BEHAVIOR CHANGE COMMUNICATION
ON HIV/AIDS RISK REDUCTION:
A STUDY OF BROOKSIDE DAIRY LIMITED
Background Information
Behavior Change Communication, or BCC, is an approach to behavior change focused on
communication. The assumption is that through communication of some kind, individuals and
communities can somehow be persuaded to behave in ways that will make their lives safer and
healthier (Hugh, 2003). According to Thairu (2004) BCC was first employed in HIV and TB
prevention projects. Since then NGOs in Kenya, such as PATH, Liverpool, NOPE International
and Aphia plus Kamili (USAID) have designed ways to bring about experience-sharing through
deep dialogue in groups and theater processes. In India, Bonaldi (2008) notes that participatory
community-driven theater among sex workers led to passionate and heartfelt dialogue. In many
cases, the critical reflection triggered by these discourses has led participants to self-driven
behavior changes.
Today in Kenya almost every family has lost members or takes care of infected family members,
neighbors and friends. Everybody knows the major ways of transmission of HIV, but frequently
people are still not talking entirely openly and freely about it, a strategy if adopted shall bring
Kenyans closer to addressing the major way of HIV transmission in this country, where it is
assumed that between 80 and 90 % of infections are due to sexual transmission. Hence,
promoting the adoption of safe sexual behaviors remains at the heart of HIV prevention in Kenya
(Thairu 2004).
Fischer and Needle (2003) say that although there have been significant advances in prevention
and treatment since HIV was first discovered, the virus continues to spread unabated in many
parts of the world. They add that strategies to prevent new infections must match both the
complexity and the multifaceted nature of the epidemic. According to Garry and Pear (2009),
social and behavior change communication is one such strategy that to date has been
underutilized, despite its proven effectiveness in many settings common myths and
misinformation about HIV/AIDS stand in the way of greater awareness, discussion, and
acceptance of individual and societal behavior change to reduce risk of infection. HIV-related
stigma can also be a barrier to the uptake of HIV testing and can prevent those living with HIV
from accessing resources for positive living and compassionate care. Sdorow (2003) adds that
inadequate counseling services can make it difficult for someone who is infected to understand
their options and make an informed choice about appropriate treatment, reproductive health, and
other issues. Fortunately, according to Tabifor (2012) strategic health communication
interventions can make a difference informing, equipping, and motivating people to make
appropriate choices about HIV prevention and care. Thairu (2004) suggests that HIV/AIDS
communication efforts, like any HIV/AIDS strategy, must address the whole care continuum
(i.e., prevention, VCT, care, support, and treatment) to be effective. A holistic approach goes
well beyond prevention to include tools for the biological, psychological, and social care of
people living with HIV, their families, and communities. Some organizations provide ARVs for
free.
More recently, frameworks such as the Joint United Nations Program on HIV/AIDS (UNAIDS)
communications framework, the Health Communication Partnership (HCP) Pathways and World
Health Organization (WHO) framework seek to understand and explain the role of socio cultural
influences (e.g., socioeconomic status, gender relations, cultural norms, and spirituality) and
environmental influences (e.g., government policy, access to services, and occupational risks) on
human behavior. These frameworks are based on the understanding that beyond an individual’s
social network exist larger structural and environmental determinants that affect HIV/AIDS-
related behaviors (Miller, 2011). Such an approach to communication reflects a greater
appreciation of the complexity of the HIV epidemic, and a greater emphasis on social groups and
contextual factors rather than individual behavior for instance, alone in Zimbabwe much has
been done to achieve behavioral change over the past two decades and recent reviews indicate
that these changes towards safer sexual behavior need to be maintained, but we also strongly
believe that much more can and needs to be done Family Health International (FHI, 2008).
Beyond awareness-raising and communication on Abstinence, Faithfulness, Condom (AFC),
there is a need to address underlying factors for multiple partnering including imbalanced gender
relations. So far, a majority of programmes has not been guided by systematic and strategic
programming, nor were many programmes based on evidence from research (Jackson, 2005).
A report by NACC (2013) indicates that since the inception of HIV and AIDS programmes in
Kenya, there has been minimal behavioral change (BC) strategy to guide various programme
implementers. As a consequence there was limited focusing of prevention programmes, which
partially resulted in duplication of efforts, but also large gaps in geographical and thematic
coverage of programmes. Heath et al (2006) notes that, Thailand was the first Asian nation to
realize that it had a serious HIV/AIDS problem. One that was so serious that it became a top
priority on the national agenda. In the early 1990s, HIV prevalence of brothel-based sex workers
had reached 15.2%, up from 3.1% in 1989. Prevalence was also rising among young Thai men
from 0.5% in late 1989 to 3% in late 1991. It was soon determined that the majority of new
infections were occurring through commercial sex. To address this alarming trend in new
infections, Thai public health officials devised a new strategy in 1989 to promote condom usage
among those engaging in commercial sex in the Ratchaburi province. They called this strategy
the 100% Condom Program.
