1- Objective
To achieve the creation of
appropriate AIDS prevention materials (short movies or video clips,
posters, leaflets, or other type of mass-media communication tools)
delivering newly conceived line of messages (mainly inspirited by the
Thai epidemical context).
2- Rational
2.1. Need
of a new generation of AIDS prevention materials.
To facilitate the understanding
of this project proposal, some clarifications as per used terminology
are needed.
"Material" refers to an entity which includes mainly
3 leading components: a target group (for instance: the group
of the agrarian homosexuals), a media (for instance: poster)
and one or two leading message(s) (for instance: first or/and
second line of messages)
"First line"
of AIDS prevention messages refers to the scientific, technical and
logistical basic information that can not be ignored by anyone concerning
HIV/AIDS ways of contamination and relevant prevention (for instance:
you can not catch HIV by mosquitoes or saliva). The former HIV/AIDS
prevention campaigns have mainly focused on first line HIV/AIDS prevention
messages.
"Second line"
of AIDS prevention messages refers to messages that can only be delivered
if the "first" line of HIV/AIDS messages has been delivered
and received among the population. This second line of AIDS prevention
messages is more focusing on reasons why people are not following the
first line prevention messages that they know. This may be relevant
to psychology, sociology or even culture and may not be directly related
with the specific characteristics of HIV/AIDS disease.
The virtual concept of "first"
and "second" lines of AIDS prevention messages may be difficult
to understand. Here is one example to clarify this concept.
More than 90% of Thai men are
aware that they should use condoms when having casual sex or a new sexual
partner. This awareness came from the first line of AIDS prevention
messages. But, in the reality of life, some of them are not using condoms
and are evoking different reasons such as afraid of impotency, less
feeling, fear of partner's opinion, etc.
The "second" line of AIDS prevention messages must tackle
directly these reasons and focus on "why are these men not following
the well known AIDS prevention recommendations?"
2.1.1. Need to sharpen first line of AIDS prevention
messages
It has already been mentioned
that a quite large majority of the Thai population has already received
the most basic messages on AIDS prevention: "faithfulness in the
couple, sexual abstinence and use of condom for casual sexual relationship".
These classical messages delivered by the long and strong former HIV/AIDS
prevention campaigns are part of the first line of HIV/AIDS prevention
messages.
Only a few subgroups of the
population (for instance: migrants from the Thai-Burmese border who
do not read Thai) still do not have access to these basic information.
As these migrants are recognized as a new AIDS high-risk subgroup, some
AIDS prevention materials with first line messages must be made available
for them.
Moreover, it has been noted
that, in many subgroups of the Thai society, there is still a definite
severe ignorance about practical details on some first line messages.
For instance, many people are still unable to explain clearly "what
is safe sex when condoms are not available?" or "what are
the actions to be taken after exposure to dangerous sexual practices?"
There is therefore a definite
need that the first line of AIDS prevention messages should be briefly
revised. If some subgroups of the Thai population have not been targeted
or if some topics are not well understood, the new generation of HIV/AIDS
prevention materials must carefully fulfill these gaps.
2.1.2. Need to create a second line of AIDS prevention
messages.
To emphasize on the need for
the creation of second line AIDS prevention messages, an example has
already been previously mentioned. "Why do some men not follow
the well known AIDS prevention basic recommendations?"
Another example, based on common
knowledge, is hereby described.
It is indeed reported than more than 90% of HIV infected women, who
are faithful wives, have been contaminated by their husband or single
partner.
The husband knows very well that because of his unprotected extra conjugal
sex relationship with a sex worker for instance, he is at high risk
to be HIV infected. He knows the risk through the first line of AIDS
prevention messages.
It is definitely true that it is extremely difficult for him to confess
to his wife that he had an extra conjugal relationship and that he did
not use a condom. It is easier for him to lie or to hide his extra relationship
than to confess it to his wife.
Such situation is definitely leading the husband to infect his wife
with HIV.
The second line of AIDS prevention messages must take up the challenge
and must find the most appropriate way to enter upon this sensitive
issue. It must deal with realistic understanding of the husband, with
the efficient protection of the wife against HIV and with the respect
of the couple as an entity.
2.2. Need to consider sociologic tools
for the new AIDS prevention materials.
There are many ways to divide
a population into groups. It can be based on criteria such as "Muslim/Buddhist",
"migrant/native", etc.
Some well known epidemiological
tools divide the society into groups based on criteria like "male
/ female", "child / teenager / adult / old ", "married
/ single", "homosexual / heterosexual", etc. The combination
of different division criteria will already define some "subgroups"
and will be useful to primarily identify new high risk communities and
to elaborate basic prevention strategies.
