Communication and HIV: Multi-Dimensional Frustration

• Author: Marjan de Bruin
• Pages: 130-152

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SEXUALITY, SOCIAL EXCLUSION AND HUMAN RIGHTS

INTRODUCTION

Experts in HIV prevention in the Caribbean are beginning to realize

that their efforts, in which communication planning and

interventions play crucial roles, have not been very successful. Although

studies show some achievement, important groups of people are still not

responding as expected. In 2006 the Caribbean’s average HIV rate was

one per cent but prevalence in individual countries varied considerably.

While Cuba’s adult HIV prevalence was among the lowest in the world

at 0.1 per cent, rates in The Bahamas and Haiti were among the worst —

as high as 3.3 per cent and 3.8 per cent (UNAIDS 2007). Particularly

vulnerable communities such as commercial sex workers –– mobile

groups, in-country as well as intra-regionally –– inhabit a range from 3.5

per cent in the Dominican Republic to 31 per cent in Guyana. With such

disparities, it is more appropriate to speak of a region with multiple

epidemics –– some of which have stabilised while others are still growing.

HIV in the Caribbean is transmitted primarily through unprotected sex

with an HIV-positive partner –– much more commonly than through use

of needles or contaminated (transfused) blood and hardly at all through

mother-to-child transmission (MTC), the rate of which is falling rapidly.

Recent data reveal a ‘mosaic of homo/bi and heterosexual transmission with

a current male-to-female ratio of almost one-to-one.’ (CAREC 2007, 4).

This chapter will examine the role of communication in HIV-

prevention strategies. Assuming that HIV-prevention interventions in

the field are guided by national and regional strategic planning, I intend

Communication and HIV

Marjan de Bruin

Chapter 7

Multi-Dimensional Frustration

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COMMUNICATION AND HIV

to identify precisely what role is ascribed to ‘communication’ by policy

frameworks in the region, generally, and specifically in three countries —

Barbados, Jamaica and Trinidad and Tobago. I will do this by analysing

the recent policy frameworks in this area: the relevant National Strategic

Plans (NSPs) and PANCAP’s (the Pan Caribbean Partnership against

HIV and AIDS) Regional Strategic Framework (RSF) and Regional

Action Plan. In my analysis, I will try to identify the models and strategies

of communication approaches to which these policies refer and raise

questions on the underlying, apparently implicit, assumptions.

Before presenting the results of this analysis, I will point to some of

the puzzling data in Caribbean research on sexual behaviour: contradictions

and gaps in the quantitative data, mainly coming from knowledge, attitude,

practice and behaviour (KAPB) surveys. In trying to understand these

gaps, I will return to data from qualitative research which seems to give

the surveyed realities more depth. These ‘puzzling gaps’ may indicate the

need to revise some of the concepts and assumptions employed in HIV

prevention and the role communication may usefully play.

I will show that the Caribbean is not the only region in which there are

serious questions about the foundations of communication interventions

in HIV prevention. International debates, over the last decade, have focused

on similar issues. I will conclude my examination by identifying the need

for conceptual revision and reorientation of policy and proposing

suggestions for follow-up action.

HIV AND SEXUAL BEHAVIOUR IN THE CARIBBEAN

To develop a better understanding of sexual behaviour in the Caribbean,

studies in the ’80s, and certainly up to the mid- ’90s, tried to map out

the more salient issues such as risky sexual behaviour, partnership status,

median age at first sex, knowledge of HIV-prevention methods and use

of condoms. Later additions were stigma and discrimination –– all

explored through regular, large-scale KAPB surveys. These studies were

mainly descriptive, providing important baseline information and enabling

the tracking of changes in sexual behaviour. Although we see the occasional