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External Evaluation Of The Southern African Regional .

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External Evaluation of the Southern African Regional Social and BehaviorChange Communication Program, as Implemented in NamibiaPaul Hutchinson, Dominique Meekers, Jennifer WheelerJohn Hembling, Philip Anglewicz, Eva Silvestre, and Joe KeatingDepartment of Global Health Systems and DevelopmentTulane University School of Public Health and Tropical MedicineNew Orleans, Louisiana, USAJune 2012

AcknowledgementsThis report was written by Paul Hutchinson, Jennifer Wheeler, Dominique Meekers, John Hembling,Philip Anglewicz, Eva Silvestre and Joe Keating of the Tulane University School of Public Health andTropical Medicine. Data were collected by Social Impact Assessment and Policy Analysis Corporation(SIAPAC) led by David Cownie, Robin Weeks and Randolph Mouton. The authors would like to thankMrs. Aina Shinyemba and Mr. Mr. Thimo Hangula of the National Statistics Office, Namibia, for theirtimely assistance in selecting the sample and preparing the enumeration area maps. We are particularlygrateful to Esca Scheepers for her comments, suggestions, and guidance with the evaluation. We thankMrs. Rejoice Chakare from SAfAIDS and Mrs. Rosa Ndahafa from Desert Soul, who provided informationabout their programs and guidance with the training; Soul City Institute colleagues Sue Goldstein,Michael Jana, and Renay Weiner, who contributed their regional experience to the evaluation, and DFID,for their support. We are also thankful to Invest in Knowledge (Malawi) and Susan Watkins for assistingwith the development of materials for this evaluation.i

AcronymsARTAntiretroviral TherapyARVsAntiretroviral DrugsAVAudio-VisualCBOCommunity Based OrganizationCBVCommunity Based VolunteerDfIDBritish Department for International DevelopmentEAEnumeration AreaGBVGender-based ViolenceIKIInvest in KnowledgeIVInstrumental VariablePHCPopulation and Housing CensusPLHIVPeople Living with HIVPLWHAPeople Living With HIV and AIDSPSMPropensity Score MatchingSADCSouthern African Development CommunitySAfAIDSSouthern African HIV and AIDS Information and Dissemination ServiceSBCCSocial and Behavioral Change CommunicationSC IHDCSoul City Institute for Health and Development CommunicationSEMStructural Equation Modelingii

Table of ContentsACKNOWLEDGEMENTS . IACRONYMS . IITABLE OF CONTENTS. IIILIST OF FIGURES. VEXECUTIVE SUMMARY . VIIICHAPTER 1. INTRODUCTION . 11.1 BACKGROUND .11.2 OBJECTIVES OF THE EVALUATION .3CHAPTER 2. METHODS . 42.1 STUDY DESIGN .42.2 SAMPLING.42.2.1 SAMPLE DESIGN .42.2.2 SAMPLE ALLOCATION.52.2.3 SAMPLING PROCEDURES .62.3 FIELDWORK.72.3.1 FIELDWORK TRAINING .82.3.2 QUESTIONNAIRE DEVELOPMENT .102.3.3 RESULTS OF FIELDWORK .102.4 QUANTITATIVE METHODS .112.4.1 PROGRAM EXPOSURE MEASURES .112.4.2 MULTIVARIATE REGRESSION ANALYSIS .132.4.3 PROPENSITY SCORE MATCHING .142.4.4 SIMULTANEOUS EQUATIONS MODELING .152.4.5 OTHER ISSUES .17CHAPTER 3. SAMPLE CHARACTERISTICS . 183.1 GENERAL DESCRIPTION OF SAMPLE .183.2 LOGFRAME INDICATORS FOR NAMIBIA ONELOVE .20CHAPTER 4. DESERT SOUL RESULTS . 224.1 EXPOSURE MEASURES .224.2 REACH .274.2.1 REACH OF THE ONELOVE CAMPAIGN .274.2.2 REACH OF DESERT SOUL .294.3 RESULTS FOR GENERAL POPULATION (TOTAL, MALE, FEMALE) .294.3.1 MULTIPLE PARTNERS .304.3.2 OTHER RISK FACTORS .384.3.3 HIV COMMUNICATION .394.3.4 CONDOM USE .42iii

