1. Behavioural Monitoring for an All of Society Approach to HIV / AIDS Risk Reduction in Mozambique Prof. Andrew E. Collins Department of Geography / Disaster and Development Network (DDN) Northumbria University andrew.collins@northumbria.ac.uk Dealing with Disasters Conference 17 th – 18 th September

2. Purpose of this presentation Explore an example of a whole of society approach to health disaster risk reduction Progress an avenue of disaster and development thinking for health and wellbeing based on one specific disease Solicit new knowledge to better live with uncertainty in health disasters 2

3. Overview 1.HIV/AIDS from a HCDRR perspective 2.Findings from Behavioural Monitoring in Mozambique 3.Conclusions: whole of society infectious disease risk management 3

4. HCDRR and HIV / AIDS magnitude slow onset and persistent a particular infectious disease with constructed interpretations 4

5. Nature of HIV/AIDS from a HCDRR Perspective persistent pandemic - undergone substantive investment – interpretation and reinterpretation of societal causes and risk factors - knowledge and behaviour contradictions – complex Opportunity – address the underlying risk factors – awareness – address uneven development – rights and responsibilities – health centred risk reduction – restore hope – address constructivist influences Review the right intervention at the right place, at the right time and with the right people 5

6. Understanding HIV / AIDS to inform HCDRR: particularity and proxy Risk: disease hazard, vulnerability (immunity) and capacity. Risk = Hazard x Vulnerability Capacity Health ecology: Disease ecology and health ecology; HIV1 and 2 – susceptibility – personal, institutional, cultural and political economic aspects – uncertainty including problem of detection Health security, resilience and wellbeing: Build up to offset – live with it in a health centred way – what is it really to prevent and to respond? 6

7. Behavioural Monitoring for HIV / AIDS risk reduction in Mozambique Context, sample and reasons: Opportunity with Family Health International (FHI) ‘Corridors Project’ – based on rational of corridors of risk (high risk places and people – exposure and vulnerability) – transmission, behaviour Long-distance truck drivers; female sex workers, out of school youth, vulnerable women in market places and at home Impact? How to deal with persistent HIV / AIDS? Prevention, ART drugs … and what else? 7

8. Sample Target PopulationsTotal Long Distance Truck Drivers (LDTD) 272 Out of School Youth (OSY) Male Female 1,318 456 Female Sex Workers (FSW)610 Women in Households622 Women in Market Places665 Total3,943 8 Local Interviewers Rigorous Ethical Screening

9. Behavioural Monitoring Survey Topics Sexual history: number and types of partners Commercial sex partners Non-commercial sex partners HIV/AIDS Knowledge, opinions and attitudes Stigma and discrimination Gender based violence Alcohol and drug abuse Exposure to HIV/AIDS projects 9

10. 10 Education levels by target group N= 3,943

11. Percentage of LDTD who had sex with commercial and non- commercial partners during the previous three months 11

12. Percentage of respondents who used a condom at last sex by group and type of partner 12

13. Percentage of FSW by area and number of commercial and non- commercial partners 13 N = 610

14. 14 Percentage of Female Sex Workers with zero, one or more partners – all areas N = 610

15. Some findings Knowledge, communication, information, capacity is not enough Rights and responsibilities in decision making includes interplay of; – Forced risk taking – Voluntary risk taking Risk of wide transmission is pervasive due to small number of outliers – from early transmission factors to persistence factors to new factors – ‘risky behaviour and cultures of risk’ 15

16. Some findings Misunderstanding about where the risk is and solutions there are: – E.g. LDTD cautious vs. lack of caution in society as a whole – Changing challenge to prevention i.e. condom use – if everyday life = no reproduction – FSW and normal life – where next Balance on addressing hazards between extremes and everyday life – Complex behavioural risk management plan – We know from other HCDRR work (IDRM) that it is about being in the right place at the right time with adequate forms of protection. Process of achieving this is key rather than universal solution grabbing. This in itself suggests new ways of thinking in disaster risk reduction. i.e. Show Learning Model. 16

17. Proximate and secondary systems of meaning Intuitive and experiential learning Development representations and outcomes Change Environment: - Power - Technology - Behaviour Disaster representations and outcomes Learning in Disaster and Development Outcomes Collins, A.E. (2015) ‘Beyond experiential learning in disaster and development communication’ in: Egner, H., Schorch, M. and Voss, M. (Eds.) Learning and Calamities: Practices, Interpretations, Patterns, London: Routledge, pp.56-76.

18. Summary: The Case of HIV/AIDS Infectious Disease Risk Management in HCDRR Shift: A whole of society approach rather than vulnerable groups and ‘ignorant’ people. Living with long-term underlying burden. Shift: An understanding of grounded everyday adaptability to risk and reactions to risk rather than uniplanar thinking in disease management. Shift: HCDRR embeds principle of building wellbeing to offset harm. Working with aspiration and motivation rather than coping and resilience. Improved culture of Prevention. 18