C-Picks #16 - Tools and Media Campaigns Promoting Behaviour Change from C-Change

CHANGING SOCIAL NORMS AND BEHAVIOURS AROUND MCP – AFRICA

5. Evaluating "Project Ignite" including Shuga - MCP Social Norms and Behaviour Change in Kenya and Zambia

"The Project Ignite Evaluation: Tribes in Trinidad & Tobago and Shuga in Kenya and Zambia", an external evaluation published in July 2010, examines 2 of 3 country campaigns of MTV's over-arching Staying Alive Ignite campaign – "Shuga" in Kenya and Zambia, and "Tribes" in Trinidad and Tobago - which used television drama, social networking platforms, and interpersonal communication to put forward key messages around transmission, prevention, condom use, HIV testing, MCP, and stigma and discrimination relating to HIV/AIDS. C-Change provided technical assistance to MTV's Staying Alive Foundation to produce "Shuga" in Kenya. The three-part, fast-moving drama was part of a multi-component campaign designed to reach young people on issues related to HIV/AIDS. Filmed in Nairobi, the series addresses sexual networks, MCP, substance abuse, and living with HIV. In addition, the campaign included an online component, radio programming, training for local broadcasters, and a Training of Trainers and educational toolkit for peer education in communities vulnerable to HIV. Several recommendations for future research and campaigns are offered here.

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6. Examining a National Multi-level Communication Programme to Reduce MCP in Botswana

Published in October 2010 by AIDSTAR-One, this case study looks at Botswana's O Icheke - Break the Chain campaign which is designed to change attitudes and behaviour around multiple concurrent partnerships. According to the study, O Icheke is seen as key to achieving Botswana's long-term goal of zero new HIV infections by 2016. The three-year campaign uses the national mass media to stimulate public discussion about MCP. At the same time, interventions at the district/community level - which are linked to the national mass media by the same branding, messages, and tools - are designed to encourage communities to change norms and individuals to change behaviour. Community-level activities include one-on-one sessions, group discussions, dramas, testimonials by people living with HIV, community and church events, youth clubs, and schools and poetry/music groups. This study looks at the rationale behind the campaign, how it was developed, and provides a brief evaluation of the programme's first year. It also includes recommendations and information around future programming.

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7. Developing a Marketing Plan to Address MCP Behaviour in Zimbabwe

Published by Population Services International (PSI) in May 2010, “Concurrent Sexual Partnerships in Zimbabwe: Using DELTA to Develop a Marketing Plan for a Complex Behavior” outlines the multiple step process PSI/Zimbabwe used to apply the findings of formative research to design a national marketing strategy to address concurrent partnerships. According to the case study, developing the messages was dependent on a clear understanding of the primary audience(s) and adequate positioning of the desired behaviour - reduction in concurrent sexual partnerships among the sexually active population. The case study explains that the DELTA process has been widely applied to develop marketing plans for PSI products and services but only recently applied to developing marketing strategies for behaviour change communication interventions. In doing so, DELTA is increasingly recognised as a planning tool for all types of social marketing interventions.

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8. Addressing MCP among Individuals on HAART in South Africa

This December 2009 working paper from the Centre for Social Science Research (CSSR) shares findings of a study to measure the prevalence of MCP and condom use among individuals on highly active antiretroviral therapy (HAART) in the township of Khayelitsha in Cape Town. Comparisons are made between individuals on HAART and the general population from the same geographic area. According to "Concurrent Sexual Partnerships Among Individuals on HAART in South Africa: An Opportunity for HIV Prevention", the prevalence of reported concurrency was relatively high both among a sample of HAART patients and in the general population while reported consistent condom use was significantly higher among HAART patients compared to the general population. Given the large numbers of people living with HIV (PLHIV), particularly in southern Africa, there is a need for specific efforts to promote partner and concurrency reduction among the general population and specifically among PLHIV and those on HAART. While increasing the risk perception of concurrency is important in the short term, research needs to evaluate structural factors, such as economic and gender inequalities, which play a role in engaging in concurrent sexual partnerships.

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9. Extra-marital Sexual Partnerships and Male Friendships in Relation to MCP in Rural Malawi

This January 2010 paper, published by the Max Planck Democratic Research Institute, investigates the roles of two types of male friendships - best friends and friends with whom men talk about AIDS - in determining whether men have extra-marital sexual partnerships (EMSPs). The author argues that EMSPs are a major route of HIV/AIDS transmission in sub-Saharan Africa, and that men's extra-marital sexual behaviour in rural Malawi is closely correlated with the behaviour of their best friends. According to the paper, this study, along with previous findings, raises the possibility of developing effective interventions designed to change men's non-marital sexual behaviours by harnessing men's social networks, particularly their male friendships. Specifically, individuals within the social network could be targeted for behaviour change communication in order to better utilise men's social networks to disseminate messages about the risks of concurrent sexual partnerships.

