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Community Need Assesssment Programme Background In swift response to the HIV / AIDS situation, the State Government set up the State Project Cell in 1992. Realising the need for a broader and more effective response, and to facilitate smooth implementation of HIV / AIDS prevention and control activities, the Government formed the Tamil Nadu State AIDS Control Society (TNSACS) in 1994, registered under the Societies Registration Act. Since its inception, the society has made remarkable progress in the prevention and control of HIV / AIDS in the state, with the financial assistance from National AIDS control organisation (NACO) and the State government. The results are reflected in the form of highest level of awareness due to constant efforts, mainly by evolving IEC strategies or awareness programmes. The Tamil Nadu State AIDS Control Society has been the role model in the entire country in creating awareness and behavioural changes by using all the available media. To identify and further strengthen the IEC strategies and behaviour change communications, a study was conducted by TNSACS through M/s.AC Neilsen which looked into, awareness levels, and behavioural changes, among the high risk and general population, besides indicating communication needs to further strengthen the system Aids Prevention & Control Activities in Tamil Nadu Awareness Programmes: Awareness is the key to the prevention and control of HIV / AIDS. Fear is not likely to solve any of the problems, neither is ignorance. The electronic, print and other media are fully exploited, optimising the use of the resources of TNSACS. The first phase of the IEC campaign has been a resounding success, as independent surveys of professional agencies have indicated. The campaign is already being hailed as a model for the other states in the subcontinent. The emphasis has shifted towards interpersonal communication and behaviour change communication to ensure positive behavioural changes. Many Non-Governmental organisations (NGOs) are involved in creating awareness, and implementing intervention programmes. TNSACS has identified several demographic groups with risk-prone lifestyles such as CSWs, truckers and migrant workers. It has initiated several targeted intervention projects through the NGOs to promote safe sex behaviour and condom use among groups with high-risk behaviour. 338 0 0 0 intervention projects were implemented so far in the state in urban and rural areas. Blood Safety Measures :Safe blood is now available for transfusion in 63 Government blood banks which have been modernised by providing cold chain equipment such as air conditioners, refrigerators and HIV testing equipment and kits. The working of 101 private blood banks is closely monitored to ensure the availability of safe blood. The Government has initiated these steps to combat HIV transmission through blood transfusion. All blood banks are required to conduct mandatory tests for VDRL, HbsAg, HIV and Malaria that are monitored through a monthly reporting system and periodical inspection. STD Control Measures :The STD clinics in the 51 Government hospitals in Tamil Nadu have been upgraded by the provision of essential equipment, lab supplies and drugs. In this sphere, the Government has been focusing on strengthening the facilities for diagnosis and treatment at the various STD clinics with the involvement of NGOs. The counsellors have been appointed at the STD clinics and condoms are promoted. Treatment seeking behaviour is on the rise due to the impact of the awareness programme. To cope with the increased demand for improved services, the Government is consolidating its efforts by outreach activities. Training and Capacity Building :The Medical officers and paramedical staff in all Government medical institutions are being trained in the prevention and control of HIV / AIDS and other relating aspects. They are also oriented towards patient care and support. The Medical officers who care for HIV / AIDS patients were identified and given training on the care of HIV / AIDS cases and syndromic management of STDs. Far-sighted PRAMs (Physicians Responsible for AIDS Management) initiative has ensured that each Medical College Hospital / District Hospital has at least one PRAM whose role is to provide further training to doctors and paramedical personnel. This initiative will go a long way in addressing the need for qualified personnel in HIV / AIDS care across Tamilnadu and to build the capacity of personnel to face the Future challenges. Surveillance and Reporting :TNSACS has been able to cover new ground through its Sentinel Surveillance programme in Tamilnadu. It has enabled TNSACS to keep track of the prevalence levels of