Introduction to the Special Supplement
Everett M. Rogers, University of New Mexico
Since the AIDS epidemic was first identified by epidemiologists in
1981, it has spread throughout the world. In some nations like
the United States, HIV/AIDS was mainly transmitted through sexual contact
between men. In much of Asia and Africa, however, the main means
of transmission has been heterosexual. The AIDS epidemic in India,
Thailand, Mexico, Brazil, and Sub-Sahara Africa is quite different than
in Euro-America. UNAIDS estimates that 90 percent of all new HIV
cases are occurring in Latin America, Africa, Asia, and the Caribbean.
The present special issue of the Journal of Health Communication provides
evidence of the widely different types of human behavior involved in
the spread of the AIDS epidemic, a matter of great importance to communication
scholars who conduct research on the prevention of HIV/AIDS (see Airhihenbuwa
& Obregon in this issue).
What general lessons have been learned from research on the AIDS epidemic?
We summarize in terms of four main themes.
1. Culture is an important influence on HIV/AIDS behavior. Culture is defined as the total way of life of a people, composed of
their learned and shared behavior patterns, values, norms, and material
objects (Rogers & Steinfatt, 1999). One of the influences
of culture on HIV/AIDS behavior, as mentioned previously, is whether
the virus is transmitted by heterosexual or homosexual contact.
In part, this matter depends on the first individuals who were infected.
For example, in the United States one of the early individuals involved
in the epidemic was Patient Zero, an Air Canada steward who has sexual
intercourse with about half of the first 40 men identified with AIDS
by the CDC (Centers for Disease Control and Prevention). Similarly
in England, a gay airline steward infected many of the first individuals
diagnosed with AIDS. The key role in transmitting the virus in
India and in East Africa was played by long-distance truck drivers,
who slept with commercial sex workers at truck stops. In Thailand,
commercial sex workers were also important in transmitting HIV through
heterosexual contact.
Another cultural factor influencing HIV/AIDS prevention is individualism/collectivism.
Individualism is the degree to which an individual's goals are valued
over those of the family, community, work organization, or other collectivity.
Collectivism is the degree to which the collectivity's goals are valued
over those of the individual (Rogers & Steinfatt, 1999). The
cultural dimension of individualism/collectivism determines whether
or not the individual is in sole control of the decision to adopt a
method of HIV prevention. For example, in most Asian societies
a wife must negotiate with her husband regarding condom use. In
some nations, issues of female empowerment and gender equality are involved
in HIV prevention.
2. The issue of AIDS was very slow in gaining priority on the national
agenda of the United States, and hence appropriate policies, funding
and programs to combat the epidemic were delayed (Dear & Rogers,
1996). The usual public health strategy for combating an epidemic
is to identify the means of transmission as rapidly as possible, and
then immediately to launch all possible means of prevention and treatment.
Why did the agenda-setting process for the issue of AIDS require four
years before the media, the public, and policy-makers gave attention
to this issue? Two main factors are generally important in putting
an issue on the national agenda in the United States: (1) the White
House, and (2) The New York Times. In the case of the AIDS epidemic,
President Reagan did not give a speech about the epidemic until the
late 1980s. The issue was also slow to appear on the front page
of The New York Times. So neither of these two forces played their
usual role in putting AIDS on the national agenda.
Similarly, the president of one East African nation refused to acknowledge
that the AIDS epidemic was underway in his country through most of the
1980s. He presumably feared that accurate treatment of the epidemic
in his nations= press would discourage international tourists.
So journalists who reported on the AIDS epidemic were jailed, or expelled
from the country. As a result, the epidemic continued to spread.
3. Health organizations themselves have changed in various important
ways due to the AIDS epidemic. For example, the role of communication
and the other social sciences has increasingly been recognized by health
organizations like the CDC and WHO. One reason for this recognition
is because an effective, affordable cure for AIDS has not yet been found,
so the main strategy for controlling the epidemic must be prevention.
For example, the CDC has employed a number of communication scholars,
anthropologists, and social psychologists in designing HIV prevention
programs and in their evaluation. Prior to the AIDS epidemic,
few if any of these social scientists were employed by the CDC.
The joint United Nations Programme on HIV/AIDS (UNAIDS) was established
to offer direction in the global efforts in HIV/AIDS prevention, care
and support.
4. HIV/AIDS prevention behavior is not mainly a problem of transmitting
knowledge, but rather one of changing attitudes and especially, overt
behavior. Hence the task for communication scholars is to
create and apply a range of communication strategies, research designs,
and behavior change theories that can lead to behavior change on the
part of large numbers of people. Because HIV/AIDS prevention involves
a motivational, rather than an informational, challenge, interpersonal
communication from peers, perhaps stimulated by certain types of mass
communication, is crucial.
One communication strategy, entertainment-education, has been utilized
in a variety of HIV prevention programs. Entertainment-education
is the intentional placement of educational content in an entertainment
message (Singhal & Rogers, 1999). An example of an effective
entertainment-education campaign occurred in Tanzania with a radio soap
opera, ATwende na Wakati@ (Let=s Go with the Times), That was broadcast
in the 1990s. This entertainment-education intervention had its
main effects by stimulating peer conversations, often leading Tanzanian
adults to decreasing their number of sexual partners and adopting other
prevention actions (see Vaughan, Rogers, and Singhal article in this
issue).
The Tanzania study also illustrates several of the communication research
methods utilized in the investigations reported in the present special
issue: Field experiments, focus group interviews, personal interview
surveys, and content analyses of letters and media programs. Other
studies reported here illustrate the variety of qualitative research
methods use in studies of AIDS behavior.
Researchers working on HIV/AIDS prevention behavior have reported varying
degrees of success using a range of behavioral change theories: Social
learning theory (Bandura, 1997), stages of change (Prochaska, DiClemente,
& Norcross, 1992) McGuire’s (1989) hierarchy-of-effects, social
marketing (Kotler & Roberto, 1989), the health behavior model, the
diffusion of innovation (Rogers, 1995), and the theory of reasoned action.
In summary, the AIDS epidemic of the past two decades has helped demonstrate
that communication is central to prevention behavior. This UNAIDS special
supplement offer a new direction that allow us to take into account
the physical and social environment in ways that have not been done
seriously in the past.
Everett M. Rogers is
Chair of the Department of Communication and Journalism at the University
of New Mexico.
