Brothers for Life: why building social support could improve HIV testing and treatment among men
Study finds a programme in Côte d’Ivoire offering male-only groups and peer support is helping men test for HIV, accept treatment and stay on it.
An assessment of a behaviour change programme in Côte d’Ivoire called ‘Brothers for Life’ finds it transformed men’s perceptions of HIV treatment and what it means to live with HIV.
The Johns Hopkins Center for Communication Programs (CCP) began Brothers for Life in Côte d’Ivoire in 2013 after first developing it in South Africa. The community-based initiative uses male-only groups facilitated by ‘peer navigators’ – local men with experience of working with people living with HIV – to develop a sense of fraternity and social support among men. The programme aims to encourage participants to take responsibility for their health, including in relation to HIV prevention, testing and treatment, while tackling negative masculine norms.
Between April 2017 and January 2018, 7,410 men from Yopougon in Abidjan, Bouaké and San Pédro took part in 330 Brothers for Life discussion groups. Participants were aged 25 and above and a mix of married and single. Groups met for five two-hour sessions to discuss the following topics: men and sexuality, men as lovers, HIV prevention and testing, adherence to antiretroviral treatment (ART), and life-skills. Around 84% of men assessed attended all five sessions.
Group members were also offered one-on-one HIV counselling and testing. Those who tested positive were encouraged to access and stay on ART, with peer navigators providing up to six months of adherence support.
Of around 7,200 participants evaluated, 81% tested for HIV during the programme and 2.3% (135) tested HIV-positive. Being older and having no education were associated with a positive result. Uptake of HIV testing was not associated with whether testing was available during the group meetings or through a referral, nor was it associated with the age, marital status, number of children, religion or education level of participants.
Almost everyone (97%) who tested HIV-positive in the programme began treatment; 93% within four days of testing. Around two-thirds of those who tested HIV-positive accepted peer support. After six months, all those who had begun treatment were still on it.
Semi-structured interviews with 48 participants conducted in November 2017 suggest the group discussions gave men the courage to test for HIV, and that peer navigators helped people who tested HIV-positive to accept their diagnosis. HIV-positive interviewees described peer navigators as providing the emotional and logistical support they needed to begin treatment and remain on ART, despite its side effects.
Participants said they found value in meeting with other men in their communities and described gaining life-long friendships. They also described an increased willingness to engage with people living with HIV, less fear of an HIV-positive diagnosis, and a newfound understanding that living with HIV is not a death sentence.
The study has some limitations. First, it did not record how many men refused to take part in the group discussions or how these men differed from participants. Neither did researchers collect information on programme cost and whether participants had tested for HIV before or were HIV-positive.
Despite these restrictions, these findings suggest that providing social support is an effective way to identify HIV-positive men and support them to start and stay on life-saving treatment.