How the ‘Mzake ndi Mzake’ peer initiative increased condom use

A peer-group programme in Malawi run by community volunteers has increased condom use by supporting people to not only know the facts about HIV but how to talk to their partner about safer sex. 

What is the research about? 

The research evaluated a peer-group HIV prevention programme called Mzake ndi Mzake (Friend to Friend). The programme was run by community volunteers from rural communities in southern Malawi, an area with high HIV prevalence (around 15%). 

Trained health workers previously ran the scheme in other parts of Malawi where it had been successful at increasing HIV knowledge and condom use. The scheme was going to be extended, but healthcare worker shortages made this impossible. Instead, community volunteers were trained to run Mzake. A previous study on this community-led version found it increased HIV prevention knowledge. This study looks at whether it also increased condom use. 

Why is this research important? 

Despite being the most widely available HIV prevention method, condom use is low in many places. There are many reasons for this, including concerns that using a condom signals a lack of trust in a relationship, especially within marriage. Looking at ways to change this in areas of high HIV prevalence is important. And that means finding schemes that work and are cost-effective.  

What did they find out? 

In each community, volunteers set up 12 adult groups (aged 19+) and 16 youth groups (aged 13-19). The youth groups were led by adult volunteers trained in youth-friendly methods.  

Just over 1,000 people signed up to join the groups. Each person was invited to attend six peer-group sessions on topics including what HIV is, how it is spread and how to prevent transmission, how to use a condom, and how to communicate with your partner about HIV prevention. 

Group members were surveyed after 11-13 months. Their answers were compared with the answers of people in a third rural community that did not have the peer groups. 

People in the peer groups were twice as likely as people in the control group to use condoms frequently in the last two months. They were 1.8 times more likely to have used a condom the last time they had sex. 

Being young and not having a regular partner were associated with increased condom use over past two months and at last sex. 

Although the peer groups increased HIV knowledge, this was not found to influence whether someone regularly used condoms or not. But people who felt confident to assert their need for safer sex and people who felt able to communicate well with their partner were more likely to use a condom. 

What does this mean for HIV services? 

HIV prevention schemes run and delivered by trained community volunteers work. Not only are they effective, they are more cost-effective than working with overstretched healthcare workers. 

The finding that people who felt confident to communicate with their partner and/or assert their desire for safer sex were more likely to use condoms show how important it is to support people to develop these skills, as well as educating them on the basic facts of what HIV is and how it is spread. There is also a need to address the issue of sexual pleasure, and show people how to make condoms part of having pleasurable sex.