Behaviour change and how it relates to HIV


BEHAVIOUR Change Communication (BCC) may be difficult as most of us who are involved in it can acknowledge, but we are probably barking up the wrong tree.
Most of us, even the so-called experts, have a tendency of focusing on the communication part of BCC.

However, I would really urge us to look at it differently and begin focusing on the starting BC (Behaviour Change) because I strongly feel BCC should be more about changing behaviour and not about the medium of transmitting information.

In as much as Information, Education and Communication (IEC) help inform us about things we should be informed about, it falls short of providing us with strategies and methods and the positive reinforcements or appeals that would really help and change and sustain the desirable behaviours. We should empower those that we communicate with to have a sense of self-efficacy to adopt new, health-protective behaviours.
Behaviour change is more a changing thought process that eventually affects behaviour not how much or how often we bombard people with the right information. The minute we use this new approach, we will start focusing on the behaviour theories and psychology and not so much on communication and media theories.

Over time, it has become clear that while IEC has been an effective system in raising awareness about health and HIV, it has largely been ineffective in changing behaviour. In Sub-Saharan Africa, more than 90 percent of people in the hardest hit communities report awareness of the virus but there is little evidence to demonstrate a concomitant decrease in HIV transmission or in high risk behaviours. The awareness achieved is often insubstantial and not accompanied by any skills development in individuals to protect themselves from infection. Behaviour change approaches recognise that presenting facts alone does not ensure a shift in attitude and that change may take some time to occur. BCC goes beyond an informational or scientific approach to one that combines facts and often emotional appeals.
The principles for HIV and AIDS communication campaigns include, but are not limited to:

  • Realistic goals: We should ensure that we set achievable goals to our target audience, according to them. For example, we usually say sex workers should leave the streets and go sell vegetables. But in as much as this feels right to us the designers of the messages, does vegetable-selling appeal to the sex worker? We often say, “Yes, because it does not have the same risks as sex work”. But let me analyse the situation for you. We should know how much the sex worker makes per night, how much money his/her needs require, how many hours he/she works to accumulate that money and now the crucial questions; will selling vegetables in an already congested market provide for all his/her needs? Is he/she equipped with managing the cashflow? Does he/she have the time to work during the day? If we cannot answer these questions convincingly, then it may not be a good intervention for the sex worker.
  •  Behaviour substitution instead of elimination: Often we want the target audience to eliminate the old behaviour instantly and we do not provide the new behaviour that would substitute the old undesirable one. For instance, we simply tell a man to stop having multiple concurrent sex partners. How about telling him to reduce the number of sexual partners gradually and methodically? Do we know why he has multiple partners? Do we know how the love situation is at his home? Do we know if he feels like a man that he is at home (in control) or does he only feel like a man in control when he buys favours on the street? I know one long-haul driver who said, “it is good to have a girlfriend in every town because then I can get a decent sleep. But if she is expecting something else, I give it to her.” Can you really change his behaviour without addressing his sleeping comforts?
  •  Environmental support for behavioural change: Behaviour change cannot be done on an outreach or with a few counselling sessions. Some people need two, others need 10 so that they do not relapse into old undesirable behaviours. Counsellors, support groups, family and the community need to be in a position to help the client on a desirable path in order for the behaviour to change.
  • Cost-effectiveness: Is often the culprit of why we often do a rushed job (focusing more on IEC and less on BCC). But do we budget for the whole continuum or do we only focus on IEC and communication? Often this is the case.
  • Programme accessibility to intended audience and attention to legal and socio-cultural obstacles to change: Behaviour change should be done in context and also be culturally sensitive.

We often tell our young girls that they should be pure when they get married like the girls in the Bible. This is good teaching and I applaud it, but do we know how old those girls in the Bible were when they got married? A lot of them were between the ages of 12 and 18. Now the demands of life require that at the age of 18, you go to college and spend another four years then start working, maybe another two years before you get married.

With the kind of exposure and independence that a modern woman has, we should provide alternatives. When abstinence is the only sure and primary way to prevent HIV, we should be in a position to provide plan B and C where possible. One learned friend of mine said let us make sure they are alive first, then try to help them change their behaviour gradually.
By the time they know what to do, they will still be HIV negative.

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