C IDS ONT A R H O D L N I P S R O G R W A A M R M S.A.C.P A E G A IN ST AIDS 2013 Foreword HIV is transmitted by people to people and can be prevented by certain behaviors to reduce the risk of infection, including safer sexual practices and accessing counseling and testing at the right time. Prevention can be achieved by individuals when they have the necessary information that can lead to right decisions and choices in their behaviors and practices. HIV Communication is the means to provide this prevention information to any individual who at any stage maybe exposed to a situation with the risk of HIV infection. Communication offers an important tool in the country’s AIDS response where the most widely used means of communication for health and sexual matters is person to person or interpersonal communication, and is the key method of behaviour change communication (BCC). Mass communication through print and electronic media remains an important part of the strategy to foster an enabling environment, to increase social participation, and to address stigma and discrimination through information education communication (IEC). Advocacy communication is especially important as a method to be employed by stakeholders and key agencies, both government and civil society, to support policy development and decision making for better AIDS control. In the end I wish to thank and acknowledge the contribution and support of UNICEF and UNAIDS in the country’s AIDS response generally and their support in the development of this communication strategy which will help us in effective HIV & AIDS related communication. Syed Muhammad Javed National Program Manager National AIDS Control Program December 2013 Acknowledgements Mr Ahmed Saleem (Communications Specialist) was the Consultant for the development of this HIV Communication Strategy, who during the process had detailed consultations with a broad range of stakeholders. Valuable contributions of numerous individuals from public and private health sectors, independent researchers, NGOs working in service delivery programs, governmental and UN Agencies were instrumental in the development of this document. The support of UNICEF and UNAIDS is specially acknowledged for funding this work and of Dr Nasir Sarfraz, HIV/AIDS Specialist (UNICEF) for coordinating the process of developing this strategy, and reviewing various drafts. The strategy owes greatly to all the four Provincial AIDS Control Program Managers, namely Dr Salman Shahid (Punjab), Dr Fazli Moula (Khyber Pakhtunkhwa), Dr Muhammad Ahmed Kazi (Sindh), and Dr Mohammad Siddiq Aftab (Balochistan), for providing guidance and support during provincial consultations. This document greatly benefited from the issues raised by and contributions of Dr Muhammad Saleem, Strategic Information Adviser (UNAIDS), Mr Naeem Akhtar Malik, Sociologist (NACP), Dr Rajwal Khan, M&E Specialist (Khyber Pakhtunkhwa) and People living with HV, specially Association of People Living with HIV. Last but not the least, this task would not have been possible without the stewardship and patronage of Mr Oussama Tawil, previous UNAIDS Country Coordinator who guided the initiation of this process and Mr. Marc Saba, current UNAIDS Country Director. Contents Acronyms and Abbreviations viii Executive Summary 10 1 HIV and Pakistan 12 1.1 Background 12 1.2 HIV and AIDS Situation 12 1.3 Knowledge, Information, Awareness and Behaviours 13 2 Need for Communication Strategy 14 3 HIV Communication Analysis – Issues & Challenges 16 3.1 Communication Issues and Challenges 16 3.2 Key Findings and Recommendations 18 4 HIV Strategic Communications Design & Objectives 20 4.1 Goal and Objectives of the Communication Strategy 20 5 Priority Strategic Directions 21 5.1 Strategic Communications Recommendations 21 6 Audience for Pakistan HIV Communication Strategy 24 6.1 Audience Segmentation 24 6.2 Profiles of audience 25 6.2.1 Young People 25 6.2.2 Key Populations at Risk 26 6.2.3 People living with HIV or AIDS (PLHIV) 27 6.2.4 Healthcare Providers 27 6.2.5 Policymakers/Decision Makers, Opinion Leaders & Media 28 6.2.6 Men and Women of Reproductive Age 28 7 Strategic Communication Matrix 30 8 Monitoring & Evaluation 40 8.1 Operational Guidelines 40 8.1.1 Coordination and avoidance of unnecessary duplication 40 8.1.2 Efficiency 41 8.1.3 Focused interventions 41 8.1.4 Spread- achieve broad coverage 41 8.2 Steps to Implementation 41 8.3 Quality Control for Communications Materials 41 8.4 Coordinating Role 42 9 Bibliography 43 ANNEX 1: Analysis of Last National Communications Campaign 46 The Strategy 46 Message Development 46 Selection of Media Channels 48 Management and Reporting 48 Summary Findings of Impact Survey 49 ANNEX 2: Role of Communications in Addressing HIV & AIDS