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Program Context

Promoting HIV Prevention Behaviors Through Mass Media and Community Engagement in Malawi Presenter(s): Glory Mkandawire & Rajiv N. Rimal Johns Hopkins University Bloomberg School of Public Health Center for Communication Programs Co-authors: Rupali Limaye , Peter Roberts, Jane Brown.

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Program Context

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  1. Promoting HIV Prevention Behaviors Through Mass Media and Community Engagement in MalawiPresenter(s): Glory Mkandawire & Rajiv N. RimalJohns Hopkins University Bloomberg School of Public HealthCenter for Communication ProgramsCo-authors: RupaliLimaye, Peter Roberts, Jane Brown

  2. 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

  3. 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

  4. 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 ofproject

  5. 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

  6. 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)

  7. 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

  8. 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

  9. Acknowledgements • PEPFAR for funding the project • Implementing partners • Collaborating partners • Ministry of Health • National AIDS Commission Thank You

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