More than “best practices” for HIV-AIDS control:
redressing the class-based organization of
public health and health communication
Bella Mody
School of Journalism and Mass Communication
University of Colorado
Boulder
http://spot.colorado.edu/~mody
IAMCR Taipei 2005
Outline
• The class-based nature of HIV prevalence
• Socio-political versus medical causes of the
disease
• Class-biased benefits of AIDS media campaigns
• Proposal for a socially-rooted multi-sector
long term health-and-development approach
that is biased in favor of the poor
• My thesis: equitable multidimensional
national and local development is the best
protection against HIV-AIDS
The class-based nature of HIV-AIDS prevalence
• Predominantly a disease of poor countries and
poor people (95% of PLWA are in developing
countries)
• Increasing number of children-headed orphan
households
• A disease that kills 15-24 yr olds who are the
future of their countries
• Spread by poor villagers forced to sell blood
and drugs and/or migrate to the city for work to
support their families in the village
The causes: proximate medical, distal socio-political
• Proximate medical causes: sex with multiple partners,
infected needles, contaminated blood, pregnant motherto-child
• Distal socio-political enabling conditions: power
inequities in terms of low education, employment skills,
purchasing power (to buy condoms, antibiotics and ARV
meds); gender hierarchies that prevent women from
refusing sex, limited job opportunities, a stigmatizationprone culture; a public health infrastructure based on the
ability to pay as a result of structural adjustment
conditions (WB-IMF) and national responses (e.g. Deng
“reforms” require provinces in China to raise their own
funds for healthcare)
• Health education interventions (e.g. CDs,
videos, music, house visits, counseling, media
campaigns) alone are inadequate:
-Address distal conditions (e.g. lack of
employment, poor agric prospects, poor public
health infrastructure) that lead to proximate
causes, e.g. willingness to sell blood and drugs
to make money, migration to the city for work to
support the family in the village, inability to pay
for antibiotics to treat early genital ulcers or treat
AIDS symptoms with ARV meds
• Health education media messages and
interpersonal counseling are class-biased
-Prevention media messages have reached fewer
than 1 in 5 at risk over the last 20 years
-HIV awareness has increased primarily in the
urban middle class
-Men are reached more often than women: more
women are being infected than men presently
-Extension workers prefer to talk to young,
educated and upper income people
• Why is multidimensional equitable national and local
development the best intervention?
Poverty, lack of jobs and socio-political conditions influence
-lack of ability to read instructional texts on prevention and
the consequences of HIV-AIDS
-age at which individuals start sex
-the viability of abstinence and monogamy (the AB of ABC)
-the neglect of condoms
-willingness to sell blood to earn money
-earning income by dealing in injectable drugs and
subsequent vulnerability to their use
-access to good primary healthcare to prevent and treat
HIV-AIDS
• Recognition of the need for holistic structural
reorganization attempts against HIV-AIDS is not
new:
-World Bank and UNAIDS’ Convergent Community
Action: design of national AIDS control orgs that
include staff in medicine, information extension,
counseling, testing, and drugs
-Gates Foundation: integrate strategic elements
with communication and advocacy
-DFID India: link info-education-communication to
other interventions
Recommendation:
• Go beyond individual-targeted medical-model-based
interventions
-Health interventions needed to address distal enabling
causes such as social group inequalities in resources by
economic class, gender and region
(ex: micro-credit combinations with HIV-AIDS
interventions in Morocco)
-Lessons from 19th century infectious disease declines in
England, child health in the 1980s
-Recent statistics indicate 99% of the women who die in
pregnancy and childbirth are from low and middle
income countries
My proposal:
• Design a long-term development-and-health infrastructure
activation approach at the lowest unit that
- simultaneously mobilizes all non-health sectors of development
infrastructure complicit in causing AIDS, e.g. agriculture, education,
health
-learns from rather than imitates someone else’s “best practices”, e.g.
successful AIDs orgs in Brazil, Thailand and pre-Bush Uganda
-builds social choice, citizen participation and democratic deliberation
into the design and functioning of local health and development
institutions
-uses health education interventions via media and face-to-face as one
essential component