Talk and its Importance in HIV
Prevention
Susan Kippax
Social Policy Research Centre
University of New South Wales
Health Communications
• formal health communications such as in HIVprevention campaigns/interventions
• the advice given by clinicians to
patients/counselling
• the informal talk between people as they go
about their everyday lives.
Under What Conditions
•
•
•
•
•
Who says
What to
Whom in
What Micro Contexts and
What Macro Contexts with
• What Effects
0
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
HIV diagnoses in Australia, by year
1600
1400
1200
1000
800
600
400
200
HIV diagnoses in MSM
Other HIV diagnoses
Australian Gay Communities
1982-1998
•
•
•
•
•
Who
What
Whom
Micro Contexts
Macro Contexts
• What Effects
Gay peer educators
Community Strategies
Gay community
Range of gay events
Culturally familiar,
High mortality
Safe Sex Practice
Australian Gay Communities
1999-2014
•
•
•
•
•
Who
Gay Educators & High Profile C’tors
What Community & Biomedical Strategies
Whom
Gay community
Micro Contexts
Gay events & Clinics
Macro Contexts
Optimism
• What Effects Decline in Safe Sex Practice
Median HIV Prevalence of ANC
Median HIV prevalence of ANC attendees from major
Attendees:
19971997
to 2009.
towns
and outside from
to 2009
Major Urban
Outside Major Urban
14
13
12
10
12
10
9.7
8.4
8
7
6
3.6
4
3.8
2
0
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2009
Source: MOH (2010) Epidemiological Surveillance
3: Median HIV prevalence of ANC attendees from major towns and outside, 1989- 2009
Ugandans : late 1980s to 2003
•
•
•
•
•
Who
What
Whom
Micro Contexts
Macro Contexts
• What Effects
Family/friends
Community Strategies
Family/friends
Range of informal settings
Culturally familiar,
High mortality
Safe Sex Practice / Decline
in HIV
Ugandans : post 2004
•
•
•
•
•
Who
What
Whom
Micro Contexts
Macro Contexts
• What Effects
Government, churches
Abstinence and Monogamy
General Population
Clinics, schools, churches
Declining epidemic
Decline in Safe Sex Practice /
Increase in HIV
Conditions of Success
• Collective agency/action lies in people’s
connectedness to others
• Talk is the central element in that
connectedness
• The building of community capacity (via
funding and support from the state)
Individualist Paradigm
• Neo-liberal rational agent
• Communication typically top-down from
expert to individual
• Purpose to change individual’s
behaviour/s
Social Paradigm
HIV prevention as a matter for communities
who, in response to the risk of HIV
• Develop their own risk-reduction strategies,
strategies that are not inimical to their
cultural/social values, and
• Engage with formal and other public health
messages, talk about them, interpret them,
accept, reject or modify them.
Social Paradigm
• Social beings are connected to others
• Communication is typically horizontal
within networks/communities of people
• Purpose of communication is to change
social norms and social practices
Conclusions
• If there is one thing that the last 30 years of
experience in HIV has taught us, it is that
communities and collective action provide the
possibilities for change.
• Social change is always a function of the collective
actions and interactions of groups of people.
• Sustained individual behaviour change depends
on the above.