For instance, to tackle the
sensitive issue of intra conjugal HIV contamination, the prevention
strategy will probably focus on moral argumentations in the subgroup
"male and teenager", use concrete alarming arguments in the
subgroup "female and married" and emphasize on post exposure
actions to be taken in the subgroup "male and married".
Another well known epidemiological
tool is to divide the society into four groups which are:" tribal
/ agrarian / industrial / post-industrial". Some specific characteristics
for each group are described in Annex 1. In Thailand,
these four sociologic groups are well present and are unequally affected
by HIV/AIDS epidemic.
It is already quite evident
that for each of these four sociologic groups, a different strategy
is needed, not only as per the contents of the AIDS prevention messages,
but also for the way of disseminating the required messages.
For instance, details about some marginal sexual practices related to
homosexuality may probably only intrigue the tribal group but such words
or images are simply unsuitable for the agrarian and industrial groups
as such information may induce contra productive psychological shocks.
In the Thai context, it is
definitively the combination of this major epidemiological tool with
one or more other classification criteria that will be most helpful
to determine specific high risk subgroups, to elaborate fully efficient
prevention messages and to identify lacking prevention materials.
For instance: AIDS prevention
materials dealing with homosexuality are quite abundant but are mainly
available for the subgroups "male + homosexual + industrial"
and "male + homosexual + post industrial". AIDS prevention
materials for the important "male + homosexual + agrarian"
subgroup are scarce. Such materials should consider the fact that, in
the agrarian group, gay's life is not structured as gay's bars, specialized
magazines, etc. are hardly available. Booklets that will include explicitly
the concept of homosexuality will hardly be openly distributed by agrarian
public institutions.
This principle to consider
combinations of some major epidemiological classifications, which results
in a clear definition of specific subgroups, has been partially omitted
in the previous AIDS prevention strategy. This partial omission can
be explained by the fact that, confronted with the extensiveness of
the HIV/AIDS epidemic, the Thai authorities had to produce HIV/AIDS
prevention materials that should quickly reach the large majority of
the population, mainly agrarian and industrial subgroups.
It results that, for some "forgotten" subgroups of the Thai
population, interest in AIDS prevention materials has declined and the
willingness to know more about this deadly disease has faded.
(It is important to mention
here the recent emergence of new high risk groups such as high college/university
or vocational students, young factory workers and immigrant workers.
It has indeed been reported that the rate of HIV infection among these
specific groups is drastically increasing. Same pattern can also be
described for young factory workers, coming from all provinces to search
for job in the cities or in the industrial areas located near the large
cities)
***
3- Project overall strategy and activities.
3.1. Creation of the new AIDS prevention materials.
3.1.1 Project selected media for the new AIDS prevention
materials.
Among all the available and
possible mass communication media, the project has selected to produce
5 types of media: VDO clips (DVD and VCD), posters, leaflets or booklets,
tracts, stickers and one website.
Among these 5 different selected approaches, the project will focus,
with a certain level of priority, on video clips or small movies production.
It has been noted that Thai people are very fond of and sensitive to
such mass media communication visual tool. But the final choice of media
will mainly depend of the message to be delivered, the targeted subgroup
of the population and the constraints and advantages inherent to each
type of media.
3.1.2. Messages to be delivered by the new generation
of AIDS prevention materials.
The project methodology to
find out what are the messages to be tackled in the new generation of
AIDS prevention materials that the project aims to produce, is quite
simple and logic (see 2.1 & 2.2).
Here enclosed a few more considerations.
- In order to protect the leading convictions of some
sociologic groups such as agrarian and industrial groups and to avoid
contra productive reactions, the first line of AIDS prevention messages
has emphasized on sexual abstinence and couple fidelity as the best
AIDS prevention principles. The new generation of AIDS prevention
materials should not limit its messages to these ethic rules only,
as the people, who are unable or not willing to follow these ethic
rules of abstinence and fidelity, are the main cause of the HIV pandemic
and the intra- conjugal infections. The new generation of AIDS prevention
materials must respect these ethic rules but must go beyond them.
- Previous AIDS prevention materials have also been
using a lot of metaphoric allusions in the first line messages and
did not dare to clearly enter upon some high risk sexual practices.
The new generation of AIDS prevention materials must avoid as much
as possible the use of metaphoric allusions in its messages and must,
with all required precautions, expose facts and practical details
about all dangerous sexual practices, active and passive, which are
definitely "the" HIV/AIDS sexual transmission ways.
