Malawi’s BRIDGE Project

Developed to address the rapidly increasing rate of HIV infections in Malawi, the BRIDGE Project had five main objectives: (1) increase the median age for becoming sexually active, (2) decrease the number of unmarried youth having sex, (3) decrease the number of men reporting more than one sexual partner, (4) increase condom use among unmarried youth, and (5) increase condom use by adults with non-regular partners. Project development began with a literature review and the creation of a logic model that divided the program into national, community, and individual levels and outlined activities, interventions, and short and long-term outcomes associated with each. Program developers worked with local partners to identify eight districts where BRIDGE programming could be implemented, while a mass media campaign would have a national reach. Focus groups and one-on-one interviews were used to uncover perceptions, norms, key motivators and barriers, and the best channels for distributing information to target audiences. Phase one of the campaign was designed to increase self-efficacy among Malawians in their ability to prevent HIV and AIDS. This was done by presenting audiences with small, do-able actions like discussing HIV with family members and encouraging friends to avoid risky situations. After self-efficacy had been increased, the focus of BRIDGE programming shifted to promoting risk reduction behaviors. Pregnant women, older men, younger women, and community leaders were the primary audiences targeted through this campaign. A variety of unique programs were developed under the BRIDGE umbrella to reach each of these audiences, including the Tisankhenji (the choice is mine) radio program, radio diaries, Nditha! Sports, girls’ leadership congress, and Agogos ("grandmothers") training. In addition to each of these specialized programs, the “Hope Kit” was developed to assist community organizations in conducting local outreach, providing them with materials like ready-to-use discussion guides and activities and demonstrations that modeled HIV prevention behaviors. As the campaign progressed, updates were created for the kit to reflect the needs of each participating district. Effectiveness of the BRIDGE program was measured through the use of household surveys, that used non-intervention groups for comparison. All eight districts were surveyed pre and post intervention, and four districts also completed two midterm surveys. Overall knowledge about HIV/AIDS increased from about 67% at baseline to more than 77% by the end of the campaign. Improvements were also seen in HIV testing rates, with the rate increasing from less than 15% pre-intervention to over 50% by the end of the project. 
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