4.3.5 HIV TESTING .484.3.6 HIV TREATMENT .524.3.7 HIV STIGMA .544.3.8 GENDER-BASED VIOLENCE .574.4 RESULTS FOR VULNERABLE POPULATIONS .584.4.1 WOMEN AGED 15-24 .584.4.2 BORDER AREAS .65CHAPTER 5. SAFAIDS RESULTS . 735.1 EXPOSURE MEASURES .735.2 REACH .765.3 RESULTS FOR GENERAL POPULATION (TOTAL, MALE, FEMALE) .765.3.1 MULTIPLE PARTNERS .775.3.2 OTHER HIV RISK FACTORS .795.3.3 HIV COMMUNICATION .795.3.4 CONDOM USE .805.3.5 HIV TESTING .835.3.6 HIV TREATMENT .845.3.7 HIV STIGMA .855.3.8 GENDER-BASED VIOLENCE .865.4 VULNERABLE POPULATIONS .875.4.1 WOMEN AGES 15-24 .875.4.2 BORDER AREAS .89CHAPTER 6. MARGINAL AND CUMULATIVE EFFECTS . 906.1 METHODOLOGY .906.2 RESULTS .936.2.1 MULTIPLE AND CONCURRENT PARTNERSHIPS .936.2.2 OTHER RISK FACTORS .946.2.3 HIV COMMUNICATION .946.2.4 CONDOM USE .956.2.5 HIV TESTING .966.2.6 HIV TREATMENT .976.2.7 HIV STIGMA .986.2.8 GENDER-BASED VIOLENCE .98CHAPTER 7. VALUE-ADDED OF THE REGIONAL PROGRAM PARTNERS . 1007.1 MULTIPLE PARTNERS AND OTHER HIV RISK FACTORS .1007.2 HIV COMMUNICATION .1017.3 CONDOM USE .1027.4 HIV TESTING .1027.5 HIV TREATMENT .1037.6 HIV STIGMA AND GENDER-BASED VIOLENCE.104WORKS CITED . 105iv

List of FiguresFigure 1: Kish grid. 7Figure 2: Exposure to OneLove, by gender . 23Figure 3: Exposure to OneLove, by domain . 24Figure 4: Effects of exposure to OneLove on self-reported having concurrent partners in the past 12months . 36Figure 5: Effects of exposure to any OneLove media channel on agreement that people discuss theincreased HIV risk with having multiple partners . 37Figure 6: Effects of exposure to OneLove booklets on HIV communication . 41Figure 7: Effects of Exposure to OneLove radio program on condom use at last sex, if regular partner. 43Figure 8: Effects of exposure to two or more media channels on condom use at last sex among thosewho had sex in the last year . 48Figure 9: Effects of exposure to OneLove radio on having and HIV test in the last 12 months, males . 49Figure 10: Effects of exposure to OneLove booklets on disagreement that HIV is a punishment for sinning. 56Figure 11: SAfAIDS exposure by sex . 73Figure 12: SAfAIDS exposure by age, men . 74Figure 13: SAfAIDS exposure by age, women . 74Figure 14: SAfAIDS exposure by domain. 74Figure 15: Effects of exposure to SAfAIDS and reporting not needing a sexual partner to fill gap . 78Figure 16: Effects of exposure to SAfAIDS on agreement that communication can improve sex life . 80Figure 17: PSM results for condom at last sex, always/usually use a condom, and condom use amongthose who had sex in the last 12 months . 82Figure 18: SAfAIDS exposure and having supported someone on ART . 85v

List of TablesTable 1: Number of EAs to be selected, by domain and subdomain . 6Table 2: Sample characteristics. 18Table 3: Logframe Indicators (targetsand progress) . 21Table 4: OneLove exposure by domain. 25Table 5: Summary of multivariate results for OneLove and multiple partners . 31Table 6: Summary of multivariate results for OneLove and other HIV risk factors . 38Table 7: Summary of multivariate results for OneLove and other HIV communication . 39Table 8: Summary of multivariate results for OneLove and condom use . 44Table 9: Summary of multivariate results for OneLove and HIV testing . 49Table 10: Summary of multivariate results for OneLove and HIV treatment . 52Table 11: Summary of multivariate results for OneLove and HIV stigma. 54Table 12: Summary of multivariate results for OneLove and gender-based violence . 57Table 13: Summary of multivariate results for OneLove and multiple partnerships, women 15-24 . 58Table 14: Summary of multivariate results for OneLove and other HIV risk factors, women 15-24. 60Table 15: Summary of multivariate results for OneLove and HIV communication, women 15-24 . 60Table 16: Summary of multivariate results for OneLove and condom use, women 15-24 . 62Table 17: Summary of multivariate results for OneLove and HIV testing, women 15-24 . 63Table 18: Summary of multivariate results for OneLove and HIV treatment, women 15-24. 64Table 19: Summary of multivariate results for OneLove and HIV stigma, women 15-24 . 64Table 20: Summary of multivariate results for OneLove and GBV, women 15-24 . 65Table 21: Summary of multivariate results for OneLove and multiple partners, border areas . 66Table 22: Summary of multivariate results for OneLove and other HIV risk factors, border areas . 67Table 23: Summary of multivariate results for OneLove and other HIV risk factors, borde

External Evaluation of the Southern African Regional Social and Behavior Change Communication Program, as Implemented in Namibia . Pau