You are the local Director of Public Health in your region where HIV infection is a major public health issue and national leaders do not support drug use or barrier contraception. Describe how you would use your knowledge of public education, individual’s perception of risk and the use of the media, to promote healthy behaviour to limit disease impact, and increase the use and public acceptance of drug therapy. Reinforce your answer with evidence based interventions as far as possible.

1. SUMMATIVE ASSIGNMENT
HP27 – HEALTH PROMOTION:
PSYCHOLOGY AND HEALTH PROMOTION
November 2003
Word count: 2031
Dr Josep Vidal-Alaball

2. HP27. Health Promotion. Summative Assignment. 21344
You are the local Director of Public Health in your region where HIV infection is a
major public health issue and national leaders do not support drug use or barrier
contraception. Describe how you would use your knowledge of public education,
individual’s perception of risk and the use of the media, to promote healthy
behaviour to limit disease impact, and increase the use and public acceptance of
drug therapy.
Reinforce your answer with evidence based interventions as far as possible.
Scenario
For the purpose of this assignment I will assume I am the local Director of Health in a sub-
Saharan Christian region of Africa. Traditionally national leaders have been opposing the
use of drugs to combat HIV/AIDS for economical reasons and religious leaders have been
discouraging the use of condoms. This attitude is affecting the HIV/AIDS programmes run
by international agencies to prevent the spread of the disease and is stopping moves to
provide affordable drugs.
The Problem
More than three million people died worldwide from AIDS during 2002, from those 2.5
million where adults and more than 600,000 children (UNAIDS/WHO, 2002).
In the sub-Saharan Africa, 29,400,000 adults and children where estimated to be living
with HIV/AIDS during 2002 and 3,500,000 became newly infected from HIV during the
same period (UNAIDS/WHO, 2002).
There has been important advances in the treatment of AIDS and is faster becoming a
chronic illness in rich countries. Unfortunately, the situation is very different in the sub-
Saharan region where patients can not afford these treatments and governments do not
want or can not pay for these expensive drugs. To aggravate the problem, often religious
leaders in the region do not support barrier contraception.
So far, most of the interventions of the national and international agencies seem to be
focusing in women (O'Farrell, 2000), ignoring that according to UNAIDS young men (15-
24 years old) represent more than a quarter of all people who have HIV infection. These
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3. HP27. Health Promotion. Summative Assignment. 21344
young men are the most at risk of contracting the infection as they more likely to engage
in unprotected sex with more than one sexual partner and they are more likely to inject
drugs and share needles (Crowe, 2001).
How to tackle the problem
My aim is to improve knowledge and understanding of the HIV problem amongst young
men, hoping that this will change their behaviour. Men often put women in vulnerable
situations regarding taking risks and an intervention targeting this group could be
contributing to control the spread of HIV infection.
At the same time I am planning to start lobbying the government in order to get their
support to provide affordable drugs to treat patients with HIV/ADS.
Stakeholder Analysis
In order to address the problem of lack of support from national and religious leaders, my
first intervention is going to involve a stakeholder analysis. My objective will be to identify
those people or organisations than can influence behaviour in young men regarding
HIV/AIDS or can increase the use and public acceptance of drug therapy. [See appendix 1
for stakeholder analysis (Varvasovszky and Brugha, 2000)].
Once the stakeholders have been identified I will meet them to explain the campaign I am
preparing, I will do my best to convince sceptics with help from supporting organisations.
I will use The Declaration of Alma Ata (1978) to try to convince national leaders. I will
explain them that “health is a fundamental human right”, the “most important world-wide
social goal” and that “health is essential to sustained economic and social development”.
The HIV/AIDS pandemic has reduced average national economic growth rates by 2-4% a
year in Africa (Dixon et al., 2002). Finally, I will remind them that “governments have a
responsibility for the health of their people”.
I am aware of the power religion has in my community and that this may influence my
programme. A recent article published in The Lancet Infectious Diseases, has criticised
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4. HP27. Health Promotion. Summative Assignment. 21344
severely the Catholic Church in Africa for jeopardizing programmes aimed to increase the
use of condoms (Editorial, 2003). However, it is possible to engage the religious sector in
the fight against HIV/AIDS. To do this it is essential to exchange ideas with this sector
which can be done through conferences and creating alliances at community level
(UNAIDS/WHO, 2000). It is also possible to promote good sexual health using the schools
attached to religious organizations.
Public Education
My program to promote healthy behaviour to limit disease impact and increase the use
and public acceptance of drug therapy will consist in 2 related interventions:
• An eye catching media campaign with adverts on TV and radio.
• Community Development Programme (community participation).
It is very important that I give a credible and consistent message. Trust is essential and I
will try to avoid contradictory messages. Who gives the message is also relevant; I will use
a famous figure, a local footballer now playing in Europe to promote the message. He is a
strong positive role model with young people and well known for his involvement in
HIV/AIDS campaigns. I will hope to involve the National Football Federation and
organisation that has influence over thousands of young men.
