1. Strategic Communication Framework for Hormonal Contraceptive Methods and Potential HIV-Related Risks
G. Arzum Ciloglu, MPH, DrPH
February 2, 2017

2. Why are we talking about a Strategic Communication Framework?
A tool to help countries communicate any changes in MEC to multiple audiences
Women, health providers and other stakeholders have a need for correct and adequate information regarding potential increased risks
The Adaptable Strategic Communication Framework (ASCF) was developed for this purpose
Each country can adapt ASCF to develop strategy to fit its’ own circumstances after decision on how to interpret any changes in MEC

3. Background: Communication Challenges and Solutions
Women’s groups urged WHO to develop guidance to help women and providers understand potential risk of HIV acquisition for informed decision making
WHO convened 2 consultations to grapple with issues:
Protecting women’s right to have children
Balancing risks to protect health
Protecting women’s right to informed FP choice
Reducing maternal & infant morbidity and mortality
WHO & USAID asked HC3 to develop adaptable strategic communication framework

4. Why do we need communication on HC and HIV?
Evidence is not straightforward
Need for messages to be correct, consistent and tailored for specific audiences
Ensure proper allocation of available resources among materials and activities
Establish targets and milestones for
monitoring and evaluation
Commmunication strategies also address:
Who are the potential audiences?
What are the key messages?
At what level should the information be aimed?
How much detail is needed? How simple or complex should the messages be?

5. What is a communication strategy?
is a tool for guiding the development of all communication products and activities for a given project.
provides everyone with guidance on what is to be achieved and how to go about getting there through…
a complementary set of mutually reinforcing products and activities harmonized towards a shared vision of change

6. Purpose of Strategic Communication Framework
Guide local efforts to communicate risks and benefits of hormonal contraceptives
Provide “roadmap” for country adaptation with key audiences, suggested messages & activities/channels
Not “one size fits all” model--a foundation to be adapted and expanded upon by countries to create national/ subnational communication strategies tailored to the local context
Ensures communication activities and outputs are coordinated to achieve agreed-upon goals and objectives.
Implementers use communication strategies as the basis for their behavior change program design, which eventually results in the development of activities, including mass media programming, community-level activities, interpersonal communication and counseling and other strategic approaches.
The communication strategy is not a static product. It must be responsive to an ever-changing environment. Adaptations may be necessary in order to respond to new research findings and data, unexpected events, changing priorities, or unforeseen results.

7. Step by Step Process to Guide Country-level Adaptation
Parts of a Communication Strategy
Situational Analysis
Audience Segmentation
Strategic Design
Audience Profile
Communication objectives
Positioning
Key messages
Strategic approaches and activities
Monitoring and evaluation

8. Audiences Included Primary Audience Segments
Sexually active women of unknown status or who are HIV-negative using or considering using progestogen-only injectables.
Rationale: Women need all available information about the potential risks of HIV acquisition associated with progestogen- only injectables, even if the evidence is not yet conclusive.
Sexually active women living with HIV, including those on ART, using or considering using hormonal conception.
Rationale: HIV-infected women need all available information about various methods of hormonal contraception and how these do or do not influence the risk of HIV transmission to men, HIV disease progression, and potential drug interactions
with ART.
Health system managers (MOH unit heads, health facility directors, district health leaders, etc.)
Rationale: This group is responsible for ensuring national guidelines and communication interventions are implemented at the facility and community levels.
Clinical service providers (public and private)
Rationale: This audience segment provides direct counseling, family planning, and HIV services to women and their
partners. Providers often influence women’s contraceptive options and choices. They need to understand the WHO medical eligibility criteria for contraceptive use and be able to communicate this information to their clients.
Non-clinical service providers (community health workers, etc.)
Rationale: Community outreach workers orient couples, families, and communities on health behaviors, and provide family planning methods and/or refer clients to family planning and HIV services

9. Audiences, continued Influencing Audiences
Male partners of women of reproductive age
Rationale: Men play a key decision-making role in couple communication for family planning, condom use, child spacing, HIV prevention, treatment and sexual risk behavior. Also, HIV-negative male partners in sero-discordant couples may be at risk for HIV acquiring HIV from their female partner, while HIV-positive male partners in sero-discordant couples may be at risk of transmitting HIV to their female partner.
Civil society stakeholders in HIV, family planning and women’s health, and empowerment programs (NGOs, CBOs, etc.)
Rationale: Activists and interest groups function as watchdogs in many societies for women’s rights in health and play a
critical role in advocacy.
Media/journalists
Rationale: Journalists may convey facts about emerging data to policy makers, civil society stakeholders, community
leaders as well as citizens through popular news formats such as radio and TV programs. They have the potential to
communicate and/or miscommunicate information about the relationships between different methods of HC and various
HIV-related risks, including the potential risk of HIV associated with progestogen-only injectable contraception.

10. Malawi Total Population (2015 estimate): 17million
HIV prevalence 10.6%
Contraceptive Prevalence 42%
Unmet Need for FP 26%
Use of hormonal injectable is 32.2%
Two country adaptations of tool: Malawi and Swaziland
Worth noting is the fact that Malawis’ population is generally young, and over fifty percent are women.

11. Malawi Adaptation Process
Preliminary Discussions
Adaptation Workshop January 2015
Scrutiny by Technical Working Groups
Approval by MOH (pending)
Stakeholders met in January 2015 to adapt the Strategic Communication Framework.
Participants included:
Three key departments of the Ministry of Health led the process
National AIDS Commission
Civil Society such MANET +, NAPHAM
WHO
USAID
PSI, BLM
The draft has been presented to relevant committees
FP and Safe-motherhood Subcommittees,
HIV Prevention Technical Working Group
Health Promotion Technical Working Group
Yet to be presented before the SRHR TWG

12. Materials Development
Brochures and leaflets for women
An addenda to 3 flipcharts: FP, CHW, ART
FAQ guide for providers as reference material

13. Swaziland Context HIV prevalence: 26% Contraceptive prevalence: 66.1%
38% in women
23% in men
Contraceptive prevalence: %
Injectables most common: %
Unmet need for contraceptives: 15.2%

14. Adaptation Consultative Meeting
Adaptation Meeting March 2015
Discussion arising:
With evidence still inconclusive; would it be more detrimental than helpful to release this information to the general public?
Concern about potential drop in contraceptive use (especially injections) as a result
Important to balance risk with benefits of contraceptive use
Concern that men may begin to blame women for transmitting HIV as they are use hormonal contraception
Decision to focus on dual protection rather than focus on inconclusive evidence about potential increased risk of HIV acquistion

15. Materials Produced Updates to National FP Guidelines
Updates to FP Training Manual for providers
Adapted materials from South Africa ZAZI campaign on dual protection
Brochure
Poster
Outcomes:
Encourage dual protection rather than distribute info on inconclusive studies
Important to strengthen FP counseling
Materials produced should stress importance of dual protection
Still important for providers to understand risks around some hormonal contraception
Information should be provided in trainings and guidelines for providers

16. Swaziland Materials

17. Program Implications
Communication should be accessible and tailored to country context
Various audiences need information regarding the potential risks 
FP information and counseling tools must be updated
It is a woman’s right to access a wide range of contraceptive tools
Public health importance of hormonal contraception and HIV prevention

18. The Way Forward If MEC guidance is changed:
ASCF will be revised and made available online for adaptation
HC3 Project ends September 2017
Potentially available for very limited virtual technical assistance before then
Swaziland and Malawi materials are available for adaptation on request

19. Resources