Strategic Considerations for Communications on Multiple and Concurrent Partnerships within Broader HIV Prevention in Southern Africa

This guidance document resulted from interactions with civil society in Southern Africa and a collaboration between UNAIDS, the Harvard AIDS Prevention Research Project, and the World Bank, including an expert meeting on MCP held on January 28-29 2009 in Gabarone, Botswana. The document arose from the recognition of the need for regional guidance on the principles and good practice for Multiple and Concurrent Partnerships (MCP) campaigning to assist national programmes, in particular, to strengthen HIV prevention efforts for MCP reduction. According to the document, programming for MCP is complex and some issues are not yet completely understood, including the best ways to measure MCP, the relative importance of concurrent as opposed to multiple partnerships in general, and how MCP messaging should relate to other aspects of HIV prevention. This document therefore aims to provide basic guidance that can be built on and elaborated over time.

After defining the concept of MCP, the document outlines the strategic goals of an MCP approach. Firstly, it should reduce the number of multiple and concurrent partnerships through social and behavioural change and, where feasible, through addressing structural factors (such as lengthy separation of partners) that increase the likelihood of MCP. Secondly, interventions should reduce the transmission of HIV within multiple and concurrent partnerships as well as within known discordant relationships – including through consistent correct male or female condom use, male circumcision, HIV testing, and treatment adherence.

The document then outlines some key principles of MCP programming as well as some key approaches to messaging. Some of the key programming principles sited include the need for nationally led, coordinated, sustained, and large scale initiatives which should be multi-pronged and multi-layered and bring national, local, and indigenous leadership on board. Initiatives should also utilise advocacy, mass media, community programmes, interpersonal communication, and other approaches. In addition to the development of specific MCP campaigns, reduction messages should be integrated wherever possible into existing programmes, and ensure complementarity with other prevention programmes.

Some of the key messaging guidelines sited in the document include the need to reflect overarching, harmonised regional themes, particularly in culturally similar regions while specific messages are tested and developed locally. It also emphasises the need to develop a hierarchy of messages beneath the core theme of MCP reduction, with staging of messages that are mutually reinforcing and contribute to the core concept. Messages should also be clear, simple, direct, understandable, culturally-relevant, and unambiguous; and highlight the need to reduce and break up sexual networks based on overlapping concurrent partnerships.

According to the guidelines, all strategies addressing MCP within HIV prevention should seek to lower HIV incidence through clearly describing the changes they seek to achieve. The document outlines some of the changes that should occur at both individual and societal level. For example, at the individual level, the results of any intervention should lead to growing numbers of men and women, including young people, who: have heightened and accurate risk perception; aspire to mutual monogamy or, if in a polygamous relationship, ensure this is a closed circle of relationships; and believe that men can control their sexual impulses, and are able to take protective action and reduce their personal risk.

As stated in the document, individual attitude, knowledge, and behavior change takes place within a community context that can support, facilitate, or frustrate such behavior change efforts. Underlying this, are the wider socio-cultural, political, and economic factors that influence people’s attitudes, values, norms, and behaviour. Activities to tackle these layers of influence should therefore also be incorporated into MCP strategies. These could include efforts that, for example, increase the number of influential leaders and other opinion makers who choose not to engage in MCPs or in age-disparate sexual relationships, and thereby set positive role models to change the social acceptability of MCP; and efforts that increase the number of well-informed political, faith, traditional, and celebrity leaders engaging in informed public discourse around MCP.

Finally, the document looks at the issue of measurement. It states that measurement of MCP programmes requires an understanding of (a) what needs to change (to know when we have been successful), (b) what measurements are required to assess whether the changes are taking place, and (c) appropriate tools with which to measure.