Community Development Programme. This programme will try to mobilise the community
in my region in order to obtain their cooperation in the assessment and planning of the
campaign to limit the impact of HIV/AIDS in young men. Hopefully they will be also
involved in the implementation of the programme and in the monitoring and feedback. My
main objective will be to empower the community to increase control over the health of
their youngsters.
Risk communication
Risk communication is an inherent part of public education. Ideally, I would address
individual’s perception of risk as studies have shown that individualised risk
communication leads to increased participation in programmes (Edwards et al., 2003).
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5. HP27. Health Promotion. Summative Assignment. 21344
Realistically this may be difficult, to address this I will communicate risk to groups using
the media.
Before doing this I will interview 20-30 young men in order to know existing health
believes. Believes built through the family and religion are the most difficult to change. I
want to establish what they know and what they want to know about risks of HIV/AIDS. I
am aware that young men may receive conflicting information from different sources and
that social factors may influence the way they react to risk information (Alaszewski and
Horlick-Jones, 2003), to address this I will ask them where they take the information from
and I will assess how accurate it is. I will explore perception of risk-taking, as many young
men will participate in some health risk-taking.
Use of the Media
It is important to carefully plan the media campaign, to do so I will use the 10-point
strategic planning described by Anne Gregory (Gregory, 1996).
ANALYSIS OBJECTIVES
PUBLICS
MESSAGES
STRATEGY
TACTICS
TIMESCALES
RESOURCES
EVALUATION
REVIEW
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6. HP27. Health Promotion. Summative Assignment. 21344
I will run a media campaign to promote public awareness of both, prevention and
treatment of HIV/AIDS. I need the media as it covers large audiences and the age group I
am targeting is likely to be consumers of media in many different formats. It is important
that I can have the media on my site so I will develop a two-way relationship; I will try to
know the media and I will let them now my program. I will meet key health journalists and I
will provide them with regular briefings on how the campaign is going. I will target several
types of media always focusing in media young men consume.
It is important I know who runs the media, in my region, there is a national government
lead TV and a less important new TV channel. Some people have access to cable TV but
just in the inner city areas.
I will launch the media campaign, coinciding with the World Aids Day, with a special media
conference where I will present the TV advert with my famous footballer. The campaign
will be launch on TV and radio in the first instance but them I will insert adverts on
magazines used by young men and on local newspapers. The tone of the adverts will be
concise, comprehensive and accurate. I will prepare news releases regularly to inform
about how the campaign is going and I will organize another media conference six months
and one year after the campaign starts to review and explain how the campaign is going.
(See appendix 2 for initial press release)
Using the Evidence
There is evidence that targeted information coming from trusted sources and linked to
community resources, such as the provision of condoms, does reduce high risk behaviour
(Myhre and Flora, 2000).
There have been initiatives linking football with HIV/AIDS prevention in young men. In
Nairobi, Kenya, the “Break the Silence: Talk about AIDS” campaign organized a football
tournament and several related activities with the objective of promoting awareness
amongst youngsters through football. The campaign reached further as involved the whole
community and contributed changes to policy affecting young people (Awasum et al.,
1999). A recent systematic review has also concluded that mass media interventions can
have a positive influence in the utilization of health care services (Grilli et al., 2003).
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7. HP27. Health Promotion. Summative Assignment. 21344
Community mobilization has proved to be a key factor in trying to prevent the spreading of
HIV/AIDS in Africa. It is well known that it is easy to start a community effort but it is very
hard to sustain the programmes. To ensure sustainability it is essential to have a broad
and representative group of community members providing an equal partnership and
maximizing community resources (UNAIDS/WHO, 2000).
In Zambia there have been examples of partnership between religious organizations and
NGOs to provide sexual health education to religious youth groups (UNAIDS/WHO, 2000),
proving that it is possible to engage religious groups in HIV/AIDS prevention programmes.
Conclusions
It is possible to promote healthy behaviour to limit the impact of HIV/AIDS among young
men using an educational media campaign involving an area of interest to those men, as it
is football and a Community Development Programme to secure the long term
sustainability of the programme.
The programme has another intention; to be used as a tool to lobby the government in
order to stop interfering in the efforts to provide affordable antiviral drugs.
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8. HP27. Health Promotion. Summative Assignment. 21344
References
(1978) In International Conference on Primary Health Care. Alma Ata, Kazakhstan.
Alaszewski, A. and Horlick-Jones, T. (2003) 'How can doctors communicate information
about risk more effectively?' BMJ, 327, 728-731.
Awasum, D., Sienche, C. and Obwaka, E. (1999) John Hopkins University.
Crowe, S. (2001) 'AIDS education must target young men in developing countries', BMJ,
323, 472d-.
