Conclusions

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Summary Table of the Communications Framework for HIV/AIDS

References

The problem of HIV/AIDS in Ethiopia has been a devastating phenomenon that needs a joint action at all levels. One of the major problems in curbing the problem of HIV/AIDS has been difficulty to bring the intended individual behavior and social changes due to lack of appropriate interventions based on a comprehensive national HIV/AIDS communication framework. To this effect, Pact Ethiopia in collaboration with key stakeholders initiated the adoption of a communications framework developed by UNAIDS. The bases of this framework are the five interrelated domains i.e. government policy, socio –economic, culture, gender and spirituality. The communication framework addresses major issues in HIV/AIDS, their implications in HIV/AIDS, desired outcome, advocacy and BCC objectives, audience, message, channels of communication indicators for measuring success and possible partners for implementation. More than one communication approach or objective can be used in the process. This communication framework creates an enabling environment for individual behavior and social change. Only by addressing all of the issues that affect the individual’s ability to achieve change can the goal of reducing HIV/AIDS transmission be achieved in Ethiopia. However, there is a need to develop region/provincial specific HIV/AIDS guidelines based on this general framework.

Summary Table of the Communications Framework for HIV/AIDS

Policy and Policy Implementation Domain

Issues	1. Lack of comprehensive communication guideline 2. No clear guideline for intersectoral collaboration and mobilization exist among all levels of government bureaucracy and community groups. 3. Inadequacy of ethical, legal and human rights framework for HIV/AIDS intervention related to discrimination of PLWHAs, rape, premeditated transmission of HIV/AIDS. 4. Inadequate policy Support for the involvement of private sector in HIV/AIDS communication activities. 5. Inadequate policy Support for provision of services at workplaces and training institutes that support HIV/AIDS communication programs 6. Inadequate policy support to use mass media (Radio, TV and print) in a sustainable way for HIV/AIDS communication programs 7. Rape is increasing due to poor law enforcement.
Implications for HIV/AIDS	1. The absence of a clear and comprehensive guideline may lead to communication intervention failure. 2. Implementing partners will not be able to know their roles during implementation and there will be duplication of efforts. 3. Many BCC and advocacy materials produced and disseminated on HIV/AIDS lack production quality, are not culture sensitive and target specific. 4. The bureaucracy lacks a clear mandate to coordinate HIV/AIDS prevention activities. 5. Efforts of government sectors, NGOs’, CBOs’ and private are inadequate because of lack of coordination of effort. 6. The human rights of PLWHAs, punishments of rape and premeditated transmission of HIV/AIDS are not adequately addressed and enforced 7. The private sector is uninvolved in HIV/AIDS prevention activities as a result: Workforce is being depleted. 8. Efficiency and profitability are decreasing 9. Failure to achieve the desired outcome in HIV Prevention programs among the specific target population. 10. Lack of conducive environment to implement HIV communication programs. 11. Lack of adequate and sustainable coverage of HIV/AIDS issues through mass media makes BCC and advocacy programs very weak and time taking. 12. High probability of HIV infection due to unprotected sex. 13. Psychosocial implication on the victims.
Desired Outcome	1. Comprehensive guideline is in place. 2. All stakeholders participated in the implementation of HIV/AIDS communication activities based on guideline. 3. Quality BCC and advocacy materials will be available to specific target audience. 4. A Clear guideline for intersectoral collaboration and mobilization prepared and adopted for implementation 5. Legal and human right frameworks in place. 6. The rights of all in protection against AIDS satisfactorily observed. 7. Stigma for PLWA is reduced. 8. Supportive policy to encourage the private sector to be involved in HIV/AIDS prevention and care. 9. Supportive policy in place to encourage the concerned actors to provide services related to HIV/AIDS prevention and care. 10. Programmers/ managers of different media give prompt and adequate media coverage for HIV/ AIDS communication. 11. Supportive rules and regulations in place. 12. Improved law enforcement 13. Increased psychosocial support of the rape victims
Advocacy Objective	1. To gain support and commitment of policy/decision makers to develop and adopt a comprehensive guideline 2. Advocate for the existence of a clear collaboration guideline to be used for inter-sectoral coordination 3. To mobilize support and commitment for the adoption of a legal framework that supports the rights of all in protection against AIDS, rape, elimination of stigma for PLWHAs 4. Advocate for policy support to promote the participation of the private sector in HIV/AIDS activities. 5. Advocate for policy support to promote the participation of the private sector in HIV/AIDS activities. 6. To gain government commitment and support to use mass media to the maximum for the dissemination of HIV/AIDS programs/massages in a sustainable manner 7. To increase the commitment of law enforcing officials at all levels 8. To increase the involvement of relevant organizations working in psychosocial support
Audience	Policy/decision makers, relevant regional bureaus and program managers, legal reformers, media managers, elders and community leaders, factory managers and trade union leaders, teachers and student leaders, Law enforcing officials, professional such as psychologists, sociologists etc and public and civil societies.
Message	1. The guideline enables the stakeholders to implement HIV/AIDS communication activities with confidence. 2. The coordinating bodies at different level would be able to effectively monitor implementation activities 3. The application of the guideline facilitates the implementation of HIV/AIDS communication. 4. The coordinating body would be able to effectively monitor implementation activities. 5. Undertaking clearly identified communication intervention under the guideline will facilitate the achievement of the desired goal. 6. There is a need to have legal framework, 7. Respect for human rights 8. Prominent roles played by private sector in national development. 9. The significance of the involvements of the private sector in HIV/AIDS prevention activities. 10. The impact of adequate services to the desired communication outcome. 11. The advantage of having the service like STI,VCT and condom at the concerned places 12. The use of mass media on HIV/AIDS communication is not adequate. 13. Maximizing the utilization of mass media for HIV/AIDS intervention have tremendous impact. 14. The magnitude and impact of rape is significantly contributing to the spread of HIV/AIDS. 15. There is a need for enforcement of law and strengthening psychosocial support for rape victims.
Channel	Mass media (radio, print & TV), sensitization-seminars/workshops and conferences, panels and press release.
Indicators/ Measurement of success	1. A comprehensive communication guideline adopted. 2. Action taken for implementation and Guidelines Implemented 3. A guideline for inter-sectoral and community mobilization developed and adopted. 4. Legal framework adopted. 5. Number of cases given appropriate judgment. 6. Decreasing trend of stigma 7. The nature of the policy that involve private sector is significantly more favorable to initiate activities and programs 8. The degree of involvement of the private sector in HIV/AIDS activities. 9. The workplace policy and guidelines developed. 10. Proportion of workplaces and training institutes rendering services. 11. Guidelines regarding media use developed and enforced. 12. Proportion of air time/column provide by media organizations for HIV. 13. Rape cases reduced 14. Involvement of concerned professionals and partners increased.
Partners	· Sectoral ministries, Regional bureaus, NGOs, CBOs,Policy/decision makers, managers at all levels, groups of private sectors. Private and government workplaces, trade unions, training institutes, advocacy NGOs, professional in relevant institutions and donors

