COMMUNICATIONS BRIEF

ADDRESSING: 1) Sharing N/S w/people one knows well

2) Consistant Condom use w/Regular Partner

1. Background:

Second round tracking studies conducted in August, 2006 identified key indicators/ determinants contributing to IDUs N/S sharing and condom use behaviors. A review of study results (summarized as appendix below), identified key indicators/determinantswhich should be prioritized to form the basis of the next round of communications campaign. Priority determinants are as follows:

Determinant one: The attitude that it is okay to share needles/syringes with people one knows well was more common among sharers than non-sharers.

Determinant two:Their attitudeabout appropriateness and necessity of using condoms with regular partners. More specifically, IDUs that do not use condoms are more likely to believe that:

  • It is not appropriate to use condoms with a regular partner
  • Condoms are not necessary with a regular partner

Determinant three: Their Intention to use condoms. IDUs who consistantly use condoms are morelikely to say they carry condoms when they think they are going to have sex, than IDUs who do not use condom.

2. Communication’s Theme:Don’t sharing N/S with people knows well and consistent condom use with regular sex partners

3. Theme duration:December2006through March 2007

4. Expected output:

Measurement on the tracking survey:

  • Signifigantly Reduce N/S sharing attitude indicator “it is okay to share needles/syringes with people one knows well” from 1.97 by the end of March 2007
  • Signifigantly reducecondom attitude indicators
  • “it is inappropriate to use condoms with a regular partner” from 2.42;
  • “Condoms aren’t necessary with regular partners” from 2.28 by the end of March 2007
  • Increase Condom intention indicator “I usually carry condoms when I think I am going to have sex” from 2.71 by the end of March 2007

5. Target Audience Male IDUs age 15-45 years old in Thai Nguyen city, Uong Bi town and Mong Cai town.

6. Communication Objectives: After viewing this campaign, the target group that see IEC materials, participate in games, and inteact with IPC will:

:

  • Believe they are at risk if they share needles/syringes with people one knows well
  • Think it is necessary and appropriate to use condoms with their regular partners as IDUs are at high risk and they should protect their loved ones from HIV.
  • Be in the habit ofpreparing for sexual encournters, whether with a sex worker or their regular partners, by carrying condoms when they think there is a chance or opprotunity to have sex.

7. Communication Suggestions:

FROM ISDS:The core element of this drug subculture are group dynamics which have been created by interactions between its members. The main features of this drug subculture include its homogeneity and internal hierarchy, screening mechanism, group pressure and sustaining mechanism with a strong economic basis. Drug, as shown in this section, is the glue that attach members of group to each other and drug use is the threat that closely links or facilitate most group processes and strengthens cohesion of the group[1].

According to ISDS, “Group pressure and sustaining are further reinforced by the homogeneity of the group, where members find themselves are in similar situations (family background, life experiences etc.), thus are “dutifully” interlinked and one’s behaviors must be considered in harmonious relationship with those of the others. Essentially, all see themselves as “in the same boat”.

Determinant one: Theattitude that it is okay to share needles/syringes with people one knows well was more common among sharers than non-sharers is a complex one, and could be approached from different messages and view. Follows are three approaches tomove the indicator “it is okay to share needles/syringes with people one knows well.”

A belief IDU know everything about a friend: Some IDU may believe they know everything about their injecting partner/injecting friend. They might believe their friends only inject with ‘clean people;’ they may believe they know whether s/he is sick or not (“he can’t be infected with HIV, I know him so very well”); or even believe “that kind of person can’t get HIV. I put my trust in my friend, I know his character very well.”“Generally I also feel afraid of [transmitting diseases]. But we are brothers who have been so close together that we all know that we have no problem at all, so there's nothing to worry about. I am only afraid of sharing with unknown strangers. So if there's a stranger, I'll have to be the first one to play. (Hien, male, 23)[2].

