Evolving Strategies, Opportunistic Implementation: HIV Risk Reduction in Tanzania in the Context of an Incentive-Based HIV Prevention Intervention.

\ud Behavior change communication (BCC) interventions, while still a necessary component of HIV prevention, have not on their own been shown to be sufficient to stem the tide of the epidemic. The shortcomings of BCC interventions are partly due to barriers arising from structural or economic constraints. Arguments are being made for combination prevention packages that include behavior change, biomedical, and structural interventions to address the complex set of risk factors that may lead to HIV infection. In 2009/2010 we conducted 216 in-depth interviews with a subset of study participants enrolled in the RESPECT study - an HIV prevention trial in Tanzania that used cash awards to incentivize safer sexual behaviors. We analyzed community diaries to understand how the study was perceived in the community. We drew on these data to enhance our understanding of how the intervention influenced strategies for risk reduction. We found that certain situations provide increased leverage for sexual negotiation, and these situations facilitated opportunistic implementation of risk reduction strategies. Opportunities enabled by the RESPECT intervention included leveraging conditional cash awards, but participants also emphasized the importance of exploiting new health status knowledge from regular STI testing. Risk reduction strategies included condom use within partnerships and/or with other partners, and an unexpected emphasis on temporary abstinence. Our results highlight the importance of increasing opportunities for implementing risk reduction strategies. We found that an incentive-based intervention could be effective in part by creating such opportunities, particularly among groups such as women with limited sexual agency. The results provide new evidence that expanding regular testing of STIs is another important mechanism for providing opportunities for negotiating behavior change, beyond the direct benefits of testing. Exploiting the latent demand for STI testing should receive renewed attention as part of innovative new combination interventions for HIV prevention.\u

Improving the Reproductive Health of Married and Unmarried Youth in India

Provides insights and lessons learned from a ten-year multi-partner research program to improve youth reproductive and sexual health in India. Includes recommendations to strengthen community and government efforts

Hearts and Minds: The Untold Story of How Philanthropy and the Civil Marriage Collaborative Helped America Embrace Marriage Equality

In 2004, a group of foundations came together to create a funder collaborative in support of Freedom to Marry's state-by-state strategy to win marriage equality. Over the following 11 years, this unique collaborative and its funding partners invested a total of $153 million to support a wide range of activities across the country to change hearts and minds on a massive scale -- and ultimately to deliver a historic win for equality and love. This case study tells the untold, behind-the-scenes story of this funder collaborative -- how its members worked with movement leaders to develop a strategy for winning, how they persevered in their support despite enormous setbacks, and how they invested in the opinion research, state-by-state grassroots action and litigation that pushed marriage over the finish line from coast to coast. As the Civil Marriage Collaborative closes its doors in 2015, the case study and video also draw lessons from this historic victory for foundations supporting other social justice causes

Understanding the Role of Relationship Maintenance in Enduring Couple Partnerships in Later Adulthood

Intimate relationships in later adulthood are understudied despite their positive association with health and well-being. This cross-sectional mixed methods study sought to redress this gap by investigating relationship maintenance in later adulthood. Our international sub-sample comprised 1,565 participants aged 55 + and in an ongoing relationship. Results from hierarchical multiple regression indicated that overall happiness with the relationship had the largest effect size on relationship maintenance, with 53% of the variance explained. Content analyses of open-ended questions identified companionship and laughter as some of the “best liked” aspects of the relationship. Housework/cooking and saying “I love you” were among the behaviors that made participants feel appreciated. Results illustrated the types of maintenance behaviors adults in later adulthood who are in enduring partnerships employ

Subjective expectations in the context of HIV/AIDS in Malawi

In this paper we present a newly developed interactive elicitation methodology for collecting probalistic in expectations in a developing country context with low levels of literacy and numeracy, and we evaluate the feasibility and success of this method for a wide range of outcomes in rural Malawi. We find that respondents' answers about their subjective expectations take into account basic properties of probabilities, and vary meaningfully with observable characteristics and past experience. From a substantive point of view, the elicited expectation's indicate that individuals are generally aware of differential risks. For example, individuals with lower incomes and less land rightly feel at greater risk of financial distress than people with higher socioeconomic status (SES), and people who are divorced or widowed rightly feel at greater risk of being infected with HIV than currently married individuals. Meanwhile many expectations - including the probability of being currently infected with HIV - are well-calibrated compared to actual probabilities, but mortality expectations are substantially overestimated compared to life table estimates. This overestimation maylead individuals to underestimate the benefits of adopting HIV risk-reduction strategies. The skewed distribution, of expectations about condom use also suggests that a small group of innovators are the forerunners in the adoption of condoms within marriage for HIV prevention. © 2009 Adeline Delavande & Hans-Peter Kohler