75720 DIME BRIEF The Effects of Social Mobilization and Peer-Education on Counseling and HIV Testing in Senegal The Development Impact Evaluation Initiative is a Policy context broad-based World Bank Voluntary counseling and testing (VCT) is an important component of the fight program to generate against HIV/AIDS. VCT constitutes an entry point for various interventions, from the knowledge on the treatment of other sexually transmitted diseases and tuberculosis to psycho-social effectiveness of assistance for sero-positive individuals. government programs. It supports government Similarly to other African countries, HIV/AIDS efforts in Senegal have focused on agencies adopt a culture increasing voluntary counseling and testing. From the supply side, VCT services are of real time evidence- freely available and VCT sites increased from 5 in 2002 to 281 in 2008. From the based policy-making on demand side, government and donors have drawn on the existing network of NGOs to the basis of rigorous provide HIV/AIDS sensitization programs. Most NGOs use social mobilization impact evaluation. By techniques to encourage HIV testing. Despite the considerable efforts deployed, testing how to make voluntary testing in Senegal remains extremely low, with only 1.1% of the total policies work, it population having been tested. contributes to improving policy performance. In 2008, Senegal’s national HIV/AIDS agency planned to replace social mobilization with peer education strategies, having shown the latter to be more effective in some DIME works with 300 contexts. In the peer-mentoring approach, the information would be transmitted to agencies in 72 countries only a third of beneficiaries and request them to mentor at least two other individuals across 15 thematic programs to generate in the community. It is hoped that transmitting the information to two-thirds of the knowledge, improve target individuals through the mentors will allow the mentors to be trained in a more quality of operations and intensive manner, and ensure that the recipients absorb the material in a more user- strengthen country friendly manner. capacity for evidence- based policy- making. Impact evaluation During an impact evaluation workshop organized by DIME, the HIV/AIDS agency laid This impact evaluation is out its plan for rolling out the new peer-counseling strategy. During the workshop, part of the Africa Impact the government modified its plans and in order to evaluate the impact of both Evaluation for HIV/AIDS strategies, decided to randomly phase-in the new strategy. As a result, the and generously supported by DFID and government randomly assigned one-third of the health districts to one of the UBW. following categories: (i) health districts that continued using traditional social mobilization methods; (ii) health districts that introduced peer mentoring; and (iii) districts without intervention. Using a simple experimental design, Poisson regression techniques and routinely collected administrative data from health districts, the impact evaluation not only assessed whether funding to NGO sensitization campaigns can significantly affect testing rates and counseling, but also whether peer mentoring was more effective than social mobilization methods in conveying the message. Impact evaluation results The results of the impact evaluation are surprising. Contrary to expectations peer- mentoring is not more effective than social mobilization across the board but rather each approach is greatly more effective than the other on different target groups and objectives. DIME Brief on Senegal HIV Prevention 1 Impact of Interventions Relative to Control Group (no intervention) Peer-mentoring Social Mobilization Got tested 88% 0% Participated in pre-test counseling 93% 0% Picked up test results 115% 0% Tested positive and partner came to get tested 64% 88% Tested positive and followed post-test counseling 105% 148% Peer mentoring doubles the number of individuals who pick up their results, peer mentoring proved to be get tested, who follow pre-test counseling and who pick more effective for HIV-positive individuals, while up their test results, especially among women. social mobilization proved to be more effective in Traditional social mobilization appears to be ineffective increasing the number of partners of HIV-positive in all three. Neither method increased the number of individuals who come and get tested. individuals who tested positive and who picked up their The value of these findings is of interest to both results. Senegal’s and global HIV prevention efforts. Social mobilization is greatly more effective, however, in Source: Arcand, J., Diallo P., Sakho, C., Wagner, N. “HIV/AIDS increasing the number of male partners of HIV-positive sensitization, social mobilization and peer-mentoring: women who get tested. Evidence from a randomized experiment in Senegal” (unpublished report) Finally, both methods significantly increase the number of HIV-positive individuals who follow post-test The Africa HIV/AIDS Impact Evaluation Program (AIM-AIDS) counseling. Peer-mentoring is more effective among men and traditional social mobilization more effective AIM-AIDS was launched in February 2008 as a regional initiative for women. to generate and support country specific IE of HIV/AIDS prevention and build country capacity for evidence-based policy making in national HIV agencies in Africa. AIM-AIDS uses Policy recommendations impact evaluation to build “management for results” into HIV/AIDS programs. More specifically, the program: The evaluation shows that it is possible to rigorously evaluate alternative interventions using routinely i) Builds organizational capacity for rigorous impact evaluation through a learn-by-doing approach; collected data if the alternative interventions are ii) Works to embed impact evaluation into national randomly introduced. Governments often forgo this HIV/AIDS programs; learning opportunity when introducing new programs. iii) Supports countries through technical assistance in designing and conducting rigorous impact evaluation The evaluation also shows that replacing policy of HIV/AIDS interventions; iv) Coordinates and harmonizes evaluation methods interventions would have been a mistake: the two across countries; and interventions are not substitutes but rather complement v) Provides cross-country venues for dialogue, each other in reaching out to different populations at networking, and information sharing. risk. AIM-AIDS focuses on testing prevention policies like peer- mentoring, social mobilization, behavioral change campaigns, By doubling the number of people who get tested and conditional cash transfers, and school-based education. www.worldbank.org/dime For more information email vorozco@worldbank.org DIME Brief on Senegal HIV Prevention 2