Issue 27 | FEBRUARY 2011
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Evaluations of SBCC interventions to prevent HIV

C-Channel 27 presents six articles that evaluate outcomes of social and behavior change communication (SBCC) interventions and campaigns to prevent the spread of HIV. Such interventions and programs incorporate behavior and prevention theories, formative research, advocacy toward an enabling environment for change, and community mobilization.

Of Interest

C-Change developed the Community Conversation Toolkit to assist communities in the southern Africa region to initiate discussions around key drivers of HIV. The interactive formats of the six materials are designed to mobilize adults age 20 and over to take actions to prevent HIV. The toolkit can be downloaded at C-Hub, and will be available in Sotho and Zulu in February.

The first article reviews an intervention to reduce gender-based violence and HIV risk in South Africa, and the second evaluates a US-based, parent-child communication program adapted to rural Kenya. The third and fourth articles address, respectively, outcomes of a multi-channel behavioral intervention and a community-based prevention program in India for two populations considered at high risk of HIV infection and transmitting the virus: female sex workers and their clients and men who have sex with men. The fifth and sixth examine SBCC programs in the Caribbean: the impact of strategies and campaigns to prevent HIV in Trinidad and Tobago, and the results in the Bahamas of combining a theory-based SBCC program for youth with a parental communication program.

C-Change recently launched Version 2 of the C-Modules-a six-module learning package for facilitated, face-to-face workshops on SBCC for communication practitioners working in development. A facilitator's guide accompanies each module. Feedback from practitioners, an expanded section on application of theory and models, and a nuanced explanation of the tipping point for change informed this version. Download C-Modules from the C-Change website.


In this issue

Evaluations of SBCC interventions in sub-Saharan Africa

1. An intervention in South Africa that integrates gender-based violence and HIV prevention 

2. A US program to improve parent-child communication about sex adapted for rural Kenya

Outcomes of SBCC interventions for at-risk groups in India

3. A multimedia behavioral intervention among clients of female sex workers

4. A theory- and community-based program for sex workers and MSM

Results of SBCC interventions to prevent HIV in the Caribbean

5. HIV prevention strategies and campaigns in Trinidad and Tobago

6. A prevention program for Bahamian youth coupled with a parent intervention

Evaluations of SBCC interventions in sub-Saharan Africa

1. Integrated gender-based violence and HIV risk reduction intervention for South African men: Results of a quasi-experimental field trial

Authors: Kalichman SC 1; Simbayi LC 2; Cloete A 2; Clayford M 2; Arnolds W 2; Mxoli M 2; Smith G 2; Cherry C 1; Shefer T 3; Crawford M 1; Kalichman MO 1
Institutions: 1 University of Connecticut, USA; 2 Human Sciences Research Council, South Africa; 3 University of the Western Cape, South Africa
Source: Prevention Science, Sep 2009; 10(3): 260-9. [Epub before print; PubMed Central]

South Africa is in the midst of one of the world's most devastating HIV/AIDS epidemics and there is a well-documented association between violence against women and HIV transmission. Interventions that target men and integrate HIV prevention with gender-based violence prevention may demonstrate synergistic effects. A quasi-experimental field intervention trial was conducted with two communities randomly assigned to receive either: (a) a five session integrated intervention designed to simultaneously reduce gender-based violence (GBV) and HIV risk behaviors (N = 242) or (b) a single 3-hour alcohol and HIV risk reduction session (N = 233). Men were followed for 1-, 3-, and 6-months post intervention with 90% retention. Results indicated that the GBV/HIV intervention reduced negative attitudes toward women in the short term and reduced violence against women in the longer term. Men in the GBV/HIV intervention also increased their talking with sex partners about condoms and were more likely to have been tested for HIV at the follow-ups. There were few differences between conditions on any HIV transmission risk reduction behavioral outcomes. Further research is needed to examine the potential synergistic effects of alcohol use, gender violence, and HIV prevention interventions.

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2. Evaluation of a U.S. evidence-based parenting intervention in rural Western Kenya: From Parents Matter! to Families Matter!

Authors: Vandenhoudt H 1; Miller KS 2; Ochura J 3; Wyckoff SC 2; Obong'o CO 3; Otwoma NJ 3; Poulsen MN 2; Menten J 1; Marum E 2; Buvé A 1
Institutions: 1 Institute of Tropical Medicine, Belgium; 2 Centers for Disease Control and Prevention, USA; 3 Kenya Medical Research Institute
Source: AIDS Education and Prevention, Aug 2010; 22(4): 328-43.

