ICTs and HIV/AIDS Literacy: Appropriate tools and applications for an effective information dissemination service for Zimbabwean libraries

Author: Bhowa tg, Infoprenuer, zimisis
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© Bhowa tg 2010



Abstract

Thrust- the thrust of this article is to describe the effective use of appropriate ICTs to disseminate preventive health care information in arresting the vagaries of HIV/AIDS epidemic in Zimbabwe. The role of libraries and documentation/information centres in increasing HIV/AIDS awareness are discussed. Finally, a variety of recommendations are offered and the conclusion is drawn that libraries and information professionals must develop HIV/AIDS literacy programmes where possible by manipulating appropriate ICT tools and applications.

Methodology/approach: Literature search, web site information and personal interaction with key persons associated with various HIV/AIDS awareness projects.

Findings: The generality of Zimbabwean population is very knowledgeable about HIV/AIDS, its modes of transmission, ways to avoid infection and treatment options. Libraries and information centres can make a huge impact on local communities by developing community-based HIV/AIDS literacy programmes taking full advantage of ICTs and hopefully make a meaningful contribution in saving the society from the HIV/AIDS epidemic. There is perceived need for providing health information services through libraries/information centres in collaboration with HIV/AIDS based institutions such as NGOs to both urban and rural Zimbabweans who are increasingly making themselves vulnerable to HIV/AIDS. However, awareness of ICT tools and applications is low, especially in rural Zimbabwe. One positive solution is to increase take-up and run HIV/AIDS awareness campaigns through manipulation and maximization of available and appropriate ICT tools and applications.

Keywords: HIV/AIDS; HIV; AIDS; ICT; LIBRARIES; INFORMATION PROFESSIONALS; ZIMBABWE




Background and context

Zimbabwe has a low urban and high rural population density, high literacy levels comparable worldwide and consequently, high levels of awareness of HIV/AIDS which is one of the most challenging health problems faced by the country. Rightfully, information is the first vital step in HIV/AIDS prevention; we know and appreciate the consequences of ignorance about the disease and how the virus is transmitted can generate fear and prejudice towards those who are infected or affected. Libraries and information centres through information professionals need to care about this and act on it. This article suggests some ICT-based measures that might be adopted, based on the literature review of best practices on the use of ICT for HIV/AIDS literacy in other countries developing or developed. Educating people about HIV/AIDS and prevention in Zimbabwe is simple but not a simple task, as we have multiplicity of major languages coupled with different dialects bringing in the cultural diffusion factor. To overcome such challenges, with the use of convergence technologies these barriers maybe history. Innovative strategies to disseminate HIV/AIDS information among the disadvantaged population groups are needed. It’s a fact that awareness of HIV/AIDS is higher among those who are literate. For the unfortunate libraries need to provide tailor-made education programmes taking full advantage of the power and flexibility of ICTs?



