**2. Adolescence risk for HIV/AIDS**

Adolescents are at high risk of STDs, including HIV/AIDS. Evidence shows that age between 15 and 24 years is the highly vulnerable one for the infection. About one third of HIV infection cases occur in this age group and most of them are women (CDC, 2008). The adolescents and youth are among the high risk groups, because of their propensity in indulging in risky sexual activities and drug abuse. Negative attitudes regarding prevention misconceptions of HIV/AIDS reflect a false perception of the disease among these vulnerable groups. Strong well organized actions to increase awareness and improve behaviors are imperative. This calls for a wide comprehensive information, education and communication strategies targeting the youngsters as early as possible.

### **3. Education against HIV/AIDS**

Since STDs, particularly HIV/AIDS, represent such a major health problem, more resources need to be devoted. There are several complementary ways in which STDs, including HIV/AIDS, can be controlled. Education of the public is an important control measure. The epidemic will not subside until most people around the world know how HIV is transmitted, understand how to prevent the spread of the infection and practice healthy safe behaviors (United Nations, 2002). The level of knowledge on STDs, including HIV/AIDS, and the attitudes of people are vital in preventing and eradicating the virus and disease (Binswanger, 2000). Hence, accurate and timely information, education and communication represent the best opportunity for changing life-styles and acting towards combating

However, it should be mentioned that most of the current health education programs are *Risk factor-oriented.* It aims at eliminating particular risk factors in order to prevent associated diseases. Its main advantage is the recognition that a single risk factor can be linked to more than one disease category. The connection between unsafe sex and the STDs represents an example. But the model's view of health is inadequate; educational interaction is limited; and experts dominate. On the other hand, the relatively new *Health-oriented health education* has a dual focus. Its aim is to enhance positive health as well as to prevent ill-health. The physical, mental, and social components of health are recognized. Thus, the positive focus enhances the educational validity by developing comprehensive programs of health education in key people and key settings. Multidisciplinary and intersectorial collaboration is facilitated. Obviously, the health-oriented approach should be the preferred model for planning health education programs, including those to prevent and control

Health education used to be seen as concerned mainly with personal health actions. It was perceived as a series of messages about healthy practices and the avoidance of risk behaviour. Though these kinds of health messages remain important today and should not be neglected, it is equally important to direct education towards collective action. Empowering people to take responsibility for collective health is a challenge that has to be met. Health promotion, on the other hand, is a broader term which covers all aspects of those activities that seek to improve the health status of individuals and communities. It starts out by considering the whole population in the context of their everyday lives, not

Health promotion had probably developed from health education. The latter is seen as a very important element in health promotion. It is one route to the improvement of people's health, encompassing all those activities which aim to provide health via learning of one kind or another. Therefore, health promotion can be regarded as health education 'plus'. Health promotion includes health education and other proactive aspects of health. Health promotion can be the umbrella term for three elements; health education, disease prevention and health protection. The three of them are essential elements in combating HIV/AIDS. The term health promotion is not synonymous with the term public health. Health promotion, however, constitutes a dynamic and interactive process based on personempowerment, whereas public health focuses on the crucial issue of health-engendering social structures. Health promotion can be considered as the new public health. It is defined by the World Health Organization (WHO, 1984) as the process of enabling people to increase control over and to improve their health. The concept of HIV/AIDS control and prevention represents a component of this enhanced collective health and health promotion. To demonstrate the shift from individual to collective and societal action to improve health,

Ewles and Simnett (1996) described five approaches to health promotion. These are:

3. Educational; to impart knowledge and act on well-informed decisions.

2. Behaviour change; to adopt healthy life-styles and change attitudes and behaviour.

1. Medical; to prevent or ameliorate ill-health, in order to achieve freedom from medically

4. Client centred; to enable people to make their own decisions and choices according to

selected individuals or groups. Its goal is to enhance collective health.

HIV/AIDS.

**3.3 Health promotion** 

defined disease.

their own value systems.

