USAID Responds to HIV/AIDS

In the mid-1980s, USAID undertook two large scale projects called the AIDS Public Health Communication Project (AIDSCOM) and the AIDS Technical Support (AIDSTECH) Project. Through the AIDSCOM Project, which ran from 1988 to 1992, the Agency for Educational Development (AED) and its partners were involved in “targeted and strategic national campaigns for behavior change” (Demus and Jimmerson, 1993). From the beginning AIDSCOM was involved in promoting all of the behaviors leading to prevention of sexual transmission of HIV.

AIDSCOM used an Applied Behavior Change (ABC) Framework, which integrated behavioral and social psychology, social marketing and communication (Day and Smith, ND; Helquist and MacDonald, 1993) to guide its early work in countries such as the Philippines, the Eastern Caribbean, Jamaica, the Dominican Republic and Ghana. These behavior change communication campaigns conducted from 1989 to 1992 focused on abstinence, fidelity and condom use either separately or in groups of two, but did not draw on all three to create a comprehensive approach. For example, a “virgins campaign” in the Philippines in 1992 increased young men’s and women’s belief that waiting until marriage for sex is okay and that abstaining from sex is smart; the campaign also increased sexually active males’ intentions to use condoms. A media campaign in Ghana from 1991 to 1992 led to significant changes in attitudes among young adults to be concerned about AIDS, and increased acceptance of having only one partner and about condom use (Debus and Jimmerson, 1993: 167).

A campaign in the Dominican Republic called on people to be faithful to their partners and if they strayed, to use condoms. In Uganda, AIDSCOM supported the development of the film, “It’s Not Easy,” as part of a workplace-based program strategy to help people discuss sexual behaviors, dispel myths and misinformation about HIV/AIDS, promote acceptance of people living with HIV/AIDS, and encourage safer sexual behavior (Lather-Parker, 1993). Demus and Jimmerson (1993: 156) wrote that “Many countries have launched effective, targeted communications campaigns that have played a powerful role in reassuring young people that it’s right to wait to have sex, in helping people view condoms as an acceptable or even appealing part of sexual relationships, in calming irrational fears of HIV and AIDS, or in lessening discrimination against people living with AIDS.”

Julia Rosenbaum, Field Implementation Coordinator for AED’s Hygiene Improvement Project, worked as Regional Resident Advisor on the AIDSCOM Project from 1992–1993 and recounts, “I remember the CAREC [Caribbean Epidemiology Centre] resource library was chock full of print material from all over the Caribbean promoting abstinence, fidelity and condom use. Those materials were general, slogan-type materials that included multiple prevention messages. The adolescent campaigns had a strong abstinence and ‘lifestyle’ focus. We also worked with various country programs to develop more targeted materials, linking either abstinence or fidelity with condom use” (Rosenbaum, 2004). Anton Schneider, currently Behavior Change Communication (BCC) advisor for AED’s T-Mark Project in Tanzania, related a story about working in the Caribbean in the early 1990s when he was a Senior Research Associate with Porter Novelli International. AIDSCOM wanted to sponsor a band for the Carnival celebration in St. Lucia. Working with the Catholic Church, the project had three bands­—one for abstinence, one for be faithful and one for condoms. The patois word for condom was “cock-a-lock-socks” (a rooster with socks), so the t-shirts for the other two bands were two chickens hugging (“You’re the one for me”) and two chicks (“I’m not ready for that yet”) (Schneider, 2004). Such a compromise represents the context from which an integrated ABC approach emerged.

Complementary to AIDSCOM’s work in the general population was USAID’s AIDSTECH project, implemented by FHI, which operated from 1987 to 1992. The AIDSTECH mandate was to identify and work with high-risk populations, promote and ensure access to condoms, control STDs, and to prevent HIV transmission through transfused blood (FHI, 2003a). Because the project addressed high-risk groups, such as sex workers and long-distance truck drivers, FHI’s work focused on partner reduction and condom use.

In 1992, USAID merged the AIDSCOM and AIDSTECH projects into the AIDSCAP Project. AIDSCAP’s mission was to develop comprehensive country approaches to minimize high risk behavior, improve control of STDs and increase access to and use of condoms. AIDSCAP recognized that “determinants of high-risk behavior include individual and psychosocial factors as well as interpersonal and environmental causes” (FHI, 2003b). In consideration of the unique needs of women related to HIV, AIDSCAP also included a special initiative on women and AIDS.

A project from Nepal illustrates AIDSCOM’s work linking partner reduction and condom use in a high-risk population of truck drivers. Dhaaley Dai was a condom character used to present messages to truck drivers, their assistants and sex partners along the main transport routes in Nepal’s Terai region. “The popularity of Dhaaley Dai was matched only by that of Guruji and Antare, the title characters in AIDSCAP’s film about the adventures of a truck driver and his hapless assistant. Like the condom character, the film uses humor to convey a serious message: Condoms are strong, durable and the only way to protect yourself from HIV/AIDS and other STDs if you cannot remain faithful to one partner” (FHI, 1997: 10 on web-based version).

The early literature about HIV/AIDS includes references to abstinence, fidelity and condom use, but “ABC” does not emerge in the international literature until 1992—from a country in Asia. Thereafter, the term was quickly picked up and used in other places.