Health information literacies in the context of HIV/AIDS

Simply put, information literacy skills (ILS) are the ability to find and use information. Other schools of thought suggest otherwise; ILS assist people, in our case information professionals, to satisfy their changing information needs, pursue independent lifelong learning and contribute to the development of an informed society. In other words, in the context of a well equipped information professional armed with the necessary ILS, buttressed by appropriate ICT tools and applications, would be able to deliver an effective dissemination service thereby greatly demystifying the HIV/AIDS scourge.
A Medical Library Association taskforce in the USA developed the following working definition for health information literacy in 2003:
Health Information Literacy is the set of abilities needed to: recognize a health information need; identify likely information sources and use them to retrieve relevant information; assess the quality of the information and its applicability to a specific situation; and analyze, understand, and use the information to make good health decisions. (www.mlanet.org/resources/healthlit/define.html).
Others (e.g. Kickbusch et al., 2002) have identified three levels of health information literacy:
a) Functional health literacy. Represents the cognitive and social skills required to determine the motivation and ability of individuals and communities to gain access to, understand, and use information in ways which promote and maintain good health.
b) Interactive health literacy. Focuses on personal and social skills development, such as self-confidence, negotiation, and assertiveness, and the resulting individual health-related behaviours associated with these attributes.
c) Critical health literacy. Refers to the development of specific higher level cognitive and communication skills, such as accurately interpreting and evaluating media reports, navigating health care systems, and the capacity to effectively access and use health information.
As Information professionals we can assist people to acquire the first two levels which will bring empowerment to achieve the third level.
There are many stakeholders in the area of health information literacy, including:
• patients;
• content developers and designers; and
• printers and distributors.
In this context we as librarians need to identify and co-ordinate the activity of the various stakeholders for the dynamic development of education materials suitable to their local needs (Siddamallaiah, 2005).
Furthermore, there has been an explosion of knowledge and enormous advances in technologies' in the twenty-first century. As a result, we live in an information environment characterized by the following;
 the development of information services as an integral part of the economy
 an expansion of the range of sources of information
 appearance of information specialists and consultants
 a variety of online information forums and agencies
 the transient nature of information
The new ICTs can make information services directly available to the end user. Indeed the increasing range of electronic information is based on the willingness of individuals and organizations to attempt to market their information products directly to the end user. In such a situation, library and information professionals may be expected to assist the users:
• with carefully and well organized information, particularly electronic information;
• by providing information which has been evaluated and repackaged to meet their needs precisely; and
• by facilitating their use of both the technology and information.
The interactive online services will provide a service to those who prefer privacy, but human interaction of a librarian could become an even more essential piece in the health information seeking process (Warner and Procaccino, 2004). Technology provides the opportunity and the spur for rethinking a great number of traditional paradigms. For instance, different health resources can be searched through one common index using a single tool i.e. search engines such as google.
HIV/AIDS information, ICTs and libraries
Literatures addressing the role of libraries in disseminating HIV/AIDS information are still scarce, and even fewer on their use of ICT. Despite this challenge, Chikonzo (2005) in her paper on the use of ICT for AIDS prevention in developing countries presented at the 2005 World Library and Information Conference (WLIC) suggested the use of a variety of ICT “tools” including:
• e-mail, web sites and CD-ROMs;
• appropriate databases and documentation
• list serves and online discussion groups;
• online questions and answer fora and chat rooms;
• video-conferencing; and
• distance education programmes.
Five years down the line Chikonzo's could have included the following new technologies and applications;
 mobile technologies
 portals
 institutional repositories
 MP3/4
 Solar technologies
Ghosh (2005) proposed a model of ICT-driven public libraries for India and suggested that public libraries could offer a single integrated environment for dissemination of HIV/AIDS information. The journal Aslib Proceedings: New information perspectives devoted a special double issue on Health Informatics in 2003 (Vol. 53, Nos 5/6) with papers covering:
• Reasons for use of the Web for accessing health care information.
• Efficacy of providing patient information via touch-screen information systems.
• Potential of using television sets at hospital bedsides for health information provision.
• Effectiveness of digital interactive television in providing health information services.
Batambuze (2003) in his WLIC paper discussed HIV/AIDS in Uganda and recommended library intervention to control the epidemic and the Uganda Aids Commission (2003) developed a concept paper for HIV/AIDS information and knowledge management in the country. Muswazi (2000) surveyed 14 public libraries in Swaziland regarding the availability of HIV/AIDS resources and found out that information resources were lacking in appropriateness and limited in number and are not updated frequently. The US National Commission on Libraries and Information Science (NCLIS) in the USA has published a book on the role of libraries in HIV/AIDS information dissemination in Sub-Saharan Africa (NCLIS, 2005).
My research reveals a worrying trend as it concerns Zimbabwean libraries in HIV/AIDS interventions as none exist either from the National Library and Documentation Service (NLDS) or Zimbabwe Library Association (ZimLA). As information professionals we need to be directly involved in this multi-sectoral approach to the scourge.
Today, networking of computers play a vital role in the communication and dissemination of information. ICTs, as well as traditional media, mass media, and digital technology can have a powerful influence, but are not sufficient to prevent HIV transmission. They can, however, be viewed as tools to facilitate empowerment and the realization of human rights by creating economic, educational, social and political opportunities.
The following are examples of a few of the ICT-based initiatives which involve libraries in the dissemination of HIV/AIDS information:
• The AIDS Library of Philadelphia (www.aidslibrary.org/). The AIDS Library serves the community through delivery of information on HIV, such as treatments, nutrition, and history of the pandemic, and referrals to regional and national resources. This information is provided through a variety of media including books, periodicals, medical journals, videos, audio cassettes, CD-ROM, and the Internet. The AIDS Library provides free computer access to the library's online resources, the library catalogue, the Internet, and word-processing, and offers one-to-one computer tutorials. The library's website offers an easily accessible, 24-hour online resource for HIV information and services. In addition, the AIDS Library regularly hosts events on HIV-related issues.
• Detroit Community AIDS Library (DCAL www.lib.wayne.edu/dcal/index.html). DCAL is a partnership of academic health sciences, medical hospital and public libraries which was set up in 1995 with the goal of providing a gateway to local and worldwide HIV/AIDS information resources for people in Detroit and Southeastern Michigan. Funding for this project comes from the National Library of Medicine and has been utilized to strengthen participating library collections on HIV/AIDS and educating librarians to better meet the HIV/AIDS information needs of the community, and to provide a computer-based networked resource on HIV/AIDS.
• In Kenya, the Kenya National Library Service (KNLS) introduced an HIV/AIDS awareness programme in 1996 in response to the Government's appeal for a multi-sectoral approach to combat HIV/AIDS (www.knls.or.ke/aids.htm). The KNLS is associated with an AIDS awareness project that repackages and translates information from foreign sources (Sturges, 2001).
• In the UK, the Digital Libraries network (DLnet) was established during 2003 by the National electronic Library for Health (NeLH). DLnet aims to become a “community of practice” providing marketing and training, and facilitating the sharing of ideas, materials and experience. Librarians have been invited to sign up as “representatives” to join DLnet. NeLH is working in partnership with other library services to unify and maximize communication efforts (Turner et al., 2003). NeLH is now known as the National Library for Health (NLH) and, inter alia, provides access to a range of information (www.library.nhs.uk/).
Zimbabwean initiatives to disseminate HIV/AIDS information
1. National AIDS Council (NAC www.nac.org.zw)
Have web presence and very informative site inclusive of a discussion forum and giving a national perspective to government approach/policy to issues of HIV/AIDS.
2. Zimbabwe AIDS Network (ZAN www.zan.co.zw)
Takes a multi-sectoral approach and networks various stakeholders and is mainly advocacy type of work. Impressive interactive site which includes a media centre page with interesting FAQ options, where you can get answers to the basic questions such as; what is HIV? What is AIDS? When does a person have AIDS?
3. SAFAIDS (www.safaids.net)
The site contains collaborative efforts within SADC with detailed HIV/AIDS information. A comprehensive CDS/ISIS bibliographic database exists and is maintained by the library.
4. UNAIDS (www.unaids.org)
The website contains situational country data technical and statistical.
From the above analysis one can notice that all apart from SAFAIDS, there is no library involvement but to some extent have information professionals contributing. Library databases or portals are virtually non-existant.
This research reveals that at national level there is no physical evidence to suggest any initiative at the moment for collaboration, synergies and networks as regards a multi-sectoral approach. All efforts are institutionally based. The above examples are ripe products for a national HIV/AIDS portal or database with the NAC taken responsibility for the initiative.

