This framework, the product of a participatory research project on the use of communications for HIV prevention, finds conventional communications that focus on behaviour change limited in their scope and effectiveness. It questions the relationship between knowledge and behaviour, and the stress in ‘behaviour change’ communication on individual change. For sustainable change, the influence of a number of domains of social context need to be addressed, including: political and policy frameworks, gender, socio-economic status, spirituality and religion, and culture. It builds on these domains to create broad regional strategies for communications in Asia, Africa and Latin America and the Caribbean. Its suggestions for future national strategies combine interpersonal communication and mass media in key areas of HIV/AIDS prevention and care. It stipulates that participatory processes are central to designing and operationalising national strategies