To facilitate the understanding of this chapter, some clarifications as per used terminology are needed.
"Material" refers to an entity which includes mainly 3 leading components: a target group/subgroup (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).
"Message" is the content that a material is suppose to disseminate and which is suppose to induce reduction of unsafe attitudes in the targeted group/subgroup.
"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 "condom reduce the risk of HIV transmission"). The former HIV/AIDS prevention campaigns have mainly focused on first line HIV/AIDS prevention messages.
"Second line" of prevention messages refers to messages that can only be delivered if the "first" line of prevention messages has been delivered and received among the target group/subgroup. This "second line" of AIDS prevention messages is more focusing on reasons why people are not following the first line of prevention messages that they know. This may be relevant to psychology, sociology or 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?"
"Target group/subgroups" is the ensemble of persons for which a material is dedicated. We have to make the distinction between "target group/subgroup" and "audience group/subgroup".
"Audience group/subgroup" is the group of persons who will be in contact with the material which was made for a specific "target group/subgroup". Example: a TV spot (="media") can deliver a "message" specifically designed for homosexuals ("target group") but prevention campaign designers must be aware of the impact that such "material" can also have on the others groups/subgroups included in "audience group/subgroup" (everybody can see TV). The impacts can be very useful or counterproductive (scandal, compassion, stigmas, etc). We can imagine for instance that to disseminate a specific "message" in the "target subgroup urban + teenager" it could become a necessity to have an "audience group" which include parents or teachers..
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Difference between first and second line messages is fundamental in HIV prevention. It is why we dedicate a few explanations to make things clear.
Suppose you want to protect your child from HIV. First of all, your child must know:
We call that "first line prevention".
2-1-1 "First line" topics
Here a list of "first line topics" which should be know by anyone who have sexual activities
- Main characteristic of HIV infection
- HIV can be assymptomatic
- Deathly disease
- What medicine can do and cannot do.. and problems induced by treatments.
- Main characteristics of transmission
- Specific sexual practices
- Role of wounds (including STD)
- Other ways of transmission (needle, breath feeding.. etc, but not mosquitoes nor saliva nor..) (this is NOT subject of our web site)
- Concrete logistical info's (Where? Price? Anonymous?...)
- Condom, lubricant.
- HIV test.
- Concealing.
- Safer Sex rules
- Allowed sexual activities when condom is available
- Sexual activities when condom is not available
- Post exposure protocol . (How? When? Where?)
2-1-2 "First line prevention" and ethic
First line messages are not ethical messages. "Science" is not "Ethic" (but scientist must have ethic of course!). First line message tell about a medical danger, not about the ethical value of the dangerous act. Encouragement of faithfulness is not first line messages.. This do not mean that ethical messages are not need in prevention strategies.
2-1-3 "First line prevention" and modesty
Modesty can be a problem during deliverance of "first line" messages. It is admit that anyone who do not feel relax to speak about sexuality (sodomy, fellatio etc) should NOT be obliged to make prevention because the uneasiness during presentation could be worse than silence.. Not all teacher are advisable for such duty and parents, sometimes, could find advantage to require the help by a family's friend to make children aware about HIV.. (NB the problem are the same in "second line prevention..)
2-1-5 "First line prevention" and culture
Same as modesty, the cultural facts can give problems. To touch homosexuality or prostitution in some muslim countries.... To speak about sodomy in agrarian cultures...Grass rooted example in Thailand.
2-1-5 "First line prevention"and "oral sex"
Prevention should forbidden unprotected fellatio or not. We must dare to say here that designers of prevention campaign can follow their own convictions. Scientists admit that such transmission of HIV is possible but will also tell that the risk is statistically not significant. Considering that campaigns forbidding unprotected oral sex " can have also dangerous side effects (especially in low layer of population) your have to make your own opinion to decide what is the worse..To see our position, click here.
2-1-6 Rumors, alternative medicines/protections and first line prevention
In western countries, in Thailand and many others countries we observe new contaminations in the groups of people well informed by "first line prevention" (knowing the danger of HIV and the way to prevent contamination). We touch here the structural limits of "first line prevention". The causes of insufficiency of "first line prevention" may be relevant to psychology, sociology or even culture and may not be directly related with the specific characteristics of HIV/AIDS disease. Observing why such informed people became infected we find causes like: side effects of shyness, side effects of alcohol, fear of sporadic impotence induced by condoms, etc
We definitively need another kind of prevention campaigns which tackle such topics and that we call "second line prevention" (“second line” because such prevention is useless if “first line" messages are not received previously).
Example: it is reported than more than 90% of HIV infected women in Thailand, are faithful wives and 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. But it is definitely true that it is extremely difficult for him to confess to his wife that he had an extra conjugal affair. 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.