Emerging role for information professionals in disseminating HIV/AIDS information
As Information professionals we can play dual roles as both advocates and educators in the process of HIV/AIDS information dissemination. Fourie (2004), while commenting on new roles for librarians, stated “…they require empathy, tireless dedication to a cause, commitment, and a service-for-free orientation…for the benefit of society at large”. Ready availability of up-to-date information enables timely and informed decision-making, as well as efficient allocation and mobilization of resources. Information professionals in Zimbabwe have to play a decisive role through the process of educating their society, because they are generally the people who have the responsibility for collecting and organizing the resources commensurate with the needs of local communities. Information professionals working in public and medical libraries can play an active role in developing open archive collections by helping researchers to make their output on HIV/AIDS freely available for the benefit of the local community. A search of the Open Archives Initiative's OAIster database (www.oaister.org) of almost 10 million articles for papers on HIV/AIDS and Zimbabwe resulted in 0 “hits” as of July 2010. It’s a fact that a lot of local HIV/AIDS research has been conducted since the onset of the pandemic but this is not easily accessible. Regular user awareness programmes could be conducted and, at times, services to archive the work on HIV/AIDS by Zimbabwean authors could be offered on their behalf. It is also necessary for information professionals to update their knowledge about HIV/AIDS regularly, become committed to educating people about the disease, have an understanding of different cultural values, reacquaint themselves with current developments in the treatment of HIV/AIDS and of course governmental policies for dealing with it. As a consequence of becoming HIV/AIDS educators, librarians must engage in a form of social marketing. The main activity of this marketing is the promotion of HIV/AIDS information from NGOs, health centres, social workers and clinical professionals working in this area. Librarians need to expand their roles as educators to that of health educators and target local groups within the community which might require the attention of information specialists.
The National Commission on Libraries and Information Science (NCLIS) (2005) study in the USA titled New roles for libraries in HIV/AIDS information dissemination in Africa, made three main recommendations:
a) Libraries' role in disseminating HIV/AIDS information is strongest when they establish partnerships with other organizations already involved in dissemination and education activities.
b) Libraries in Africa should expand the scope of information resources they collect and distribute to include sources outside the role of traditional libraries, including taking a leadership role in using ICTs for sharing digital materials, and providing information in formats that are accessible and interesting to children and young adults who are making decisions about their own sexual behaviour.
c) An opportunity for African librarians now exists to redefine their traditional roles and take a strong lead in the dissemination of HIV/AIDS information.