Socio-Economic Domain

Issues	1. Many of the rural women migrating to towns in attempt to look for jobs usually end up in prostitution. 2. Certain occupations (such as long distance driving) are predisposing many men and women to indulge in high-risk sexual behaviors. 3. Limited access to technical skill training and job opportunities for young men and women is leading people to indulge in unprotected commercial sex. 4. Availability and access to health service is poor and health education is weak throughout the country. 5. The more economically better-off segments of the population – ‘sugar daddies’ indulge in high-risk activities 6. Little access to technical skill training opportunities available to people, especially women 7. Women are economically dependent on men, hence hold a subordinate position in the relationship, thus are not empowered to make decisions in sexual relationships 8. Private sector is inadequately involved in HIV/AIDS prevention and care activities 9. HIV/AIDS prevention and care activities including STD management and care do not exist inmost of the work places, especially in the industries 10. Productivity is affected by sick leave and death of PLWHA 11. PLWHA, orphans and affected families are not getting the required support to lead relatively healthy lives in their respective communities
Implications for HIV/AIDS	1. A significant number of rural women are sexually abused by men, while trying to find a job in urban areas (particularly by brokers). 2. Women anticipating better life in towns usually end up getting nothing but in bars, hotels and restaurants to be prostitutes through women traffickers. 3. Facilitates the spread of HIV and STDs among people practicing multi-partner sexual practices and eventually to their families. 4. Young boys and girls are tempted to broker or sell sex in order to get some income. 5. Young girls and sex workers are frequently sexually abused. 6. Increase in prevalence of STDs and HIV among sex workers and young people. 7. There are extremely little opportunities for people to know about their sero-status and accordingly shape their behaviors. 8. Inadequate and inappropriate STD treatment facilitates HIV acquisition and spread. 9. Promotion of high risk behaviors leading to spread of HIV and STDs. 10. Lack of technical skills leads women to indulge in prostitution. 11. Among men lack of technical capacity leads to joblessness, eventually to street life and indulging in high risk behaviors leading to the spread of HIV infection 12. Women are less able to negotiate their positions and have lesser power in decision making regarding family planning, condom use, HIV/STD testing. 13. The rate of STDs/HIV infection increases because of lack of resources and hence girls are less likely to stay in school and are more vulnerable to older men, sugar daddies, and prostitution 14. HIV can become occupational hazard in some industries and can facilitate spread of HIV infection. There can also be increased discrimination and stigmatization of PLWHA in work places. 15. Significant proportion of productive workforce is reduced due to AIDS. 16. Production centers selectively avoid providing job opportunities to PLWHA. This leads to greater discrimination and stigmatization of PLWHA. 17. Overall the economy of the community and the country at large is greatly compromised. 18. Increased burden on health services to cope up with increasing number of AIDS patients. Increased stigmatization and discrimination against PLWHA and their families.
BCC Objectives	1. Increase the self-protection skills of women against rape and other forms of abuse. 2. All women protect themselves against acquisition of STDs and HIV by using condoms. 3. Women have adequate knowledge and skills of identifying the proper channel of finding jobs. 4. Travel and migration along various transportation corridors is encouraging people to indulge in high-risk practices hence increasing the incidence of HIV in the relatively low risk population. 5. Reduce the spread of HIV from high-risk group population into family structures. 6. Increase the condom use rate by the mobile people. 7. Reduce the number of sexual partners of mobile population, and the youth. 8. Increase the capacity of young men and women to develop the skills of finding appropriate jobs. 9. Decrease the prevalence of high-risk behaviors among the whole population and particularly the risk groups. 10. Reduce the prevalence of misconceptions regarding HIV/AIDS to the minimum. 11. Develop positive attitudes towards STD management and care given at health institutions. 12. Increase the peoples’ have favorable health seeking behaviors. 13. Increase demand for VCT services among the population in general and among the high-risk groups in particular. 14. Reduction in prevalence of high-risk behaviors (mainly multipartner sexual contacts and commercial sex) among the rich and better-offs 15. Enhancement of decision making capacity of women 16. Development of negotiating skills of women in resource sharing as well as sexual relationships. 17. Building capacity of women in engaging income generating activities. 18. Influence private investors develop positive attitudes and steps in engaging in HIV/AIDS related control activities. 19. Managers and administrators develop positive attitudes towards HIV/AIDS control in work places. 20. Promote the capacity of PLWHA to enable them to fight for their rights.