We evaluated Families Matter! Program (FMP), an intervention designed to improve parent-child communication about sexual risk reduction and parenting skills. Parents of 10- to 12-year-olds were recruited in western Kenya. We aimed to assess community acceptability and FMP's effect on parenting practices and effective parent-child communication. Data were collected from parents and their children at baseline and 1 year postintervention. The intervention's effect was measured on six parenting and parent-child communication composite scores reported separately for parents and children. Of 375 parents, 351 (94%) attended all five intervention sessions. Parents' attitudes regarding sexuality education changed positively. Five of the six composite parenting scores reported by parents, and six of six reported by children, increased significantly at 1 year postintervention. Through careful adaptation of this U.S. intervention, FMP was well accepted in rural Kenya and enhanced parenting skills and parent-child sexuality communication. Parents are in a unique position to deliver primary prevention to youth before their sexual debut as shown in this Kenyan program.

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Outcomes of SBCC interventions for populations at risk of HIV in India

3. Increases in self-reported consistent condom use among male clients of female sex workers following exposure to an integrated behaviour change programme in four states in southern India

Authors: Lipovsek V 1; Mukherjee A 2; Navin D 2; Marjara P 3; Sharma A 2; Roy KP 2
Institutions: 1 Population Services International, USA; 2 Population Services International, India; 3 Ministry of Health & Family Welfare, India
Source: Sexually Transmitted Infections, Feb 2010; 86(S1): i25-32.

PURPOSE: As part of the Avahan India AIDS Initiative, a behaviour change communication programme sought to increase consistent condom use (CCU) among male clients of female sex workers (FSWs) in four Indian states through the use of outdoor static promotional materials, interpersonal communication and mid-media activities. This paper presents key findings related to programme coverage levels, trends over time in self-reported condom use, and correlations between levels of exposure to programme activities and self-reported condom use.
METHODS: Five stratified two-stage cluster sample surveys were conducted between April 2006 and November 2008 (sample sizes ranged from 1741 to 2041). The independent samples were composed of clients of FSWs in selected clusters. Multivariate logistic regression was used to model whether behavioural outcomes varied between baseline and endline, and whether they varied with levels of exposure to the intervention.
RESULTS: Over two-thirds of men in each survey round recalled one or two of the main intervention channels. An increase in CCU with FSWs was found between baseline and endline (63.6% vs 86.5; p<0.01). Men exposed to two intervention channels reported higher CCU than men exposed to none or only static outdoor media (89.4% vs 82.0%, p<0.05). This trend was sustained for condom use at last sex (96.2% vs 92.6%, p<0.05).
CONCLUSION: Evaluation suggests that a multi-channel behavioural intervention delivered at sites where FSWs are solicited can increase CCU among male clients of FSWs. Further research is needed on the dynamics of exposure to multiple communication channels and the contributions of complementary interventions.

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4. Community-based prevention leads to an increase in condom use and a reduction in sexually transmitted infections (STIs) among men who have sex with men (MSM) and female sex workers (FSW): The Frontiers Prevention Project (FPP) evaluation results

Authors: Gutierrez JP 1,2; McPherson S 3; Fakoya A 3; Matheou A 4; Bertozzi SM 1
Institutions: 1 National Institute of Public Health, Mexico; 2 London School of Hygiene & Tropical Medicine, UK; 3 International HIV/AIDS Alliance, UK; 4 India HIV/AIDS Alliance
Source: BMC Public Health, 18 Aug 2010; 10:497. [Open Access]

BACKGROUND: India has an estimated 2.0 million to 3.1 million people living with HIV; it has the highest number of HIV-positive people in Asia and ranks third in the world. The Frontiers Prevention Project (FPP) was implemented in 2002 to conduct targeted prevention intervention geared towards female sex workers (FSW) and men who have sex with men (MSM) in the state of Andhra Pradesh (AP). This paper reports the overall changes in behaviour and STI outcomes between 2003/4 and 2007 and also describes the changes attributed to the FPP.
METHODS: The evaluation used two cross-sectional surveys among MSM and FSW at 24 sites in AP. Surveys were implemented using a similar methodology. Univariate analyses were conducted by comparing means: baseline vs. four-year follow-up and FPP vs. non-FPP. For both MSM and FSW, random and fixed-effects logit regression models at the site level were estimated for condom use with last partner, syphilis sero-positivity and HSV 2 sero-positivity. In addition, for FSW we estimated models for condom use with regular partner, and for MSM we estimated models for condom use with last female partner.
RESULTS: Among MSM, fixed-effects analysis revealed that FPP was positively correlated with the probability of condom use with last female sexual partner and negatively correlated with the individual probability of sero-positivity to syphilis and HSV 2. Among FSW, the FPP intervention was significantly correlated with increased condom use with regular partners and with lower probability of STI sero-positivity.
DISCUSSION: Important changes in behaviours related to an increase in prevention activities translated to reductions in STI sero-prevalence in AP, India. In contrast with non-FPP sites, the FPP sites experienced an intense community approach as part of the FPP intervention, and the general increase in condom use and its effect on STI sero-prevalence reflected the efficacy of these intense prevention activities focused on key populations in AP.