Challenges to HIV/AIDS information access, management and control in Zimbabwe
In order to control the epidemic's expansion, health communications and education programmes must not limit their operations to prevention messages, but rather address the interrelated components of the HIV/AIDS continuum prevention, care and support (UNAIDS, 2001).
There are, however, challenges to the provision of HIV/AIDS information for librarians in Zimbabwe posed by both the epidemic and the socio-economic environment:
• HIV/AIDS information overload – the availability of a huge amount of unorganized information on HIV/AIDS is creating problems for staff in Zimbabwean libraries to access and manage these materials. A possible and practical solution is to invest in Social-bookmarking software such as Connotea (www.connotea.org). It was developed to solve the problem of information management and control for clinicians and scientists generally, and could be used by information professionals working with HIV/AIDS in Zimbabwe. As (James (2006) states “Connotea will be important for sharing news, resources, and other information on AIDS research, medicine, services, and activism”.
• The dynamics of the epidemic raises the need to keep abreast with new developments, thus the need to actively collect, synthesize and disseminate information. This however may well be constrained by lack of adequate resources (human, financial and material) to initiate and sustain efforts.
• Low levels of penetration of the infrastructure and supporting environment necessary to effectively use ICTs.
• Lack of ICT-related training for staff working in libraries.
• The multiplicity of demand for consistent, relevant and timely information for HIV/AIDS, and the existence of factors at various levels, and in different settings, also poses a challenge in processing and packaging the same information for different levels of users.
• A poor information culture. Limited ILS increases demands for more information processing to add value to information and services, and to promote information awareness, accessibility and usability. There is limited capacity (human, financial and structural) at an organizational level to promote knowledge sharing within the community. In addition, there is a lack of appropriate fora for sharing knowledge on HIV/AIDS. There is also a shortage of researched information about the various categories of information users, their specific HIV/AIDS information needs and desired delivery mechanisms.
• Lack of organizational capacity and initiative for information management. There is fragmentation of information management efforts that creates the potential for duplication of effort and wastage of scarce resources. The reality in Zimbabwe as shown by this research is that coordination is still a high sounding word amongst the interested stakeholders. Limited capacity at local level particularly constrains information dissemination efforts to communities, as well as inadequate structural and physical information delivery systems at all levels that could be exploited for information access and sharing. Consequently, many potential users are not aware of the existence of the required information and/or sources of such information and the appropriate channels for access.
• Inadequate funding of libraries by their governments might make it difficult for libraries in Zimbabwe to harness ICTs effectively for the provision of HIV/AIDS information.



