus (HIV), acquired immune deficiency syndrome (AIDS) is essential because the lack of a medical cure for AIDS puts the focus on prevention.  In the absence of pharmacological, immunological, and medical interventions for the prevention and cure for HIV/AIDS, changing behavior has been recognized as the only possible way to contain the spread of this disease (Edgar, Fitzpatrick, &Freimuth, 1992; Maibach, Kreps & Bonaguro, 1993; Freimuth, Hammord, Edgar, & Monahan, 1990; World Health Organization [WHO], 1988).  although HIV has been identified as the etiological agent causing AIDS, transmission of this virus depends on human behavior related largely to sexuality and drug use.  Communication plays an important role in this process because it disseminates information that may prevent risk behavior and spread awareness leading to reduction of social stigma (Melkote & Muppidi, 1999).  AIDS prevention programs, disseminated through mass media or community awareness campaigns, are directed toward changing sexual practices and use of intravenous needles.  However, not all of these programs are successful and sometimes fail to bring about appropriate behavior change.  To minimize the chances of failure, an impressive array of psychosocial theories have been developed to drive communication campaigns and to predict the consequences of the interventions (Maibach et al., 1993).  In this article we will (i) review various sociopsychological models that inform AIDS prevention, (ii) critique the sociopsychological approaches in the context of socioeconomic, race, and gender factors that impact the transmission of the AIDS virus, and (iii) provide an analytical framework that integrates behavioral and societal level variables to guide policy interventions.

HIV/AIDS Communication Campaigns: Progress and Prospects
Myhre, S.L. and Flora, J.A.

The mass media have been the primary method for disseminating human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS) prevention messages worldwide.  In this article, we update previous reviews by systematically examing published articles (n=41) of empirical evaluations of international HIV/AIDS prevention campaigns.  Of the 41 studies identified, 17 countries are represented.  In this review, we examine six components related to media campagin design and evaluation: target audience, communication channel(s), message content, campaign theme, exposure, and outcomes.  Of the studies included in this sample, each one described the target audience; 93% reported on channel selection; 75% described message content; 63% mentioned a campaign theme; and 62% documented campaign exposure.  We investigate also the extent to which HIV/AIDS prevention efforst have moved beyond media campaighs to comprehensive communitywide programs.  We conclude that HIV/AIDS prevention efforts would benefit from: (1) better reporting of media campagin components and outcomes, (2) more systematic evaluation, (3) greater integration of theory, and (4) increased attention to communitywide intervention strategies.

Coping in Cyberspace: The Impact of Internet Use on the Ability of HIV-Positive Individuals to Deal with Their Illness
Reeves, P.M.

The human immunodeficiency virus (HIV) poses one of the greatest health threats of modern times.  The Internet provides unparalleled access to resources that can assist individuals coping with HIV nfection.  Despite the promise of online resounces to help individuals manage and cope with their illness, few studies have investigated the impact of their use.  Those that have looked primarily at Internet use from a group perspective.  These studies were unusually "bounded" as well, focusing on electronic support groups or highly structured computer-based support sustems that offer selevt users prescribed resource options.  Little is known about how individuals who are "on their own"-without access to these services-use the vast unstructured array of resources available through the internet.  The purpose of this study was to investigate the impact of Internet use on the coping ability of HIV-positive individuals. This research study emplyed a descriptive qualitative design that used in-depth, semi structured, face-to-face interviews for data collection.  The samle of 10 purposefully selected HIV-positive individuals reflected diversity in gender, age, race, education, employment, number of years living with HIV, and Internet use.  Data analysis guided by constant comparative method revealed that the impact of Internet use on coping ability involved three themes: The Internet promotes empowerment, augments social support, and facilitates helping others.

Peer Promotion Programs and Social Networks in Ghana: Methods for Monitoring and Evaluating AIDS
Prevention and Reproductive Health Programs among Adolescents and Young Adults
Wolf, R.C., Bond, K.C. and Tawfik, L.A.