- The new generation of materials should however always
carefully consider the targeted sociologic groups. For instance, details
about marginal sexual acts such as homosexuality may probably only
intrigue tribal groups but are at risk to shock agrarian and industrial
sociological groups. Moreover, such details may "give dangerous
ideas" to tribal and agrarian adolescents while just adjusting
some knowledge of postindustrial adolescents. Messages or drawings
including practical sexual details must therefore be carefully and
deeply assessed and correctly disseminate in order to avoid contra
productive group reactions. They also should not be a promotion tool
for dangerous marginal sexual practices.
- A cultural characteristic of Thailand
is the systematic use of hierarchic considerations and sophisticated
politeness protocols between "server" and "client"
or "provider" and "receiver" in any human contact.
Real dialog and interactivity between teachers and students, doctors
and patients, monks and laics, even spouse and husband, etc. are sometimes
almost inexistent. This explains why school's teachers or university's
professors, monks, parents or even health care providers are often
reluctant to get too much involved with details in AIDS prevention.
It is important for the project to assume this restrictive cultural
fact. Teachers, professors, nurses, monks, etc. should not be confronted
with AIDS prevention details if they feel uncomfortable with sexual
details. They may utilize AIDS specialized persons from outside their
environment (external persons) to deliver the AIDS prevention information
or they may refer to non metaphoric AIDS prevention materials that
can be consulted in total privacy. One example can be described in
universities. Professors will definitely be very reluctant to deliver
themselves detailed information on dangerous sexual practices. Relationship
between professors and students is definitely not allowing such intimacy.
The project will approach rectors or deans to be granted authorization
to distribute the new AIDS prevention materials in their universities
but without using the "teaching" structure. For instance,
the non metaphoric material may be display in some private places
like toilets in their universities.
Here is a non-exhaustive list
of messages, which are already identified by the project and which need
to be addressed. It is quite evident that, through more discussions
with AIDS prevention experts and other people, more needed messages
will be proposed and added.
"First line messages":
- Impossible to recognize a HIV positive partner.
HIV contaminant person can be asymptomatic, fat, sportive, good looking,
academic teacher, etc.
- Post exposure behavior or attitude: how to deal
with broken condom or after unprotected relation.
- Distinction between safe sex and condom (it is still
possible to have a strong and safe sexual practice without condom).
- Prevention messages without metaphoric language
for homosexuals in rural areas.
- Logistical realities: availability of condoms, adequate
lubricants, anonymous blood tests, ARV treatments, etc.
- ARV therapy imposes drastic constraints and is not
curative. ARV can not be a pretext to reduce caution about HIV contamination
risk.
- etc.
"Second line messages":
- Adultery and intra-conjugal lies (90% of infected
women are infected by their husbands). Woman should be more alert
and skillful in protective strategies.
- Update the concept of virility: a male unable to
deal with condom side effect can not be considered as "virile",
- Sexual impotency as one of the most severe side
effects of condom, but there are ways and attitudes for both partners
to manage this side effect of condom.
- Ways and attitudes to improve the protective strategies
of man and woman… Reasons why men do not like or refuse to use
condoms although they know that they are involved in dangerous sexual
practices and reasons why women accept to have dangerous sexual relationship
with men not willing to use condoms should be well know by both genders
to elaborate strong protective strategies.
- Ways to tell to close relatives about own HIV positivity
- Alcohol as inductor of dangerous behaviours
- Ethic rules about post exposure behaviours.
- etc.
3.2. Distribution and dissemination of the new AIDS
prevention materials.
To ensure an efficient and
large dissemination of the materials, the project will need to contact,
meet and discuss with a quite large number of people. As the project
team will only be composed of four staffs, it is evident that the expected
extensive distribution of the new generation of AIDS prevention materials
will require a large number of intermediaries.
However, the first priority of the project will be to receive the appropriate
authorizations from the Thai Ministry of Public Health (MoPH) and the
department of communicable disease control (CDC) for the distribution
of the newly conceived AIDS prevention materials.
When the material is granted the official approval from the appropriate
Thai authorities, the project will produce more samples of this proposed
product and can start the distribution process.
The first approach will focus
on official state agencies channels and network.
For instance, upon approval from the appropriate Thai authorities and
the support of few influential persons, video clips will be presented
and proposed to national TV channels. Main priority will be to approach
the two state owned TV channels in which some broadcasting emissions
are exclusively reserved for health related messages.
As there are six national TV channels in Thailand,
it is expected that, as soon as one TV channel will agree to display
the proposed video clip, other TV channels will be more favorable to
follow their TV partner.
In a second approach, other
AIDS related NGOs or groups will be contacted.