HIV/AIDS. These should cover a wide range of sexual and social attitudes and behaviors. Therefore, the best way to avoid HIV/AIDS is to change those attitudes and behaviors, including avoidance of unsafe sexual practices.

#### **3.1 Health education**

Health education can be regarded as the communication of knowledge and the provision of experiences to help individuals to develop attitudes and skills which will assist their adopting behaviors to improve and maintain health for themselves and their fellows. The preventive model of health education adopts behaviors which will prevent infections and/or diseases, such as HIV/AIDS, at all levels. However, the self-empowerment model seeks to facilitate choice, not merely by providing understanding, value clarification and practice in decision making, but by attempting to empower the individual. Empowerment is about increasing people's power to change or improve their health. It includes motivation which is the inner force that drives the individual to a certain action. The process of selfempowering people involves modifying the way people feel about themselves, through improving their self-awareness and self-esteem. It involves supporting and encouraging them to think critically about their own concerns and gain the skills and confidence to build up their own values and beliefs system and to make a responsible action upon them (Tannahill, 1990; Downie et al., 1996).

#### **3.2 Levels, approaches and categories of health education**

Primary level health education is the type of education that is utilized for the prevention and control of HIV/AIDS. Different from the secondary and tertiary levels, it is directed at healthy people and aims to help individuals or groups learn how to keep healthy and how to prevent the onset of infection, disease and disability. Health education for primary prevention encourages people to develop behavior conductive to good health, such as that prevents contracting HIV infection. Primary prevention should aim at educating individuals, groups and communities about the advantages of prevention, including behaviors of discriminate and safe sex. It has to be accepted, however, that there is no agreement on the principles of normal sexual behavior.

Primary prevention is the level at which health education is able to encompass its role and function, not only to influence individual behavior change but also to influence group and community action. These include environmental, economic and organizational alterations to protect and promote health. HIV/AIDS prevention and control represent an appropriate example. Several approaches may be utilized separately or in combination. The persuasion or directive approach is the deliberate attempt to influence the individual to do a certain action or to follow a certain practice. The informed decision-making approach is about giving people information, problem-solving and decision-making skills to make decisions, but leaving the actual choice to the individual.

Furthermore, health education can be conducted on the basis of three categories. *Diseaseoriented health education* is still utilized by several health education programs despite the improvements in the field. It has a negative focus, merely aiming at the prevention of specific diseases, with an emphasis on progress towards target rates of morbidity and mortality. Major preventable diseases, such as AIDS, are dealt with by specific preventive programs aimed at reducing relevant 'risk factors'. This orientation of health education works on single topics in isolation from one another, with an incomplete view of health.

HIV/AIDS. These should cover a wide range of sexual and social attitudes and behaviors. Therefore, the best way to avoid HIV/AIDS is to change those attitudes and behaviors,

Health education can be regarded as the communication of knowledge and the provision of experiences to help individuals to develop attitudes and skills which will assist their adopting behaviors to improve and maintain health for themselves and their fellows. The preventive model of health education adopts behaviors which will prevent infections and/or diseases, such as HIV/AIDS, at all levels. However, the self-empowerment model seeks to facilitate choice, not merely by providing understanding, value clarification and practice in decision making, but by attempting to empower the individual. Empowerment is about increasing people's power to change or improve their health. It includes motivation which is the inner force that drives the individual to a certain action. The process of selfempowering people involves modifying the way people feel about themselves, through improving their self-awareness and self-esteem. It involves supporting and encouraging them to think critically about their own concerns and gain the skills and confidence to build up their own values and beliefs system and to make a responsible action upon them

Primary level health education is the type of education that is utilized for the prevention and control of HIV/AIDS. Different from the secondary and tertiary levels, it is directed at healthy people and aims to help individuals or groups learn how to keep healthy and how to prevent the onset of infection, disease and disability. Health education for primary prevention encourages people to develop behavior conductive to good health, such as that prevents contracting HIV infection. Primary prevention should aim at educating individuals, groups and communities about the advantages of prevention, including behaviors of discriminate and safe sex. It has to be accepted, however, that there is no

