HIV and AIDS

ICRW researchers spoke to participants of a new project that has transformed attitudes and opened minds.

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A three-year program in Namibia that aimed to reduce people’s risky sexual behavior by curbing their alcohol use showed promising results that may be applicable in other settings in sub-Saharan Africa, a new report by AIDSTAR-One finds.

The report was part of an AIDSTAR-One initiative, in collaboration with the Gen Pop and Youth Technical Working Group of USAID’s Office of HIV/AIDS. AIDSTAR-One provides rapid technical assistance to USAID and U.S. government country teams and is funded by the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR). On behalf of AIDSTAR-One, the International Center for Research (ICRW) led the effort in partnership with the Society for Family Health (SFH) in Namibia.

Namibia is experiencing a severe, generalized HIV epidemic and has very high rates of alcohol consumption. The program was based Kabila, an informal settlement on the outskirts of Namibia’s capital city, Windhoek., The Kabila neighborhood, which encompasses about 2 sq miles, has a significant concentration of informal, home-based bars – 256 in total – that provide one of the few steady sources of income for community members. Drinking helps residents cope with stress associated with poverty, and going to a bar is among the few forms of entertainment for them.

ICRW and SFH worked with bar owners, patrons and community leaders to design, implement and evaluate a program to encourage the community to address hazardous alcohol use and make bars less risky environments for HIV transmission.

Among the findings from the evaluation:

• Binge drinking decreased from 54 percent to 25 percent
• Bar patrons who had the most exposure to program activities consumed less alcohol during bar visits
• Heavy drinkers were more likely to be exposed to the program’s activities and were significantly more likely to discuss condoms with a partner, buy condoms and refuse to have sex without a condom
• Bar owners found it feasible to change their bar’s environment by having shorter hours and displaying educational materials about alcohol. Sixty-four percent of patrons noticed the former, and 33 percent noted the shift in hours.

The effort in Namibia was one of a few taking place globally that seeks to develop community-level solutions to hazardous alcohol use. Most existing evidence around alcohol and HIV prevention programming is from sub-Saharan Africa, and focuses on individual drinking and risky behavior – not whole communities or the dynamics of bars that enable heavy drinking.

“The findings from this project in Namibia provide a significant contribution to the small, but growing body of evidence on how to tackle alcohol consumption as a contributor to HIV risk,” said Katherine Fritz, director of ICRW’s global health research and programs and a leading expert on the link between alcohol use and HIV. “The experience demonstrated that with community support, bar owners are willing to alter their establishment’s environment and intervene when they witness alcohol-induced risky behaviors.”

Fritz said the experience from the Kabila study can be built upon there and in other similar settings. To do so, the report offers several recommendations, including targeting binge drinking, which has been shown to contribute significantly to harmful behaviors; and encouraging bar staff to talk to patrons about safe sex practices, among other recommendations.

ICRW continues to gather evidence and identify innovative solutions to tackle social forces – like heavy alcohol consumption – that increase people’s vulnerability to HIV infection. ICRW is a member of STRIVE, a global research consortium that is investigating the social norms and inequities that drive HIV. Among efforts in this partnership, ICRW is addressing the correlation between alcohol, drug abuse and HIV among youth participating in an expanded version of Parivartan, a sports-based program in India.

Read more about this project:

Namibian Community Unites to Curb Alcohol Use and HIV Risk

ICRW Tackles Links Between Alcohol Use and HIV Risk

Environmental Influences  

As the year draws to a close, the International Center for Research on Women's (ICRW) Asia Regional Office in New Delhi, India, is preparing to expand a groundbreaking program that uses sports as a vehicle for social change.

In this case the sport is cricket, omnipresent in India, from high-end neighborhoods to slum communities. The ICRW program is called Parivartan, an innovative effort that from 2008 to 2012 drew in young men and boys through cricket to challenge them to question traditional notions of manhood in their society and teach them about respecting women and girls and preventing violence against them. Targeting boys 10 to 16 years old, the program took place in formal cricket sessions at Mumbai schools as well as informal settings in two Mumbai slum communities called Shivaji Nagar and ChittahCamp. With funding from The Nike Foundation, Parivartan was modeled after the "Coaching Boys Into Men" program by Futures Without Violence (formerly Family Violence Prevention Fund).