This article summarizes the observations and lessions learned regarding the application of human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS) prevention and reproductive health evaluation and methodologies in the context of adolescent and young adult populations and discusses the use of peer network evaluation to understand the dynamics of peer promotion.  To examine the interpersonal communication process of peer education, this study tested a new approach using multiple semistructured interviews and network analysis to collect data on 106 peer educators and 526 of their contacts.  These evaluation activities were conducted at three sites in Ghana during April 1998, in both periurban and rural locations in both in-school and out-of school settings.  By evaluating the social networks of peer educators it was possible to gain a better understanding of the process of peer education in terms of (a) defining the composition of peer contacts, (b) identifying the social norms that play a critical role in youth decision making, and (c) observing the range of messages and services transmittd during peer education.  The objective of this paper is to disseminate the experience of the Center for Education and Development of Population Activities (CEDPA) and Focus on Young Adult's cooperative development of evaluation methodologies for peer promotion and to highlight utilization of these methodologies in a case study in Ghana.  The results will be discussed in terms of their possible implications for program managers, researchers, and international agencies.

Entertainment-Education and HIV/AIDS Prevention: A Field Experiment in Tanzania
Vaughan, P.W., Rogers, E.M., Singhal, A. and Swalehe, R.M.

Entertainment-education is the process of designing and implementing an entertainment program to increase audience members' knowledge about a social issue, create more favorable attitudes, and change their overt behaviors regarding the social issue.  The results of a field experiment in Tanzania to measure the effects of a long-running entertainment-education radio soap opera, Twende na Wakati (Let's Go with the Times), on knowledge, attitudes and adoption of human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS) prevention behaviors are presented.  Multiple independent measures of effects and the experimental design of this study confer strong internal and external validity regading the results of this investigation.  The effects of the radio program in Tanzania include (1) a reduction in the numner of sexual partners by both men and women, and (2) increased condom adoption.  The radio soap opera influenced these behavioral variables  through certain intervening variables including (1) self-perception of risk of contracting HIV/AIDS, (2) self-efficacy with respect to preventing HIV/AIDS, (3) interpersonal communication aout HIV/AIDS, and (4) identification with, and role modeling of, the primary characters in the radio soap opera.

Toward a New Communications Framework for HIV/AIDS
Airhihenbuwa, C.O., Makinwa, B. and Obregon, R.

In response to the overwhelming burden of new cases of HIV in Africa, Asia, and Latin America and the Caribbean, UNAIDS, in 1997, initiated a project to examine the application of existing communication theories/models to HIV/AIDS prevention and care in these regions. In the past year, 103 leading researchers and practitioners from different parts of the world were invited by UNAIDS to participate in one of five consultative workshops designed to review these theories/models and rethink their adequacy for Africa, Asia, Latin America and the Caribbean. A new communications framework for HIV/AIDS was developed to move from a focus on the individual to a focus on five domains of ‘contexts’ that influence behaviors - government policy, SES, culture, gender relations, and spirituality.

LESSONS FROM THE FIELD

From Government Policy to Community-Based Communication Strategies in Africa: Lessons from Senegal and Uganda
Diop, W.

More than a decade after the appearance of AIDS cases in West Africa, the rate of HIV infection remains low in Senegal (between 1 and 1.6%).  Naturally, this relatively stable rate, confirmed through regular epidemiological surveillance, appears to be an exception in a region where the infection rates range from 3 to 10%. It is this fact which creates growing interest among researchers and practitioners in recent years. However, the  low infection rate at the national level conceals some worrisome situations  in some parts of the country. As early as 1989, Fadel Kane et al. documented, in an epidemiological study, an HIV 1 infection rate of 10% among the spouses of emigrants in the Matam zone.  This region situated in the north of Senegal is well-known for its singularly high rate of emigration.  Another study conducted in localities within the Zinguinchor region in the south of the country had produced nearly the same results.  However, for those who have closely followed the evolution of AIDS in Senegal, it can be maintained that there was not really an epidemic of HIV to date within any single group.

