National Teacher Training HIV End Line Survey Malawi 2009

This 60-page report shares findings from an external evaluation of the first year of Theatre for a Change (TfaC)'s work with trainee teachers in Malawi to reduce HIV/AIDS. According to the report, published by TfaC and the British Council, Malawian teachers have the third highest HIV prevalence rate among occupational groups after sex workers and police officers. The goal of TfaC’s Teacher Training College (TTC) programme is to reduce this high risk of HIV infection among teachers and, in turn, their future pupils. TfaC offers an after-school programme that uses participatory learning techniques to provide teachers with the knowledge, attitudes, and behaviours to protect themselves from HIV infection. According to the evaluation, TfaC has achieved commendable success in their first year of intervention, with a few areas of weakness that need to be examined.

Launched in September 2008, the TTC programme included working with a core group of 20 to 40 people at each college for ten months. Towards the end of the academic year, the core group members paired up and started their own "peer group" to practice their facilitation skills and pass on their knowledge. The peer groups participated in the programme for eight weeks. The evaluation was intended to measure the impact of the TTC programme on core and peer group members in the 2008/2009 academic year. Independent Malawian-based consultants compared baseline data collected at the start of the programme to data they collected at the end of the programme, using the same data collection tools. To gather the data, a representative sample of the core and peer groups were surveyed using a questionnaire, semi-structured interviews, and observations of their behaviour in a role play.

The evaluation noted the following results:

HIV Knowledge
The evaluation reports that core group members saw an average increase of 30% in their knowledge of HIV transmission and prevention from the baseline. Peer group members saw an increase of 17% from the baseline. There was little change among core group women (an increase of 7%) and peer group men (an increase of 4% in treatment knowledge). Men in the core and peer groups only saw an increase of 2 and 4 percentage points, respectively, in the belief that HIV testing is accurate. This means, at the endline, 50% of men thought HIV testing was accurate. HIV testing was another area of success for TfaC. The evaluation found that 96% of women and 92% of men who participated in TfaC's programme were tested for HIV. This is an increase of 24% and 27% for men from the baseline survey.

HIV Prevention
According to the evaluation, men and women's knowledge and attitudes towards condom use improved. At endline, 89% of women and 85% of men in both groups reported they could use a female condom, an average increase of 65%. As well, 91% of women core and peer group members said they could use a male condom at the endline, an increase of 45%. This brought women's reported ability to use a male condom to that of men, 92%. Finally, at the baseline, 12% of women and 18% of men demonstrated they could effectively negotiate condom use in a workshop demonstration. At the endline, on average, 92% of women and 83% of men demonstrated in a role play that they could successfully negotiate condom use. This is an increase of 80% for women and 65% for men. Women in both groups demonstrated an increase in the frequency that they reported always using condoms. At the baseline, 12% of women and 43% of men reported that they "always use a condom" when they have sex. At the endline, 53% of women in the core groups and 25% of women in the peer groups reported that they "always use a condom" when they have sex.

Rights and Teaching Methods
The evaluation also found that rights and teaching methods showed improvement. Women and men demonstrated an improvement in knowledge of and their ability to advocate for their sexual and gender rights. Also, the endline survey and workshop observations showed an improvement in the core group members’ ability to identify and report child abuse. For example, at the endline 76% of women and 79% of men demonstrated in a workshop observation that they would assert a child’s right not to be sexually abused and report an incident of sexual abuse to the authorities. This is an increase of 66% for women and 69% for men from the baseline survey. Finally, TfaC participants saw a distinct increase in their ability to use participatory teaching methods in the classroom and 355 became accredited facilitators through the Open College Network at St. Mary’s University, London.

The evaluation concluded that it is important to bear in mind that behaviour change is a difficult and, at times, lengthy process. While Theatre for a Change has equipped the men and women who participated in their programme with the building blocks to make real-life change, to achieve lasting behaviour change these students most likely need more time to process what they have learned and continue to receive support from their peers, family, community, and society to make safe choices to reduce their risk of HIV infection.

The evaluation recommended that:

• the TTC programme should continue, as it has demonstrated clear successes in all 5 focus areas;
• the Ministry of Education should consider supporting TfaC to expand into all TTCs in Malawi;
• TfaC should partner with TTCs to lengthen the time of the programme as people who demonstrated the most change participated in the programme for the longest amount of time;
• TTCs should support gender-related behaviour change in their curriculum, in their policies, and on campus;
• TfaC should review its curriculum to address areas of weak performance in their focus areas, such as HIV treatment methods, accuracy of HIV testing, and self-reported condom use; and
• TfaC should also review its curriculum and approaches to ensure that it resonates with men and women equally.