Behaviour change communication

Two years into the COVID-19 pandemic and there is still much misinformation around the disease. This is fuelling vaccine hesitancy and undermining efforts to respond effectively and protect the most vulnerable.

To respond to misinformation around COVID-19 and HIV, UNAIDS and the Africa Centers for Disease Control and Prevention (Africa CDC), with support from the German Ministry of Health, are organizing a series of training sessions to strengthen the capacities of African Ministries of Health and National Public Health Institutes. The sessions cover key areas of risk communication and community engagement on COVID-19 and HIV such as strategic communication planning, media engagement, familiariziation with continental and regional guidelines, social media and rumour management.

“These trainings aim at harmonizing and coordinating our risk communication and community engagement interventions on COVID-19 and HIV, and better engage our communities in the response to pandemics” said Benjamin Djoudalbaye, Head of Public Health Diplomacy at Africa Centers for Disease Control.

According to the World Health Organization, in the first three months of 2020, nearly 6 000 people around the globe were hospitalized because of coronavirus misinformation. Rumors on COVID-19, HIV, and most recently Monkeypox are reinforcing stigma and discrimination affecting populations which are already marginalized due to their race, economic status and/or gender identity.

To track and address rumors and fake information surrounding COVID-19 and HIV, UNAIDS and Africa CDC are running a rumor management system—a software that uses machine learning combined with human expertise to collect and analyze rumour data from open source traditional media (web-based, broadcast) as well as social media (Facebook, Twitter, Whatsapp). The system enables the identification of false and misleading narratives and sentiments related to COVID-19 and HIV. Weekly reports are then consolidated and used by Africa CDC as an alert system across the continent.

The first training session was held on 28 June in Dakar, Senegal for eleven countries of the West Africa Region. Two other training sessions will be held in the central and north African regions in July 2022.

An infectious disease can spread around the world in days. Human factors that have quickened the pace of virus transmission include the growing global population, urbanization and the industrialization of food production. The Smithsonian’s National Museum of Natural History in the United States of America features nine diseases that have spilled over from animals to humans in its newly opened exhibition, Outbreak: Epidemics in a Connected World.

One hundred years after the influenza pandemic, the three-year-long exhibition sheds a light on the causes of disease outbreaks such as Nipah virus and severe acute respiratory syndrome (SARS) and the various responses to epidemics.

“The 2014 Ebola outbreak in western Africa was the catalyst, but we wanted to have HIV—the pandemic of our time—as a big focus of the exhibition,” said Sabrina Sholts, the lead curator. For HIV, the museum created a three-dimensional timeline showing the landmarks of the AIDS response in the United States, from the activism to the science to the policy changes and treatment. Objects such as red ribbon pins, ACT UP T-shirts with a pink triangle with the saying Silence=Death, condoms, antiretroviral medicine bottles and photos guide visitors from the start of the HIV epidemic until now. A large touch table allows for people to explore new infections around the world today based on the latest UNAIDS data.

“We didn’t want to leave the impression that AIDS is over and limited to one place, so the interactive component resonates with people as to where we stand right now,” said Ms Sholts.

The UNAIDS Strategic Information Department worked with Ms Sholts’ team and provided specific epidemiological data. Timely and accurate data on diseases are the clues to trends in an epidemic. Displaying and using those data are critical pieces of our work,” senior UNAIDS epidemiologist Mary Mahy said.

Ms Sholts admits that making the data visually engaging was a challenge, but by simplifying the language and adding context, the digital interactive centerpiece works well.

The curator’s aim was to have visitors understand the varying difficulties of getting people to know their HIV status and ultimately the long-term benefits that that entails.

“Diseases are scary stuff, so for every dire challenge or obstacle, we created an “on the upside” component to highlight a success story or uplifting angle,” she said. For the HIV pandemic, the upsides focus on various organizations serving people in need, like the Ponce de Leon Center in Georgia, United States.

She explained that the main goal of Outbreak is to raise public awareness about pandemic risks with the perspective that human, animal and environmental health are all connected as one.

The exhibition also showcases a mock-up of an Ebola treatment ward and a game, played on touch screens, that has visitors simulate a variety of roles—epidemiologist, wildlife biologist or community worker—to complete tasks as a team to end an outbreak.

Part of Outbreak focuses on the detective work involved in tracking down and containing diseases. Future viruses are inevitable, which is why understanding human influence on their emergence and development is key. 