Advocacy Objectives	1. Advocate for formulation of new or reinforcing existing laws to protect women from being sexually abused. 2. Lobby among various NGOs and other business entrepreneurs to create jobs for rural women. 3. Advocate for increase the opportunities for decent jobs for women. 4. Promote involvement of influential community groups to strengthen family values and sense of protectionism among family members of mobile people. 5. Job opportunities created for young people. 6. Alternate job opportunities sorted out for CSWs. 7. Advocate for commitment of more resources by policy makers for making quality health services (including STD care and VCT) available, affordable and physically accessible to the needy population. 8. Advocate for promotion of skills training establishments to the majority of the needy population. 9. Lobby for increase in more opportunities for women (affirmative action) to generate their own income. 10. Sensitize to strengthen and operationalize the women’s policy in promoting women’s rights. 11. Lobby for creating more conducive political atmosphere for the private sectors to be involved. 12. Lobby for formulation of policies and strategies related to handling HIV/AIDS related issues in work places. 13. Advocate for commitment of more resources to make work places safe against acquisition and spread of HIV infection 14. Advocate for protection of rights of PLWHA by policy and legal support. 15. Lobby for commitment of resources by the government and other donor communities to provide optimal care and support to PLWHA to keep them healthy, physically fit and productive. 16. Advocate for increased commitment of resources for provision of care and support for PLWHA.
Audience	Rural residing women, male brokers, law makers, policy makers, long distance travelers (including truck drivers and soldiers), CSWs, migrants, regional and federal health and labor/social affairs officials, Investors, officials of faith based institutions, youth (in and out of school), parents, Federal and Regional Health and Labor/Social Affairs Officers, The general public (urban and rural), high-risk groups, Orphans and street children, the press people, tourists (local, international), MOE officials, Regional Education Bureau officials, bankers, community and religious lobbyists, Trade Union Leaders, Officials of Chambers of Commerce, Factory and office Managers, PLWHA and heads of their organizations, leaders of NGOs, UN Agencies and donor communities, the general public, NACS/RACS officials
Message content	1. Building capacity of vulnerable women on how to protect them from being raped and abused. 2. Sensitization of women on potential job opportunities. 3. Teach methods of developing skills to negotiate condom use with their partners. 4. Lobby for formulation of relevant laws and regulations. 5. Create jobs for women particularly for those migrating from rural areas. 6. Mobile people should be encouraged to use condoms whenever having casual sex. 7. Mobile people should reduce their number of sexual partners as much as possible. 8. Influential members of the community should encourage stronger family responsibilities, especially those of mobile population. 9. NGO’s and other agencies should create jobs for women who are otherwise involved in commercial sex along the various transportation corridors. 10. Young people (men and women) should protect themselves from acquisition of HIV and STDs. 11. Young girls should protect themselves from getting unwanted pregnancies. 12. Parents give more freedom to their young ones (especially their daughters) in using their income. 13. NGOs and other concerned agencies create job opportunities for CSWs and other young people. 14. All the public should obtain accurate and reliable information about HIV/AIDS. 15. All should protect themselves from infecting themselves or infecting others by following the ABC rule. 16. Health care should be provided to all the needy population. 17. The quality of health services including VCT should be optimally standard. 18. The health services should be attractive and user-friendly. 19. People should develop positive attitudes towards the STD care services provided and eventually use them whenever demanding. 20. Wealthy people should not sexually exploit young girls using their financial influence. 21. The number of sexual partners should be kept to the minimum. 22. Whenever casual sex occurs all should use condoms. 23. Make technical skills training opportunities available to all the youth. 24. Women should be able to negotiate for their rights with men. 25. Women should have the right over the resource they generate. 26. Women should have the right to decide on their sexual intentions. 27. Men should not subordinate women. 28. Private sector should be increasingly involved in various HIV/AIDS control and prevention activities. 29. Policy makers and political authorities should create a conducive atmosphere for investment in HIV/AIDS control. 30. Make work place safe against HIV transmission. 31. Optimal care and support be given for PLWHA at work places. 32. PLWHA should not be discriminated because of their sero-status at work. 33. Provide care and support to PLWHA. 34. Increase capacities of PLWHA to keep them healthy and productive. 35. PLWHA should get the necessary care and support they need. 36. It is everybody’s responsibility in the communities to provide support to PLWHA.