Messages could ling the concept of being close to ‘brothers,’ even for a long time, mean that brothers “look out after each other.” Positive reinforcement could emphasis positive aspects of helping each other, keeping each other, healthy, helping though good and bad times.

Supporting knowledge could convey “Youcan‘t knowwhether your friend has HIV or not” and that using your own needle doesn’t represent lack of trust, but love and support.

Messages could also confront the subjective assessment on HIV status of the people one know well, and include variations such as you “can’t tell by looking,” or something like ‘AIDS does not discriminate’

A belief that keeping a tight circle of injecting friends prevents HIV from entering the circle: Some IDUs may believe “If I only share needles/syringes with my closest friends, and they only share with me, there’s no risk for HIV.”Question from ISDS research: Can a strange guy join the group?) “How come! It’s scary. Only known ones can join the ‘gang’. A strange can never do this (Hieu - male, 23 years ol[3]d)

Messages should make IDUs understand that one best friend who shared N/S with them may haveinjected with other IDU groups and also shared N/S, so that they are at high risk of contracting HIV. Realistic messages should work with IDU to bring up the possibility that injecting friends may have, at some time, shared N/S with someone else, or that THEY may have shared w/someone else, putting their friend at risk.

They should make clear that although you may know somebody very well and for a long time, the risk of contracting HIV depends on the behavior, not the individual. Even one time (instance) of sharing a N/S can put you at risk for HIV infection.

A Bond, or ‘Tribe’ between IDUs expressed through sharing: clients may believe that “sharing N/S with best friends is the way to express our comradeship”; or that being part of a special tribe or group means they share everything, from emotional support, attachment to drugs, and needles.There will be no friend, except addicted ‘friends’ as they are the only ones who understand us and can be with us. The others know nothing. (Khanh - male, 22 years old)[4] “Drug in this context becomes first the impetus for group formation and then the means to express and reinforce the group members’ sense of “we are in the same boat”.

Conversely, IDU may fear breaking up that bond, or tribe, by NOT sharing. They may fear that “refusing to share reduces mutual trust between friends,” or that “I am afraid that my friends will be offended if I refuse sharing, and i will lose valuable friendships”. “The feeling of having “to be nice” to other group members and thus the fear of being discriminated by them can be found among all the respondents.”[5]

Determinant two: Their Attitude about appropriateness and necessity of using condoms with regular partners. More specifically, IDUs that do not use condoms are more likely to believe that:

  • It is not appropriate to use condoms with a regular partner
  • Condoms are not necessary with a regular partner

There is a need to Counter (correct) thoughts that condoms is only necessary when having sex with sex workers, to correct the believe that IDU do not need to use condom with trustable and knowable partner. “I use condom with newly acquainted people, but with whom I am already familiar with, I don’t use [condom]. (Hien - male, 23 years old).”

To address this problem, program messages and activities should clearly promote a more proactive and positive attitude towards condom use with regular partners.

Play to Responcibility: Clients neet to be well aware that it is necessary and appropriate to use condoms with their regular partners as IDUs are at high risk and they should protect their loved ones from HIV. Some methods this might be done is through:

  • Increase risk perception of IDU; they should well aware that IDUs are really at high risk of contracting HIV even though they haven't known about your HIV status, and even more, they put their sexual partners at risk by not using condoms.
  • Turn Risk around for an IDU: rather than using condoms to protect themselves, condoms are importatn to protect their loved ones. Correct the thoughts that “I do not need to use condom because my wife/girl friend is not at risk of HIV. Condoms are more than pregnancy prevention”.
  • Enforce to IDU his role as a husband, boyfriend, father: What does it mean to be a ‘head of household’ or ‘owner of family”? How can it be used to get a father, a husband, to take resposibility to protect their wife, girlfriends, and their children.
  • However, in many cases, have sex without condoms is not risk for that person but for his partner. Therefore, you should always use condoms to protect your partner as you are at high risk of having HIV.