Dixon, S., McDonald, S. and Roberts, J. (2002) 'The impact of HIV and AIDS on Africa's
economic development', BMJ, 324, 232-234.
Editorial (2003) 'The leading edge. Faith no more', The Lancet Infectious Diseases, 3.
Edwards, A., Unigwe, S., Elwyn, G. and Hood, K. (2003) 'Effects of communicating
individual risks in screening programmes: Cochrane systematic review', BMJ, 327,
703-709.
Gregory, A. (1996) Planning and Managing a Public Relations Campaign, Kogan, London.
Grilli, R., Ramsay, C. and Minozzi, S. (Eds.) (2003) Mass media interventions: effects on
health services utilisation (Cochrane Review), John Wiley & Sons, Ltd., Chichester,
UK.
Myhre, S. L. and Flora, J. A. (2000) 'HIV/AIDS communication campaigns: progress and
prospects.' J Health Commun, 5(suppl), 29-45.
O'Farrell, N. (2000) 'Getting HIV/AIDS accepted on the political agenda', BMJ, 320, 516a.
UNAIDS/WHO (2000) In UNAIDS Best Practice Collection.
UNAIDS/WHO (2002) In AIDS Epidemic Update: December 2002.
Varvasovszky, Z. and Brugha, R. (2000) 'How to do (or not to do)... A stakeholder
analysis', Health Policy and Planning, 15, 338-345.
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9. HP27. Health Promotion. Summative Assignment. 21344
APPENDIX 1. STAKEHOLDER ANALYSIS
Stakeholders Involvement Interest Influence/ Position Impact
in the issue in the Power of
issue issue
UNAIDS/WHO Providing High Medium Mobilised Medium
programmes Strong
leadership
NGOs Providing High Low Mobilised Low
programmes
Government Afraid of loosing High High Non- High
control compliant
Religious Afraid of loosing Medium High Non- High
leaders control compliant
Tribal leaders Following advise Low High Non- High
from government and mobilised
religious leaders
Medical Willing to provide High Low Supportive Low
profession care
Drug Willing to provide High Medium Supportive Low
manufacturers medication
Media Heavily controlled by Low Medium Non- Medium
government mobilised
National Football Not interested in the Very low Medium Non- Medium
Federation problem mobilised
General public Unaware of the Low Low Non- Medium
problem mobilised
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10. HP27. Health Promotion. Summative Assignment. 21344
APPENDIX 2. PRESS RELEASE
MEDIA CONFERENCE
Launch of campaign to increase awareness of HIV/AIDS amongst young men.
Monday 1st December 2003
More than three million people died worldwide from AIDS during 2002, from those 2.5
million where adults and more than 600,000 children. In the sub-Saharan Africa,
3,500,000 adults and children became newly infected from HIV during 2002. There has
been important advances in the treatment of AIDS and is faster becoming a chronic
illness.
Until now, most of the interventions of the national and international agencies seem to be
focusing in women, ignoring that according to UNAIDS young men represent more than a
quarter of all people who have HIV infection. These young men are the most at risk of
contracting the infection as they more likely to engage in unprotected sex with more than
one sexual partner and they are more likely to inject drugs and share needles.
We are launching a campaign to promote the use of condoms amongst young men in
order to stop the spread of HIV/AIDS in our region. Condoms have been shown to prevent
this fast growing illness and they are cheap and easy to use.
Mr. X. Goal, our famous football player, will launch the campaign. He is well know for his
long lasting lobbing work to provide with affordable drugs people suffering from HIV/AIDS.
He will also be the main actor in our adverts. He will answer your questions and will be
available for a photo opportunity at the end of the conference. We will like to thank him for
his altruistic collaboration with the campaign.
Dr J Vidal-Alaball
Director of Public Health
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11. HP27. Health Promotion. Summative Assignment. 21344
APPENDIX 3. REFLECTIVE STATEMENT.
What I have learned in undertaking the assignment.
I have acquired a deeper understanding of the problem that HIV/AIDS posses to the
development of the sub-Saharan Africa. I was aware of the problem but I was shocked to
know the full scale of the HIV/AIDS pandemic in this region.
I have learnt how to use the media to promote healthier behaviour though public education
and how to manage individual’s perception of risk. I have though about different ways to
get a clear message to young men and I have come across football as a mean or health
promotion.
I have learnt about better ways to encourage community participation and to ensure the
sustainability of the projects and I have discovered the Community Development
Programmes.
Literature search methods
I have used Ovid-Athens to locate articles using the following words: HIV/AIDS,
campaigns, health Promotion, Community Development Programmes, Africa.
I have used www.bmj.com and the Cochrane Library. I have hand searched the
bibliography of interesting articles to find out more references.
I have downloaded several documents from UNAIDS/WHO and the Health Development
Agency Website. I have also used www.google.com.
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