The Maryland Department of Health (MDH or the Department), Center for Injury and Violence Prevention (CIVP), is issuing this solicitation to support the implementation and evaluation of a social marketing campaign on the intersections of DV and HIV, targeting the African-born population of two Capital Region counties of Maryland: Montgomery and Prince George’s.
The Contractor will conduct formative research to identify effective strategies for broad-based implementation of evidence-based interventions to educate the target population on DV and HIV and how they intersect. The results of the formative research must lead to a greater understanding of the beliefs and attitudes that influence behavior change (i.e. perceived risk, perceived severity, etc.), the key motivation for attitude and behavior change (i.e. perceived benefit/cost of behavior change) in the population, the best way to segment the target audience (i.e. according to demographic and/or attitudinal differences), the most effective message style and placement, and how to identify and connect with leaders that influence the community.
This social marketing campaign aims to 1) Educate the African-born population in Maryland on DV and HIV and how they intersect. 2) Promote HIV testing among the African –born population of Montgomery and Prince George’s counties. 3) Provide resources for the African-born population affected by DV and or HIV
Background:
DV/HIV Prevention Program
The Maryland Department of Health’s Domestic Violence and HIV Prevention Program is funded by the CDC’s “Integrated HIV Surveillance and Prevention Programs for Health Departments- 2018-2022.” The purpose of this grant is to implement comprehensive and integrated HIV surveillance and prevention programs, improve health outcomes for people living with HIV, and reduce related health disparities. The Infectious Disease Prevention and Health Services Bureau, Center for HIV/STI Integration and Capacity (CHSIC) has identified survivors of violence as a high-risk population and has partnered with MDH’s Center for Injury and Violence Prevention on a DV/HIV program. The impact goals of the DV/HIV Initiative are to (1) reduce new HIV infections among high-risk populations and (2) improve health outcomes for people living with HIV.
HIV among African-born Population in Maryland
HIV diagnosis rates among the African-born population in Maryland are higher than other populations. In 2019, of the 931 diagnosed with HIV, 154 were born in a foreign country. And among these new HIV diagnosis African-born person accounted for 9.9% of the total newly reported HIV diagnoses and 59.7% of the foreign-born diagnoses. Of the 31,630 persons living with diagnosed HIV, 3,680 were foreign-born. African-born residents account for 7.3% of the total persons living with HIV and 62.9% of the foreign-born people. African-born persons living with diagnosed HIV were born in 44 countries. The most common reported countries were Cameroon (27.0%), Ethiopia (15.7%), and Nigeria (12.6%). African-born women are particularly impacted by HIV. In 2019, of the 92 diagnoses born in Africa, 64.1% were female, and 35.9% male (Maryland Annual HIV Epidemiological Profile, 2019).
Structural and Cultural Challenges of Domestic Violence and HIV
Cultural values and gender roles seem to be largely related to the increased impact of HIV on African women. HIV is heavily stigmatized among African women likely due to the taboo nature of HIV/AIDS and the relation to sex and promiscuity. Women’s risk of HIV acquisition is elevated due to their inability to discuss sex, negotiate safe sex and condom use, or request for their partner to be tested for HIV. (Foley, 2005; Nnaji, Slopadoe, Rao, Babirye, and Pwamang, 2016). Women report concerns that their husbands are unfaithful and may have HIV, but are unable to protect themselves (Foley, 2005). Finally, women who are HIV positive fear disclosing their status, even to their partner and immediate family, due to facing severe isolation in their community (Foley, 2005).