HIV / AIDS infection in the state since 1993. Groups with high risk behaviour and low risk groups are monitored alike, as part of the surveillance programme. The trend is assessed among the groups such as STD patients, pregnant women, drug addicts, MSM, TB patients. The Voluntary Counselling and Testing Centres are created to extend the testing and counselling facility to the people. Care and Support activities :A large number of HIV / AIDS cases have been detected and measures have been taken to provide proper care and support to those infected. Special care wards are created in various parts of the State to treat opportunistic infections in institutional set up. The Community Care Centres have also been initiated with the involvement of NGOs and Private sector. Advocacy and Social Mobilization :It is well known that Tamil Nadu has displayed a high level of political commitment for HIV / AIDS control. The involvement of all the opinion makers has contributed a lot to sensitize the larger sections of people. TNSACS has conducted several advocacy workshops for political leaders, media personnel and others in various walks of life. IEC Strategies of TNSACS : The IEC Campaign is designed to create Awareness and influence individual behaviour. TNSACS works on the globally accepted premise that increased awareness is the key to change in behaviour, thus preventing the spread of the HIV infection. Many people think they know what HIV / AIDS is all about, but that is where the problem lies. Often, misconceptions have been passed off as facts. In Tamil Nadu too, the HIV / AIDS awareness levels were rather low initially, and the depth of knowledge, was shallow. Sustained and increased media activity has led to increased awareness. This has, in turn, led to a change in thinking, which is the first step towards change in behaviour. Implemented across the state, the IEC strategy has helped to create a high level of HIV/AIDS awareness. Over 85 per cent of transmission of HIV in Tamil Nadu is through the heterosexual route. Yet, most people who contracted HIV this way never thought that it could happen to them. This again points to the need for increased awareness. The messages of faithfulness and safe sex are being used as a part of the awareness campaign through the electronic and print media and through outdoor publicity campaigns or social mobilization activities in Tamil Nadu. What is IEC ? IEC (Information, Education and Communication) is a process that informs, motivates and helps people to adopt and maintain healthy practices and life styles.
Messages on caring for those infected are also being disseminated. TNSACS has selected a panel of prominent advertising agencies to design and execute its IEC campaigns. It has specifically chosen those agencies with credentials in social communica tion to have a professionalism in IEC strategy. Culturally relevant methods of outdoor publicity such as puppet shows, street plays are used in rural areas. TV spots, radio jingles and press advertisements developed with the assistance of professional agencies are used to create awareness in the community. A lot of awareness strategies have been implemented through different media. In a study commissioned by TNSACS, it was discovered that 32 percent of the audience was reached through the press. Television provided a reach of nearly 90 percent. The radio, however, remains the best medium to reach the rural areas with a reach of 74.9 percent. It was found that the reach of messages on bus panels was 38 percent. This study has thus presented an efficient and effective tool to media planners. The IEC campaigns are designed to achieve awareness at the individual and community level. The general awareness strategy appeals to individuals while social mobilization is designed to motivate community leaders to influence individual behaviour and help to reduce the risk of HIV infection. People living with HIV / AIDS often face discrimination in the community. To help them lead a normal life, TNSACS has carried out campaigns, appealing to the public to treat the PLWH/A with concern and compassion. Every year, an independent agency is commissioned to evaluate the impact of IEC campaign carried out by TNSACS and to estimate AIDS awareness among the general as well as different sub-population groups through a sample study of about 4000 people across the state. A qualitative study among students, truck drivers, people with high mobility and CSWs was also undertaken. Evaluation studies carried out by ORG-MARG and Scope Marketing in Tamil Nadu shows that the general awareness about HIV / AIDS increased from 23 percent in 1992 to 96.2 percent in 1997. The awareness level is 98.2 percent in urban areas and 94.4 percent in rural areas, due to the