Now, ICRW will launch another version of Parivartan in 2013 with a new group of youth in two underserved areas. In a separate effort, experts in the New Delhi office also are proposing to scale up the original Parivartan model in two states that hold the highest incidences of violence against women nationally.

In each of these new endeavors, youth may play cricket or a different sport that is popular in their particular community.

ICRW's move comes at a time when the role of sports in international development and social change is gaining traction globally. The growing effort includes programs such as Fight for Peace in Brazil, which uses boxing and martial arts to help youth from violent communities realize their potential; Grassroot Soccer in South Africa, where with soccer games come lessons about HIV prevention; and Women Win, which uses sports as a strategy to advance the rights of girls and women around the world. Meanwhile, the United Nations General Assembly last month reaffirmed in a resolution the power of sports in empowering women and girls, strengthening education, facilitating conflict and more.

Indeed, Parivartan's program proved to have an impact on shifting participants' ideas about manhood and women's roles in society - their views became less patriarchal and more gender equitable after the program. Results from ICRW's evaluation of Parivartan demonstrated that sensitizing boys to gender issues can potentially change stereotypes they hold as well as their attitudes about violence against women.

For the next phase of the program, ICRW will develop "Parivartan Plus" as part of the British Department for International Development's STRIVE effort, which aims to address structural drivers - such as poverty and HIV-related stigma - that continue to fuel the AIDS epidemic. Parivartan Plus will take place in rural Karnataka in southern India and again in Shivaji Nagar, the Mumbai slum community of about 600,000 residents by using the local sport as a medium of engaging with adolescents.

The original Parivartan program model will be at the core of Parivartan Plus. However, ICRW and its partners will build upon the model by designing a curriculum to include components of HIV prevention, sexual and reproductive health as well as substance and alcohol use. And, for the first time, girl athletes will be included in the program.

"Part of what we want to evaluate is the feasibility of incorporating this Parivartan Plus model into the overall STRIVE strategy," said ICRW's Madhumita Das, a senior technical specialist who directs the Parivartan program. "We also want to better understand the links between gender norms, violence, substance use, HIV and sexual and reproductive health among youth."

The Parivartan Plus curriculum will be implemented by Kartnataka Health Promotion Trust (KHPT) with girls and boys in 40 to 60 schools and their catchment areas including thousands of villages in two districts in North Karnataka.

Girls also would be included for the first time in the other proposed Parivartan effort, which would involve a major expansion of the program. ICRW is proposing to replicate the original Parivartan model - this time with girls, too - in the states of Bihar and Rajasthan, which respectively have the highest and second-highest incidence of violence against women.

ICRW would partner with Magic Bus, an organization that uses sports-based curriculum to improve children's lives to reach an estimated 7,500 participants with almost 360 mentor coaches by engaging boys and girls of similar age from 90 villages across two districts of Bihar and Rajasthan. The original Parivartan program reached about 1,200 athletes.

Das said that the original Parivartan curriculum for the proposed expanded program should easily be transferrable to an audience of girls. "It's the way that you take up the discussion, not the content," she said. "And for girls especially, being involved in sports can be transformative in terms of boosting girls' confidence and self-efficacy."

"If you really want to achieve gender equality and reduce gender-based violence and see a larger impact on the lives of women and girls, you need to engage with boys and girls," Das added. "It's an investment in both."

Additional Resources: Parivartan: Transformation Through Sports

ICRW Senior Behavioral Scientist Anne Stangl on July 24 will be a panelist for a discussion on the challenges posed by HIV-related stigma and discrimination and the innovative solutions underway globally to address the issue. 

The event is being hosted by the Stigma Action Network and is part of the International AIDS Conference this week at the Walter E. Washington Convention Center in Washington, D.C. The discussion will take place from 4 p.m. to 5 p.m. in booth 810 at the Positive Action Networking Zone in the conference’s Global Village. 

Stangl and panelists will provide attendees with an understanding of the varied forms of HIV-related stigma and discrimination, how they fuel the epidemic, the unique challenges faced by key populations, and what to do to reduce stigma. Panelists also will highlight proven approaches for incorporating stigma reduction efforts into HIV programs, new evidence about stigma and how the Stigma Action Network is working to reduce HIV-related stigma. 

Learn how you can partner with ICRW.