Challenges 51 10.1 Evolution of Social & Behaviour Change Communications for HIV/AIDS 51 10.2 Maximizing Impact through Strategic Health Communication 52 ANNEX 3: Strategy Design Process 53 10.3 Stakeholder Consultations 53 10.4 Literature Review and Desk Research 54 ANNEX 4: Conceptual Framework for the Strategy 55 10.5 Information-Motivation-Behavioural Skills (IMB) Model 55 10.6 The Extended Parallel Process Model (EPPM): Risk Diagnosis 58 10.7 Applying the Behaviour Change Theories to Development of Effective Program 59 ANNEX 5: Targets And Indicators 61 ANNEX 6: Key Messages for Priority Audience 64 ANNEX 7: Media Environment in Pakistan 66 Acronyms & Abbreviations AIDS Acquired Immune Deficiency Syndrome ART Antiretroviral therapy ARV Antiretroviral BCC Behaviour Change Communication BTA Blood Transfusion Authority CBO Community-Based Organization CCM Country Coordinating Mechanism CEO Chief Executive Officer CIDA Canadian International Development Agency CSO Civil Society Organization DFID Department for International Development (UK) DHS Demographic Health Survey EHACP Enhanced HIV/AIDS Control Project EU European Union FANA Federally-administered Northern Areas FAO Food and Agricultural Organization FATA Federally Administered Tribal Areas FELTP Field Epidemiology Laboratory Training Program FHI Family Health International FSW Female Sex Worker GARP Global AIDS Response Progress GARPR Global AIDS Response Progress Report GFATM Global Fund to Fight AIDS, Tuberculosis and Malaria GIPA Greater Involvement of People living with AIDS GF Global Fund GIZ Deutsche Gesellschaft für Internationale Zusammenarbeit viii GoP Government of Pakistan PC Planning Commission HASP HIV/AIDS Surveillance Project PC-1 Planning Commission Proforma – One (Project Document) HTC HIV Testing and Counselling PHC Primary Health Care HCV Hepatitis C virus PIMS Pakistan Institute of Medical Sciences HIV Human Immunodeficiency Virus (Islamabad) HMIS Health Management Information System PLHIV People living with HIV HRG High Risk Group PMTCT Prevention of Mother-to-Child HSW Hijra Sex Worker Transmission IBBS Integrated Biological and Behavioral PPM Provincial Program Manager Surveillance PPTCT Prevention of Parent-to-Child IDP Internally Displaced Person Transmission IEC Information, Education and PR Principal Recipient - GFATM Communication PWID People who Inject Drugs ILO International Labour Organization TACA Technical Advisory Committee on AIDS IOM International Organization of Migration TOR Terms of Reference IPC Inter- Provincial Coordination TVC Television Commercial KP Key Populations at risk TWG Technical Working Group KPK Khyber Pakhtunkhwa UNAIDS Joint United Nations Program on HIV/ M&E Monitoring and Evaluation AIDS MARA Most-at-Risk Adolescent UNDP United Nations Development Program MDG Millennium Development Goals UNFPA United Nations Population Fund MERG Monitoring Reference Group UNGASS United Nations General Assembly MICS Multi Index Cluster Survey Special Session MoIPC Ministry of Inter-Provincial Coordination UNHCR United Nations High Commissioner for Refugees MSM Men who have Sex with Men UNICEF United Nations Children’s Fund MSW Male Sex Worker UNODC United Nations Office for Drugs and MTR Mid-Term Review Crime NACP National AIDS Control Program USAID United States Agency for International NEP Needle Exchange Program Development NFC National Finance Committee VCCT Voluntary Confidential Counselling and NGO Non-Governmental Organization Testing NPM National Program Manager VCT Voluntary Counselling and Testing NSEP Needle Syringe Exchange Program WB World Bank NSF National Strategic Framework WHO World Health Organization NTP National Tuberculosis Program PACP Provincial AIDS Control Program ix Executive Summary 1. Pakistan’s estimated HIV burden is low—around 0.1 per cent of the adult population — the country though, is facing a concentrated epidemic among People Who Inject Drugs (PWID). The country has a window of opportunity to act decisively to prevent the spread of HIV. Given linkages between PWID and other Key Populations (KP) at risk including male and female sex workers, Pakistan needs to scale up targeted interventions urgently to prevent the rapid rise in HIV prevalence among Key and Vulnerable population groups. 2. This communication strategy intends to provide a practical, concise and helpful instrument for formulating effective HIV and AIDS communication interventions in Pakistan. It is not a manual on Behaviour Change Communication (BCC) or Strategic Communication processes and implementation. It is designed to cover key issues relating to national HIV and AIDS communication over the next three years (2013 – 2015) and to empower all stakeholders to devise an all-inclusive, audience responsive, culturally