constant efforts of the Government. Concepts and Themes Achieving a high success rate through innovative media campaigns, TNSACS has been dedicated in its efforts to promote AIDS awareness among the masses. The increasing success of the awareness campaigns encourages us to continue in the same vein. The present level of awareness has to be sustained to keep up the momentum of success that has already been achieved. The different concepts and themes are incorporated in strategy to meet the information needs of the community. Communication Needs Assessment Introduction In order to plan and implement the future IEC strategies in a scientific manner, TNSACS has decided to assess the need and strategies for better communication.The ensuing sections of the final report, submitted by M/s.AC Nielsen, detail the findings of the communication needs assessment study, which was conducted in the State of Tamil Nadu in three urban and three rural districts. The study was conducted among the following population sub-groups: -
Research Objectives
Indicators
Research Methodology Though the awareness strategies / IEC activities of TNSACS are addressed basically to general population, the messages generally reach the following population sub-groups:-
The study covered each of these population sub-groups in detail. The above categories were covered in both urban and rural centres. The following districts were covered in the study:-
After all the sites where CSWs operate were identified, the required number of sites were randomly selected. Around 20 interviews were conducted at each site. Truck Drivers and Helpers The site fixation was done by physically indentifying all the areas where the truck drivers/helpers congregate in the survey towns. After all the sites were identified, then the required number of sites were randomly selected. Here again, 20 interviews were conducted in each selected site. The places where these groups congregate are: Migrant Labourers The site fixation was done by first physically identifying all the localities where construction activities (building,roads,etc.) were taking place in the study centres. The information sources used in this regard were:- ? Building contractors? ? Municipal corporation/Government departments? After all the construction sites in the survey towns were identified, the required number of sites were randomly selected. In each site, 10 effective interviews were conducted. Further, Migrant Labourers belonging to both the sex were covered. Sampling Method Students Both male and female students were covered. School students studying in class-XI & XII, as well as college students pursuing any discipline were covered. The institutes within each survey town were selected by ensuring geographical spread and adequate representation of that town. 10 interviews were done in each selected institute. Men having sex with men (MSM) Since MSMs segment is difficult to identify by normal means, the respondent contact for this segment was done with the aid of NGOs (such as Prakriti, ICWO etc.) The required number of interviews was done through purposive sampling thereafter. ? IV Drug Users The sampling procedure followed for this segment was similar to that of MSMs since this segment is also difficult to identify by normal means. ? Prisoners The inmates of the main central jails in three key study centres were covered. The support of Inspector General of Police (Prisons) was taken for this pupose. The respondents were randomly selected based on the number assigned to them by the jail authorities. The total sample was proportionately distributed across the central jails in three study centres. ? Street Children The site fixation was done by physically identifying all the slum localities in the study centres. The information sources used in this regard were:- ? ? NGOs? ? Municipal corporation / Government departments? ? ? The required number of sites was randomly selected. The actual respondent identification was done through snow balling method. Around 10 interviews were conducted in each selected site. ? Clients to female CSWs ? ? This segment was primarily identified at the pre-mapped sites where CSWs operate. Around 10 interviews were conducted in each site. ? Findings Among Sub - Groups ? Findings Among Sex Workers ? ? ? 1. Awareness and knowledge about STDs is quite high ? ? ? 2. Awareness of HIV/ AIDS is almost universal ? ? ? 3. The main media from where HIV/ AIDS messages are recalled: ? (a) TV ? (b) Radio ? (c) Health workers/ NGOs ? ? ? 4. Majority feel that the Government needs to initiate and continue steps towards providing HIV/ AIDS related knowledge to people ? ? ? 5. With respect to expectation regarding the media that could be used for educating CSWs, the following media were mentioned prominently : - ? ? ? (a) TV ? (b) Radio ? (c) Direct contact with Health workers/ NGOs ? ? ? 