AIDS communications through social networks: catalyst for behaviour changes in Uganda
AbstractObjective: To investigate distinctive communications through social networks which may be associated with population behaviour changes and HIV prevalence declines in Uganda compared to other countries.
Methods: We undertook a comparative analysis of demographic and HIV behavioural data collected in Demographic and Health Surveys (DHS III) in Uganda, Kenya, Tanzania, Malawi, Zambia and Zimbabwe as well as Knowledge, Attitudes and Behaviours (KABP) surveys in Uganda in 1989 and 1995. AIDS behaviours, social communications and channels for communication about AIDS and people with AIDS were analysed by age, sex and country. Modelling was developed to investigate at what stage of the epidemic a majority of people will know someone with AIDS, given differing communication patterns through social networks. Finally AIDS reporting and Voluntary Counselling and Testing (VCT) trends were analysed to assess if the impact of social communications worked through clinical services and interventions or more directly at the population level in community contexts.
Results: Uganda showed unique patterns of communications through social networks including a shift from mass and institutional to personal channels for communicating about AIDS, 1989–1995. This was associated with higher levels of knowing someone with AIDS through social networks and, in turn, positive risk ratios for behaviour change including reducing casual sex and condom use. Youth had distinctively high levels of knowing someone with AIDS in Uganda, suggesting widespread community communication across age groups. Patterns of disclosure, AIDS diagnosis and reporting were influential on social communications about AIDS. Over 90%, 45% or under 20% of people know someone with AIDS at peak HIV incidence and high AIDS mortality, depending on whether communications through social networks are extensive or restricted.
Conclusion: There are distinctive patterns for communicating through social networks about AIDS and people with AIDS in Uganda. They appear to work directly at population level rather than in response to clinical interventions and testing and may be important in the uptake of the latter services. This communication response provides an important basis for HIV prevention if it is to be scaled to the population level. Vertical prevention (and even treatment) interventions need to engage more closely with local, horizontal communication and behavioural responses to AIDS. Communication programmes have to take root at the level of social networks working though local networks of meetings, chiefs, churches and health personnel as well as the media. Mobilising basic social communications may be a necessary resource (as much as services and finance) to scale HIV prevention and treatment to the population level.
Keywords: affective behaviour change, community, sexual behaviour, social capital, survey
African Journal of AIDS Research 2004, 3(1): 1–13