1. ViiV Evidence in Action Operational Research Project, Kenya
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Title: Comparing effectiveness of social media and peer-led social mobilization strategies in creating demand
for HIV prevention, behavior change, treatment and care services among Gay men, Men-having-sex-with-
men and Transgender populations in Nairobi, Kenya
PROJECT SUMMARY:
Introduction:
This operational research was
a joint initiative between Ishtar
MSM, a community based
organization with a mission to
increase access to health
services for men having sex
with men in Kenya; NOPE –
National peer educators and
AmfAR AIDS Research
Foundation. It was a response
to limited access to HIV and
STI prevention, treatment and
care services for Gay men, men
who have sex with men (MSM),
and transgender individuals
(referred to as GMT
populations in this document).
These men also bore the
greatest burden of new HIV
infections in the country (15-
19%). The study aimed at
identifying the most effective
social mobilization approach
(comparing peer led and social
media), and determine
effectiveness of evidence based
behavior change
communication curriculum ‘My
life, my power’.
Method:
Men who are members of GMT
population were voluntarily
recruited into the 12 month
long operational research; data
on their knowledge, ability to
access health services
(including HIV tests and
condoms), extent to which they
engaged in high risk sexual
behavior and access to
structural support services.
Data was collected using
structured interview guide at
baseline (pre-intervention) and
end of the project (post
intervention).
At baseline, total of 217 study
volunteers were recruited
through a peer led mobilization
approach, while 26 volunteers
were recruited through social
media. At endline, Only 156 of
men mobilized via peer led
approach were retained and
participated in the final
assessment.
Findings:
Majority of the GMTs mobilized
were youths aged between 19
and 35years, single and with at
least secondary school
education.
Proportion of study volunteers
who had access to information
on HIV / STI prevention
appeared high at baseline for
both peer led and social media
mobilized groups. The
aggregate knowledge score
however increased significantly
at endline, this attributed to
health education using the
curriculum “My life, my
power“. Access to HIV testing
and condoms was low at
baseline and also increased
significantly.
Peer led mobilization approach
appeared more effective in
recruitment and retention of the
study participants; however,
weaknesses in administration of
social media platform could
have contributed to its apparent
lower success rate.
Recommendations for future
programming:
These findings emphasize the
importance of a pro-youth
programming for HIV
prevention interventions
targeting men. The social-
stratification along socio-
economic classes and levels of
education may be also
necessary for effective
mobilization.
While there appears to be
awareness of HIV, there is need
for a more indepth knowledge
and skills building on HIV and
STI prevention, treatment, and
structural support services
such as psychosocial support,
access to legal support
especially where arbitrary
arrest by police often occur,
support against stigma and
discrimination, and livelihood/
access to employment . Service
delivery points need to be more
accessible and more
responsive. Economic
empowerment of GMTs is part
of improving accessibility; and
training of health service
providers is necessary.
While peer led mobilization
approach seemed to work well,
especially among the low
income and lower educated
groups, the effectiveness of
social media approach cannot
be ruled out. It should be tested
again, with a dedicated social
media moderator.

2. ViiV Evidence in Action Operational Research Project, Kenya
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Introduction:
Gay men, men who have sex with men (MSM),
and transgender individuals (referred to as GMT
populations in this document) bear the greatest
burden of HIV and STI in Kenya (15-19% of new
HIV infections). They however have limited access to
HIV prevention, treatment and care services in the
country, largely due to ineffective social mobilization
strategy (NACC - KNASP, 2009). Several barriers to
accessing HIV services for GMT population have
been reported as including homophobia, stigma,
criminalization of same-sex acts, policy barriers,
insensitivity or lack of awareness among health care
providers. Other hindrance to uptake of HIV
prevention services are denial that sexual behavior
between men takes place; inadequate or unreliable
epidemiological information; the difficulty of
reaching many MSM; inadequate or inappropriate
health facilities; lack of interest among donor
agencies in prevention programs for MSM; little or
no attention to MSM within national HIV/AIDS
programs.
