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HIV and AIDS remain one of the leading public health challenges in the world, with young women in sub-Saharan Africa bearing the brunt of HIV infection. Female vulnerability to HIV infection is exacerbated by socio-cultural, economic and biological dynamics. Vaginal microbicide, one of the first topical pre-exposure prophylaxis (PrEP) innovations for HIV prevention can offer new hope for women, but an understanding of the local cultural context and its influence on product acceptability is fundamental for effective HIV communication strategies. Critical health communication navigates through the complexities of cultural discourses to create awareness among women in dominant cultural settings. As a means of understanding the key determinants for effective HIV communication, this paper used thematic analysis of data from a study among female students at the University of KwaZulu-Natal regarding their preferences and the acceptability of two microbicide technologies: the tenofovir gel and the dapivirine ring. Keyfindings indicate that microbicides give women more options for self-protection and cater for diverse sexual encounters, and that their covert use empowers women to use the products even if male partners do not support this. However, women felt more empowered with “male-supported, female-initiated” HIV prevention options. The study suggests that in providing HIV preventionoptions to women, culturally appropriate messages must be considered. We suggested that topical PrEP must be communicated as a “male-supported, female-initiated” HIV prevention option in rural KwaZulu-Natal contexts.

Oral PrEP promotion is a key aspect of combination prevention efforts to increase opportunities for HIV prevention among adolescent girls and young women (AGYW) who are at higher risk of infection. Research suggests that communication efforts often adopt an individualistic decision-making approach that is devoid of the multiple influences that impact young women’s HIV preventative choices. Schools and educators are increasingly being identified as key role players and influencers of decision making among young women. The promotion of PrEP uptake among AGYW of school going age, thus requires an exploration of perceptions of educators about the related benefits and barriers to PrEP uptake among school girls. A qualitative study using a purposive sampling method was used to sample 6 high schools in Vulindlela, a district with the highest HIV incidents among AGYW in KwaZulu-Natal. Semi-structured interviews were conducted with a total of twelve Life Orientation educators and senior staff members from the 6 selected high schools. The data was transcribed and analysed thematically using the culture-centred approach. The findings suggested that educators acknowledged the benefits of PrEP in curbing HIV infection rates among young women. However, these benefits were clouded by barriers and concerns around minimal, or poor condom use as a result of oral PrEP use which could promote promiscuity and minimalise efficacy. These findings highlight the need for more contextual community-driven communication strategies around PrEP, and emphasise the value of a community-centred approach that promotes dialogue among key role players, like educators, to further enhance PrEP communication.

The HIV response in the African continent over past decades demonstrates the potency that the words and actions of political leaders have in either expediting or impeding the implementation and adoption of preventive measures at the individual and community levels. The article explores the health communication approaches employed by two South African past presidents (Thabo Mbeki and Jacob Zuma) in responding to the HIV epidemic, and contrasts these with the communicative approach of President Cyril Ramaphosa during the COVID-19 pandemic. Approached from this understanding, this article provides a comparative analysis of the communication approaches of these three presidencies across the two pandemics, and considers the variously trusted sources of top-down, government-driven and bottom-up, community-informed approaches to health communication. Critical lessons that emerged in South Africa during the HIV epidemic regarding the need to include communities in communicating about risks and behaviour change have not been adopted into the COVID-19 response. Political leaders are not best placed to communicate about these issues, and, in the context of pandemics, there is a clear need to reconsider top-down communication approaches that are designed without the participation of communities and ignore the interconnected nature of health and other social determinants of health.

In Sub-Saharan Africa, human immunodeficiency virus (HIV) incidence rates remain disproportionately high among adolescent girls and young women (AGYW), who are five to seven times more likely to co...

The demonstrated efficacy of pre-exposure prophylaxis (PrEP) has brought hope of controlling the epidemic among women with limited HIV preventation options. Several studies have demonstrated the importance of male partner involvement in female sexual and reproductive health but there is limited research on male involvement in the adoption of HIV prevention methods among women. Using a culture-centred approach, this article discusses perceptions of female-initiated HIV prevention methods among men and women. The data were collected using eight sex-specific focus group discussions with a sample of men and women aged between 18 and 49 years from selected urban and rural settings in two provinces of South Africa, KwaZulu-Natal and Mpumalanga. Thematic analysis was utilised to identify four key themes: increased infidelity in relationships and risky behaviour; association of PrEP with casual relationships; a partner's right to know that women are reducing their risk of HIV infection; and that men need to engage in decision-making on HIV risk reduction. The article highlights the importance of partner engagement and knowledge sharing of female-initiated prevention methods as part of a combination HIV-prevention strategy, and the urgency of creating enabling environments to utilise female-initiated methods.

