Malawi BRIDGE I and II

BRIDGE I 

The Malawi BRIDGE 1 Project, 2004-2009, was aimed at reducing new HIV infections in the country by engaging Malawians to protect themselves against HIV, assisting stakeholders in moving from talk to action, and helping communities create a more helpful future through ‘Nditha’ meaning ‘I Can’ brand. BRIDGE was designed to energize change in the way Malawians think and speak about HIV/AIDS and more importantly, in how they act.

Findings from BRIDGE I showed that exposure to the program led to improvements in factors that influence behavior, such as couple communication, efficacy to remain faithful, and community vibrancy. Creating a sense of hope, self-efficacy and community responsiveness were critical achievements in BRIDGE I

BRIDGE I Strategic Principles and Core Values were:

  • Belief in a better future (hope)
  • Risk is shared by everyone (personalized risk)
  • I can STOP AIDS (personal responsibility, action, self-efficacy)
  • Discussion about HIV/AIDS (openness, destigmatization)
  • Gender equity (girls’ empowerment and changed men’s behavior)
  • Emphasizing the positive (action orientation, community assets, positive role modeling)

The project's objectives were:

  • Increase the median age at first sex
  • Decrease unmarried youth 15-24 having sex in last 12 months
  • Decrease number of men reporting more than one sexual partner during the last 12 months
  • Increase condom use by unmarried youth
  • Increase condom use by adults with non-regular partner
 
The Nditha! (I Can!) campaign, 2005-2007, comprised a large part of the BRIDGE I project, and was designed to create an enabling environment at the national level (case study)  The goal of the campaign was to reinforce feelings of confidence and self-efficacy among Malawians in their ability to prevent HIV and AIDS. (Nditha! means “I Can” in Chichewa.) The campaign highlighted the many “small do-able” actions that people could take right away to foster an environment of openness and support that would lead to greater adherence to the “ABCs.”
 

BRIDGE II

The Malawi BRIDGE II Project, 2009-2014, was a strategic, evidence-based communication program that was designed to build on and expand the lessons learnt from BRIDGE I. The overall goal was to contribute towards “Reduction of New HIV infections” through promoting normative behavior change and increasing (HIV) preventive behaviors among adult population in Malawi. It scaled up and deepened HIV and AIDS prevention activities in Malawi by removing barriers to individual action and confronting specific drivers of behavior at the normative/society level. Program activities built on the achievements of BRIDGE 1 Project. BRIDGE II supported the operationalization and implementation of National Prevention Strategy. The project aligned itself with National AIDS Framework goals, objectives and indicators, and with the responsibilities and related indicators that PEPFAR had committed to, under the Partnership Implementation Mechanism.

BRIDGE II Strategic Principles and Core Values were:

  • Bridge knowledge and action through greater individual and collective efficacy.
  • Redefine social/gender norms and harmful traditional practices.
  • Integrate services to take advantage of opportunities.
  • Develop leadership and strengthen communities of practice.
  • Generate and disseminate research findings and best practices.
  • Expand and scale up successful evidence-based interventions.

Four key objectives provided focus for achieving the BRIDGE II goal:

  • Individual perception of HIV risk and self-efficacy to prevent HIV infection strengthened,
  • Communities mobilized to adopt social norms, attitudes, and values that reduce vulnerability to HIV,
  • Prevention interventions strategically linked to services, and,
  • Malawian institutions supported for effective leadership and coordination.

To achieve these objectives, BRIDGE II implemented a multi-level HIV prevention program, intervening at the individual, district/community and national level to influence norms and behaviors. Key interventions included: a mass media campaign platform, reality radio programming, community mobilization, referral and linkages to services, and capacity building. These interventions aimed at all levels of the socio-ecological environment: At national level, the Tasankha mass media campaign and other radio programming served as the backbone of the project, and provided strategic behavior change messages on key issues, and complemented efforts at the district and community levels. At the district and community levels, one-on-one and group discussions supported individuals and communities to change risky behaviors and adopt healthier behaviors, seek out health services, and instilled a sense of ownership of the project, ensuring sustainability. Small group sessions were held with individuals and couples (where appropriate) that enabled them to access their risk, explore their options for reducing risk and make a plan to do so, including accessing services. Cross cutting activities such as capacity building served to strengthen capacity of local organizations and groups, empowering them to lead behavior change efforts.

Cross-sectional evaluation results for BRIDGE II indicate positive correlations between exposure to BRIDGE II interventions and HIV related outcomes. These include:

  • Higher HIV related knowledge among both women and men
  • Getting tested for HIV in the last twelve months
  • Greater self-efficacy to protect oneself from HIV
  • Greater intention to have only one partner and use condoms every time one has sex
  • Greater reported condom use at last sex
  • Higher ability to negotiate condom use
  • More positive attitudes towards gender equality