Channels	Mass and Interpersonal - Examples are: – (Radio, TV & print), rural mass gatherings, panel discussions, traditional and folk media like coffee ceremonies and others, meetings among trucking companies and military units, etc. intra-family communication, ,professional associations declarations, community and religious lobby group meetings,
Desired Outcomes	1. Women are protected from sexual abuse. 2. Legal measures are put in place to discourage those raping women looking for jobs. 3. The practice of women trafficking is legally condemned and halted. 4. Better job opportunities are created for migrating rural women. 5. Better job opportunities created for women to stop migrating. 6. High risk sexual behaviors of the mobile population modified. 7. Spread of HIV from urban to rural areas halted. 8. Families of mobile people protected from acquisition of HIV infection. 9. Young men and women are protected from acquiring STI and HIV infections. 10. Appropriate job opportunities created for young people. 11. Alternate and more productive job opportunities created for CSWs. 12. Men and women are empowered by opportunities for a more secure livelihood and do not engage in high-risk HIV/AIDS associated activities. 13. Health services are optimally accessible to the needy population. 14. Quality of STD management and care is optimally adequate. 15. VCT services are available and accessible to all demanding. 16. Overwhelming majority of the population have adequate knowledge and awareness about the essentials of HIV/AIDS. 17. Economically and educationally better-off develop more responsible sexual behavior towards their families and other members of the community 18. Access to skills training is provided to the needy population, especially the jobless youth on streets. 19. Those on streets start leading secure and healthy life styles. 20. Decision-making power of women increased thus making her less dependent financially on her male counterpart. 21. An increased income generation activity for married women. 22. Mechanism to enforce laws that protect women’s rights instituted by the government. 23. The private sector plays important and prominent role in community and national development. 24. Private sector is convinced that it is in their best interest to implement prevention and care activities. 25. Government instituted tax incentives and other policies to support private sector involvement in HIV/AIDS prevention in the workplace and the community. 26. The spread of HIV infection is reduced at work places. 27. People affected by HIV/AIDS get optimal care and support in work places. 28. PLWHA are not discriminated in their work places. 29. PLWHA get the optimal psychological, medical and physical support and care to remain fit for work and lead relatively healthy life. 30. Discrimination and stigma against PLWHA is largely abolished at production centers 31. PLWHA obtain the optimal care they deserve to get.
Indicators / Measurement of success	1. Proportion of women reported raped over time. 2. Law related to rape in place. 3. Number of new jobs created for rural women. 4. Proportion of rural migrating women using condoms. 5. Condom use rate among travelers 6. Number of sexual partners of mobile people 7. Number of gatherings of truckers/soldiers where education about sexuality given 8. Condom use rate among young people 9. Number of sexual partners of young people 10. Number of new job opportunities created for young people. 11. Prevalence of STD in the general population and in risk groups in particular 12. Trend of STD care utilization 13. Trend of VCT service utilization 14. Proportion of the public having accurate and correct knowledge about STDs and HIV/AIDS 15. Prevalence of high risk behaviors among the economically better offs 16. Prevalence of STDs among the partners of the ‘sugar-daddies’ 17. Number of existing and new skills training institutions established 18. Enrollment rate of jobless youth in skills training institutions. 19. Proportion of jobless youth getting skills training 20. Proportion of men having positive attitude towards women’s sharing resources 21. Proportion of women able to make their own decisions over their resources 22. Proportion of women able to make their own decisions over their sexuality 23. The amount (volume) of private investment in HIV/AIDS control effort 24. Relevant policies, laws and legislations formulated. 25. Number of companies and organizations having work places related activities on HIV/AIDS prevention and control 26. Proportion of PLWHA not discriminated at work places 27. Number of sick leaves presented by PLWHA in work places. 28. Number of AIDS related deaths at work places. 29. Amount of resources (financial) lost due to AIDS related absenteeism and deaths. 30. Amount of resources put in place for care and support for PLWHA. 31. Number of PLWHA obtaining optimal care and support.
Partners	NGOs, UN agencies, Federal and Regional law makers, the judiciary, private investors, health service providers, bar owners, Women’s Rights Groups, transport companies, health care delivery institutions, CBOs, Skills training organizations, policy makers, youth organizations, MOH, RHBs, NACS, RACS, PLWHA Associations, Local and international touring organizations, investment agencies, gender lobbyists, Investors, community organizations, Women Affairs Authorities and organizations, micro finance institutions, private industries, Chambers of Commerce, labor and trade unions, MOLSA, MOLSA

