Looking back on the Breaking the Cycle Project

This piece was orginally featured on LinkedIn by James Bell, Associate Director at Ipsos.

Back in 2017 Ipsos, Population Services International, Matchboxology and the Bill and Melinda Gates Foundation embarked on an ambitious programme of work to understand the HIV-related needs of young men in South Africa. The project quickly arranged around three central ideas:

  1. That men’s needs have at times been overlooked, but that understanding what they need is vital for controlling the HIV epidemic in the country
  2. That men aren’t a single homogenous group, and their fears, needs and preferences vary widely, which should be taken into account in intervention design and service delivery
  3. That services as they are currently set up may not be optimally responding to the needs of men

Over the course of the research we spoke to over 2000 men in the provinces of KwaZulu-Natal and Mpumalanga. Our qualitative worked, reported here and here, uncovered that while men may appear to be indifferent, they are often immobilised by fear: testing positive for HIV represents a loss with no corresponding gain, and disclosure of a positive HIV test would reduce their standing in the community.

Our quantitative work, which has recently been published in PLOS ONE, addresses the second and third pillars of the research. Analysing over 2,000 survey responses using a segmentation methodology, which splits a population into subgroups based on their attitudes, beliefs and behaviours, we were able to break apart the idea that men have broadly the same needs when it comes to HIV services. Through applying a Human Centred Design (HCD) analysis process, we propose that men have very different life circumstances, personal histories with HIV, coping mechanisms for stress and uncertainty, and relationship to their community and community norms and expectations, which inform their approach to HIV testing and treatment initiation.

Understanding these different needs, we believe, has implications for the planning and delivery of HIV services for men. Although the results come from a robust quantitative methodology, one of their main applications is to provide a qualitative understanding of the ways in which men differ to service providers, which can inspire more differentiated (and therefore hopefully more effective) testing and treatment services.

This understanding led to the Coach Mpilo intervention, which takes the idea of differentiated care to its logical end-point, and pairs newly diagnosed men with individual HIV-positive coaches who can guide them through not only the testing and treatment process, but the wider social ramifications of diagnosis, such as disclosure to family and friends, and ongoing challenges including medication adherence. Early indications from a pilot with BroadReach and Right to Care, suggest that this focus on building relationships and thoroughly understanding individual needs and fears, is having a positive effect.

Looking back on the whole programme of work, I believe it shows the need to go beyond automatic assumptions about certain social groups (see, for example, Dean Peacock’s work) to a more empathetic understanding of more disaggregated needs and preferences. This could be an operational challenge, but need not be insurmountable with tools such as segmentation, and models such as Coach Mpilo to follow.

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