Peer-led social mobilization strategy, while
traditionally used to mobilize such hidden population
to access health services, face the challenge of lack of
anonymity, fear stigma and discrimination, and
requirement that members of a peer support group
must be relatively sedentary. Social media is a
growing social mobilization strategy has the potential
to overcome most challenges faced by peer-led
strategy. In the search for an appropriate BCC
strategy for Kenya, the national Technical Working
Group (TWG) on key-populations at risk of HIV
approved the use of an evidence based intervention
informed curriculum - “My Life, My Power” - in
behavioral change communication. This is a twelve
(12) session curriculum designed to empower MSMs
to make healthy sexual choices.
Method:
This study sought to compare the effectiveness of
social media against peer-led mobilization strategies
in creating demand for HIV/ STIs prevention
services; encouraging less risky sexual behavior
through behavioral change communication using
evidence based intervention (EBI) curriculum - titled
‘My life my power’; and increasing demand and
access to treatment and care services among GMT
populations in Nairobi, Kenya.
Figure 1: Photo of health education session
This was through a quasi-experimental study design.
One study arm comprised of participants mobilized
via social media; while the other comprised of
participants mobilized primarily through peer leaders
in addition to social media. Baseline data was
collected between the period of June and August
2014. A total of 26 study participants were recruited
in the social media arm against a target of 185.
Figure 2: Photo of peer support group session
The peer led study arm recruited 217 study
participants, 32 more than the calculated sample size
of 185. The endline data was collected between the
periods July and Aug 2015 from 156 study
participants mobilized via peer led group only. It was
not possible to trace the study participants who were
recruited via social media at the end of the project.

3. ViiV Evidence in Action Operational Research Project, Kenya
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Results:
Distribution of study participants by age was similar
in the two study arms, majority being in age bracket
19-29years. However, fewer study participants in the
peer leader mobilized group (48%) had had access to
college level education and formal employment
(15%); this is compared 96% who had college
education and 62% who had formal employment in
the social-media mobilized group. On marital
relations and sex partners, proportion of those
married to female partners was comparable at 11%
(social media group) and 12% (peer led group);
however, social media group had more study
participants (15%) cohabiting with male sex partners
compared to the peer leader mobilized group (1%).
About a third of study participants in both study arms
preferred receiving HIV and other health services
from specialized clinics such as Ishtar-MSM drop-in
centre. Level of awareness was generally high among
both social media and peer led groups, with over 70%
correctly identifying a prevention method or
dispelling myths.
Table 1: Comparison of select knowledge indicators on HIV prevention among participants mobilized via peer led
approach (baseline and endline data)
Variable Baseline (%) End line (%) % Change
HIV can be transmitted by mosquito
Yes
No
8.30
82.9
8.00
92.00
+9.10
One can get HIV by sharing food
Yes
No
9.7
83.9
10.7
89.3 +5.40
Anal sex has higher risk to HIV/STI than virginal sex
Yes
No 59.4
25.3
86.1
13.9
+26.7
Condoms reduce pleasure during sex
Agree
Disagree
12.0
88.1
35.5
64.5 -23.60
A health looking person may be carrying HIV
Agree
Disagree 85.7
9.7
95.3
4.7
+9.60
A Wilcoxon signed-rank test showed that knowledge
of HIV/STI among the study participants mobilized
through peer led mobilization approach, elicited a
statistically significant change between endline and
baseline of the project (Z = -8.526 p = 0.000). This
implies that there was an increase in knowledge of
HIV/STI among the peer led mobilized study
participants who also participated in the behavioral
change training using the curriculum “My life, my
power’.
Access to health facilities varied by group; social
media group preferred private hospital (38%), while
peer leader mobilized group had more access to
public hospitals – possibly due to socio-economic
differences. Health seeking behavior was poorer
among peer led group (14% tested for HIV in one
year period) compared to social media mobilized
group (46% tested HIV). Most (77%) peer led group
considered themselves as being at higher risk to HIV
infection compared to 46% of social media group.