It is important to insist here on the necessity of deep analyses of each "pretext" that people having unsafe practice will use to justify their attitude. A young student will possibly tell us that she accepted unprotected relation with her partner because she was confident to him.. It is more easy to speak about the confidence she had than to confess that she was just afraid to loss her partner that she love so much.. Even more typical is the male who refuse condom because the condom "reduce his feeling". It is definitively true that condom reduce feeling. But a normal person will not refuse a Mercedes Benz because he prefer a Roll Royce isn't? In fact, it is more easy to use such pretext than to admit that the reason of his unsafe attitude was his fair of impotency (which is a possible sporadic side effect of condom) or his impatience because he had no condom in his pocket and was mentally too weak to accept to deadly a little bid the sexual intercourse.
2-2-1 “Second line” topics.
- Confidence and HIV
- Impotence and HIV
- Sporadic lack of erection induce by condom.
- Erection without hardness ("condom is too little ")
- Shyness and HIV
- Love and HIV
- Fear to loss the partner
- Blindness induce by love
- Alcohol and HIV
- Alcohol and shyness
- Alcohol and skill
- Alcohol and evaluation of a risk
- Sexual immaturity and HIV
- Gender issues and HIV
- Hierarchy of genders
- Empower woman's
- Marriage and HIV
- faithfulness and HIV
- Religion and HIV
- Modesty and HIV
- Ethic gaps and HIV
- Confidence in treatments/medical research and HIV
- Etc. (see article about grass rooted observations)
2-2-2 "Second line" strategies
Each time a important topic is detected, a study is needed, a strategy must be elaborated which will make understand which kind of material is needed and the best ways to disseminate such material.
Nobody will discuss the beauty of confidence, the beauty of love and the beauty of faithfulness. The question is in another field. Just admit that we have to deal with what the world is and not only with what the world should be. Millions of faithful people HAVE died, ARE DYING AND WILL DIE of AIDS because they HAVE misunderstood OR STILL MISUNDERSTAND NOW that even “the best” partner can fail one day, one hour, one minute. We are not equal considering the sexual temptations and sexual opportunities. Some have very strong desires, some others not. Some have to face very strong temptations, some others not. Some have unspeakable frustrations, some others are never shy and do not have unspeakable desires, some accept easily to confess the most severe mistakes they did..For some people, their job, the culture, the sport or their religious convictions can be passions that make them forget the impetuosity of sexual desires but for others, there is nothing strong enough to forget the sexual temptations and attractions.
Love can induce dangerous attitude because unbalanced relation between "logical requirements" and "affective requirements". He/she will maybe accept a risk because he/she fears that his/her partner leaves him/her if he insists too much on safety. He/she can also accept a risk just because he/she fears that the partner could interprete a safety requirement as a lack of confidence (wrongly associate with love).
We observe an inadequate bipolar moral tendency:
- "HIV infection is a punishment as it reflects the notion of immorality…" This is especially promoted by uneducated traditional people in the agrarian and industrial societies and by certain religious groups. This perception usually induces severe stigmatization against the HIV / AIDS patients.
- "There is no question of morality connected with HIV infection…" This is strongly promoted by some activist groups in reaction to stigmatization.
Things are in fact much more complex and sensitive than either of these extremes suggest.
There is definitely a moral message that nobody should elude: It is criminal to refuse to use a condom when practicing any form of unsafe sex. This notion is not only related to "technical issues" but mainly to fundamental "ethical" principles. This is a CONDITIONAL NECESSITY to achieve efficient AIDS prevention.Too many persons (not only inconsiderate persons) still do not incorporate the notion of infection of their partner by HIV into the ethical principles leading their life. They just think that using or not using a condom is a personal choice. It is very common to hear: "I am not using a condom because I do not fear AIDS." Sometimes it is even worse: "…now that I am HIV positive, I do not have to protect myself anymore…".
Only a negative HIV blood test done at least 3 months after the last unsafe sexual practice allows anyone to refuse to use condom (the risk is only for the person himself in that occurrence).
First relation for women (but also for men). could be dangerous because stress make often the girl unable to require the use of condom.First relation means also "little wound" which increase dramaticaly the risk of contamination.
Note 001
Typically western countries need more second line messages than first line messages. This is due not to the excellence of former prevention policies but to the relative good qualities of information network which makes possible since many generations to receive and valorize scientific information.
In other countries, it depend of local considerations. In Thailand for instance, first line prevention is less need than second line prevention because the excellent action in past (Mr Meechai). But Thais urgently needs second line prevention because instruction network (school, media's) doesn't emphasize correctly scientific knowledge.
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 can 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 argumentation's 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
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, to exhibit 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. Dissemination strategies must be extremely aware of that.
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, to elaborate clever dissemination strategies 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. By consequence, the best way to disseminate the info's concerning homosexuality in agrarian area is probably to include them in the material dedicated to heterosexuals.. but with caution.. to avoid that agrarian heterosexuals reject such kind of material, etc
000-aidspreventionpro-03-theoricalroots
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paul yves wery - aidspreventionpro@gmail.com
aids-hospice.com & prevaids.org & stylite.net