Condoms as a normal part of marriage: Encourage normalization of condom use with regular partners. Make them feel more confident when they discuss about condom use with regular partner. We might provide IDUs strategies that can persuade their regular partner accepts to use condoms. Strategies or arguments could include:

  • Having IDU openly discuss their drug use with loved ones
  • Using condoms for birth control

It’s important not to make clients feel BAD for past behavior, which could cause them to stay away from IPC. We are not trying to lecture, but rather, reinforce key values that clients may have problems, but they can still responcibly protect their partners, and families. (Messages might remind IDU that even if they’ve had unprotected sex with their wives,

Determinant three:Their Intention to use condoms

IDUs that consistantly use condoms are more often carry condoms when they think they are going to have sex than IDUs who do not use condom.

To address this problem, program messages and activities should encourage clients to prepare aheadto use condoms to avoidthe situations that they can not buy or get condoms when they have sex.

Address barriers for condom use intention such as:

  • do not have time to go and buy condoms
  • think thatsex workers alwaysprepare for comdoms, no need to carry condoms
  • feel embarassed to buy condom (some people said that they have to wait until no customers are in the pharmacy before they buy condom)
  • scared of problems may arise if their wife finds out that they have condoms

Promote a habit that always keep a condom in their wallet

Usually carry condoms is very necessary for unexpected sex ( such as after drinks, drug use, meet casual partners…)

Give information aboutthe places that often sell condoms(pharmacies, guesthouses, teashops, andcigarette shops…)

8. Final Outcomes or Desired Response:

At the end of the campaign, IDUs should:

  • Will understand that share needles/syringes with people one knows well is very high risk behavior
  • Be well aware that it is necessary and appropriate to use condoms with their regular partners as they are at high risk and they should protect their loved ones from HIV; and feel more confident and comfortable when they discuss about condom use with regular partner.
  • Be be aware that it is necessary often carry condoms when they think they are going to have sex

9. Communication Materials to be developed:

For each determinant above, should develop 2-3 key messages that will be memorable, relevant, credible, and compelling to the target groups.

Communication materials/or activitiesmust:

  • be comprised of messages, themes, images, etc. that will be perceived as credible by IDUs
  • be eye catching enough to create some ‘stir” and spark discussions among the target groups
  • be very memorable to ensure that the key messages are easily recalled by IDUs even after the campaign has ended

Suggested communication activities/materials to be developed:

  • Storyboard
  • Flipchart
  • interactive games
  • short drama
  • comedy
  • memoirs
  • songs, poems
  • IEC materials (brochures, leaflet)
  • posters

10. Additional Considerations:

It is very important that all messages should be very clear and simple, easy to understanding, appropriate with target groups (IDUs), closely with IDUs languages and real circumstances

Communication messages don’t judge on drug use problem; and should not preach; and just only focusing on give advises how to stop drug using.

Communication activities should be invovative, very interactive, that make IDUs involved, engaged, encourage them take time to think about the given issues. Facilitate discussion among IDUs rather than just providing information.

It is very important that communication activities should be fun, combine educate and entertain target audiences.

Besides 3 key determinants mentioned above, we should make more clear messages about “healthy looking people can have HIV”. IPCs should continue introduce Fruit Game with new clients with focus on the message “healthy looking people can have HIV”, For old clients, we should develop supplementary IEC material on this determinant.

For “I’m better off to plan ahead for injecting in order to avoid sharing needles in an emergency”, next round we should continue working on this indicator, with a supplementary game/activity, or IEC material because IDUs often face with this problem.

[1]A SKETCH OF DRUG SUBCULTURE IN HANOI, ISDS

[2] ISDS

[3] Same same

[4] Same same, however, “Sometimes, the group can even invite those who are not group members to “play” together, simply for the purpose of fun”.There is also a differentiation of injecting friends. ‘Play’ with friends is fun as afterwards we still can go for drink together. For guys we do not know well, after ‘playing’ each one goes his way. Playing with friends is thus different from playing with guys who are not friends. (Diep, male, 24 years old)

[5] Same same