The rampant spread of COVID-19 has created a catastrophic surge of pandemic pandemonium, with many countries unprepared and under-resourced to address this global public health crisis. At the onset of the pandemic, COVID-19 communication stringently adopted a public health strategy, but there remains an urgency to indigenise global health responses through the lens of glocal knowledge, cultural contexts, and challenges emanating from behavioural change complexities. Two trajectories account for the rise of health communication: the first sets health on the agenda of public health and health promotion, while the second contextualises health communication as a subdiscipline within the field of communication for development and social change. Health communication, embedded within the field of communication for development and social change, allows for a theorisation and critique of public health issues in a South African context through localised cultural contexts and draws impetus to community engagement. This chapter offers a reflective discussion of these theoretical perspectives in the context of the initial phases of the South Africa lockdown. This study adopts a communication for development and social change lens to discuss and critique the initial public health approach of physical distancing in communities during the initial phase of the South African lockdown and how it was localised at community levels. In many cases, deep rural communities have localised their COVID-19 responses, reconstructing and adapting the dominant health messages in marginalised settings, affirming the presence of a glocalised COVID-19 communicative response. This chapter argues that COVID-19 prevention strategies are likely to yield better health outcomes when community voices and dialogue are integrated as part of a comprehensive preventive approach for South African communities.

Examines the global communicative landscape during the early stages of the COVID-19 pandemic in a range of interdisciplinary contexts Engages with the complex media environment and how it intersects with the controversial political, sociocultural, and public health communication of COVID-19 Interrogates, challenges and critiques a wide range of global contexts while exploring the unique localised knowledge and communicative experiences of the COVID pandemic

Scholarly knowledge about the communication dimensions of the COVID-19 pandemic contributes to interdisciplinary lessons for future public health emergencies. This collection nurtures further thinking about the ‘messiness’ that comes with communication during an infectious disease outbreak such as COVID-19, and how we can embrace and learn from it. The chapter highlights the importance of communication preparedness and the urgency to make meaningful efforts to improve communication knowledge, especially during times when public health measures are highly reliant on communication, without which health messages remain unheard and unattended to. It further discusses the need for partnerships to address communication inequalities between health authorities and trusted community organisations; and the mobilisation of community-led organisations as key partners for the people most severely impacted by COVID-19. The chapter concludes by suggesting areas of future research to contribute to a nuanced understanding of the diverse pandemic experiences of specific sub-groups and populations with varying cultural and ethnic influences.

This chapter introduces the diverse communication dimensions of the COVID-19 pandemic that are analysed and discussed in this book, which brings together scholars from around the world. Their disciplinary insights illuminate a wide range of communication challenges and opportunities. The chapter articulates the book’s contribution to knowledge about the pandemic through the detailed analyses and perspectives of scholars from communication, public health, journalism, sociology, psychology, and political science. In introducing each of the chapters, we identify key findings and themes as they variously relate to the roles of journalists, governments, public health agencies, scientists, health professionals, and citizens in communicating and responding to the medical, scientific, social, cultural, political, and technological dimensions of this profoundly mediatised public health crisis.

The Centre for Communication, Media and Society (CCMS) at the University of KwaZulu-Natal (UKZN) in South Africa has contributed to the intellectual growth, pedagogy, and practical implementation of communication for social change over the past two decades. During this time our approach has evolved considerably. These transitions speak to both the structural and political situations in a transforming South Africa, as well as the personal and theoretical interests of the Centre’s staff. An indication of these shifts is visible through the changing names of our graduate modules. The chapter reflects some of the ways in which the established development communication paradigms framed the CCMS pedagogy, discourses and fieldwork over the past twenty years. It tracks and problematizes the way in which the modules have transitioned from Media, Democracy and Development (MDD) (2002) to Communication for Participatory Development (2019). Our changing interpretations of this field has informed three key CCMS research tracks: health communication and social change; rethinking indigeneity; and community media. These tracks also inform and structure the approach to, and content of, Masters, PhD and staff research and community engagement. In rethinking the power of development and the impact of community engagement, we reflect on CCMS’s development communication operationalization through partnerships with NGOs, indigenous communities and civil society organizations.

