Community Mobilization: Design Authors: Althea Anderson, Erin. Stern, T. Mokganyetji, Dumisani. Rebombo, Catherine. MacPhail, N. Khoza, Sarah. Treves-Kagan, Amanda. Selin, Dean. Peacock, Audrey. Pettifor, Sheri. Lippman, Kathy. Kahn, Rhian. Twine

Community Mobilization (CM) is… Promising but understudied / under conceptualized Potentially key to reduce GBV, promote gender equality, increase testing, engagement in care, uptake of bio-medical interventions Most people understand community mobilization as having something to do with people coming together – it evokes images of people getting out into the streets – of making change happen when a group or community is fighting for their rights. In the field of HIV prevention, community mobilization work is usually undertaken with groups that are marginalized or vulnerable to HIV (such as sex workers), or undertaken to demand rights to care and treatment. Often it includes advocacy work, support of policies that protect human rights, community building initiatives to confront stigma or unite group’s in their demand for recognition. What’s also become clear in the past few years is that without community support, some of our most effective HIV prevention tools – things like treatment as prevention and potentially PREP – won’t work. In 2012 we learned that 2 major trials of Preexposure prophylaxis had failed to reduce HIV incidence among women in Africa. We also learned that adherence was quite low and that generally women didn’t feel ‘supported’ to utilize these bio-medical strategies. I would argue that if the community doesn’t stand behind our interventions – be they biomedical or behavioral – those intervention are more likely to fail. UNAIDS defines critical enablers as “activities that are necessary to support the effectiveness and efficiency of basic programme activities” – these are social enablers and programme enablers.

Community Mobilization: Design Design: Community randomized design Primary endpoint: Gender Equitable Men’s Scale (GEMS) Visits: Young men and women ages 18-35 complete two cross-sectional questionnaires. Baseline in mid-2012 and Endline in mid-2014 Intervention: 22 villages randomized – 11 receive CM and 11 do not receive CM 11 CM communities receive an intensive 2 year intervention led by 15 community mobilizers and 10 community action teams To determine whether young people ages 18-35 living in villages that are randomized to a mobilization intervention focused reducing negative gender norms and HIV risk behaviors demonstrate positive changes in gender norms compared to young people living in villages that are not randomized to mobilization. Incidence of IPV in each arm is an additional study outcome

Impact: CM CCT Combination Groups % IPV YW exposed to both interventions 28.12% YW exposed to CCT only 30.75% YW exposed to CM only 34.41% YW in both control conditions 38.57% We further analyzed the YW into 4 groups – those that received CCT or not and those that were in a CM village or not. Young women who received CCT and also were in a village receiving CM reported the least amount of IPV over time and the young women who did not receive CCT and were not in a village receiving CM reported the most IPV over time. There is no modification effect noted in this analysis therefore the effect of the CCT intervention remains the same regardless of whether you are in a CM village and vice versa. We also looked to see if there was a time effect and did not find that the effect of CM and the effect of CCT varied over time.

Impact: CM and HIV testing

Partnerships Sonke Gender Justice MRC/Wits- Agincourt Wits Reproductive Health and HIV Institute University of North Carolina Chapel Hill University of California San Francisco HIV Prevention Trials Network