African cultural and gender norms also impact help seeking behaviors for women experiencing domestic violence. A cultural acceptance of gender inequality and violence towards women creates barriers to seeking help. African communities place a high emphasis on resolving conflicts through networks led by immediate and extended family. Women reported dissatisfaction with this support system but are unaware of other methods of support. If a woman experiencing domestic violence chooses to seek support outside her network and go to the police, it would result in family and community isolation. “It is clear that there is a need for active outreach within the community to both men and women to provide information, education, and culturally informed resources through different types of media and in different languages. Additionally, given the cultural emphasis on collective problem solving, potential interventions should draw on collective, group, and family-oriented perspectives.” (Akinsulure-Smith, Chu, Keatley, and Rasmussem, 2013)” A brief scan of literature shows that stigma, lack of knowledge about resources, and lack of community support regarding HIV and DV impact help seeking and protective behaviors among women. (Foley, 2005; Nnaji et al, 2016; Akinsulure-Smith, 2013) Formative research should continue to examine the intersections of DV and HIV among African-born populations in Maryland, including as outlined earlier, further defining the target audience, engaging community networks and stakeholders, and identifying effective messages, placement and community leaders for the campaign.
Scope of Work:
3.2.1.1 Be available within one week of contract execution to advance the project through weekly working meetings/conference calls with the contract monitor through the duration of the Contract. 3.2.1.2 Conduct formative research activities to better understand how to address the intersections of domestic violence and HIV among the African-born population. This formative research will lay the foundation for a social marketing campaign addressing the intersections of domestic violence and HIV among African-born communities in Montgomery and Prince George’s counties. The objectives of the formative research are to:
A. To understand beliefs and attitudes that influence behavior change (i.e. perceived risk, perceived severity)
B. To define generational differences in cultural beliefs
C. To explore key motivations for attitude and behavior change (i.e perceived benefit/cost of behavior change)
D. To segment the target audience according to demographic and/or attitudinal differences
E. To determine effective message style and placement
F. To identify and connect with leaders that influence the community
3.2.1.3 Complete and submit an IRB (Institutional Review Board) Request to the Maryland Department of Health (MDH) Prevention and Health Promotion Administration. Upon Contract award, the Contract Monitor will provide the Contractor with the MDH IRB application protocols and guidelines for completion and submission, including IRB Form I (DHMH 2124) or IRB Form II (DHMH 2125), IRB Form 4664, Abstract Summary, Informed Consent, and other documentation required by the Administration. Prior to submission, all IRB Request documents must be forwarded to the Contract Monitor for review, approval and to ensure signature by the Director or Administrator of the Division of Support and Coordination Note: Discussions with health department staff or experts are not considered engagement with human subjects and are permitted without IRB approval. These conversations can be used to inform key informant interviews, focus group discussion guides, survey questions, and potential venues for recruitment.
3.2.1.4 Primary data collection shall include a variety of methods including:
A. At minimum four (4) focus groups– two in each, Montgomery County and Prince George’s County. Focus group attendees must represent a variety of countries of birth, religions, languages, age groups, and genders. These stakeholders must also include individuals with lived experience related to domestic violence and/or HIV. The contractor may conduct more than four focus groups as deemed necessary.
B. At minimum ten (10) key informant interviews. Key informants represent a variety of countries of birth, religions, languages, age groups, and genders. These stakeholders must also include individuals with lived experience related to domestic violence and/or HIV. The Contractor may conduct more than ten interviews as deemed necessary.
C. A minimum of one (1) survey to be disseminated among the target population and other relevant community stakeholders. Respondents should represent a variety of countries of birth, religions, languages, age groups, and genders. These stakeholders should also include individuals with lived experience related to domestic violence and/or HIV. The Contractor may conduct more than one survey as deemed necessary.
D. The contractor will be responsible for developing research materials, including focus group discussion guides and survey questions. Research materials will be developed in collaboration with the contract monitor, community stakeholders and approved by the Contract Monitor.
Due Date:
May 25, 2021 at 3:00 PM Local Time
Address:
Akua Boatema Center for Injury and Violence Prevention 201 W. Preseton Street, 4th Floor Baltimore, MD 21201 Phone: 410-767-5782 akuab.boatema@maryland.gov
Relevant agencies to consider for this include Rubenstein PR and Zeno group.