Behaviour change communication in action : a study of Uganda's 'ABC' AIDS communication model

Uganda s ABC approach to the prevention and control of HIV/AIDS has gained prominence and garnered controversy in recent years. Several studies have praised the approach for its remarkable feat in reducing HIV prevalence rates, while others, especially recently, have started to criticise and question this alleged success. Studies from the Ministry of Health s sero-behavioural survey (2005) and UNAIDS Aids Epidemic update (2005) have reported that despite years of dramatic success, Uganda stands at the brink of reversed HIV/AIDS success with prevalence rates stagnating between 6-7% of the total population for the last five years. Although several researchers and development agencies have tried to study this stagnation problem, the majority of their writing centres on issues like; government of Uganda bias in favour of AB of the ABC, the U.S Government s Emergence Plan for Aids Relief, which critics say, emphasises certain aspects of the campaign and downplays others, and complacency and aids fatigue among members of the target audiences. While this study does not explore all the above propositions, it adds to this debate and attempts to explain the above stagnation problem from a communications angle; looking specifically at the efficacy of ABC messages in relation to their design, reception and impact. Who designs ABC messages and how are they designed? How relevant are the designed messages to members of the target audiences? How do audience members receive and react to these messages and what impact, if any, do these messages have on their target populations? The academic impetus driving this study emanates from Prochaska et al s (1992) Stages of Change model and Bandura s (1986) Social Cognitive Theory, both of which are part and parcel of the wider health communications and behaviour change communications. From in-depth qualitative interviews with ABC message designers and a largely open-ended questionnaire with the different ABC audiences, the study reports that the current stagnation in Uganda s HIV reduction efforts is partly, communication related. The manner in which ABC messages are designed is not entirely reflective of the audiences dynamic and complex socio-cultural environment. Specifically, the MoH s HEPU and ACP and the UAC have not fine-tuned the ABC model to suit the dynamic and challenging circumstances of intended receivers. The majority of messages like; Be Responsible, Say No to Un-safe Sex Use a Condom are too general and do not address the current stages of change to which audience members lie on the behaviour change continuum. The study recommends that while the ABC model has had tremendous success over the years, it needs to be fine-tuned and energized to suit new trends and circumstances of the target audiences. It needs to go beyond raising awareness and include what Bandura (1986) calls self-efficacy factors, which are; skills building, motivation, modelling, social support enhancement and confidence building. The design of ABC messages should also be targeted, tailored and customised to suit the needs and circumstances of various audiences at their respective stages of change

Targeted Interpersonal Communication for Adolescent Girls and Young Women for Integrated Maternal Health Services in Uganda: Evidence from DREAMS Project 2016-2017

Save The Mother Conference and Reunion Presentations, 2018.Background Uganda has the highest population of young people below 18 years in the world. Among these adolescents, contraceptive use is still low at 11% compared to the unmet need (30.4%) for family planning services. This increases the risk of HIV transmission as well as unwanted teenage pregnancies. Uganda embraced the Determined, Resilient, Empowered, AIDSfree, Mentored, and Safe women (DREAMS) initiative together with implementing partners to address the these challenges. Objective: Within the DREAMS initiative, USAID/Communication for Health Communities (CHC) focuses on the provision of technical support and spearheading Social Behavioural Change Communication Interventions (SBCC). Methods: CHC supported development of participatory health communication materials and tools and the training of peers on communication skills. CHC worked with village health teams, girl mentors, and implementing partners to reach these adolescents using an integrated IPC approach which included home visits, one-on-one dialogues, small group discussions, and youth bashes. During the intervention, we provided information, motivation and referral to HIV, family planning and other reproductive health services. Results: A total of 16,732 adolescent girls and young women (AGYW) were reached during IPC activities between April 2016 and December 2017. A total of 96,975 AGYWs received HIV testing tested during the project implementation July 2016 to June 2017. The positivity rate reduced from 3% to 2% for AGs and 6% to 5 % for YWs. This was attributed to the HIV prevention packages offered and SBCC pro-health behaviours of condom use and reduction in multiple concurrent partners. Female condom usage increased by 20% among AGs and by 95% among YWs. Conclusion: Interpersonal communication was key in promoting behavioural change for the adolescent girls and young women in the DREAMS initiative.USAID/Communication for Healthy Communities (CHC

Adolescents Discussing Sexual Behaviors With Key Influencing Audiences

There is an increasing concern on early initiation of sexual activity among adolescents, increasing sexually transmitted infections, and teenage pregnancy in Uganda. Adolescents perceptions of these sexual behaviors might be the result of discussing sexual and reproductive health issues with key influencing audiences. This study qualitatively explored the effect of sexuality discussions with key influencing audiences by means of in-depth interviews and focus group discussions with adolescents (N=83). Findings indicate that adolescence stage comes with changes of intense sexual desires, often presumed difficult to control thus leading adolescents to engage in sexual activities. Adolescents indicated that they were aware of the sexual behaviors such as condom use, contraception use, and multiple concurrent partnerships, but intertwined with persistent myths and misconceptions. Although discussing sexuality issues with someone was found to be instrumental, adolescent highlighted challenges that hinder discussion with key influencers. Challenges include, parents lack of time to talk to their children; some religious affiliations perceived to discourage use of contraception; limited skills of community health workers to address adolescent information needs; meetings held in groups not followed up with age-focused or one-on-one discussions; negative health workers? attitudes and use of technical language; and peer pressure. These findings suggest the need to provide adequate and updated information to clear any misconceptions and strengthening of key influencers? communication skills to gain confidence in addressing adolescent sexual and reproductive health needs.