Recommendations for the use of ICT for HIV/AIDS awareness for information professionals in Zimbabwe
Below are some recommendations as to how ICTs may be used by information professionals in Zimbabwe for HIV/AIDS awareness and information provision:
• There are insufficient libraries and information institutions to meet the needs of the range of culturally and linguistically diverse people in Zimbabwe and so a “virtual” (i.e. web-based) health resource centre should be created to provide medical and health related information resources to the general public. This could at the instigation of NAC.
• Harnessing of mobile technologies can be fully exploited. Most Zimbabwean whether urban or rural has access to a mobile phone. With this technology (tool) and convergence with a sms platform (application) bulk text messages on HIV/AIDS information can be sent to the majority of the population. At a cost of 5 cents per text the budget for this workshop could have delivered vital HIV/AIDS interventions to 24 000 needy Zimbabweans countrywide.
• Infrastructure inadequacies and lack of incentives for increasing the use of health care information to face challenges related to HIV/AIDS are hindering progress to combat the disease. Governments (national or local) in Zimbabwe should take libraries and the provision of HIV/AIDS information seriously and make available a reasonable amount of money to libraries, especially public libraries, for this.
• There is a need to enhance competencies for disseminating health information. Information professionals must have well developed training and facilitating skills, to help people to use, not only libraries, but also electronic information sources in different forms and formats.
• Community networks should be developed and a web-based HIV/AIDS information portal should be accessible through libraries. The Internet has brought people together, even from remote regions, to a “virtual conference table” and a “virtual consultative process”. Some of the most marginalized communities of the world are actively involved in dialogue and in policy making on HIV/AIDS. People living with HIV/AIDS are not confident enough to speak up for themselves, but might join a network.
• Librarians should have a well planned approach to ICT issues to capture funding from either internal or external sources. They should develop suitable strategies to bring ICTs into libraries and for persuading politicians and funding agencies to listen to the needs of libraries. Critical to planning any adoption of ICTs is the requirement to ensure trained staff is available to maintain the network.
• Collaboration and synergies with NGOs and other libraries/networks. Health-related information seekers often prefer to talk with someone with the same condition, public libraries may consider collaborating with medical librarians in approaching support groups for those with similar medical conditions (Warner and Procaccino, 2004). Further collaboration with organizations that focus on HIV/AIDS could be considered. Librarians should co-operate and establish links with external partners and international organizations for funding programmes and should aim to have vibrant organizations concerned with HIV/AIDS.
• Creating the virtual opportunities for the disadvantaged. As ICT infrastructures improve, location independence increases. On the one hand it lets people access distant resources and information and on the other hand outsiders can more easily be contacted. A library network itself is a virtual library. It can support the growth of virtual libraries, especially those offering services to users in remote areas of the country. There are abundant opportunities, driven by the users' demand, to create new applications and services for under privileged people. An excellent example is from practicalaction Zimbabwe (www.practicalaction.org.zw) in their successful manipulation of MP3/4 players in disseminating agricultural information to rural communities in Zimbabwe. Within the rural set-up there are already established structures such as headman, Chief etc.. Within a community practical action have identified a community leader and provided him/her with two MP3 players inclusive of enough battery supplies. At a growth point or service centre they have established a lab equipped with basic recording equipment which the whole community uses to record in local languages farming methods. How it operates is that members of the community access the MP3 players from the community leader's homestead at their own time and pace and in a language they understand. Importantly they have even recorded traditional methods of doing things as compared to modern inventions. The cost of implementing this technology is less than $100 per community.
• Inclusion of modules on Medical Informatics or Medical Librarianship in Library and Information Studies (LIS/RAM) syllabi.
• Open Access digital repository on HIV/AIDS/ National HIV/AIDS database. The Government of Zimbabwe should take initiatives to create a national level open access repository on HIV/AIDS. The majority of research reports created at considerable expense never gets public attention regardless of their merits, and never reaches people who need to know about them. Although NGOs and other agencies disseminate their research materials free of charge, it is still insufficient. Restrictions on access to health information are hindering progress in combating HIV/AIDS, particularly in the world's least-developed countries. Essential information is locked away behind such barriers as journal subscription charges or individual article download fees. Journal articles are typically subject to restrictive copyright licences that prevent reproduction, distribution, translation, or the creation of derivative works, all of which would help published work to be used for AIDS prevention and control. Provision should make it mandatory for researchers, health workers and clinical professionals to submit their research findings, survey reports, and project reports and so on in open access repositories or the national HIV/AIDS database.

Conclusion:
To effectively combat the HIV/AIDS pandemic it is of utmost importance to deliver timely, credible, and multi-sectoral information about HIV/AIDS. It has to reach not just clinicians and scientists, but a huge array of others, such as behavioural specialists, policymakers, donors, social activists, industry leaders as well as common people. Zimbabwe has an emergency in terms of treatment, especially with new WHO guidelines which stipulates that if you CD4 count is below 350 one starts AVRs, but if it ignores the preventive aspects it will face a crisis in coming years, which will use up its already strained resources. There is a need for strong advocacy and political support at the national level. Educating the users in libraries how to access health information on the Internet and other ICTs which have the potential to give them knowledge to maintain more healthy life styles, provide them with reliable information about their problems and make them aware of possible treatment options. One of the keys to successfully combating the HIV/AIDS epidemic is the creation of an infrastructure that concurrently develops healthcare networks, education programmes, and community participation.