BRIDGE Behaviour Change Project

BRIDGE's central strategy is to increase the capacity of government, non-governmental organisations (NGOs), community-based organisations (CBOs), faith-based organisations (FBOs), and influential people in the community to plan, implement, and monitor effective behaviour change interventions (BCI). Another core approach is co-ordinating and mobilising community and national stakeholders to implement Malawi's National Behaviour Change Interventions Strategy for HIV/AIDS and Sexual Reproductive Health (NBCI). This effort to support an enabling environment involves harmonisation of action plans and creation of unifying themes, such as "openness" and "hope", at the national level. In addition, collaborators are mobilising the social system at the district and community level through a community action cycle and workshops to enable change agents to assume a more powerful and persuasive role. Reaching individuals, including youth, involves a range of approaches such as sports interventions and youth events.

The programme uses innovative behaviour change models and lessons learned from both CCP and non-CCP programmes in the Africa region. Informing these important outcomes are the proposed BRIDGE principles and values, which guide all BRIDGE activities:

• Belief in a better future (hope)
• Risk is shared by everyone (personalised risk)
• I can STOP AIDS (personal responsibility, action, self-efficacy)
• Discussion about HIV/AIDS (openness, destigmatisation)
• Gender equity (girls' empowerment and changed men's behaviour)
• Emphasis on the positive (action-oriented positive-deviant role modelling).

The intention is that stakeholders at national and community levels will implement evidence-based BCI that encourage Malawians to act on their HIV prevention knowledge. Outlets such as the media, community leaders, and national celebrities are used to model and reinforce changed behaviour and support NBCI activities.

Specifically, activities to date - created in response to formative research conducted in early 2004 - are as follows (for further details, click here):

• Nditha! ("I Can!") Campaign - a multi-media campaign that seeks to reinforce feelings of confidence and self-efficacy among Malawians in their ability to prevent HIV and AIDS. Using national radio, billboards, posters, and community outreach, the campaign highlights small, "do-able" actions that people can take in the short term that to help foster an open, supportive environment that encourages abstinence, mutual faithfulness, and condom use.
• Hope Kit - a package of action-oriented tools and materials designed to be used in a variety of settings to stimulate family and community dialogue about local HIV/AIDS issues, promote the ABCs (Abstain, Be faithful, use Condoms) of HIV prevention, and build confidence in Malawians' abilities to take action against AIDS. The main components of the Hope Kit are the "Journey of Hope Activity Book" and a variety of supplemental materials such as photographs and testimonials from people living with HIV and AIDS (PLWA), information about voluntary counselling and testing (VCT) and antiretroviral therapy (ART), and a "Positive Living Handbook". Supplements to the Hope Kit include the "Bambo Wachitsanzo" update (a package of learning activities that encourage men's involvement in HIV prevention) and a prevention of mother-to-child transmission of HIV (PMTCT) update designed to generate dialogue and positive support among communities for a spectrum of PMTCT behaviours.
• Radio diaries - short, first-person narratives that are updated weekly and give listeners a powerful and personal look into the lives of PLWAs. Broadcast on 6 local stations, these diaries are designed to address stigma. Each station's production team, consisting of a radio producer and one male and one female PLWA, was trained in interviewing, storytelling, and editing skills to ensure the development of honest and engaging diaries. Production teams receive counselling and support from local PLWA groups. Additionally, radio listening groups monitor community reactions to the diaries on a weekly basis.
• Youth activities - designed to facilitate an environment in which young people are efficacious, empowered, and energised to "make a difference" in the fight against HIV and AIDS. BRIDGE is working with the National Youth Council of Malawi (NYCOM) to strengthen the leadership they provide to youth groups. BRIDGE also participates in the NAC Technical Working Group on Young People, USAID Life Skills Technical Working Group, Malawi Girl Guide Association, and Safe Schools Project/YONECO. BRIDGE is supporting youth to take action through its collaboration with PSI's Youth Alert! Program. In its youth activities, BRIDGE emphasises skills building with community youth groups and involving youth leaders in the design of interventions.
• The Sara Initiative - an effort to build HIV awareness and confidence in personal ability to prevent HIV among girls aged 10-14. Originally designed by the United Nations Children's Fund (UNICEF), Sara is the main character in series of comic books which BRIDGE has worked to re-translate and reproduce. As a spin-off, the concept of "Tisankhenji: The Choice is Mine" emerged. The radio programme features original story lines designed to reach girls aged 10–14, and models self-efficacy, decision-making, and life skills in the context of HIV prevention.
• Nditha! Sparks Newsletter - a collection of open-ended and discussion-provoking scenarios related to relationships and risk behaviours drawn from real-life situations. The series of drawings and scenarios are designed to stimulate discussion around reproductive health issues and build life skills among young people aged 15-19.
• District community mobilisation activities - include youth festivals, Hope Kit sessions for local groups, "Agogo" workshops to mobilise the involvement of senior women in HIV prevention, community dialogues and debates with traditional leaders on HIV/AIDS and cultural practices/traditions, local advocacy campaigns combating stigma and discrimination, monitoring and strengthening HIV prevention activities, conducting HIV prevention meetings, and so on.

HIV/AIDS.

According to CCP, Malawi is one of 10 countries worldwide most affected by HIV/AIDS. Youth are at highest risk, with over 50% of new infections in the 14-24 age group. While studies show that 93% of Malawians have the knowledge necessary to prevent infection, most people do not engage in preventive behaviour. Social stigma, gender inequalities, limited access to basic services, and poverty are some of the main reasons that prevent people from adopting low-risk behaviour. The Government of Malawi has responded by developing a NBCI strategy, and the Bridge Project forms part of this approach. Specific project aims include:

• Increase the median age at first sex;
• Decrease the number of unmarried youth aged 15 to 24 having sex in the past 12 months;
• Decrease the number of men reporting more than one sexual partner during the previous 12 months;
• Increase condom use at last sexual activity among unmarried youth; and
• Increase condom use by adults with a non-regular partner.