BRIDGE II (B2) is a 5-year agreement designed to promote normative behavior change to decrease HIV prevalence in the adult population in Malawi. B2 activities will strengthen individual perception of HIV risk and self-efficacy to prevent HIV infection; mobilize communities to adopt social norms, attitudes, and values that reduce vulnerability to HIV; link prevention interventions to services; and support Malawian institutions for effective leadership and coordination. In 2014, B2 community-based activities will reach 75% of the adult population 25% through direct contact in small group discussions and approximately 50% through community-wide events and trainings in southern Malawi, which has the highest HIV prevalence rate in the country. Additionally, B2 mass media campaigns have the potential to reach at least 45% of the adult population in the country with multiple exposures. B2s activities are aligned with and contribute to reduction of new HIV infections, one of the priority areas of USG support under the PFIP and the GHI Strategy.

To address sustainability, B2 both mentors and advocates for innovative and effective programming by working with government, civil society, and the private sector. The intention is to transfer capacity to design, implement, monitor and evaluate social and behavior change communication (SBCC) programs by the end of the project to all levels of government and civil society. B2 also works with district administrations to help them plan more accurately for integrated SBCC in their annual District Implementing Plans (DIP). B2 has an extensive M&E plan building on a baseline survey, a quantitative and qualitative mid-term evaluation, as well as checklists to address minimum standards for community level interventions.

Within the national response, limited capacity of national, district and community partners continues to be a major barrier to rollout of HIV prevention efforts. One of the intermediate results for B2 is the strengthening of Malawian institutions for effective leadership and coordination of HIV prevention. B2 is implementing a community referral model and promoting services using Community Referral Agents (CRA). The CRAs make home-visits, conduct talks with individuals and families, and make referrals to services such as HTC, PMTCT or VMMC, as needed. B2 successfully piloted a community referral model which increased registration in service utilization with 4,693 people linked to HTC, family planning and adherence support. In FY12 and FY13, B2 will scale-up and strengthen community referral additional districts. In FY11, B2 completed a baseline Organizational Network Analysis (ONA) assessment of NGOs and CBOs in all the 11 districts to assist in identifying networking, linkage gaps, and challenges. The combination of the ONA and the mapping process jointly form one of the keystones in B2s holistic approach to creating meaningful community and normative change. In FY12, B2 will review the findings and facilitate development of a package for CBO network strengthening. Best Practice Conferences provide an avenue for CBOs and other district partners to share best practices for possible scale up. In FY11, B2, in partnership with PACT, organized district-based best practice conferences in three B2 districts to bridge the knowledge-transfer gap from the national to the district level. In FY12, B2 will scale-up implementation of the best practices conferences to all the districts. In FY11, B2 initiated discussions with the Ministry of Health and Malawi Teacher Professional Development Support (MTPDS) to develop an HIV curriculum for teachers. In FY12, B2 will develop the curriculum and collaborate with MTPDS for roll out in Teacher Development Centers. As part of strengthening behavior change competency, B2 is collaborating with Africomnet to introduce a Gender and HIV course into the University of Malawi, Chancellor College. In FY12, B2 will link the college with Africomnet and support introduction of the course.

B2 will support Voluntary Male Medical Circumcision (VMMC) communications development and implementation through multi-level communication platforms in all districts and Traditional Authorities slated for VMMC roll out (Mulanje, Phalombe and Thyolo). In FY11, B2, worked with the PEPFAR service delivery partner, and participated in a pilot campaign in 3 TAs in Mulanje district through the production and distribution of a video on VMMC, focusing on a young couple who decided to have the man go for VMMC. The video has been incredibly successful in motivating men to go for testing, almost exceeding capacity to respond to the demand.

In FY12, B2 will play a leading role in implementing community-level activities to support USAIDs plan for scaling up VMMC in Mulanje, Phalombe and Thyolo districts by working closely with Banja La Mtsogolo (BLM), PSI and other USG service delivery partners. B2 will facilitate targeted community mobilization and demand creation, advocacy and community referral to VMMC services using the Community Action Groups (CAGs), Village Discussion Groups, and traditional leaders to help link community members VMMC services.

Targets for B2 are entirely dependent upon the targets set by the service delivery providers. In the Mulanje pilot, Ministry of Health and MCHP anticipated just over 5,000 circumcisions. On early evidence from Mulanje, there is huge untapped demand for VMMC in all B2 districts. CIRC is also covered under P8.5D for community-wide events, P10.2D for workplace, P12.1D for norms about masculinity.