Touching wild animals, a lack of vaccination, unprotected sex and travelling when sick all contribute to a virus’ proliferation, linking distant and diverse populations to each other beyond their communities, countries and continents. The response to these diseases, therefore, must also involve everyone.

“We are all connected, we all matter and we have to think holistically, collaboratively and collectively,” Ms Sholts said.

For those not travelling to Washington, DC, the Smithsonian has a free pared-down version of the exhibition—including the UNAIDS interactive display—available for translation and customization worldwide.

Analysis of social media use shows that, on the whole, most users tend to engage most with information that aligns to their existing beliefs and perceptions on the world. This phenomenon has been described as the echo chamber effect, whereby users find themselves surrounded, in general, by content from like-minded people and preferred information sources.

Echo chambers can be an opportunity as well as a barrier in the response to HIV. Some online communities offer spaces for people to access and share HIV-related information and resources in a stigma-free manner. On the other hand, echo chambers can also enhance stigmatization, promote discriminatory behaviours or spread inaccurate or false information. To some extent, the echo chamber effect can limit the ability of individuals or organizations to reach people outside of their natural audience bases.

UNAIDS and ViiV Healthcare chaired a symposium on breaking out of such echo chambers at the International AIDS Conference, being held from 23 to 27 July in Amsterdam, Netherlands. The panellists discussed various ways of being heard in a cluttered digital and non-digital space that has radically changed in the past decades.

Science magazine reporter Jon Cohen explained how he uses print, radio, television and Twitter to keep up with the onslaught of news. Despite the non-stop nature of his job, he stressed the importance of quality journalism.

“A medium is a medium and sadly a lot of people do not use the vehicle they have to tell stories well,” he said, likening it to a doctor not using his sharpest tool during an operation. In his opinion, it’s easy to lose readers and viewers, so he advised people to engage as much as possible with their audience and avoid preaching to people.

“Even if I offend people, I describe the reality, because I want you to see it and feel it,” he said.

Georgia Arnold, the Executive Director of the MTV Staying Alive Foundation, explained that the HIV television drama Shuga had had such a successful run for the past nine years because the show focused on teens and spoke to them at their level. It depicts relatable characters that deal with real issues and there is constant youth-based feedback. Recently, MTV introduced a gay character, which she said demanded some adjustment because some countries outlaw homosexuality.

“Use technology to transcend boundaries,” she said, explaining how MTV had to air two versions of the show but uploaded the gay version to YouTube and followed up on Twitter and Instagram. “Flex boundaries, do not smash them,” she advised.

J.P. Mokgethi-Heath couldn’t agree more. He is a policy adviser on HIV and theology for the Church of Sweden and uses his pulpit and sacred texts to reach his audience. “I help people understand texts in a different way,” he said. For him, his style of storytelling in person leads to an immediate response, so he aims to always stay true to his beliefs.

Immediacy and immersion drove Rowan Pybus and Sydelle Willow-Smith to try their hand at virtual reality video-making. The founders of Makhulu Productions based their 3-D short films on young South Africans’ experiences and highlighted one adolescent girl’s journey with HIV, making viewers feel like they are walking into a clinic for an HIV test.

“Virtual reality can have a physical effect on people, and that is a very exciting space to be in,” Mr Pybus said. Ms Willow-Smith added that the fact that Google, UNAIDS, the Desmond Tutu HIV Foundation and the Children’s Radio Foundation all partnered to make the films possible reflects how there is real interest to “break out of individual echo chambers.”

UNAIDS Communications Director Mahesh Mahalingam said that World AIDS Day provides a great opportunity to reach out to people about HIV. Last year, he said, UNAIDS wanted to communicate in a fresh way. The team produced a magazine-like report on the right to health in general, going beyond issues related to HIV. Various communities weighed-in in a series of questions and answers on what the right to health means to them.

“People got to say what they wanted through the UNAIDS mouthpiece, allowing us to break barriers and reach new audiences,” he said.

The symposium ended with ViiV Healthcare and UNAIDS announcing a new digital storytelling challenge prize. “If you feel you engage hard-to-reach groups on issues related to HIV prevention, testing, care and/or stigma, then apply,” said ViiV Healthcare Positive Action’s Jennifer Carpenter. She also recognized the two winners of the Every Footstep Counts video competition, Rogers Simiyu from the Elisabeth Glaser Pediatric AIDS Foundation and Joseph Baguma of THETA-Uganda.