Primary prevention is the level at which health education is able to encompass its role and function, not only to influence individual behavior change but also to influence group and community action. These include environmental, economic and organizational alterations to protect and promote health. HIV/AIDS prevention and control represent an appropriate example. Several approaches may be utilized separately or in combination. The persuasion or directive approach is the deliberate attempt to influence the individual to do a certain action or to follow a certain practice. The informed decision-making approach is about giving people information, problem-solving and decision-making skills to make decisions,

Furthermore, health education can be conducted on the basis of three categories. *Diseaseoriented health education* is still utilized by several health education programs despite the improvements in the field. It has a negative focus, merely aiming at the prevention of specific diseases, with an emphasis on progress towards target rates of morbidity and mortality. Major preventable diseases, such as AIDS, are dealt with by specific preventive programs aimed at reducing relevant 'risk factors'. This orientation of health education works on single topics in isolation from one another, with an incomplete view of health.

including avoidance of unsafe sexual practices.

(Tannahill, 1990; Downie et al., 1996).

**3.2 Levels, approaches and categories of health education** 

agreement on the principles of normal sexual behavior.

but leaving the actual choice to the individual.

**3.1 Health education** 

However, it should be mentioned that most of the current health education programs are *Risk factor-oriented.* It aims at eliminating particular risk factors in order to prevent associated diseases. Its main advantage is the recognition that a single risk factor can be linked to more than one disease category. The connection between unsafe sex and the STDs represents an example. But the model's view of health is inadequate; educational interaction is limited; and experts dominate. On the other hand, the relatively new *Health-oriented health education* has a dual focus. Its aim is to enhance positive health as well as to prevent ill-health. The physical, mental, and social components of health are recognized. Thus, the positive focus enhances the educational validity by developing comprehensive programs of health education in key people and key settings. Multidisciplinary and intersectorial collaboration is facilitated. Obviously, the health-oriented approach should be the preferred model for planning health education programs, including those to prevent and control HIV/AIDS.

#### **3.3 Health promotion**

Health education used to be seen as concerned mainly with personal health actions. It was perceived as a series of messages about healthy practices and the avoidance of risk behaviour. Though these kinds of health messages remain important today and should not be neglected, it is equally important to direct education towards collective action. Empowering people to take responsibility for collective health is a challenge that has to be met. Health promotion, on the other hand, is a broader term which covers all aspects of those activities that seek to improve the health status of individuals and communities. It starts out by considering the whole population in the context of their everyday lives, not selected individuals or groups. Its goal is to enhance collective health.

Health promotion had probably developed from health education. The latter is seen as a very important element in health promotion. It is one route to the improvement of people's health, encompassing all those activities which aim to provide health via learning of one kind or another. Therefore, health promotion can be regarded as health education 'plus'. Health promotion includes health education and other proactive aspects of health. Health promotion can be the umbrella term for three elements; health education, disease prevention and health protection. The three of them are essential elements in combating HIV/AIDS. The term health promotion is not synonymous with the term public health. Health promotion, however, constitutes a dynamic and interactive process based on personempowerment, whereas public health focuses on the crucial issue of health-engendering social structures. Health promotion can be considered as the new public health. It is defined by the World Health Organization (WHO, 1984) as the process of enabling people to increase control over and to improve their health. The concept of HIV/AIDS control and prevention represents a component of this enhanced collective health and health promotion. To demonstrate the shift from individual to collective and societal action to improve health, Ewles and Simnett (1996) described five approaches to health promotion. These are:


school, church, mosque and town hall, where families live whose values are rooted in a shared history. This has begun to change in places where geographical barriers have been overcome by communications and transport. People no longer live where they work and their support networks do not coincide with any geographical boundaries. These considerations must be taken into account when the activities of groups, communities or

Empowerment gives a sense of personal control and the ability to bring about change in the social and health conditions through collective mobilisation. Participation in the decisionmaking process is desirable, not only from the ethical point of view but also in order to