The release of World Health Organisation guidelines recommending the prophylactic use of daily Truvada® for all populations at high risk of acquiring HIV opens the way for implementation of oral pre-exposure prophylaxis (PrEP). The impact of new prevention technologies is, however, dependent on demand creation strategies such as user awareness, acceptability and access, which in turn are influenced by sociocultural and gender norms. This study was conducted in three locations in KwaZulu-Natal, urban, rural and peri-urban, with six participatory workshops. Knowledge, desirable features of a product and demand positioning for PrEP were assessed using a participatory action media research process which included art-based activities and group discussion using a semi-structured interview schedule. The data were analysed using thematic analysis. The key themes that emerged in relation to product adoption were: ability to maintain secrecy of product use; the need for agency with personal choices around H...

Despite significant advances to the HIV epidemic, prevention remains a challenge globally. Adolescent girls and young women in southern and Eastern Africa are still at high risk of acquiring HIV infection with limited prevention options. The expanding product pipeline of novel drugs and delivery approaches has highlighted the importance of acceptability and uptake of these anti-retroviral based products to realize their full prevention potential. Community engagement is now imperative to inform both product development and uptake; with research directed to understand what potential users are willing to use given the broader cultural-gender context in which HIV prevention product choices are made/negotiated. We conducted ten gender specific discussion groups with 112 participants in three of the eight highest HIV prevalence districts in urban, peri-urban, and rural KwaZulu-Natal. The participants where purposively selected according to age, location and sex. The data was analysed thematically in terms of the key enablers and barriers of accepting three key HIV dosing strategies; the oral pill, the vaginal ring and the injectable among men and women. The study found that women are willing to consider HIV prevention options that align with their current sexual and reproductive health routines, offers the longest duration of protection, and requires minimal/no partner involvement, in contrast most men were not supportive of their partners using of any form of PrEP, irrespective of dosing strategies and formulations as it raised questions of infidelity and side effects on men. The findings is indicative of the complexities of women's product choices, which are often embedded in a system of personal preference on an intrapersonal level, but also of male dominance, gender norms and cultural contexts at an interpersonal level. Understanding this intrapersonal-interpersonal interplay can enhance PrEP messaging and promotion; further highlighting the need to expand biomedical innovations for women initiated technologies.

Within development communication, gaps remain in theory and practice: communication innovations are taking place which either do not incorporate theory or fail to challenge the assumptions of development communication and HIV/AIDS theory. This can lead to the implementation of unsuccessful interventions that lack theoretical frameworks or to uninformed practice, making it difficult to replicate. Further, research has demonstrated that entertainment education (EE) interventions have a measurable impact on behaviour in areas such as HIV/AIDS prevention. Given the transitions in EE practice and evidence of its impact, EE theory and practice can contribute insight into these challenges. A pilot study investigated these dilemmas within the context of the monitoring and evaluation of development communication. Framing this discussion is the concept of south–north dialogue, using comparative analysis of EE interventions to distil lessons through contrasting experiences in two diverse settings. It holds ...

Young women bear a disproportionately high burden of HIV infection in sub-Saharan Africa, prioritising pre-exposure prophylaxis (PrEP) can be an integral part of HIV prevention combination strategies. Women initiated HIV prevention technology options will require consistent adherence, an imperative for product effectiveness. With several PrEP clinical trials underway; exploring women's acceptability to advances in HIV prevention technologies can better facilitate demand creation for future PrEP roll out. This study utilised the opportunity of post-trial access to CAPRISA 008 women (trial) and non-trial women from three geo-spatial settings (urban, rural and peri-urban) to identify microbicide acceptability and how product associations of microbicides can influence future HIV prevention choices. Six participatory workshops using participatory action research with art-based activities and discussion groups were conducted in KwaZulu-Natal with 104 women from various geo-spatial locations and social status to understand microbicide acceptability and product associations. The data were analysed using thematic analysis. The study found that women's acceptability and product association of the tenofovir gel microbicide differed according to rural and urban areas. Most urban women identified confidence, sexiness and classiness as key associations that will encourage microbicide acceptability and use, while rural women identified respect, responsibility and confidence as the key product associations, with increased focus on the individual and collective family/community benefits of product acceptance and use. Urban-rural differences suggest a market segmentation that is contextualised to be locally responsive to promote HIV prevention technologies. Various sexual encounters further determined the types of HIV prevention technologies women would consider. In line with WHO's recommendation that PrEP should be an additional prevention choice for people at risk of HIV, this study underscores the importance of user engagement, understanding product associations and how this can influence product acceptability and promotion of HIV prevention technologies.