AIDS 2012 - Turning the Tide Together

Promoting HIV Prevention Behaviors Through Mass Media and Community Engagement in

MalawiPresenter(s):

Glory Mkandawire & Rajiv N. RimalJohns Hopkins University Bloomberg School of Public Health

Center for Communication ProgramsCo-authors: Rupali Limaye, Peter Roberts, Jane Brown

Program Context

• HIV prevalence in Malawi – 10.6% (in 2010), a decrease from 12% (in 2004)

• In the southern Malawi, prevalence is 14.5%• Primary driver is higher-risk sexual behavior –

among sero-discordant couples and through multiple and concurrent partnerships

• Formative evaluation showed a need to create an open environment with communities engaged in active dialogue and action

Description of Intervention • BRIDGE II intervention

– 11 districts in the southern Malawi – From 2009 – 2014– Follows BRIDGE I program 2003 – 2009

• Intervention components:– Mass media (Tasankha (Choices) + reality radio programs)

• More than 265 programs aired nationwide• Collective reach of 40%

– Community mobilization efforts (more than 340 communities reached at Midterm and 550 by September 2012)• Capacity building of district and community level structures• Open days, using transformative tools in small discussion groups, interactive drama,

discussion forums, Traditional Leaders Forum and community based referral

• Working assumption: Social & normative processes enhance the effects of mass media on behavior change including condom use, HIV testing and reduction in multiple partnerships

Data Collection

• Baseline: random sample of households in all 11 districts

• Midterm: – Stratified (by treatment or control communities)

random sample of household in all 11 districts– Cross-sectional component (N = 1,338)– Longitudinal sample (N = 685)

• Cost-effectiveness analysis: to be done at end of project

Impact: Midterm Evaluation (1)

• Collective efficacy– Individuals’ perceptions about their community’s

ability to fight HIV/AIDS (5 questions, α = .66)– Calculated as a “non-self-mean”: mean value in

each “traditional authority” (similar to counties in the US), taking out the value of the target person

– Controlling for age, gender, and education, exposure to BRIDGE II was a significant predictor (β = .16, p < .001) of collective efficacy

Impact: Midterm Evaluation (2)

• Controlling for demographics, – HIV testing• associated with collective efficacy (β = .07, p < .05) and • marginally associated with exposure to BRIDGE II

campaign (β = .05, p < .07)

– Condom use• not associated with collective efficacy or exposure• Associated with community-level condom use (those

living in communities with higher use also more likely to use condoms themselves)

Adaptive Programming

With high intentions:– Second phase of Tasankha (Choices) mass media

campaign focused on moving people to HIV testing services. However, limited HIV test kits continue to be a challenge. But despite limited HIV test kits, the results show increased HIV testing

– BRIDGE II is training Community Based Condom Distributors to increase condom availability at community level

Key Considerations for Replication

• Coverage vs available resources• Availability and capacity of structures to lead

the process at various levels• Availability of services• Incentives and rewards

Acknowledgements

• PEPFAR for funding the project• Implementing partners• Collaborating partners– Ministry of Health– National AIDS Commission

Thank You