AIDS in Kenya is a growing phenomenon which presents insurmountable problems to the entire
population NACC (2013). Although measures to eradicate it have been initiated, it seems that the
war against the epidemic is far from being won. UNAIDS (2006) report gives the conditions of
susceptibility to infection as 1.3 million adults and children out of a national population of about
34 millions are living with HIV/AIDS. The latest HIV/AIDS surveys done in Kenya by the KAIS
(Kenya AIDS Indicator Survey) indicate an upward surge in HIV/AIDS prevalence from 6.7% in
2003 to 7.8% in 2008. In December 2008, HFG/Kenya recognized it needed an innovative
vehicle to drive its behavior change communication to Kenya’s youth segments and thus
supported the creation of youth movement,EG-PANGE. The iconic youth brand, G-PANGE,
which means “sort yourself out” in Kiswahili, was developed by and for youth. G-PANGE uses
music, entertainment, technology, and sports to engage youth and empower them to make
healthy lifestyle choices. Other media statements on behavior change communication especially
to the married and those persons in permanent relationships are like, fanya hesabu, wacha
mpango wa kando, weka condom mpangoni and Jitambueni leo.
According to the United Nations, MDG report (2013), millennium development goal number six
– Combat HIV/AIDS, malaria and other diseases targets for universal access to antiretroviral
therapy for all who need it by 2010 was not achieved but is reachable by 2011 if the current
trends continue. The ultimate goal is preventing the spread of HIV, but knowledge of the virus
and how to avoid transmission remains unacceptably low. It is established that young women
are more vulnerable to HIV infection due to a complex interplay of physiological factors and
gender inequality. Because of their low economic and social status in many countries, women
and girls are often at a disadvantage when it comes to negotiating safer sex and accessing HIV
prevention, information and services.
It has been established that condoms are one of the most efficient means available to reduce
sexual transmission of HIV, and their use has increased in many organizations. According to
research conducted in 2011, almost 50 per cent of men aged between 15 and 24 used condoms
the latest time they had sex with a non-regular partner. This represents an increase since the
period around a decade ago. More orphaned children are now in school due to expanded efforts
to mitigate the impact of AIDS.
Currently, as treatment is scaled up, fewer people are dying of AIDS and more people are living
with HIV than ever before. The number of new HIV infections has significantly exceeded the
number of AIDS related deaths in all years of monitoring; as a result more people are therefore
living with HIV at the end of 2011. Sub-Saharan Africa still remain the most severely affected
with 1 in every twenty adults are infected accounting for sixty nine per cent of the people living
with HIV worldwide. Although HIV prevalence rates are nearly twenty five times higher in Sub-
Saharan Africa than Asia, almost five million people are living with HIV in South, South-Eastern
and Eastern Asia combined. After Sub-Saharan Africa, the region most heavily affected is the
Caribbean, where 1 per cent of adults were living with HIV in 2011. UN, MDG Report (2013).
Problem Statement
There are many factors that influence behavior such as beliefs, values, attitudes, family,
friends or the community. Personal behavior change, then, depends on changing many
processes to stimulate change. It also takes time. In addition, there might have to be some
environmental adjustment that helps facilitate behavior change. Behavior change can be
permanent or temporary, which proves that behavior can change according to the situation
and environment of that particular person. Many health and development programs use
behavior change communication (BCC) to improve people’s health and wellbeing. BCC is a
process that motivates people to adopt and sustain healthy behaviors and lifestyles. Sustaining
healthy behavior usually requires a continuing investment in BCC as part of an overall health
program.
The changing of one’s behavior requires many supporting factors to be in place since these
supporting factors are the incentive for behavior change. In a community with wide spread
HIV/AIDS infection, an individual must have the confidence and belief that it is possible to
change and must have the necessary skills or knowledge to practice a new sexual behavior.
Necessary skills include techniques to solve problems in case the behavior change cannot be
regular enough to form a habit. Resorting to old sexual habits can lead to a setback in the
behavior change process. It is therefore necessary for a person working with behavior change
to understand that one’s behavior is determined by three factors. These are personal, social
and environmental. Personal factors are knowledge, beliefs on HIV/AIDS, expectations,
acceptance and emotional states. Social factors include partners, friends, family, and the
community including social values and social norms. Environmental factors are poverty, social
services, mass media and the availability of clinics or hospitals. HIV/AIDS workers have to
analyze which of these factors facilitates behavior change and which factors inhibit it.
Promoting the supporting factors and reducing the inhibiting factors play an important role
in that person’s behavior change process. In order to change the attitude and behavior towards
STIs and HIV/AIDS, there is a need to talk about sex because the HIV/AIDS epidemic in
the dairy workplace is a direct result of unprotected sex. Practicing unsafe sex is not
necessarily due to a lack of knowledge or information rather it is a reflection of people’s
beliefs and values including culture and tradition. HIV/AIDS will only be effectively reduced
and the wellness of workers in the dairy industry workplaces improved only if there is extensive
use of behavior change communication. This study therefore aims at establishing the
effectiveness of behavior change communication on HIV/AIDS reduction and employee
wellness in the diary workplace.
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