Culture Domain

Issues	Culturally accepted male dominance in sexual relations A taboo that couples don’t discuss on sexual issues. Lack of appropriate socialization of children on issues of sexuality Abduction is widely accepted culture Inadequate involvement of community leaders in HIV/AIDS communication programs Exposure of youth to different harmful cultural diffusions like substance use, group sex and homosexuality. Harmful traditional Practices: FGM, removal of tonsils, uvula and milk teeth, post-natal use of herbal smoke to dry the vaginal wall, inheritance of female widow by relative of husband. Need for identifying positive cultural traditions for expansion of care and support like orphan adoption and care and support for the sick.
Implications for HIV/AIDS	1. High vulnerability of females for HIV transmission due to unsafe sex 2. High probability of HIV-transmission from sero-discordant couples 3. High probability of HIV-transmission due to unsafe and early sexual practice 4. Communication program doesn’t meet its objectives 5. Unsafe sexual practice by youth 6. High probability of HIV transmission due to HTP. 7. Use of positive cultural traditions significantly contributes for care and support related to HIV/AIDS.
Desired Outcome	1. Involvement of females in decision related to sexual relationship 2. Positive attitude of males towards females involvement. 3. Increased couples communication on sexual matters 4. Increased parent-child communication on sexual matters 5. Responsible sexual behavior of teenagers 6. Delay on age of sexual initiation 7. Reduction on the rate of abduction 8. Involvement of community leaders in HIV/AIDS communication 9. Decrease the rate of premarital sex 10. Increase the rate of one-to -one sexual relationship 11. Decrease the rate substance use and homosexuality 12. Avoid harmful traditional practices. 13. Improved quality of care for orphans and PLWHAs
BCC Objective	1. To increase the knowledge of the importance of sexual communication. 2. To upgrade the skill of sexual negotiation of females. 3. To increase the knowledge of the importance of sexual communication. 4. To improve negotiation practice of safe sexual practice (Either HIV-testing or condom use) 5. To increase the awareness of parents on the importance of early communication of children on issues of sexuality. 6. To improve communication skill of parents to their children 7. To increase the awareness of parents on the danger of abduction. 8. To improve the skill of females on avoiding and escaping abduction 9. To increase the awareness of program planners on the importance of involving community leaders on HIV communication 10. To improve HIV-communication skill of community leaders 11. To increase the awareness of the youth on importance of delay of sexual initiation, having one-to-one sexual relationship and avoid premarital sex, substance use and homosexuality. 12. To change the attitude of youth and parents towards new cultural norms 13. To improve communication skill of youth to the desired outcome. 14. To increase the awareness of female, traditional practitioners and opinion leaders on the impact of harmful traditional practices 15. To improve the attitude and practice of the community on harmful traditional practices. 16. To improve the skill and practice of the community on community base care for PLWHAs and AIDS orphans.
Advocacy Objective	1. To increase the support of community, opinion and religious leaders. 2. To gain the support of policy makers and legislative body 3. To increase the support of parents, grandparents or elderly. 4. To gain the support of youth and women organizations. 5. To increase the support of implementing organizations 6. To gain the support of cultural community and religious organizations
Audience (Primary)	· Children above 7 years and Youth, men and women at reproductive age, parents, teachers, men and women traditional headers and practitioners and
Audience (Secondary)	· Men partners, parents, community leaders, religious leaders, elders, opinion leaders, concerned professionals, policy makers and Health workers
Message	1. Male dominance in sexual relations is not good culture 2. Sexual relationship is mutual interest of both sexes 3. Men and women should communicate openly in sexual relations 4. Sexual communication helps both male and females to avoid unsafe sexual practices that may predispose them for HIV. 5. Every person has the risk of being infected with HIV 6. Parents should communicate with their children on issues of sexuality and RH 7. Early communication children on issues related to sexuality helps them to delay sexual initiation or avoid sex until marriage or helps them to avoid unsafe sexual practices 8. Women have the right to choose sexual partner and the right to refuse sexual practice or advances. 9. Rape and abduction promote the spread of HIV 10. Traditional leaders are partners for HIV prevention should involve on teaching the new generation. 11. Community leaders are source of wisdom and good culture. 12. Avoiding bad cultures helps to avoid HIV/AIDS, STI and teenage pregnancy. 13. Substance use, premarital sex and multi-partnership are out of fashion. 14. Harmful Traditional Practices are not supported by any religion. 15. Harmful Traditional Practices facilitate the spread of AIDS. 16. Our culture supports care for orphans and sick 17. AIDS orphans and PLWHAs needs the care and support of the community
Channel	1. Mass media and interpersonal channels and fora like traditional & folk media, radio, TV, newspaper, magazines etc..) and Printed material will be used 2. Traditional media like coffee ceremony and Community organizations like Edir and Mahber. 3. Institutions like Schools, health facilities, church and mosque. 4. Peer communication and Individuals, couples or parents counseling 5. Seminars, workshops and discussion forums Associations or clubs (youth, women, professional
Indicators / Measurement of success	1. Proportion of females who know the advantages of sexual negotiation and decision-making skills in sexual relationship. 2. Proportion of males who develop positive attitude to the participation females on sexual negotiation. 3. Proportion of females practicing sexual negotiation. 4. Proportion men and women who know the advantages of sexual communication. 5. Proportion of males & females practicing sexual communication. 6. Proportion of males & females who practice VCT prior to sexual relationship. 7. Proportion of males & females who use condom 8. Proportion of reproductive age persons who are aware of the importance of early communication of children on issues of sexuality. 9. Proportion of parents, teachers, and other adults who communicant to children on sexuality 10. Proportion of teenage group practicing safer sexual behavior 11. Age of sexual initiation. 12. Attitude of teenage group towards premarital sexual relationship 13. Rate of abduction 14. Attitude of parents, legislators, policy makers towards rape and abduction 15. Number rapist who received proper prosecution. 16. Number of community leaders involved on communication programs. 17. Attitude of people towards involvement of community leaders on HIV/AIDS communication 18. Communication knowledge and skill of traditional leaders 19. Attitude of people towards premarital sex, one-to-one relations and delay of sexual initiation. 20. Proportion of premarital sex, multi-partner sexual relations, substance use and homosexuality 21. Age of sexual initiation and proportion of one-to –one sexual relationship 22. Number of females who practice HTP 23. Attitude of people towards HTP 24. Number of New roles and regulation enacted regarding HTP 25. Number of male and females who practice care and support 26. Attitude of people towards care and support 27. Number of orphans and PLWHAs who received care and support
Partners	· MOH, Women affair offices (federal and regional), Ministry of Education and Education Bureaus, Ministry of Youth Culture and Sport, NGO working on female empowerment, on reproductive health (RH) programs, NGO working with community organization and youth organizations, NGO working on HTP, NGO working on care and support, health institutes, experts working on adolescent sexuality, professional associations, religious organization, traditional healers and association or clubs (youth, women, teachers etc..) ,