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10. Confronting Norms around MCP in the Church

This report, published by Catholic Relief Services in May 2010, assesses the effects of The Faithful House (TFH) curricula, focused on fidelity, on TFH trainers' attitudes and practices. Facilitator trainees underwent a week of training in TFH in Rwanda, Central Uganda, and Northern Uganda. Using the metaphor of a house, couples are progressively led through different rooms that include, among others: a foundation in God; four pillars of love, respect, faithfulness, and communication; walls representing their values; and windows of forgiveness. Designed to better understand the attitudes and behaviours of church attendees related to MCP and identify attitudes and behavioural intentions most and least consistently impacted by TFH curriculum, the study concludes that there is a need to train community and church leaders about what to do when confronted with MCP. Community leaders also need to be called upon to model good behaviour, church leaders and TFH trainers need to receive more training, and avenues to address MCP through church structure need to be strengthened.

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HIV PREVENTION ADDRESSING MSM

11. Improving Access to HIV Prevention Messages and Services among MSM in Togo

This April 2010 brief explores a peer-education-based programme launched by Population Services International (PSI) in 2007 in an effort to reach men who have sex with men (MSM) in Lomé, Togo, with HIV prevention messages and products, referrals to appropriate HIV counselling and testing services, psychosocial counselling, and diagnosis and treatment of sexually transmitted infections. PSI recruited and trained 17 young men to serve as peer educators and reach MSM with HIV prevention messages and products; each month, they reach more than 300 men and distribute over 2,000 condoms and 70 tubes of water-based lubricant. Peer education activities are complemented by the sponsorship of social activities, such as monthly movie nights, which serve as opportunities to further promote HIV prevention messages and products. The brief concludes with a number of lessons learned thus far.

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12. Empowering Communities of MSM to Prevent HIV in India

Written under the auspices of USAID's AIDSTAR-One programme in January 2010, "Case Study: The Humsafar Trust, Mumbai, India: Empowering Communities of Men Who Have Sex with Men to Prevent HIV" examines the work of India's Humsafar trust, which works to create a safe haven and provide support for Mumbai's community of men who have sex with men (MSM) and transgender people. Much of Humsafar's programmatic work has focused on HIV prevention, particularly street outreach and condom promotion activities. This involves bringing prevention messages and materials to cruising sites such as parks, public toilets, cinemas, truck stops, and beaches. In designing its outreach materials, Humsafar has found it necessary to be careful how it represents sexual behaviour. "...MSM who take part in Humsafar's prevention programming often report that before they received MSM-specific education, they thought condom use was only necessary during vaginal sex....The absence of discussion about anal sex in the general HIV prevention discourse puts not only MSM at risk but also women who might consider anal sex as an option to protect their virginity or avoid conception." Other challenges and lessons are outlined within this report.

For more information on Humsafar Trust, please click here.

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CHANGING GENDER NORMS - IMPROVING YOUNG WOMEN'S LIVES

13. Delaying Marriage in Yemen

This June 2010 brief describes how the Extending Service Delivery (ESD) Project, in partnership with the Basic Health Services (BHS) Project in Yemen and the Yemeni Women's Union (YWU), implemented the "Safe Age of Marriage" programme as part of Yemen's national effort to reduce maternal and neonatal mortalities. The pilot programme drew on voluntary community educators to communicate messages about ending marriage before the age of 18 and improving the poor health and social outcomes of marginalised young girls by changing entrenched social/gender norms and by stressing the importance of girls' education. The endline survey indicated that there was an 18% increase in awareness about the benefits of delaying marriage and a 16% increase in agreement that there is a relationship between early marriage, early pregnancy, and childbearing.

For more information about the Safe Age of Marriage Programme, please click here.

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14. Reaching Out-of-School and Marginalised Girls in Urban Ethiopia

This August 2009 baseline survey, published by Population Council, consists of interviews with over 1,000 out-of-school girls living in low income and slum areas of 3 cities in Ethiopia. The survey seeks to broaden understanding of the experience of the poorest and most marginalised girls, focusing on individual as well as structural and social factors that may increase girls' vulnerability to HIV and other negative health outcomes. The study highlighted that out-of-school girls are not only vulnerable, but also hard to reach. Mechanisms to reach this population may include going door-to-door to identify the most marginalised girls and negotiating with gatekeepers, such as guardians or employers, for their participation in a programme. Explicit messaging is also needed on non-consensual and transactional sex. At the same time, messages must also address the risk of HIV transmission within marriage, and to promote the condom as an appropriate family planning and disease prevention method within marriage. Programmes should also address social and contextual factors that exacerbate girls' risk of negative reproductive health outcomes, including HIV infection.

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This publication is made possible by the support of the American people through the United States Agency for International Development (USAID) under the terms of Agreement No. GPO-A-00-07-00004-00. The contents are the responsibility of The Communication Initiative and the C-Change project, managed by AED, and do not necessarily reflect the views of USAID or the United States Government.