Multiple and Concurrent Sexual Partnerships in Generalised HIV Epidemics in Southern and East Africa

This 86-page report shares findings of a desk review conducted by Communication for Change (C-Change) project of communication programmes that focus on multiple and concurrent partnerships (MCP) in Southern and East Africa. The objective of the desk review was to identify lessons learned from recent experiences in designing, implementing, and evaluating these programmes and contribute to the body of evidence used to strengthen future HIV prevention programmes. According to the report, regarding the design of future MCP communication interventions, a strategic approach that focuses uniquely on MCP and addresses both risk perception and social norms related to the practice of MCP is recommended. Although reinforcing mass media with interpersonal and/or community activities is important, the inclusion of advocacy and/or social mobilisation is suggested to further support behaviour change at both the individual and community levels.

This report provides lessons learned from the following nine campaigns that address MCP: O Icheke (Botswana), Scrutinize (South Africa), Intersexions (South Africa), Andar Fora (Mozambique), Makhwapeheni Uyabulala (Swaziland), Club Risky Business (Zambia), One Love/Get off the Sexual Network (Uganda), Break the Chain (Namibia), and OneLove (Southern Africa Region). C-Change reviewed existing literature on the nine MCP campaigns and at least one interview was conducted for each campaign. Interviews provided additional documents and clarification on information found in documents, including lessons around design, implementation, and evaluation that may not have been captured in the documents reviewed.
The report shares a synthesis of programme evaluation results, which are available for almost all campaigns in this review.

• Programme outputs and outcomes: Of the eight campaigns whose evaluation were available for review, The Break the Chain campaign was successful in reducing MCP. Makhwapheni and One Love-South Africa were successful in reducing number of sexual partners. The remaining campaigns did not have an influence on MCP or number of sexual partners. Scrutinize increased awareness of the risk of HIV infection when engaging in MCP and Get off the Sexual Network increased intention to reduce the number of partners. The O Icheke campaign increased perceived MCP risk perception, community disapproval of MCP and negative attitudes towards having a variety of sexual partners and the following HIV risk reduction behaviours: condom use and HIV testing. Similar to The O Icheke campaign, results from a post-broadcast evaluation show that Intersexions was successful in increasing favourable attitudes toward condom use and discussions about HIV testing. All campaigns assessed the reach and reception of their activities and materials. Four campaigns: The Break the Chain, Scrutinize, Andar Fora, Intersexions, measured reception and resonance.
• Design and planning: Youth and young adults were the primary audience of most campaigns. Secondary audiences tended to be at the family and community levels. Only two campaigns provided information on the basis for selection of the intended audience and segmentation. Four campaigns identified determinants of MCP based on results research findings or theory and the Intersexions campaign relied solely on the Extended Parallel Model to identify determinants.
• Strategic approach and message content: Campaigns that reported a reduction in MCP or number of partners aimed to increase awareness of HIV risk associated with MCP and acceptability of MCP among the focus. In addition, two of these campaigns developed a strategic approach where messages are delivered in phases. Two of three campaigns that were successful at reducing barriers, but did not report decrease in MCP or number of sexual partners developed messages that focused on raising awareness about the HIV risk of MCP but did not address social norms around MCP. The O Icheke campaign, which addressed social norms, did not have an effect on MCP or partner reduction but it did change MCP related risk perceptions, attitudes, and norms. This campaign was also successful at increasing condom use and HIV testing and used a phased approach.
• Implementation: All campaigns used mass media accompanied by interpersonal, community, or social media activities. Social mobilisation/advocacy activities were used only by three campaigns. Although there was evidence of monitoring of campaign activities, well-defined monitoring and evaluation plans that included process, output, and outcomes indicators were difficult to obtain. Few campaigns worked with community-based organisations (CBOs) as key partners, and about half of the campaigns established linkages to HIV testing and counselling.
• Execution of activities and materials: Comparison of the activities used by successful campaigns with less successful campaigns does not yield many lessons learned. Two of the four campaigns that reduced MCP or number of sexual partners used mass media activities that were reinforced with social mobilisation/advocacy. Although community-level activities and social media provide enabling social environments for change, social mobilisation, and advocacy have the potential to bring about structural changes and further support individual and community change.

Lessons learned from these finding include that social mobilisation and advocacy activities are potentially important components of a successful MCP programme, and more effort is needed to increase the capacity of CBOs and increase their chances of success as key partners in MCP campaigns.

Several recommendations are made in regard to the findings of this report:

• With regard to the design of MCP communication interventions, a strategic approach that focuses uniquely on MCP and addresses both risk perception and social norms related to the practice of MCP is recommended.
• As social norms are often long-standing and strongly entrenched, the time and resources dedicated to interventions aiming to reduce MCP and by extension, HIV transmission rates will need to be revisited. Smaller audience segments and adaptation of theory with data gathered through formative research is suggested for more efficient interventions.
• In addition to reinforcing mass media with interpersonal and/or community activities, it is important to include advocacy and/or social mobilisation to further support behaviour change at both the individual and community levels.
• Although working with CBOs to implement campaign activities is important for reinforcing media activities at the community level, a detailed monitoring and evaluation plan that includes process indicators is recommended to ensure that CBOs are able to play this important role.
• Evaluations need to be well integrated into programme activities to be useful and standard measures of MCP and material effectiveness need to be developed and/or used to improve the usefulness of evaluation results.