HIV Communication Panos Institute

Panos: Some History

1986

Published "AIDS and the Third World" which predicted:

• Up to 1 in 5 adults of worst affected countries would become HIV+ and in some places that ratio already existed
• That Africa would be the frontline in the epidemic
• That the spread of HIV was inextricably linked to issues of poverty, underdevelopment, marginalisation and prejudice – "a misery seeking missile"
• Strategies that tackled HIV in isolation from those linked issues would fail

1987

Talloires Consultation (with AmFAR) of major donor organisations led to some of the first budgets being created on HIV/AIDS

An historic opportunity...

• An unprecedented international mobilisation around HIV/AIDS – arguably the most ambitious mobilisation of resources and effort against a single disease in history
• A response brought about through unprecedented international leadership and commitment, including among many international and donor organisations.
• After years of neglect, the opportunity to make a real difference

...in critical danger of being wasted

• Money is increasingly part of the problem, rather than the solution
• The response is increasingly marginalising, rather than strengthening incountry responses
• We are still, particularly within HIV Communication, focusing on the symptoms of HIV/AIDS, not on the causes

A global view of HIV infection

• UNAIDS HIV/AIDS Communication Framework process; Rockefeller Foundation CSC Network; Communication for Development Roundtable and others
• Our own experience and that of many of our partners in North and South;
• Donor review processes
• Panos survey

Communication for Development Roundtable Declaration

"Progress in slowing the epidemic will require a multisectoral response and use of Communication to tackle the behaviours related to the spread of the epidemic and to address its causes (inequality, prejudice, poverty, social and political exclusion, discrimination, particularly against women)...

The VIII Communication for Development Roundtable calls for:

• the international communication response to be rooted in and subject to local ownership and agendas;
• a redirection of increased resources toward more effective communication programs based on the principles outlined above;
• programs to be accountable to those they are designed to benefit;
• increased investments in capacity building, training and research at the country level in communication for development strategies, evaluation, and appropriate indicators."

Panos Survey

• Carried out through Communication Initiative and at Barcelona AIDS Conference
• 375 responses from AIDS Service Organisations, donors, NGOs, grassroots organisations, religious and faith organisations and media
• A prompt for more systematic research, rather than stand alone piece of research
• An indicator of perceptions and concerns

Where are decisions made

Of all those service providers based in the North and working in the South 43% make the decisions relating to their work in headquarters in the North.

Of all those service providers that argue that their work is determined by their donors, 78% are funded by a Northern based agency.

Of all service providers surveyed 66 percent relied on funding sources in the North.

Short-term solutions?

What is the average time-span of projects that you fund?:

• 3 years and 6 month is the length of most projects funded
• 10, 7 and 5 years are hardly funded at all
• The long-term perspective is neglected

When asked, most donors acknowledged that institutional, bureaucratic and political constraints detract from their efforts to service those most affected by the epidemic. Only 12% of donor respondents surveyed felt that these factors do not have any effect at all.

Of all the service providers surveyed only 32% said that those most affected by the epidemic lead and own the response, although a total of almost 70% felt that there was at least moderate ownership.

• 24% said true
• 76% said not true

Historically, ownership of the response has been critical

Some of the most effective and impactful responses to HIV/AIDS have emerged from within countries and required relatively little funding:

• Gay movement
• Thailand early responses
• Uganda early responses
• Treatment Access Campaign

HIV/AIDS Communication and the power of ownership: the case of Uganda

Why Uganda has been successful?:

• political leadership
• an indigenous, internally respected research capacity/authoritative analysis of the epidemic
• strong, free, highly credible media within a context of political freedoms; media could explain issues and engage publics
• a climate where sex and sexuality could be discussed publicly and increasingly freely
• a political environment that enabled the emergence of civil society/NGOs who emerged to tackle the epidemic, not to channel funding
• donor funding, which could be spent in context of a strong political and social environment of the epidemic
• a perception of a multisectoral strategy tackling both the causes and symptoms of the epidemic

Funding spent tackling this epidemic is INSUFFICIENT, but...

If some or many current funding strategies are, rather than supporting an indigenous response, actively marginalising and suffocating in country responses, there is an urgent need to change current practice.

The international response increasingly threatens to undermine indigenous ownership of the response, rather than strengthen it.

Communication for Development Roundtable: The Declaration

Despite many successes "existing HIV/AIDS communication strategies have proved inadequate in containing and mitigating the effects of the epidemic. For example, they have often:

• treated people as objects of change rather than the agents of their own change;
• focused exclusively on a few individual behaviours rather than also addressing social norms, policies, culture and supportive environments;
• conveyed information from technical experts rather than sensitively placing accurate information into dialogue and debate;
• tried to persuade people to do something, rather than negotiate the best way forward in a partnership process.

A Major Problem of Funding Policy

Problems include:

• project frameworks with short term time horizons (3 - 5 years when real change is unlikely to occur within 10 years)
• requirement for clear, quantitative evidence of impact over the short term
• Clear evidence that impact is related to the intervention resulting in highly structured, top down interventions
• spending large sums of money quickly with low transaction costs
• A culture that encourages fear of failure, leading to lack of innovation, one size fits all interventions and an incentive to ensure that institutions retain tight control of the process and agenda.
• Stuck in the HIV/AIDS box...e.g. does establishing community radio networks constitute and HIV/AIDS strategy?

What matters

• The "quality" (inclusiveness, vibrancy, access) of communication environments
• Where decisions are taken
• Who takes them and how are they accountable
• If organisations can demonstrate that they are creating more inclusive, vibrant, accessible communication environments, social change theory provides compelling arguments of why this work is important.
• Evaluation based not on the impact of an individual or project, but on whether overall programming has changed an environment

The Panos HIV/AIDS Programme

• Coordination and leadership transferred to Panos Southern Africa
• Operating within context of a restructuring where governance has passed to southern governance structures
• Central theme: ownership, accountability, participation
• Communication and Social Change: a centre for thinking, innovation and practice

Panos and HIV Communication:

A simplified framework