HIV Behavior: Applying What We Know

By Nina Hasen, VP of HIV & TB Programs, PSI & Andrea Ferrand, Social and Behavior Change Senior Technical Advisor, Strategy and Insights, PSI

U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) staff are currently working on their Country Operational Plans (COP) for next year. In this year’s COP guidance, PEPFAR staff are encouraged to integrate behavioral and social science interventions into activities, something that hasn’t been a PEPFAR priority for some time. Here are five tips for PEPFAR staff on how to do that based on our experience at PSI, where we’ve been working on solving tough behavioral challenges related to HIV since early in the pandemic:

1.Effective behavioral interventions address the social and emotional components of HIV. In our research, we’ve seen that most people are much more scared of the social death that can come with an HIV diagnosis than they are of physical death from AIDS. The programs that tackle these fears head on get results. Check out our I CAN campaign or Coach Mpilo for example.

2. Ask your partners to use behavioral evidence and ground designs in any proven social and behavior change process. Design should include conducting or synthesizing formative research to inform key behaviors, intermediate outcomes to address those behaviors, and audience segments. These activities don’t have to be expensive or take a long time, but they should include rapid prototyping and testing of content before anything is piloted or scaled. PSI’s Keystone Design Framework is a free tool anyone can use.

3. Remember that the messenger is the message. A person living with HIV and thriving on treatment is much more credible than anyone else when it comes to persuading someone that there’s life after a positive diagnosis. HIV Survivors and Partners Network is a model.

4. Build monitoring and evaluation into the cost of the intervention. At a minimum, you’ll want to ensure that interventions are set up so that partners can track their impact on uptake indicators you’re trying to move. If you want to know what specifically worked to increase your service uptake, include measurement of intermediate outcomes, or the factors that you selected to change service use or adherence behaviors. Check out the MINA for Men campaign for a nice model.

5. Budget time and money for policy change. A lot of HIV communication ends up limited because health system leaders lack the information and confidence to endorse messages that run against conventional wisdom. For example, many health system leaders have yet to be fully exposed to the science of viral suppression and are fearful that endorsing U=U messaging will lead to dangerous disinhibition.These fears can be addressed through thoughtful exchanges of information featuring credible leaders (remember, the messenger is the message!) but it can take time. Assess the policy landscape as you plan behavioral interventions and give your partners the budget and time to address roadblocks before they implement. When it comes to U=U, Prevention Access Campaign can be a resource.


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