Gender Domain

Issues	1. Women’s widespread Economic/financial dependence on men forces them in a subordinate position 2. Many girls and women are not able to enroll and continue their education due to several obstacles resulting in low enrollment of girls/women in formal and non-formal education and educational institutions 3. Most health provisions are not “client friendly” especially to women and adolescents seeking STI treatment and other reproductive health services 4. Relatively high number of married or committed men engaged in extra-marital relations due to social acceptance. 5. Women are perceived as submitting men to sexual temptations (thus exposing men to STI and HIV, marital problems) 6. Forced and arranged marriages are widely existing (older men marrying much younger/adolescent girls – ideally virgins) 7. In terms of HBC, women carry the burden of care of PLWA within the family or community 8. Women show low health seeking behavior regarding RH 9. Some of the production and distribution of the media, messages are gender biased 10. Incidence is increasing among young girls and elderly, particularly in urban town 11. Incidence of rape is increasing among young girls and elderly
Implications for HIV/AIDS	1. Women have lower negotiating power on issues such as: HIV/STI prevention, condom use, VCT, family planning, etc.; 2. Increased rate of HIV/STD infection due to weak communication and gender inequity between within the couple 3. Men have relatively most of the decision making power in the issue of sexual activity such as using protection or not, fidelity or not, etc. 4. The lesser the education, the higher the chances of the girls having a lower economic status and the higher the chances of HIV infection 5. Delayed detection and treatment of STI, untimely checkup thus decreasing the health seeking behavior of women and adolescents 6. Increased risk of HIV infection 7. Men deny their sexual responsibility and increase the risk of contracting HIV and infecting their partners 8. Higher chances to contract HIV 9. Higher risk of exposure and infection 10. Less time to take care of other things such as income generating, taking care of children/household, education, etc 11. Decreased chance of early STI detection, adequate and preventive RH 12. Creates sexual temptation among the audiences creates distorted messages 13. Increased risk of HIV transmission
BCC Objective	1. To upgrade/develop women’s and men’s inter-spousal communication skills 2. Increase or promote society’s understanding of the need of equality in sexual decision making 3. Increase girls and women’s access to formal and or informal education and training institutions 4. Increase the ability of women and adolescents to better express themselves 5. Increase the ability of Medial Personnel to better express themselves and understand their patients 6. Increase the knowledge (for men) that extra marital relations increases their chances of contracting HIV and of putting their families at risk 7. Increase the number of men that are faithful 8. Men take responsibility for their sexual behavior 9. Women are perceived fairly and not categorized at temptresses 10. Increase knowledge among men that engaging in sexual relation with young girls or virgins does not mean HIV free relation 11. Increase training on HBC including a component on increasing men’s involvement 12. Increase the number of women seeking preventive health seeking behavior 13. Media Professionals are trained to design gender sensitive programs 14. Increase awareness and knowledge of young girls and elderly women regarding their security and the existing risk of rape 15. Change attitude of perpetrators of rape
Advocacy Objective	1. Promote men and women’s equality within the couple irrespective of their employment situation 2. Promote self employment and other income generating activities for women 3. Lobby women’s groups, education ministries and regional offices, schools to nurture women’s and young girls educational advancement and 4. Highlight the correlation between higher education and better health 5. Lobby MoE, Health care training institutes to increase the provide capacity building for personnel of Medical institutions, and improve the medical institution working environment 6. Lobby community groups to discourage extra marital affairs 7. Lobby Community elders and groups to make men take responsibility for their sexual behaviors 8. Lobby for legal support in preventing under-age sexual relations, early marriage and such other harmful traditions 9. Lobby community groups to encourage their men to participate and contribute in the care of PLWA within their household and community 10. Lobby famous Men Role models to promote the concept of men’s involvement in HBC 11. Lobby medical practitioners to appreciate and be sensitive to the needs of their clients 12. Advocate media professional to portray women in the proper light 13. Educate policy makers, community leaders on the prevalence of rape and the threat it represents regarding HIV transmission risk