More than half (55%) and 72% of peer leader
mobilized group had multiple sex partners and
unprotected sex respectively; this compared to 19%
and 4% respectively in social media group. The
health education and behavior change interventions

4. ViiV Evidence in Action Operational Research Project
were associated with better skills in negotiating for
Figure 3: Outcome of knowledge gained through health education and BCC (peer leader mobilized group at
baseline)
Barriers to accessing services were identified as inability to afford services espec
irresponsive and insensitive public health services, negative perceptions of effectiveness and inappropriateness of
the health services, socio-economic and educational limitations that make it difficult to access information in
mediums such as social media, poor retention in longer term project interventions, limited access to psychosocial
support, and negative experiences of stigma and discrimination.
Figure 4: Comparison of frequency of HIV/STI
participants 12 months prior to survey (baseline data)
Able to stand up for
Able to access services
13%
Baseline Peer led, 5%
Baseline Social-media, 0%3%
0%
10%
20%
30%
40%
50%
60%
Never/ can't rember More than 12 months
ago
Baseline Peer led
ViiV Evidence in Action Operational Research Project, Kenya
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were associated with better skills in negotiating for safe sex and ability stand up for their rights.
: Outcome of knowledge gained through health education and BCC (peer leader mobilized group at
Barriers to accessing services were identified as inability to afford services especially in private hospitals,
irresponsive and insensitive public health services, negative perceptions of effectiveness and inappropriateness of
economic and educational limitations that make it difficult to access information in
mediums such as social media, poor retention in longer term project interventions, limited access to psychosocial
support, and negative experiences of stigma and discrimination.
: Comparison of frequency of HIV/STI testing between social media and peer leader mobilized study
participants 12 months prior to survey (baseline data)
No change
7%
Reduced no of clients
8%
Stopped sex worker
Better in negotiating
safe sex
47%
Able to stand up for
my right
22%
Able to access services
NO response
4%
Baseline Peer led, 52%
Baseline Peer led, 22%
Baseline Peer led, 14%
media, 0%
23%
Baseline Social-media,
23%
Baseline Social
46%
11%
28%
Endline Peer led, 57%
More than 12 months
ago
Between three and
twelve months ago
Less than three months
ago
Baseline Peer led Baseline Social-media Endline Peer led
, Kenya
stand up for their rights.
: Outcome of knowledge gained through health education and BCC (peer leader mobilized group at
ially in private hospitals,
irresponsive and insensitive public health services, negative perceptions of effectiveness and inappropriateness of
economic and educational limitations that make it difficult to access information in
mediums such as social media, poor retention in longer term project interventions, limited access to psychosocial
testing between social media and peer leader mobilized study
Reduced no of clients
8%
Stopped sex worker
0%
Started viable
business
0%
Baseline Peer led, 7%
Baseline Social-media,
8%
Endline Peer led, 57%
Endline Peer led, 1%
No response

5. ViiV Evidence in Action Operational Research Project, Kenya
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In conclusion, the project successes in mobilizing
GMTs to access HIV prevention services; peer leader
mobilization appeared more effective in mobilizing
and retain GMTs to access services. The seeming
failure of social mobilization strategy could be due to
administrative weaknesses; these need to be
addressed by the implementing agency before the
strategy is written off as a failure in mobilization.
Figure 5: Proportion of GMTs mobilized and retained to access HIV prevention services as a proportion of
target
The project was however successful in modifying sexual behavior from high risk to low risk such as reduced
number of partners and increased number of persons accessing HIV testing. There is need to address these barriers
to improve access to HIV prevention services and also improve social mobilization.
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Principal Investigator:
MUNYUWINY Samuel (MPH)
Co-Investigators:
OGUYA, Francis (Phd)
NJERU Erastus (MSc)
WALIMBWA Jeff
Research Project Period
April 2013 to Aug 2015
Sponsors