Furthermore, various mechanisms or strategies for individuals and community action exist. Each of them is different, but all of them are complementary. The five complementary mechanisms for action proposed by the Ottawa Charter (1986), in addition to the above, include creating supportive environments, building healthy public policy and reorientation

Education about STDs, including HIV/AIDS, should cover a wide range of attitudes and behaviors. Some believe that usually the mere presence of knowledge is sufficient to motivate healthy behaviors. Hence, motivation can lead to health-influencing behavior. This is known as *the knowledge-action model* of behavior change. However, in some cases, knowledge may be sufficient to elicit changes in behavior, but in other cases, it may not. Therefore, behavior may not change as a result of providing facts. The transfer of knowledge into action is dependent on a wide range of internal and external factors, including values, attitudes and beliefs. The communication of information can create, affect or change people's attitudes. Attitude is defined by Ribeaux and Poppleton (1978) as a learned predisposition to think, feel and act in a particular way, towards a given object or class of objects. Often, values and attitudes change precedes behavioral change. Attitudes can be transferred or reflected to behaviors or feelings. In many cases, people's attitudes are taken to determine their behaviors. Therefore, proper understanding of knowledge-attitude-behavior change models and theories provides guidelines for information, communication and education planning towards

Social scientists have evolved a number of models to explain the process of change influenced by personal and interpersonal communications within an individual. Stage models view behavior change as a series of actions or events. *The health-belief model* can be the best to explain the modification towards an AIDS-related protective behaviour. Rosenstock (1974) suggested that preventive health behavior can be understood as a function of perceived self-susceptibility of acquiring the disease, perceived severity of the disease, perceived benefits to be realized by engaging in particular preventive behaviors. Health-related action, then, is hypothesized to depend upon the simultaneous occurrence of



social support networks in a given area are analysed and evaluated.

community health promotion and HIV/AIDS prevention and control.

guarantee effectiveness.

**5. Education towards behavior change** 

of health services.

three classes of action:

acceptable cost.

perceived threat); and

5. Societal change; to help people take control over their own lives and make choice easier to change the environment.

#### **3.4 Communication**

Provision of information is the principle of health education. Thus, it is vital for the prevention and control of HIV/AIDS within the communities and worldwide. In this respect, its aim is to protect and promote the health of the healthy individuals. In addition, communication aims at assisting HIV infected patients to recognise symptoms of the diseases and, by identifying the early onset of illness, to enable them to seek measures to control the problem. Furthermore, communication is to provide AIDS patients with self-care education, in order to learn about their illnesses, treatments and available health services.

Communication is conducted using a number of components. These are the receiver or the audience, the source or the provider, the message and the media or channels. A message or a medium that is effective with one audience may not succeed with another. The same applies to the source or the provider of the message. Empathy is used to describe the process by which the message provider learns to understand how others feel and think. The message will only be effective if the provided advice is valid, relevant, appropriate and understandable. Furthermore, efficiency relies on the appeal, which is the way providers organize the content of the message to persuade or convince individuals. Communication uses a variety of communication media. They can be classified according to two main groups; interpersonal (face-to-face) and impersonal (mass media). Interpersonal media include, but not limited to, school classes, university lectures, public small group discussions and doctor-patient counseling. Mass media include broadcast media, such as radio, television or social communication electronic networks; as well as print materials, such as books, booklets, magazines, newspapers, press releases, posters, leaflets or reports. McGuire's analysis of effective communication and persuasion methods (McGuire, 1969) suggests that messages that are more closely suited to the values and attitudes of those to whom they are directed will be more effective than other types of messages.

#### **4. Means of individuals and community action**

Although the many factors affecting health are beyond the reach of the individual, some individual choices or life-styles, such as the unsafe sexual practice, can influence health and well-being. Such choices can be influenced by action to empower the most vulnerable. The distinction between individual and collective empowerment is more theoretical than real. In particular, understanding a problem and acquiring the personal ability to deal with it are the basis of collective action for social change. In a social support network, each individual keeps his or her identify while receiving material support, services, information and new social contacts. These may also exist within a scope called social marketing. That is to describe the application of principles and methods of marketing to the achievement of socially desirable goals, such as health promotion or disease prevention, including HIV/AIDS control. Social marketing can be defined as the design and implementation of programs aimed at increasing the voluntary acceptance of social ideas or practices.

