Promoting HIV Prevention Behaviors in Malawi through the BRIDGE Project

"Important improvements were observed in behavioral predictors, behaviorial intentions, and some of the behaviors themselves that protect Malawians from HIV & AIDS. Improvements have also been seen in stigmatizing attitudes toward people living with HIV or AIDS..."

From the United States Agency for International Development (USAID), this report presents findings from the outcome evaluations pertaining to BRIDGE, a behaviour change initiative initiated in 2003 that aims to encourage Malawians to adopt behaviours that prevent HIV transmission. With funding from USAID, the Malawi BRIDGE project uses mass media and community-based interventions in Malawi specifically charged with preventing HIV infection through a theoretically informed behaviour change programme in 8 districts. The research report explores the following intervention components:

• Household Survey Evaluation at End-of-Project: Assessments of the relationship between exposure to the BRIDGE interventions and key outcomes at the end of the project;
• Household Survey Trends from Baseline to End-of-Project: Assessments of fluctuations in behaviours and behavioural outcomes from baseline to end-of-project;
• The Tisankhenji Radio Program: Quantitative and qualitative assessments undertaken to evaluate how the programme affected youth and how this influence occurred;
• Social Network Analysis of Dissemination of the Hope Kit: Maps the interpersonal communication patterns in a community to determine how Hope Kit dissemination occurred and what effects ensued;
• Agogo Training: Qualitative assessment to determine the effects of training traditional counsellors of young people on HIV and AIDS issues;
• Nditha! Sports: Interviews with participants in an outreach programme using games and play to teach about HIV and AIDS to determine if sports is an appropriate vehicle for learning about health; and
• Girls Congresses: Qualitative assessment to determine whether and how skills building and information can help build girls' resilience to avoid HIV.

The primary research and evaluation design comprised a series of household-level cross-sectional surveys, conducted through random sampling procedures at baseline (2003), the first midterm (2006), the second midterm (2007), and end-of-project (2008). The baseline and end-of-project surveys were conducted in all 8 BRIDGE districts. The 2 midterm surveys were designed to be representative of all 8 districts, but were conducted in 4 districts. In addition to the household surveys, the following assessments were carried out: quantitative and qualitative assessments of the Tisankhenji Radio Program, the social network analysis of diffusion of the Hope Kit, evaluation of the Agogo Training, assessment of Nditha! Sports, and assessment of the Girls Leadership Congress.

An excerpt from the report describing outcomes of each of the intervention components follows:

"Household Surveys....Important gains were observed in psychosocial predictors of behaviors, behavioral intentions, and some behaviors themselves. When compared to baseline values, at the end of the project, we observed gains in knowledge about HIV & AIDS, improvements in self-efficacy to engage in self-protective behaviors, reductions in stigma toward people living with HIV or AIDS, increases in uptake of HIV testing, and gains in behavioral intentions....At the end of the project, significant associations were observed between exposure to the BRIDGE project's activities and high-risk sexual behaviors - diminished likelihood of engaging in multiple sexual relationships and increased likelihood of using condoms consistently. These associations were observed even after controlling for demographic indicators and exposure to non-BRIDGE activities....At the end of the project, we also observed significant differences in community vibrancy (level of activity, community organizing, and unity), as reported by community residents, between areas where the BRIDGE project had an active presence and ones in which the BRIDGE project was not present.

Tisankhenji Radio Program. Evaluation of the Tisankhenji Radio Program revealed that students in the treatment, compared to control, schools were significantly more likely to have: greater career aspirations; higher self-efficacy to engage in meaningful discussions with their teachers and parents about topics relating to their future careers; and more discussions about their career plans with their friends, teachers, and parents. Positive outcomes were observed for both boys and girls in the treatment schools, even though the program specifically targeted girls. Qualitative studies done with girl participants revealed that they were cognizant of the barriers they would encounter in their pursuit of career goals, but had higher self-efficacy to overcome these barriers...

Diffusion of the Hope Kit. The social network analysis comprised a study of a community in Njolomole in Ntcheu district....Results indicated that participation in Hope Kit activities was associated with higher community efficacy, more favorable gender norms, and self-efficacy to use condoms. The analysis also found; however, that non-participants who interacted with Hope Kit participants did not gain much knowledge despite their social ties. Gains obtained by participating in the Hope Kit appears not to have been disseminated to non-participants.

Agogo Training. Assessments of the Agogo (grandmothers) training showed that grandmothers could be used as effective conduits of influence to impart information about HIV prevention behaviors and sexuality to young girls. The trained Agogo counseled not only girls in their own family but also others in the larger community, and both the Agogo themselves as well as the girls they counseled evaluated the program very highly. The Agogo also focused on removing cultural practices that put young girls at greater risk to HIV & AIDS.

Nditha! Sports. Participants...reported having undergone positive changes in their attitudes, beliefs, and behaviors with regard to sexuality. They also demonstrated keen interest in continuing their education. After the program, participating youth were found to be more knowledgeable about issues pertaining to HIV & AIDS, especially with regard to preventing HIV infection, than when the project was first introduced.

Girls Leadership Congress. Participating girls reported having acquired critical thinking skills as a result of the program. This, in turn, helped them solve problems on their own, thereby increasing self-efficacy to deal with the challenges of facing negative gender norms. Girls also reported that their social network had been greatly expanded after their participation in the program."

Click here for the 102-page report in PDF format.