Several factors can explain this Senegalese "exception."  These factors can at once be linked to the performance of one of the oldest programs addressing STDs/AIDS in the region, and also the socio-cultural, religious, and political influences.  In fact, many anthropological studies have brought to light certain number of factors which should explain the lower exposure to HIV risk in the Senegalese population. These factors include: the universality of marriage; rapid remarriage of widow(er)s and divorced persons; a severe moral condemnation of all forms of cohabitation not sanctioned by a religious act and which may involve sexual rapport; and social networks which serve to control irresponsible sexuality (extended family circles of step-parents, cousins, relatives, neighbors, etc.).  Even though long years of economic crisis along with a rapid urbanization have combined to change sexual morals especially in the big cities, there still remains deep rooted control over an individual's sexuality by family and society in general.  Fear of dishonoring one's family and the subsequent "what will they say" notion plagues the individual's conscience. In addition, familial and social solidarity is maintained even during economic crisis or even its attendant unemployment.  Yet it can be affirmed without a doubt that the major factor which triggered the fight against AIDS in Senegal was the absence of denial.  Health officials recognized the existence of the disease very early in 1986, even through only the first six cases were recorded.  The mass media became involved, followed by non-profit organizations and community associations.  All these efforts were reinforced in 1988 by the testimonials on television of two people living with HIV.  It could even be said that Senegal initiated the fight against AIDS before the disease could gain a foothold in the country.

Odô-Yã Project: HIV/AIDS Prevention in the Context of Afro-Brazilian Region
Marmo da Silva, J., Chagas Guimarães, M.A.

The HIV/AIDS epidemic in Brazil has changed the lifestyle of Brazilian people through changes in the social, cultural, political, and economic aspects of the country. HIV/AIDS revived discussions related to old taboos about sexuality, the body, and pleasure. It has also prompted some religious groups to reflect on the importance of spirituality and its relationship to disease prevention and the solidarity among HIV positive individuals.  According to Galvão (1997)  the AIDS epidemic in Brazil provided an opportunity for diverse religious traditions to work together on HIV/AIDS education and prevention and to support HIV positive individuals.  A primary aim of this paper is to examine aspects of spirituality that was the basis of communication strategy for education and prevention project for HIV/AIDS. In 1991, the Instituto de Estudos da Religião (ISER- Religious Studies Institute) initiated an HIV project based on the African-Brazilian religious tradition candomblé (an Afro-Brazilian religion) ISER focused their campaign on the terreiros de candomblé (candomble communities). Four unique features of this religion made it of particular interest to ISER; 1) sexuality is considered a source of life and pleasure; 2) in some candomblé rites, a sharp blade is used to make small incisions in the body, thus maintaining direct contact with blood; 3) news published in many newspapers associated the candomblé with the spread of HIV/AIDS epidemic, due to the high number of homosexuals in the group; and 4) most candomblé are low income Blacks or mulattos whereas official campaigns to prevent HIV are directed to the middle class white population. Moreover, the povo de santo (the followers of the terreiros) are discriminated against because are Afro-Brazilians.

Gender and HIV/AIDS in Africa-Our Hope Lies in the Future
Esu-Williams, E.

Looking into the future of the epidemic demands a critical evaluation of the past and present. Despite some of the successes reported, we cannot feel any measure of comfort in the picture which stares us in the face, particularly when we review the situation of women and HIV/AIDS in Africa. We know that girls and young women still have the highest and fastest growing rates of HIV and STD infections.  New evidence (UNAIDS, 1999) indicates that there are now more HIV infections in women than in men. Fifty-five percent of infected adults are women, translating into six positive women for every five HIV infected men. In 1998, 60% of new HIV infections were in young people aged 15 to 24 and in many countries, girls in that age range were six times more likely to be infected than boys.  Although, amongst other successes, recently discovered drug to reduce transmission of HIV from a woman to her child have provided a ray of hope. But there are still a lot of hurdles to cross because these recent advances have offered little to the mothers who need life saving therapy themselves, and because they provide the backbone of care of infants and children at the home and in the community.