The lives and livelihoods of Caribbean people are seriously threatened by HIV and AIDS. In the whole world, only sub-Saharan Africa has a higher proportion of people with HIV. AIDS is the leading cause of death for Caribbean young adults and people below the age of 44 - the most productive age group in any working population.

The region loses more than 6 per cent of its gross domestic product in direct medical costs and indirect loss of productivity. In addition, HIV infections cause expensive social disruption, drastic shake-ups in relationships and the breakdown of familial networks. Major psychological costs are added by social stigma, discrimination and isolation.

unsafe sexual behaviour

In the Caribbean, the main reason for HIV transmission is unsafe sexual behaviour. Campaigns to reduce HIV transmission have concentrated on spreading information and educating people - aiming to change dangerous sexual behaviours. However, people working in HIV prevention are beginning to feel frustration. Their hard work has been much less successful than was expected. While many people have been getting the messages intended to influence behaviour change, the increased knowledge does not seem to lead to sustainable changes in sexual behaviour. The failure of this approach to have the anticipated effects means that there is a serious need for thorough analysis of policies, a review of the models guiding the region and a rigorous documentation of prevention successes and failures.

blind spots

Senior lecturer at the Caribbean Institute of Media and Communication, Dr Marjan deBruin, has been investigating the reasons for the slow progress in changing behaviour by means of specialised communication. She analysed the Caribbean Regional Strategic Plan and examined more than 15 national policies to identify possible blind spots.

Dr deBruin determined that most of the policies speak about the complexity of HIV and AIDS, but tend to overlook the potential of 'strategic communication'. Communication in the policies is simply equated with the delivery of mass media public service announcements.

little critical reflection

The policies display little critical reflection on the more complicated processes such as 'increasing awareness' which in most of these policies is simply seen as providing people with information. The assumption is that increasing knowledge will lead to behaviour changes, even when these changes relate to complex experiences such as sexual behaviour. There seems to be little awareness that sexual behaviour is embedded in and affected by a matrix of social factors, not all of which are easily discernible. Her findings have been shared with regional policy-makers and small changes in the design of the new Regional Strategic Framework are beginning to occur.

The second part of her research, now in progress, focuses on Caribbean prevention practices where most of the models used as guidelines have been based on very different cultural economic realities. They are not usually adequate or appropriate for Caribbean emulation. Current practices have often remained undocumented, leaving the 'local knowledge' unknown and lessons learned, unshared. The results of this part of her research suggest new building blocks for theories and models relevant to the region and better adapted to Caribbean reality.