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Impact of SBCC interventions to prevent HIV in the Caribbean

5. An evaluation of intervention strategies for HIV/AIDS in Trinidad and Tobago (2000-2007)

Authors: Jurawan K; Dindial D; Hosein S; King D; Sahadeo A; Mungrue K
Institution: The University of the West Indies, Trinidad
Source: International Journal of Adolescent Medicine and Health, Oct-Dec 2009; 21(4): 581-9.

OBJECTIVE: To evaluate the impact of health promotional strategies against The Acquired Immune Deficiency Syndrome (HIV/AIDS) in Trinidad and Tobago.
METHODS: The HIV/AIDS Morbidity and Mortality reports were used to chart the pattern of change in the incidence of new HIV positive cases for the years 2000-2007 to determine the decrease in new HIV positive cases after 2004 with the implementation of the National Strategic Plan as well as What's Your Position (WYP), KNOW Your Status and Get Tested Now campaigns. These effects were tested using a quasi-experimental, post exposure design. A cross-sectional survey using street intercept interviews provided data on intervention effectiveness. Logistic regression analysis was used to determine the impact of HIV/AIDS campaigns, using their respective objectives.
RESULTS: The study showed that a 16% decline in new HIV positive cases began during 2003 and 2004 and continued to decline by smaller margins until 2007. Data collected from the 599 participants with exposure to at least one campaign found that 92.7% reported awareness of WYP, followed by GTN (71.1%), RIU (42.6%), KYS (38.4%) and OUCH! (8.5%). 23.7% participants reported condom use post program exposure, whereas 19.0% practiced informed abstinence. A relationship was found between KYS and HIV/ AIDS Testing (p = .016) and between RIU and increased condom use (p = .010).
CONCLUSIONS: Since the implementation of the programs, there have been positive lifestyle modifications among the sample population. Particularly "WYP" has been particularly effective in increasing awareness of practicing abstinence, faithfulness to one partner, condom usage when applicable, knowing their HIV status and further educating themselves about HIV/AIDS.

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6. Effects on condom use of an HIV prevention programme 36 months postintervention: A cluster randomized controlled trial among Bahamian youth

Authors: Chen X 1; Stanton B 1; Gomez P 2; Lunn S 2; Deveaux L 2; Brathwaite N 2; Li X 1; Marshall S 1; Cottrell L 3; Harris C 3
Institutions: 1 Wayne State University, USA; 2 Bahamas Ministry of Health; 3 West Virginia University, USA 
Source: International Journal of STD & AIDS, Sep 2010; 21(9): 622-30.

Data are lacking on long-term effects of HIV behavioural intervention programmes. In this study, we report intervention effects 36 months postintervention on condom use and relevant outcome variables from the theory-based programme 'Focus on Youth in the Caribbean' (FOYC). Participants (1360 sixth-grade youth) were randomized by school into: (1) FOYC, plus one of two brief parent interventions or (2) the control condition 'Wondrous Wetlands', plus a brief parent intervention. Mixed effect analysis demonstrated significant programme effects, including enhanced HIV/AIDS knowledge (effect size D = 0.44, 95% confidence interval [CI]: 0.43, 0.46), increased self-efficacy of (D = 0.42, 95% CI: 0.30, 0.54), skills for (D = 0.62, 95% CI: 0.56, 0.64) and intention to use a condom (D = 0.20, 95% CI: 0.03, 0.37). Youth who received FOYC plus the parental monitoring intervention had higher condom use rates (odds ratio = 1.49, 95% CI: 0.97, 2.28). Feedback effects from key variables were also detected, supporting the sustained effect.

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