Audience	Parents, communities, married couples, Women and adolescent girls, Health care professionals, Health care institutions management, Men, Women, Community Groups, Young girls, older men, Journalists, Advertising Professionals, Business advertising products, policy Makers, Community leaders, Religious leaders
Message content	1. Highlight the value and benefit of good communication skills in the couple 2. Increase women’s self confidence in their ability and willingness to generate income 3. Fight for a better education to access a better life and decrease the chances or risk of HIV infection 4. Proper patient care/treatment is essential to medical profession (for HC providers) 5. Women and adolescents deserve better treatment 6. Any message discouraging un-faithfulness and encouraging faithfulness 7. One always has a choice in sexual behavior 8. Availability should not always lead to action or consumption 9. Engaging in sexual relations with young girls puts the girls at greater health risk (STI, HIV, Unwanted pregnancies, etc.) 10. Young girls or virgins does not equal HIV free 11. Involvement in HBC and other household choirs does not make men lesser but rather better partners 12. Women should not have to manage HBC alone 13. Inform and educate young girls and elderly women on the magnitude and “realness” of rape 14. Educate perpetrators on the danger of rape for the rapist and the victim as well as clearly inform rapist of the legal penalties 15. The need for enforcing laws (to protect young girls and elderly)
Channels	Traditional channels, Religious fora, Mass Media, Community Group meetings, Health Professional Associations, training institutions, sports events, sports clubs, Small group discussions, workshops, woman association meetings,
Desired Outcome	1. Men and Women can better communicate on reproductive health issues and sexuality as well as better understand and express their needs within the couple; 2. Increased employment and income generating activities, especially for women, empower women to better share decision making in the couple; 3. Men and women share equal responsibility regarding reproductive health and sexuality irrespective of their employment status 4. Women have a significantly better opportunities to continue basic formal and non-formal education 5. Health care provisions improved and women friendly services made available 6. The number of men and women having extra-marital relations decreases 7. Men take responsibility for their sexual behavior 8. Men understand their behavior might their partners and spouse at risk 9. Decreased incidences of early marriage, forced marriage and other such harmful traditions 10. Caregivers will be able to take care of themselves as well and get support from the community 11. Women feel confident to seek RH service 12. Production and distribution of media messages will be ethically and societal friendly 13. Significant decrease in incidence of Rape
Indicators / Measurement of success	1. Regular assessment of changes in women’s economic status 2. Regular FGD with men and FGD with women 3. Increase the number of girls enrolled in schools and other educational institutions 4. Decrease the number of drop-outs 5. Number of women using centers for STI treatment, VCT, Counseling on HIV, MTCT, etc. increases 6. The number of Women and adolescent girls coming for check up increase 7. Random assessment of Health care providing institutions 8. Rapid assessment to change attitude and behavior changes and or Periodic FGD with men to monitor and evaluate changes 9. Rapid assessment methods to see KAP changes and KAP studies among men 10. Periodic Assessment at intervention sites and Pre-post intervention comparisons 11. Assessment of intervention areas 12. Increased number of women coming for checkup 13. Decreased number of advertising portraying women in a derogatory manner 14. Decreased incidence of rape in defined time in intervention areas
(a) Partners	Community organizations, NGO’s, religious groups, Private Sector Micro-finance Institutions, UNAIDS, PENN State, MoE, Community elders, Sports clubs, Singers, Actors, etc. (where men go to be men), women’s groups, men’s groups/clubs, Traditional community groups, MOH, RHB, Woreda Health Offices, Health institutions, Medical schools, Mass media personnel and media institution, MoI, community groups,