A baby abandoned at a health clinic, an abusive boyfriend, dating woes and fake medicines are all plot twists in C’est la Vie (That’s Life), a television series based in, and produced in, Africa. Shot in Senegal, the sitcom takes place in the fictitious Ratanga health clinic, where midwives interact with patients and work on various cases. Their life stories and office politics come into play, adding intrigue, but the overall aim is to raise health awareness through entertainment.

The series, a first in western Africa, was inspired by Mexican pioneer Miguel Sabido—who used telenovelas to promote literacy and family planning—as well as by the educational television series Shuga. Shuga, the MTV English-language series, is now in its six season and has been so successful that it has moved its filming location from Kenya to capture new stories from Nigeria and South Africa.

Réseau Africain d’Education en Santé (RAES), a nongovernmental organization backed by several United Nations agencies and the French Government, founded Keewu, a production company, to launch the show.

RAES founding member and now Keewu producer Alexandre Rideau’s motivation for launching C’est la Vie was to reach millions via television. “The statistics speak for themselves in western Africa,” Mr Rideau said. “Young people are clueless about sexuality, HIV prevention and simple things like menstruation.” He also added that it was obvious from the many questions received that people had real difficulty in accessing information.

The show highlights many of the realities of the region, from high levels of maternal deaths to HIV infection. Four in five children living with HIV in western and central Africa are still not receiving life-saving antiretroviral therapy and AIDS-related deaths among adolescents aged 15–19 years are on the rise in the region, according to a UNAIDS/United Nations Children’s Fund report, Step up the pace. 

In its second season, C’est la Vie has gained in popularity, so much so that actors are being recognized in the street. Mr Rideau recounted that a toll collector in a toll booth in Dakar would not let an actress who plays an unpleasant character in the series go through in her car.

Broadcast in western and central African countries on A+ and TV5 Monde Afrique, as well as local channels, the show reaches about 100 million viewers. Mr Rideau explained that the series may not necessarily change people’s behaviour, but it gets crucial conversations started about health issues. In Senegal and Togo, open debates about the show’s themes take place in town squares following an airing.

Mr Rideau said that he wants to roll the show out in six other countries in 2018. A radio spinoff in the Hausa language is now being distributed in Niger.

PROMO REEL - C'est la vie! - Saison 1 from Keewu Production on Vimeo.

Close to 10 years after its first edition, a fully updated International Technical Guidance on Sexuality Education published today by UNESCO advocates quality comprehensive sexuality education to promote health and well-being, respect for human rights and gender equality, and empowers children and young people to lead healthy, safe and productive lives.

“Based on the latest scientific evidence, the International Technical Guidance on Sexuality Education reaffirms the position of sexuality education within a framework of human rights and gender equality,” says UNESCO Director-General Audrey Azoulay. “It promotes structured learning about sexuality and relationships in a manner that is positive and centred on the best interest of the young person. By outlining the essential components of effective sexuality education programmes, the Guidance enables national authorities to design comprehensive curricula that will have a positive impact on young people’s health and well-being.”

The Technical Guidance is designed to assist education policy makers in all countries design accurate and age-appropriate curricula for children and young people aged 5 – 18+.

Based on a review of the current status of sexuality education around the world and drawing on best practices in the various regions, the Guidance notably demonstrates that sexuality education:

•  helps young people become more responsible in their attitude and behaviour regarding sexual and reproductive health
• is essential to combat the school dropout of girls due to early or forced marriage, teenage pregnancy and sexual and reproductive health issues
• is necessary because in some parts of the world, two out of three girls reported having no idea of what was happening to them when they began menstruating and pregnancy and childbirth complications are the second cause of death among 15 to 19-year olds
• does not increase sexual activity, sexual risk-taking behaviour, or STI/HIV infection rates. It also presents evidence showing that abstinence-only programmes fail to prevent early sexual initiation, or reduce the frequency of sex and number of partners among the young.

 The publication identifies an urgent need for quality comprehensive sexuality education to:

• provide information and guidance to young people about the transition from childhood to adulthood and the physical, social and emotional challenges they face.
• tackle the challenges posed by sexual and reproductive health issues, which are particularly difficult during puberty, including access to contraception, early pregnancy, gender-based violence, sexually transmitted infections (STIs) and HIV and AIDS
• raise awareness of HIV prevention and transmission, of which only 34 per cent of young people around the world can demonstrate accurate knowledge
• complement or counter the large body of material of variable quality that young people find on the internet, and help them face increasingly common instances of cyberbullying.

The Guidance was produced in collaboration with UNAIDS, United Nations Population Fund (UNFPA), United Nations Children’s Fund (UNICEF), UN Women, and the World Health Organization (WHO).