6. Interestingly, only a small proportion of CSWs contacted expected written material like books/ pamphlets to be given to them. ? 7. Certain gaps noticed with respect to knowledge about prevention of HIV/ AIDS ? Therefore, the focus of education should be on methods to prevent HIV/ AIDS ? Findings Among MSM ? 1 Awareness of STDs is moderate ? 2 Among those who are aware, the knowledge about STDs is quite good ? 3 Awareness of HIV/ AIDS is almost universal ? 4 The main media from where HIV/ AIDS messages are recalled : ? (a) Health workers/ NGOs (b) TV (c) Radio ? 5 Vast majority feel that the Government needs to initiate more steps towards providing HIV/ AIDS related knowledge to people ? 6 With respect to expectation regarding the media that could be used for educating CSWs, the following media were mentioned prominently: - ? (a) TV (b) Radio ? 7 Few other media also received significant mention in this regard: - ? (a) Stickers behind buses/ autos (b) Direct contact with health workers/ NGOs (c) Hoarding/ wall painting (d) Written material like pamphlets/ hand-outs (e) Play/ Drama 8 Certain degree of knowledge gaps noticed with respect to prevention of HIV/ AIDS ? Therefore, increasing STD awareness and education on methods for preventing HIV AIDS should be the focus of the communication ? ? Findings Among Truckers ? ? ? ? 1 Awareness of and knowledge about STDs is quite high ? 2 Awareness of HIV/ AIDS is universal ? 3 Knowledge about prevention of HIV/ AIDS by using condoms and by not indulging in unprotected multi partner sex is quite high. There is some scope to increase the knowledge about HIV/ AIDS prevention through condom usage. ? 4 The main media from where HIV/ AIDS messages are recalled: ? (a) TV (b) Boards/ signs behind buses/ autos (c) Newspaper/ Magazine (d) Roadside Hoardings ? 5 An overwhelming majority of truckers feel that the Government needs to initiate more steps towards providing HIV/ AIDS related knowledge to people. ? 6 With respect to expectation regarding the media that could be used for educating truckers, the following media were mentioned prominently: - ? (a) TV (b) Cinema hall (c) Newspaper/ magazine (e) Stickers/ signs behind buses/ autos (f) Roadside Hoardings (g) Play/ drama ? 7. On the whole, this segment also exhibits a reasonably high level of basic awareness and knowledge about both STDs and HIV/ AIDS. ? Therefore, the need for communication per se is somewhat lower in this segment. ? ? ? Findings Among IV Drug Users ? 1 Awareness of and knowledge about STDs is quite high ? 2 Awareness of HIV/ AIDS is almost universal ? 3 Knowledge about prevention of HIV/ AIDS by using sterilized needles / syringes is quite high. However, relatively lesser proportion seemed to know about condom usage as a possible method of prevention of HIV/ AIDS through sexual mode. ? 4 The main media from where HIV/ AIDS messages are recalled: ? (a) Cinema hall (b) Health worker/ NGO (c) Radio ? 5 Majority of IV drug users feel that the Government needs to initiate more steps towards providing HIV/ AIDS related knowledge to people. However, the proportion of IV drug users who seek knowledge about HIV/ AIDS is much lesser than other high risk segments. ? 6 With respect to expectation regarding the media that could be used for educating CSWs, the following media were mentioned prominently: - ? (a) Magazines and newspapers (b) Radio (c) TV (Note: - TV was mentioned much lower than other high risk segments) ? 7. On the whole, the need for communication per se is much lower in this segment as compared to other segments. The possible area where some education could be provided is with respect to condom usage as a method for preventing HIV/AIDS (which is probably not a priority area of concern for this segment). ? ? Findings Among Prisoners ? ? ? ? 1 Awareness of and knowledge about STDs is quite high. ? 2 Awareness of HIV/ AIDS is almost universal. ? 3 The main media from where HIV/ AIDS messages are recalled : ? (a) TV (b) Newspaper/ Magazine (c) Radio ? 4 An overwhelming majority of prisoners feel that the Government needs to initiate more steps towards providing HIV/ AIDS related knowledge to people. ? 5 With respect to expectation regarding the media that could be used for educating prisoners, the following media were mentioned prominently: - ? (a) TV (b) Newspaper/ magazine (c) Direct contact with health workers/ NGOs (d) Direct contact with Doctors (e) Direct contact with staff in Government hospitals ? 6 Interestingly, only a small proportion of prisoners expected written material like books/ pamphlets to be given to them. ? 