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
AIDS 2012 - Turning the Tide Together
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