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Health Promotion and HIV

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Policies and strategies to promote social equity in health, Institute of Future ... has often led to an individualist and rationalistic view of behaviour change. ... – PowerPoint PPT presentation

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Title: Health Promotion and HIV


1
Health Promotion and HIV
  • Dr Graham Brown

WA Centre for Health Promotion Research
2
Health Promotion
Dahlgren, G and Whitehead, M. 1991. Policies and
strategies to promote social equity in health,
Institute of Future Studies,.Stockholm
3
Organis - ational and systemic change
Community and social influence
Gay status non specific
HIV / HepC known
heterosexual men and women
Individual and group focused
4
Organis -ational and systemic change
Marketing information to promote health
Community and social influence
Individual and group focused
Heterosexual men and women
Gay status non specific
HIV known
5
Challenge of behaviour theory and risk practice
6
Use of theory for multi level interventions
Examples of strategies
Ecological level
Useful theories / models
Change strategies
Change the environment
Change peoples behaviour
Adapted from Theory at a glance-National
Institutes for Health, USA
7
Meanings of risk in HIV and health promotion
  • Inaccurate and blunt use of models has often led
    to an individualist and rationalistic view of
    behaviour change.
  • This has been damaging to the HIV and HepC
    response
  • Most behaviour that places people at risk is not
    people setting out to take a risk.

8
Risk Behaviour vs Practice
  • People act with reference to meaning.
  • For example..
  • They do not engage in sexual behaviours eg
    penis-in-anus,
  • they enact sexual practices they make love or
    have a one-night-stand or get their rocks
    off.

9
Risk Behaviour vs Practice
  • Sexual behaviour or injecting behaviour may be
    reasonably similar across time and place.
  • Sexual or injecting practice is more fluid it
    takes on a number of forms.
  • social and cultural - produced within a
    particular time and place.
  • different in Australia from European or Asian
    contexts.
  • it was different before HIV or HepC compared to
    now

10
Risk Behaviour vs Practice
  • Risk behaviour is modifiable and is open to
    intervention.
  • But we modify it by engaging with practices

11
Risk Behaviour vs Practice
  • We may be looking at reported sexual behaviour or
    injecting behaviour as a measurable outcome but
    it is the broader practices that we try and
    engage / influence.
  • Requires a broad integrated approach that
    understands and engages with the social /
    cultural meaning
  • This is why active and genuine community
    participation is so critical

12
Role and need for genuine participation
13
Community development and organisation in health
promotion
  • HIV brought a revolution in the way affected
    communities participated at all levels of public
    health initiatives
  • Built on a range of human rights, gender rights
    and social justice movements in the 60s and 70s.

14
The Jakarta Declaration 1997
  • Re-affirmed Ottawa Charter
  • Equity
  • Partnerships
  • Settings
  • Sustainability
  • Participation

15
The Jakarta Declaration 1997
  • Participation is essential to sustaining efforts.
  • People have to be at the centre of health
    promotion action and decision-making processes
    for them to be effective.
  • The challenge for the coming years will be to
    unlock the potential for health promotion
    inherent in local communities and society.
  • Capacity building and partnerships for
    participation

16
Greater Involvement of PLWHA (GIPA)
  • In 1983, The Denver Principles
  • a national AIDS conference was held in Denver,
    USA. Positive activists announced a set of
    principles that would revolutionise the way the
    world responds to an epidemic.
  • standards for human rights and self-empowerment
    in a health crisis.
  • 1994 Paris AIDS Summit Declaration
  • Central role of people living with HIV in AIDS
    education and care, and in the design and
    implementation of policies and programs towards a
    successful response to HIV/AIDS
  • Developed and debated further at a range of
    international forums and events.
  • 1999 - From Principle to Practice Greater
    Involvement of People Living with or Affected by
    HIV/AIDS (GIPA)

17
1st Australian HIV/AIDS Strategy
  • Firmly based within principle of the Ottawa
    Charter
  • Some have argued this has been watered down to
    some extent in subsequent strategies
  • Participation and community ownership in
    particular

18
Community participation
  • The process of enabling individuals and
    communities, in partnership with health
    professionals, to participate in defining their
    health problems and shaping solutions to those
    problems.
  • (Rifkin et al., Wallerstein, Minkler, Roberstson
    and Minkler, in Shediac-Rizkallah and Bone, 1998)
  • It provides the opportunity for ownership,
    empowerment and self-determination those
    difficult-to-measure intangibles that can make
    the difference between long-term success and
    failure
  • (Green and Kreuter 2005)

19
Community organising and community development
  • Community Development facilitate, encourage and
    sustain a level of community action. Decision
    making control is invested in the community, and
    is driven from a ground up approach.
  • Community Organising has a more centralised, set
    agenda approach, where the community is involved
    in an already set health objective.

20
A continuum of community participation
Rothmans model
Lower level of participation
Higher level of participation
Participation levels can vary throughout the
stages of program planning, implementation and
evaluation
COMMUNITY ORGANISATION
COMMUNITY DEVELOPMENT
top down approach
bottom up approach
21
Organising vs development
  • Community Organising (Social Planning)
  • attempts to solve community problems within
    existing power structures
  • assumes that complex community change must be
    guided by trained planners
  • tends to be task-orientated and expert-driven
  • traditionally delivered by govt and non govt
    agencies for the benefit of the community

22
Organising vs development
  • Community Development (Locality Development)
  • community change is pursued through participation
    of a wide range of people in determining their
    own local goals and action
  • health promotion practitioner is more of a
    facilitator, aiming to empower community members
    (Egger et al, 1999)

23
Organising vs development
  • It is important to achieve the right balance
    between the two, less initiatives become
    irrelevant to the lives of the communities they
    are for.
  • As the program is implemented, there is good
    potential for a change in emphasis and approach

24
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25
Overall comments
  • Clear need for
  • effective evaluation and development with genuine
    participation
  • sharing of evaluation at the project and
    programmatic level across jurisdictions
  • Evidence informed practice and practice informed
    evidence

26
Overall comments
  • Community response to HIV has played a major role
    in the development of Health Promotion and New
    Public Health.
  • Demonstration that an integrated, participatory,
    pragmatic and community driven response does
    work, and works better.
  • Sustaining this is critical to the improved
    health of PLWHA, PLWHepC and reduction of
    transmission.
  • Also relevant to broader communities of health
    and development, who often look to HIV to provide
    leadership
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