“Pinch, Leave an Inch and Roll”: Applying the Communication-for-Behavioural-Impact (COMBI) Approach to the Promotion of Proper Male Condom Use in Jamaica

IntroductionTHE PROMOTION OF CONSISTENT CONDOM use has been a longstanding strategy in the response to the HIV and AIDS epidemic. The generic "use a condom every time" message has been featured in many health communication campaigns promulgating consistent condom use. This article recounts the experience of the "Pinch, Leave an Inch and Roll" campaign which focused on the specific steps of putting on a male condom properly, and targeted males aged fifteen to twenty-four years. The campaign was planned during 2008 and implemented during 2009-2010 by the National HIV/STI Programme of Jamaica as one strategic communication activity within their overall behaviour change communication which includes a mix of mediated and interpersonal communication-based interventions. Communication for Behavioural Impact (COMBI), a multifaceted approach to communication planning, is used as the framework for understanding the process of creating the "Pinch, Leave an Inch and Roll" campaign. It must be noted that while the COMBI approach was not purposefully used in the entire planning process of the campaign, it is applied here post-implementation as a way to conduct a structured review of what occurred during the evaluation, design, and execution stages. Of the National HIV/ STI Programme's many campaigns, "Pinch, Leave an Inch and Roll" was chosen as a good example of communication in action because summative evaluation indicated that it had a relatively high message recall one year after its implementation.1 The campaign also employed many of the tenets of development communication campaign planning.2Background to the National HIV/STI Programme and its condom promotion activitiesThe National HIV/STI Programme of Jamaica was established in 1986 by the Ministry of Health as an extension of the former Sexually Transmitted Disease Control Programme, which was in existence from 1930. The National HIV/STI Programme is responsible for coordinating and leading the implementation of Jamaica's response to HIV and AIDS. In order to fulfil this mandate, the National HIV/STI Programme focuses on four main components: prevention; treatment, care and support; enabling environment and human rights; and monitoring and evaluation.3Within the HIV-prevention component of the National HIV/STI Programme, behaviour-change communication interventions promoting safer sexual behaviour are created to control the transmission of HIV and AIDS among the wider population and, in particular, among the most at-risk populations which include sex workers, men who have sex with men, people living with HIV, out-of-school youth, homeless drug users, and inmates. The prevention efforts aimed at changing risky sexual activities and sustaining safer sexual practices use a multisectoral approach. The HIV prevention team within the Ministry of Health collaborates closely with other agencies offering services that are useful to the various targeted populations. In order to ensure that individuals possess the self-efficacy to adopt and maintain relevant behaviours, the HIV prevention team utilises a number of strategies, including community outreach activities and special events which usually include free HIV testing, and distribution of free condoms coupled with condom use demonstrations undertaken by the client and guided by the intervention officer. These are supported by national media campaigns which not only provide information but also encourage the practice of appropriate safer-sex behaviours such as consistent condom use.Other strategies of the National HIV/STI Programme's HIV prevention component include the use of cultural vehicles such as television shows and party interventions. Through sponsoring of various television and party events, the programme is able to position its efforts in locations which are likely to increase the visibility of key messages and allow for the conduct of condom use demonstrations. In 2009, for example, the National HIV/STI Programme sponsored Magnum Kings and Queens of the Dancehall, the popular Jamaican dancehall competition aired weekly on the television station TVJ. …