Spirituality Domain

Issues	1. There is a need to mobilize more material, financial and technical support to religious organization to fulfill their duty in prevention of HIV/AIDS problems. 2. Inadequate resource mobilization by faith based institutions to address the problems of HIV/AIDS including care and support. 3. Inadequate incorporation of HIV/AIDS teaching with in their basic faith value and principle, including less emphasis on the reduction of stigmatization, care and support. 4. Efforts exerted by faith-based organizations are not well coordinated and networked 5. There is a need of educational training and dialog among faith based institutions on aspects of misconception, misrepresentation of cause and prevention of HIV/AIDS. 6. Leaders of traditional beliefs are not well identified and those identified are not properly utilized 7. Traditional and unscientific misconception on the causes and transmission of HIV/AIDS. Belief that “AIDS is a curse from God”
Implications for HIV/AIDS	1. There is missed opportunity of changing behaviors in faith-based institutions. 2. There is insufficient effort to control the spread of HIV/AIDS. 3. Religious teachings are not influencing the prevalence of high-risk behaviors and hence the spread of HIV is not halted. 4. There is an increase in stigmatization. 5. There is inefficient utilization of the meager resources available and duplication of efforts leading to ineffective control efforts. 6. Misconceptions and rumors distract HIV/AIDS control efforts and hence facilitating the spread of HIV 7. There is a missing fertile opportunity in the effort to modify behaviors through their faiths and beliefs, making the HIV control efforts inadequate. 8. Obstacle to the prevention programs 9. Increase the stigma related to AIDS
BCC Objectives	1. Increase communication capacity of spiritual leaders regarding HIV control activities. 2. Increase the proportion of believers strictly following the teaching of their faith in terms of sexuality. 3. Prevalence of high-risk behaviors is reduced to the minimum. 4. Increase knowledge, change attitudes and behaviors of spiritual leaders towards teachings of prevention of HIV/AIDS. 5. Change attitudes and behaviors of leaders towards coordination and networking. 6. Reduce the prevalence of misconceptions regarding causes and transmission of HIV to the minimum. 7. Increased prevalence of favorable attitudes towards condom use among the public. 8. Change attitudes and building communication capacities of spiritual leaders in combating misconceptions and unfounded rumors in the spiritual community and beyond. 9. Change attitudes and behaviors of traditional believers towards HIV/AIDS. 10. To increase the knowledge of people on the causes and made transmission of HIV/AIDS 11. To reduce discrimination against PLWHA
Advocacy Objectives	1. Advocate for increased support by donors and the government to the faith based institutions. 2. Advocate for increased commitment of leaders of faith based institutions to the HIV/AIDS control efforts. 3. Lobby for increased support by donors and the government to the faith based institutions. 4. Advocate for change in policies of faith based institutions with regard to HIV/AIDS related teaching in their respective institutions. 5. Lobby for the establishment and strengthening of coordinating and networking bodies at all levels. 6. Advocate for commitment of resources to build capacities of spiritual leaders. 7. Advocate for increased commitment of more resources in supporting traditional believers institute HIV/AIDS related teaching among themselves. 8. To increase the support of community leaders, opinion leaders, religious leaders, youth leaders. 9. To gain the support of policy makers, donors, legislators
Audience	Leaders of donor communities, NGOs, policy makers, leaders of faith based institutions, the religious community, faith related lobby groups, donors, Heads of NACS & RACS, followers of the respective faiths, the general public, followers of traditional beliefs, elders and community opinion leaders, youth, men and women at reproductive age, community & opinion leaders,
Message content	1. Commit resources to faith based institutions. 2. All believers should practice healthy behaviors. 3. All believers practice their faith. 4. Synchronize religious teaching with that HIV/AIDS prevention and control. 5. All efforts should be coordinated. 6. Avoid duplication of efforts. 7. HIV/AIDS is not a curse from God, rather due to human deeds. 8. Condom use is specially indicated for high risk groups for their own protection and those of their partners. 9. All the traditional beliefs should be identified and properly classified. 10. Teachings and beliefs regarding prevention of HIV/AIDS be incorporated into their respective faiths. 11. Traditional believers adopt less risky behaviors. 12. HIV/AIDS is a communicable disease caused by a virus 13. Any body that is exposed to the virus for various reasons could acquire HIV/AIDS. 14. Our friends, brothers or sisters, parents, children, partners or ourselves could be a person living with HIV/AIDS so let as give care for PLWA. 15. PLWA has the right to work, education and other privileges.
Channels	Religious lobbyists, Mass media, panel discussions, religious songs and drama, converted/rehabilitated CSWs, PLWHA, congregation meetings, religious ceremonies, interpersonal communications, spiritual teaching occasions, traditional media, panel discussions, traditional media, community organization meetings, printed media,
Desired Outcomes	1. Optimal resources allocated to faith based institutions for the prevention and control of HIV/AIDS in their respective institutions. 2. All faith-based institutions incorporate prevention and control of HIV/AIDS in their day-to-day activities. 3. Followers of various faiths demonstrate positive sexual behavior. 4. Followers are involved in home and community based care and support activities. 5. Resources mobilized for the prevention and control of HIV/AIDS activities increased. 6. Increase capacity of spiritual leaders regarding HIV control activities. 7. Religious teachings are given in coherence with the context of HIV/AIDS. 8. HIV/AIDS prevention and control related teaching is directly given in formal and informal organizations. 9. Prevalence of stigmatizing behaviors reduced. 10. There is coordinated effort by faith based and other organizations in the fight against HIV/AIDS. 11. Appropriate knowledge and positive attitudes prevail in the communities 12. Various spiritual organizations minimize their opposition towards some of the preventive methods of HIV/AIDS, particularly on the use of condom. 13. Reduction in the prevalence of high-risk behaviors among traditional believers. 14. Traditional beliefs and religions are properly identified and HIV/AIDS control efforts are initiated among these believers. 15. Increased knowledge on the cause of HIV/AIDS 16. Decreases on the misconceptions about HIV/AIDS 17. Abolish discrimination of PLWA
Indicators / Measurement of success	1. Amount of resources committed for HIV/AIDS control in the faith based institutions. 2. Number of faith based institutions having HIV/AIDS control programs. 3. Amount of resources committed for HIV/AIDS control in the faith based institutions. 4. Number of faith based institutions having HIV/AIDS control programs. 5. Number of trained religious leaders 6. The proportion and frequency of programs conducted in the respective religious institutions 7. Level and sites of involvement of religious leaders 8. Involvement of counseled (spiritual and problem specific) PLWHA in awareness creation measure 9. Number of religious leaders directly delivering HIV/AIDS related teachings in their respective congregations. 10. Number of spiritual leaders trained in HIV/AIDS related issues. 11. Coordinating body(ies) established and functioning. 12. Prevalence of misconceptions and rumors. 13. Number of people having negative attitudes towards physical barrier methods. 14. Number of identified traditional beliefs and their respective believers 15. Prevalence of risk behaviors among traditional believers 16. Proportion of people knows on the cause of HIV/AIDS 17. Proportion of people with misconceptions about HIV/AIDS 18. Attitude of people towards PLWA 19. Proportion of PLWA who face discrimination
Partners	Faith based institutions, donors, policy makers, NGOs, PLWHA +their associations, NACS, RACS, Health professionals & institutions, community organizations, traditional believers

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