Changes in HIV testing and condom use in Malawi: Longitudinal findings at midterm from the Malawi BRIDGE II Project

Abstract

Background: With 14.5% HIV prevalence, the southern region of Malawi is in urgent need of theoretically informed campaigns to promote behavior change. Since 2010, the BRIDGE II Project has run a mass media campaign with a potential national listenership of 70% in conjunction with community-based and interpersonal communication interventions that facilitate behavioral choices around HIV prevention in over 340 BRIDGE II communities in 11 districts in southern Malawi.We present midterm evaluation results on two key outcomes promoted by the campaigncondom use and HIV testing. Methods: A first-of-its-kind household-based longitudinal study was conducted in December, 2011 among 685 adults (56% female, average age=30.2 years, SD=10.9), two years after they were first interviewed before the campaign began. The longitudinal panel was selected on the basis of a stratified (by intervention or control) random sample. Results: Those who remained in the sample were less educated (pB.01) and poorer (pB.05) than those who dropped out. Compared to baseline, there was a 25.8% increase in HIV testing (pB.001) and 5.9% increase in condom use (p=.054) at midterm. Exposure to a key program component-the nullTasankhanull (nullWe have decidednull) messagewas associated with testing (r=.14, pB.001) and increase in condom use (r=.10, pB.05). Exposure to the reality radio program nullChenicheni Nchitinull was associated with condom use (r=.10, pB.05), but not with changes in HIV testing. Conclusion: HIV testing and condom use significantly improved at midterm, in comparison to baseline, and exposure to the BRIDGE II programs was significantly associated with these outcomes. Multiple sexual partnerships, another intervention-targeted outcome, were too few to analyze in this sample. Further analyses will explore the role of interpersonal discussion and community mobilization activities in propagating intervention messages. Overall, mass media messages, coupled with community activities, appear to show promise in the fight against AIDS.