ICRW Social and Behavioral Scientist Jennifer McCleary-Sills on July 24 will participate in a panel discussion on how to strengthen the capacity of organizations to understand and address gender issues, HIV and AIDS in their communities. 

The event is part of the International AIDS Conference this week in Washington, D.C., and will take place from 6:30 p.m. to 8:30 p.m. in mini room 8 at the Walter E. Washington Convention Center downtown. 

McCleary-Sills will discuss approaches ICRW used to guide two Tanzanian groups on how to engage with and mobilize communities to understand and address teenage girls’ vulnerability to HIV. Her presentation will draw from ICRW’s experience designing and evaluating the pilot project, "Vitu Newala,” which took place from 2010 to 2011 in a remote Tanzanian district. The effort was funded by the Positive Action program at ViiV Healthcare, a pharmaceutical company that focuses solely on HIV. 

The following day, McCleary-Sills will participate in a discussion in the Positive Action Networking Zone of the Global Village on how to involve adolescents in HIV prevention programs, and explain why programs targeting girls must also involve boys. That event is scheduled for 11 a.m. on July 25.

Learn how you can partner with ICRW.

The International Center for Research on Women (ICRW) on July 24 will co-host an event to launch a new global research consortium that will focus on investigating how to best address social inequalities that drive HIV.  The event is part of this week’s International AIDS Conference in Washington, D.C. 

Called STRIVE, the consortium is made up of six partners, including ICRW in Washington, D.C., and its Asia regional office in New Delhi, India, as well as other organizations from Tanzania, India and South Africa. The six-year effort is funded by the UK Department for International Development and managed by the London School of Hygiene & Tropical Medicine. 

“STRIVE represents an opportunity to build more evidence for what our research at ICRW has long shown—that a biomedical approach alone will not slow the rate of HIV infection throughout the world,” said Katherine Fritz, director of ICRW research and programs in global health. “It’s imperative that we also tackle the sometimes unseen but powerful forces at play – like poverty and gender inequality – that continue to make people more vulnerable to HIV and impede their access to critical treatment and prevention services.” 

The official kick off of STRIVE will include an introduction to the partner organizations and a panel discussion with leaders from around the world who are engaged in efforts to craft HIV programs that respond to the social, economic and political forces shaping the epidemic. 

STRIVE will aim to understand how forces such as gender inequality and violence, poor job prospects, stigma, and social norms around alcohol consumption fuel the AIDS epidemic – as well as undermine the effectiveness of HIV treatment and prevention programs. Researchers also will investigate what programs are effectively tackling these social, political and economic factors and how they can be expanded affordably. Finally, experts will determine how best to translate the STRIVE research into policy and on-the-ground programs. 

“If we intend to eliminate HIV from the planet,” Fritz said, “we have to design innovative programs that address these macro-level drivers of HIV risk by linking and engaging with development sectors outside of health.” 

Globally, there has been a resurgence in biomedical approaches – such as antiretroviral treatment as a prevention tool and medical male circumcision – to address the HIV epidemic.  At the same time, the global economic downturn has amplified calls to streamline HIV programs by concentrating funding into programs with proven impact. This has caused some governments and donor agencies to shy away from investing in multi-sectoral programs to address structural influences on the epidemic. Few of these types of programs have rigorous evidence of effectiveness. 

“This is why ICRW and its STRIVE partners believe that generating evidence to support the viability of addressing how social, political and economic issues in HIV programming is more important than ever,” Fritz said. 

Although ICRW’s specific contribution to STRIVE is still being finalized, Fritz suggested that ICRW could build on an existing body of work that examines the links between high alcohol consumption and HIV transmission. Under the consortium, researchers from ICRW’s Washington office also may address how to reduce stigma that inhibits pregnant women living with HIV from using services that could prevent transmission of the virus to their babies. 

Meanwhile, researchers based in New Delhi will expand Parivartan, an ICRW program for boys focused on changing norms around masculinity and violence against women. The expanded approach will now incorporate girls, and links between gender norms and violence, substance and alcohol use, sexuality and HIV. Under STRIVE, ICRW researchers also will document the adaptation and implementation of a stigma-reduction framework into five key sectors to advocate for a possible integration into India’s National AIDS Control Policy. 

Related content: Commentary: Getting to Zero

Gillian Gaynair is ICRW’s senior writer and editor.