New AIDS prevention materials
can also be proposed to community groups as these groups are also registered
through the national governmental communication system and through each
provincial governor office. The project will have to contact high level
representatives of the civil authorities but as soon as their approval
is acquired, their own network and distribution channels can be used.
Private commercial businesses
can also be contacted and their own channels of distribution used. For
instance, if a poster does have the adequate information for customers
of a commercial supermarket, the project can contact the representatives
of this supermarket and, with the pressure of some influential persons,
can convince them to display the poster in the toilets or in other rooms
of their facilities.
Private factories and business
enterprises will be more difficult to reach as quite numerous, but they
may be quite interested in such AIDS prevention materials as their business
can be affected if their key people are HIV infected. Moreover, many
enterprises are actually willing to demonstrate their concern for the
welfare of their employees.
Major teaching institutions
such as vocational training centers and universities can also be contacted
through project direct meetings and discussions with directors, rectors
or deans of these institutions. Again, with the support of some influential
persons and the prior authorizations of the Thai authorities, new appropriate
AIDS prevention materials for students can be used or displayed in such
institutions. Their own network and distribution channels will be used.
Teachers, professors, nurses,
monks, etc. will not be confronted with AIDS prevention work if they
feel uncomfortable with sexual details (see 3.1.2). They may utilize
AIDS specialized persons from outside their environment (external persons)
to deliver the AIDS prevention information or they may refer to non
metaphoric AIDS prevention materials that can be consulted in total
privacy.
The project will approach rectors or deans to be granted authorization
to utilize some already existent student's groups who are already quite
involved in AIDS prevention work inside the universities. These students
may use their own human resources or may even call for an external person
to present the new material (for instance a video clip) to university
students. If the material is a non metaphoric poster, these students
may display samples of this poster in some private places in their universities.
***
Annex 1.
Some intellectuals divided
the humanity in four major societies or groups which are: the tribal,
the agrarian, the industrial and the post-industrial.
Although these divisions are
never totally clear, they can be considered as a appropriate and quite
operational sociologic tool which helps the project to enter into topics
closely connected with HIV/AIDS prevention, such as sexuality, marital
status, morality, intra-familial relations, authority etc.
For the purpose of the project,
it must be mentioned that these four sociologic groups are well present
in Thailand.
Here enclosed a brief summary
about the main specificities of the four sociologic groups.
-Tribal groups:
- Proportionally the most HIV affected group in Thailand.
- Usually living in quite isolated rural and mountainous
areas.
- Large family structure including all generations
and servants in the same house. Polygamy is not rare and concubines
can be officially included in family clan.
- Fecundity and family structure are still the main
"social security" guaranty.
- Sex verbalization is low but with low puritan constraints.
- Sex marginalities are not structured.
- No or low privacy in social and family life. Secrets
are difficult to be protected.
- Religious believes are important but not very influent
in sexual life.
- High mobility of members inside and outside the
tribe.
- Agrarian groups:
- The biggest group in Thailand,
mainly living in rural areas and in little towns.
- Families include all generations in the same house.
- Fecundity and family are still considered as the
main and best "social security" guaranty.
- Sex verbalization is low and puritan constraints
are common.
- Sex marginalities are not structured.
- Low privacy in social and family life. Secrets are
difficult to be protected.
- Religion is important and influent in both sexual
and ethical fields.
- Highly concern with multi level hierarchy and sophisticated
politeness protocols which induce a systematic use of "social
mask" to preserve social order.
- Industrial groups:
- The most growing group in Thailand,
mainly living in urban areas
- "Nuclear families". Just a few kids. Grandparents
are usually not living in the same house.
- Employer, assurance or government are the main "social
security" guaranty.
- Sex verbalization is low and puritan constraints
are the strongest.
- Sex marginalities are becoming structured, but generally
hided and stigmatized.
- High level of privacy in social and family life.
- Superficial concern with religious and ethic arguments
concerning sex.
- Systematic use of "social mask" to preserve
social order.
- Good instruction level and good receptivity to information.
- Post-industrial groups:
- The smallest group, living in big urban or international
tourist area, often issued from rich layers of the society.
- Very low fecundity, celibacy is common.
- Many different "family" models with or
without many generations in the same house.
- Sex verbalization is high. Low concern for puritan
considerations.
- Sex marginalities are openly structured.
- High level of privacy in daily life.
- High level of information.
- Low concern with religious or ethic arguments which
can even be contra-productive; but more concern with "new international
culture".
For more details on this complex
and specialized subject, interested readers can refer to the books of
sociologists such as Toffler (US) or Brockmoller (German).
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