Strategy Recommendations and Planning Framework for HIV/AIDS Behavior Change Communication Activities funded by USAID/Haiti

This 33-page report follows several USAID/Haiti projects which sought to develop recommendations for effectively responding to the HIV/AIDS epidemic in Haiti. Contractors from the Synergy Project, working on behalf of USAID/Haiti, recommended in a final report that USAID/Haiti should consider two reinforcing strategies that would seek "to provide decentralized prevention and care throughout the country, while insuring extra coverage of high-risk settings or ‘hot spots’ where transmission is most rapid."

Another assessment , conducted by USAID/Haiti staff, sought to assess Behavior Change Communication programming in HIV/AIDS and identified the strengths, weaknesses and lessons learned from 15 years of HIV/AIDS activities in Haiti.

This Strategy Recommendations and Planning Framework , based on the backdrop of the research described above, suggests two overall goals for Behavior Change Communication activities: "reduce transmission of the HIV/AIDS virus and improve the care and support of people living with HIV/AIDS."

The Strategy Recommendations include ways to realise these goals through "selected behavioral objectives executed through coordinated, planned interventions undertaken by a range of USAID partners." The behavioral objectives of the report include:

• Objective 1. To dispel myths and improve the accuracy of knowledge about HIV/AIDS
• Objective 2. To reduce fear, stigma, and discrimination against persons living with
  HIV/AIDS
• Objective 3. To create a supportive environment that reinforces healthy choices on the
  part of those at risk
• Objective 4. To increase the appropriate self-perception of risk and the use of
  appropriate risk-reduction strategies
• Objective 5. To increase the frequency of appropriate care-seeking behaviors
• Objective 6. To stimulate community-based care and support for people living with and
  affected by HIV/AIDS
• Objective 7. To improve the knowledge, skills and attitudes of health professionals
  regarding HIV/AIDS

The report continues with a detailed description of target markets needed for each of these behavioral objectives. Section C reviews "cross-cutting" issues which the report provides in detail, but which in general include:

• Reinforcing and expanding political will
• Sustained coordination across programmes
• More rigorous behavioral analysis
• Intersectoral involvement
• Building evaluation in to programme design

The report includes a Gap Analysis with programmatic recommendations. The purpose of this assessment was to examine current (and

in some cases, proposed) USAID-funded programming against this recommended strategy. "The behavioral objectives, target markets,

delivery vehicles, measurement indicators, key messages and geographic focus of each current initiative were identified in consultation with the behavior change communication advisors for each programme."

Preliminary findings included:

1. USAID-funded programmes have conducted extensive behavior change interventions for the youth market, and as such have built up an important expertise in this market.
2. Data from Haitian behavioral surveys continues to indicate that, while awareness of the dangers of HIV/AIDS is high among virtually all groups, myths and inaccuracies abound, particularly with regard to means of transmission and risk
   factors.
3. Religious leaders and schoolteachers have the potential to play a crucial role in Objective 3: Creating a supportive environment that reinforces healthy choices among youth.
4. Parents and extended family are also a crucial element in creating a supportive environment for healthy choices by those at risk.
5. Virtually all of the Haitian HIV/AIDS experts consulted acknowledged that the so-called “Three Boats” approach to HIV/AIDS

   prevention (abstinence, fidelity and condom use) was grossly out of touch with the realities of Haitian sexual behavior.

6. Systematic interventions to reduce stigma and discrimination against HIV/AIDS are new to both Haiti and other areas of the world.
7. A range of partners has sponsored public events on HIV/AIDS prevention in various forms (concerts, caravans, pop concerts, sports matches). While public events can be useful in maintaining a high level of awareness regarding HIV/AIDS, this is no longer the predominant need in Haiti.
8. Changing health worker attitudes (Objective 7) is as important as improving knowledge and skill among health professionals about HIV/AIDS.