The framework for countrywide plans of action for health promotion (WHO & IUHPE, 2000) pointed out that community action is a concept that is both exciting and complex. In fact, the term community can mean different things in different contexts. The traditional notion of community is a well-defined geographical area with formal institutions such as

5. Societal change; to help people take control over their own lives and make choice easier

Provision of information is the principle of health education. Thus, it is vital for the prevention and control of HIV/AIDS within the communities and worldwide. In this respect, its aim is to protect and promote the health of the healthy individuals. In addition, communication aims at assisting HIV infected patients to recognise symptoms of the diseases and, by identifying the early onset of illness, to enable them to seek measures to control the problem. Furthermore, communication is to provide AIDS patients with self-care education, in order to learn about their illnesses, treatments and available health services. Communication is conducted using a number of components. These are the receiver or the audience, the source or the provider, the message and the media or channels. A message or a medium that is effective with one audience may not succeed with another. The same applies to the source or the provider of the message. Empathy is used to describe the process by which the message provider learns to understand how others feel and think. The message will only be effective if the provided advice is valid, relevant, appropriate and understandable. Furthermore, efficiency relies on the appeal, which is the way providers organize the content of the message to persuade or convince individuals. Communication uses a variety of communication media. They can be classified according to two main groups; interpersonal (face-to-face) and impersonal (mass media). Interpersonal media include, but not limited to, school classes, university lectures, public small group discussions and doctor-patient counseling. Mass media include broadcast media, such as radio, television or social communication electronic networks; as well as print materials, such as books, booklets, magazines, newspapers, press releases, posters, leaflets or reports. McGuire's analysis of effective communication and persuasion methods (McGuire, 1969) suggests that messages that are more closely suited to the values and attitudes of those to

whom they are directed will be more effective than other types of messages.

Although the many factors affecting health are beyond the reach of the individual, some individual choices or life-styles, such as the unsafe sexual practice, can influence health and well-being. Such choices can be influenced by action to empower the most vulnerable. The distinction between individual and collective empowerment is more theoretical than real. In particular, understanding a problem and acquiring the personal ability to deal with it are the basis of collective action for social change. In a social support network, each individual keeps his or her identify while receiving material support, services, information and new social contacts. These may also exist within a scope called social marketing. That is to describe the application of principles and methods of marketing to the achievement of socially desirable goals, such as health promotion or disease prevention, including HIV/AIDS control. Social marketing can be defined as the design and implementation of

programs aimed at increasing the voluntary acceptance of social ideas or practices.

The framework for countrywide plans of action for health promotion (WHO & IUHPE, 2000) pointed out that community action is a concept that is both exciting and complex. In fact, the term community can mean different things in different contexts. The traditional notion of community is a well-defined geographical area with formal institutions such as

**4. Means of individuals and community action** 

to change the environment.

**3.4 Communication** 

school, church, mosque and town hall, where families live whose values are rooted in a shared history. This has begun to change in places where geographical barriers have been overcome by communications and transport. People no longer live where they work and their support networks do not coincide with any geographical boundaries. These considerations must be taken into account when the activities of groups, communities or social support networks in a given area are analysed and evaluated.

Empowerment gives a sense of personal control and the ability to bring about change in the social and health conditions through collective mobilisation. Participation in the decisionmaking process is desirable, not only from the ethical point of view but also in order to guarantee effectiveness.

Furthermore, various mechanisms or strategies for individuals and community action exist. Each of them is different, but all of them are complementary. The five complementary mechanisms for action proposed by the Ottawa Charter (1986), in addition to the above, include creating supportive environments, building healthy public policy and reorientation of health services.
