Behavioural Monitoring for an All of Society Approach
to HIV / AIDS Risk Reduction in Mozambique
Dealing with Disasters Conference
17th – 18th September
Prof. Andrew E. Collins
Department of Geography / Disaster and Development Network (DDN)
Northumbria University
[email protected]
Purpose of this presentation
• Explore an example of a whole of society
approach to health disaster risk reduction
• Progress an avenue of disaster and
development thinking for health and
wellbeing based on one specific disease
• Solicit new knowledge to better live with
uncertainty in health disasters
2
Overview
1. HIV/AIDS from a HCDRR perspective
2. Findings from Behavioural Monitoring in
Mozambique
3. Conclusions: whole of society infectious
disease risk management
3
HCDRR and HIV / AIDS
• magnitude
• slow onset and persistent
• a particular infectious
disease with constructed
interpretations
4
Nature of HIV/AIDS from a HCDRR Perspective
persistent pandemic - undergone substantive investment –
interpretation and reinterpretation of societal causes and risk
factors - knowledge and behaviour contradictions – complex
•
Opportunity – address the underlying risk factors –
awareness – address uneven development – rights and
responsibilities – health centred risk reduction – restore hope
– address constructivist influences
•
Review the right intervention at the right place, at the right
time and with the right people
5
Understanding HIV / AIDS to inform HCDRR:
particularity and proxy
• Risk: disease hazard, vulnerability (immunity) and
capacity.
Risk = Hazard x Vulnerability
Capacity
• Health ecology: Disease ecology and health ecology;
HIV1 and 2 – susceptibility – personal, institutional,
cultural and political economic aspects – uncertainty
including problem of detection
• Health security, resilience and wellbeing: Build up to
offset – live with it in a health centred way – what is it
really to prevent and to respond?
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Behavioural Monitoring for HIV / AIDS risk
reduction in Mozambique
Context, sample and reasons:
• Opportunity with Family Health International
(FHI) ‘Corridors Project’ – based on rational
of corridors of risk (high risk places and
people – exposure and vulnerability) –
transmission, behaviour
• Long-distance truck drivers; female sex
workers, out of school youth, vulnerable
women in market places and at home
• Impact? How to deal with persistent HIV /
AIDS? Prevention, ART drugs … and what
else?
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Sample
Target Populations
Total
Long Distance Truck
Drivers (LDTD)
272
Out of School Youth (OSY)
Male
Female
1,318
456
Female Sex Workers (FSW)
610
Women in Households
622
Women in Market Places
665
Total
3,943
• Local Interviewers
• Rigorous Ethical Screening
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Behavioural Monitoring Survey Topics
•
•
•
•
•
•
•
•
Sexual history: number and types of partners
Commercial sex partners
Non-commercial sex partners
HIV/AIDS Knowledge, opinions and attitudes
Stigma and discrimination
Gender based violence
Alcohol and drug abuse
Exposure to HIV/AIDS projects
9
Education levels by target group
N= 3,943
60
50
LDTD
40
OSY
30
FSW
20
Women in
households
10
Women in market
places
0
10
Percentage of LDTD who had sex with commercial and noncommercial partners during the previous three months
70
N = 272
61
60
50
50
40
30
19
20
10
16
10
10
7
6
6
5
2
3
4
1
0
None
One
Two
Commercial sexual partners
Three
Four
Five or more
Dont know
Non-commercial sexual partners
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Percentage of respondents who used a condom at last sex by
group and type of partner
100
100
90
88
92
88
78
80
70
65
62
60
50
43
40
34
31
30
20
10
0
LDTD
OSY
With commercial partner
FSW
Women in households
Women in markets
With non-commercial partner
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Percentage of FSW by area and number of commercial and noncommercial partners
N = 610
80
70
60
50
40
30
Moamba
Ressano Garcia
Munhava
20
10
Manga
Inchope
0
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Percentage of Female Sex Workers with zero,
one or more partners – all areas
N = 610
Commercial Sex Partners
Non-commercial Sex Partners
0 partner 1 partner
3%
5%
Don't know
12%
Don't know
6%
1+ partners
10%
0 partner
43%
1 partner
41%
1+ partners
80%
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Some findings
• Knowledge, communication, information,
capacity is not enough
• Rights and responsibilities in decision making
includes interplay of;
– Forced risk taking
– Voluntary risk taking
• Risk of wide transmission is pervasive due to
small number of outliers – from early
transmission factors to persistence factors to new
factors – ‘risky behaviour and cultures of risk’
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Some findings
• Misunderstanding about where the risk is and solutions
there are:
– E.g. LDTD cautious vs. lack of caution in society as a whole
– Changing challenge to prevention i.e. condom use – if everyday
life = no reproduction
– FSW and normal life – where next
• Balance on addressing hazards between extremes and
everyday life
– Complex behavioural risk management plan
– We know from other HCDRR work (IDRM) that it is about being
in the right place at the right time with adequate forms of
protection. Process of achieving this is key rather than universal
solution grabbing.
• This in itself suggests new ways of thinking in disaster risk
reduction. i.e. Show Learning Model.
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Learning in Disaster and Development Outcomes
Intuitive and
experiential learning
Disaster
representations
and outcomes
Proximate and
secondary
systems of
meaning
Change
Environment:
- Power
- Technology
- Behaviour
Development
representations
and outcomes
Collins, A.E. (2015) ‘Beyond experiential learning in
disaster and development communication’ in: Egner,
H., Schorch, M. and Voss, M. (Eds.) Learning and
Calamities: Practices, Interpretations, Patterns, London:
Routledge, pp.56-76.
Summary: The Case of HIV/AIDS
Infectious Disease Risk Management in HCDRR
• Shift: A whole of society approach rather than vulnerable groups
and ‘ignorant’ people. Living with long-term underlying burden.
• Shift: An understanding of grounded everyday adaptability to
risk and reactions to risk rather than uniplanar thinking in
disease management.
• Shift: HCDRR embeds principle of building wellbeing to offset
harm. Working with aspiration and motivation rather than
coping and resilience. Improved culture of Prevention.
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