Battling HIV– how to reach young men in Bangladesh and Kenya?

News

29 November 2013

MI - Kenya

KIT has teamed up with AMREF (Kenya),  Bandhu Social Welfare Organisation (Bangladesh) and GGD Amsterdam to battle HIV among young men in Kenya and Bangladesh . Aim of the Motivational Intervention (MI+) program is to find out how to motivate young male to make safer choices about their sexuality and health. Young men are often absent in current programs focusing on sexual reproductive health (SRH), and health workers struggle finding the right way of approaching this group. The project started in September in Kenya, the first study and trainings in Bangladesh will take place in the coming two months.

Why young male in Bangladesh and Kenya?

Bangladesh has a concentrated HIV epidemic, and males who have sex with males (MSM) are particular at risk of becoming infected with HIV. The Government of Bangladesh is acknowledging the importance of reaching key affected populations with HIV prevention programmes, however, only 9.3% [1] of the group MSM-group is reached by any programme in Bangladesh.
Kenya has a mixed HIV epidemic.  About 5.9 % of the population (1.2 million people) is currently infected with HIV. The percentage of young people with HIV  is higher, up to 8%. Adolescents still have inadequate access to SRH information and services and only 12% of the health facilities provide youth friendly services. Especially young men are currently neglected in studies and interventions. To tackle these growing numbers of young males infected with HIV and young male not treated for HIV, KIT and partners developed the MI+-programme.

From moralizing to motivating

Health staff all over the world often face challenges with addressing young’s people sexuality. Sessions traditionally end up providing information and advice, often in a moralizing way. The Motivational Intervention- project (MI+) has three goals:

  1. To better equip young male in Dhaka and Chittagong in Bangladesh and young men in Ugenya in Siaya county in Kenya with the motivation, skills and supportive environment to make healthier choices about their sexuality.
  2. To enhance the skills of medical service providers, counsellors and peer educators to assist clients/peers with how they could change their behaviour by helping clients to explore and resolve ambivalence instead of telling them what to do.
  3. The research element of the project aims to provide an evidence base to inform policy and practice in being more responsive to the social reproductive health needs and rights of young males, regardless their sexual preferences.

Motivational Interviewing

Motivational interviewing (MI) refers to a counseling approach. It is a semi-directive, client-centered counseling style that helps clients to explore and resolve ambivalence. Compared with non-directive counseling, it’s more focused and goal-directed. Motivational Interviewing is a method that works on facilitating and engaging motivation within the client in order to change his behavior. A recent publication [2] on MI applied in groups shows that this can help raising the interest of young men in available SRH services, and, making them comfortable in using these services. MI  is believed to be an effective method to reach those young men reluctant to participate in SRH services .

Innovative MI+ Approach

Motivational Interviewing has been used to address a variety of other health-related issues. However, application in the HIV/Social Reproductive Health-domain, especially among young men, has been limited. This intervention combines Motivational Interviewing that is mostly focused on the individual with peer-led group activities. This newly developed approach is labeled MI+. This idea is based on a systematic review of Downing et al (2006) that indicates that sexual risk reduction interventions are (more) effective if behavioral individual level interventions are combined with group–level peer-led interventions addressing issues of intimacy, relationships, coping skills, interpersonal skills, relapse prevention, sexual negotiation and communication skills.

Additional operational research

Apart from designing effective interventions in Kenya and Bangladesh, KIT, in collaboration with national researchers, conducts operational research. KIT wants to find out whether MI+ would be an effective approach to improve the access to sexual reproductive health services and information for young men in Bangladesh and Kenya.
Are those who have never used services now taking them up and are those using them getting better quality services addressing their SRH needs and rights?
Adding operational research to the project, will help with gathering lessons learned, and help explain why certain things worked or why not, in different contexts.
In 2014 KIT and partners will publish the research results of this project.

Partners

MI+ is lead by KIT but supported by a consortium of Dutch and local strategic and academic partners.

We work with researchers:

  1. Mohammad Bellal Hossain, Associate Professor, Department of Population Sciences, University of Dhaka University, Bangladesh and;
  2. Paul Kiage, Population Scientist/Demographer, Nairobi, Kenya

Our partners are:

  1. GGD Amsterdam – the STI clinic;
  2. Bandhu Social Welfare Society Bangladesh;
  3. AMREF Kenya;
  4. Dance for Life Kenya.

MI+ is Sponsored by the Dutch ministry of Foreign Affairs under the DGIS SRHR-fund

Get in touch

Interested to learn more about this methods or our work on HIV/AIDS?
Contact: Pam Baatsen, Senior Advisor Health KIT Project Leader MI+
E p.baatsen@kit.nl
T +31 (0)20 568 8432

[1] UNAIDS (2012), UNAIDS Country Progress Report: Bangladesh
http://www.unaids.org/en/dataanalysis/knowyourresponse/countryprogressreports/2012countries/ce_BD_Narrative_Report[1].pdf
[2] Wagner C. C. and Ingersoll K.S. (with contributors) (2013) Motivational Interviewing in groups