Within the past year, B2 reached saturation of 75% of the adult population with evidence based community risk-reduction programs in 62 Traditional Authorities in all the 11 target districts. B2 addresses community issues through its sub partners complementary approaches as follows: Faith-based Organizations address HIV prevention through couples counseling; Story Workshop Education Trust trains local drama groups in interactive drama and produces a weekly 30 minute reality-based national radio program available on 10 stations; National Association of People Living with HIV/AIDS in Malawi through their support groups address stigma, positive living, and prevention for positives using Hope Kit, Positive Prevention and African Transformation (AT) toolkits; Youth Network and Counseling trains local facilitators who use the Hope Kit, Tasankha Discussion Guide and AT to help youth develop personal risk reduction strategies, address gender norms and female vulnerability; Save the Children builds capacity of District AIDS Coordinating Committees, Area Development Committees/Community Mobilization Teams and Community Action Groups (CAG) to use Community Action Cycle (CAC) to address community issues; PACT conducts organizational network analysis to assess community-based organizations network linkages and identify areas to be strengthened; and HIV Alliance links people to various services through a community based referral model.

Wtih FY12 funds, B2 will facilitate communities to take collective action to prevent HIV by increasing advocacy efforts with the District Health Office (DHO), Area Development Committee/Community Mobilization Teams, Traditional Leaders Forums and CAGs to ensure leaders support the communitys response to HIV prevention and testing. High functioning communities will support neighboring communities to implement CAC process. B2 will train districts structures and CAGs to collect and disseminate their own local service data to communities, and continue working with DHOs to better integrate social and behavior change communication into District Implementation Plans.

The National HIV Prevention Strategy (2009-13) identifies multiple and concurrent sexual partnerships, discordancy in long-term couples, low and inconsistent condom use, and late initiation of HIV treatment as some of the key determinants of HIV infection. B2 identified and works with large scale employers in the tea estates in B2 districts as their workers constitute some of the Most at Risk Populations (MARPS). Employees in these estates are at higher risk because of their conditions of employment, notably, high density single sex housing and available cash, making transactional sex easier to negotiate. B2 also works with populations in market centers in all 11 districts, mostly with MARPs as part of the larger population. B2 does face-to-face referral services in 4 districts for the general population including MARPs.

Through FY12 and FY13, B2 will continue to mobilize communities, conduct community referrals and use transformative tools such as the Hope Kit, Tasankha Discussion Guide, and Positive Prevention Toolkits to provide an avenue for communities, employees in estates, and people in market places to discuss and identify risk reduction measures. B2 will work with employers in tea estates and plantations to scale up HIV prevention activities and advocate for more services such as HTC, condoms and support for voluntary male medical circumcision among employees within the tea estates.

HVOP is also covered under P8.5D for community-wide events, P10.2D for workplace, P12.1D for norms about masculinity and P8.6D and P8.7D for mass media.

BRIDGE II (B2) supports Malawi's priorities in HIV prevention programming by expanding Option B+ to build on previous years activities. In FY11, BRIDGE II promoted Option B+ at the community level through various materials, toolkits, small group discussion guides, and electronic media (e.g., the national weekly flagship radio program). These activities will continue in all B2 communities. B2 will increase the exposure of individuals and communities in all B2 districts to Option B+, with an increased focus on having all pregnant women visit ANC services earlier in their pregnancy, get tested for HIV, and, if HIV positive, agree to antiretroviral therapy (ART) for life.

B2 will integrate issues of gender norms and male involvement into the discussion around Option B+. Through targeted B2 activities, men will be supported to participate in couple testing and to support their wives if ART is necessary. B2 will also work closely with the new PEPFAR-funded Support for Service Delivery (SSD) project to integrate Option B+ materials into the integrated toolkits and message guides, which the SSD project is expected to develop to support roll out in the SSD implementation districts.

The promotion of demand for PMTCT Option B+ services is contingent upon the availability of test kits and allocated ARVs in the B2 districts. Demand cannot exceed providers capacity to deliver services. There have been and are currently severe shortages of test kits in these districts, so this intervention will be need to be monitored closely to ensure services have the necessary kits at all times.

PMTCT is a part of all project activities and communication tools produced and used at the community level. As such, there are no separate targets but rather fall within P8.1D and P8.2D where all the small groups take place, P8.5D for community-wide events, P10.2D for workplace and P8.6D and P8.7D for mass media.