7 Certain gaps noticed with respect to knowledge about prevention of HIV/ AIDS- particularly with respect to condom usage as a preventive method against HIV/ AIDS. ? Therefore, the focus of education should be on methods to prevent HIV/ AIDS ? Findings Among Migrant Labourers? ? ? 1 Awareness of STDs is moderate. ? 2 Among those who are aware, the knowledge about STDs is quite good. ? 3 Awareness of HIV/ AIDS is almost universal. ? 4 Certain degree of knowledge gaps noticed with respect to prevention of HIV/ AIDS- particularly with respect to condom usage. ? 5 None of the media received very high mention when migrant labourers were probed about the media from where they had received HIV / AIDS related messages. Only TV was mentioned prominently in this regard. A significant proportion also mentioned radio and cinema halls. ? 6 An overwhelming majority of migrant labourers feel that the Government needs to initiate more steps towards providing HIV/ AIDS related knowledge to people. ? 7 With respect to expectation regarding the media that could be used for educating prisoners, the following media were mentioned prominently: - ? (a) TV (b) Radio (c) Cinema halls (d) Newspaper / magazine (e) Roadside Hoardings / Wall posters (f) Direct contact with staff in Government hospitals (g) Play / drama ? ? ? Findings Among Street Children ? 1 Awareness of and knowledge about both STDs and HIV/ AIDS is quite low in this segment ? 2 Significantly, majority of the street children are unable to make up their mind with respect to Government initiating more steps towards providing HIV/ AIDS related education to street children like them. This could possibly be caused due to the inability to articulate their needs that is normally observed in many of the children below 15 years. ? Findings Among Students ? 1 Awareness of both STDs and HIV/ AIDS is quite low in this segment ? 2 However, among those who are aware about these diseases, the knowledge levels are quite high ? Therefore, the focus of education should be to increase the awareness about STDs and HIV/ AIDS ? 3 The main media from where HIV/ AIDS messages recalled are as follows: - ? (a) TV (b) Boards behind buses ? 4 Significantly, majority of the students are unable to make up their mind with respect to Government initiating more steps towards providing HIV/ AIDS related education to students like them. This inability to articulate their needs could be the possible reason. ? Media Preference ? l When the respondents were probed on from which media they would like to get educative information on HIV/AIDS, some interesting responses were obtained apart from the expected response related to mass media such as TV, Radio, Cinema and print ads. Significant proportion of respondents mentioned direct contact with health workers / social workers, doctors and hospital staff as possible routes for spreading HIV / AIDS related messages. ? Impact of Inter-personal Communication ? In general, the awareness levels on STD/ HIV/ AIDS are considerably high among all the population sub-groups surveyed. Obviously, the high awareness levels can be attributed to the interventions done through mass media like TV, radio, cinema and newspaper/ magazine in the past few years. It is a well-known fact that mass media vehicles are very effective in creating general awareness levels of the disease (viz., spreading horizontal knowledge). However, these mass media vehicles have limited application in imparting in-depth vertical knowledge. Interestingly, the data clearly shows that personal attention actually increqses the depth of knowledge related to the spread and prevention of HIV/ AIDS, which is very important. ? Impact of Interaction ? The data on knowledge indicators was analysed separately for those who had an interaction with social workers (such as Health Workers, Counsellors, NGOs etc.) and those who did not have an interaction with social workers. ? From this table, it is clearly evident that the knowledge levels are significantly higher among the respondents who received information from the social worker / counsellor on an one to one basis. On the whole, it can be concluded that increased focus on mass media may not necessarily lead to a considerable change in the knowledge and behaviour of the population sub-groups. However, personal one to one interaction with specific groups like Social workers, Counsellors, Doctors and NGOs might be more effective in dealing with the misconceptions of people and in educating them, particularly with regard to the spread and prevention of HIV/ AIDS. ? Summary ? ? Television is the most prefered media, followed by Radio.? ? Awareness on HIV/AIDS is higher than the awareness on STD/RTI.? ? Major source of information on HIV/AIDS was through TV, Radio,? ? |
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