Nudging Georgians to self-test for HIV

Note: This article first appeared on the Caucasus Data Blog, a joint effort of CRRC Georgia and OC Media. It was written by Dustin Gilbreath, a Non-Resident Senior Fellow at CRRC-Georgia, The views presented in the article are of the author alone, and do not necessarily reflect the views of CRRC-Georgia, UNDP Georgia, Caritas Czech Republic, Tanadgoma, or The United Nations Development Programme under the Czech-UNDP Partnership for SDGs.

CRRC Georgia data suggests incentivising people to test for HIV and making tests more accessible can encourage more young people to self-test.

HIV and AIDS are highly stigmatised diseases in Georgia: a 2020 report found that half the public would not buy vegetables from someone they knew had HIV, and two in five do not think HIV-positive children should be able to attend school with other children.

This stigma stands in the way of more people being tested for HIV, a critical issue in Georgia.

While the country is on track to meet international standards for the share of HIV-positive people receiving treatment and for those receiving treatment to have viral loads suppressed, only one in three people (36%) with HIV is estimated to be aware of their HIV status.

In this context, CRRC Georgia conducted a study in partnership with Caritas Czech Republic, Tanadgoma, and UNDP in Georgia with the financial support of The United Nations Development Programme under the Czech-UNDP Partnership for SDGs to promote self-testing among young people. The tests were offered by Selftest.ge.  

The study found that running a smartphone raffle and minimising the amount of information needed to order a test made young people more willing to participate in HIV self-testing.

The method was found to be comparable in cost to some of the least expensive global interventions used to encourage people to self-test.

To reach these conclusions, the study made use of three randomised control trials (RCT) — the gold standard for scientific evidence.  RCTs randomly assign large groups of individuals to receive different interventions. By randomly assigning individuals to receive different interventions, researchers can ascertain that the only difference between the groups on average is that one received the intervention and the other did not.

In total, each randomised control trial had between 38,000 and 54,000 participants, reaching 16-22% of those aged 18–34 using Facebook in Batumi, Kutaisi, and Tbilisi.

The randomised control trials tested three messages against a basic control message. The first message attempted to assuage people’s fears of being diagnosed with HIV. The second message highlighted that the services of selftest.ge were highly confidential and sensitive to young people’s needs. The third message offered a chance to enter a raffle for an iPhone 13.

The first study found that the iPhone 13 message was more effective than the two others at getting people to click through to the order page, followed by the message which focused on user confidentiality. In contrast to expectations, the message that attempted to assuage young people’s fears about a positive test result had a negative effect — people were less likely to click this message than the neutral control message.

Despite the large scale of clickthrough achieved in the trial, few people ordered self-tests. Project team members suspected that this may have stemmed from individuals not paying full attention to the messages. Therefore, a second trial was conducted with the same messages, but adding a one-sentence highlight of the key message to the Facebook post. However, this failed to produce more orders, with only one HIV self-test order coming through during the second randomised control trial despite thousands of clicks.

In the third and final trial, the study team inferred that the order form was too detailed and complicated for users. A new and simplified order form was trialled on Facebook with the two most effective messages (focusing on anonymity and the iPhone 13 raffle).

This final study started to lead to orders, with the combination of the iPhone 13 raffle and the simplified order form leading to the most self-test orders. In terms of the cost per order, this combination of a simple order form and the iPhone 13 raffle lead to a cost per self-test order of $2.66. This compares favourably to studies conducted internationally, which have identified the cost of testing promotion in the realm of $2 to $50+. 

While the stigma associated with HIV and AIDS in Georgia is a large-scale societal problem, enabling young people to access self-testing is critical to ensuring that people living with HIV know that they have it, and in turn, can seek treatment. This study provides one viable path for actors working on the issue to address this challenge.

The full policy brief which this report is based on is available here.

This post was written within the scope of the project Behavioral insights for low uptake of HIV testing in Georgia, which is implemented by the United Nations Development Programme (UNDP) through the Challenge Fund, with the financial support of the Ministry of Foreign Affairs of the Czech Republic.

The content of this material does not necessarily represent the official views of the Ministry of Foreign Affairs of the Czech Republic, or of the United Nations, including UNDP, or UN Member States.

Greatest Threats Facing the World | Data from the 2009 CB & the Global Attitudes Survey

By Jesse Tatum and Vazha Burduli

From environmental catastrophe to violence, our world currently faces serious challenges with long-term consequences. In this context, what do people in the Caucasus consider to be the most acute problems?

Regarding the greatest threats to the world today, the spread of nuclear weapons and poverty are foremost on the minds of people in the South Caucasus, according to the 2009 CB.

The CB asked respondents to choose from a list of six dangers which one they believe poses the greatest threat to the world. In Georgia and Azerbaijan, the spread of nuclear weapons topped the list, with 44 percent and 36 percent, respectively. Meanwhile, in Armenia, poverty was chosen first, with 35 percent, just edging out the threat of the spread of nuclear weapons. Curiously, more people in Azerbaijan seemed to worry about AIDS and infectious diseases -- something still to look into.

The 47-Nation Pew Global Attitudes Survey, which also asks people which threats currently pose the greatest risk to our world, found that pollution and environmental problems are increasingly taking over the top spots as the most pressing world dangers. (Note that CRRC's question was phrased slightly differently, and offered another option.)

Compared with the Global Attitude Survey's results, people in the South Caucasus are less concerned with pollution and environmental problems than in other parts of the world, especially Sweden, Canada and East Asia (China, S. Korea and Japan).

The amount of data available between the two surveys is extensive indeed. We hope you will check out Pew's report, and then compare other figures with our CB in order to see where South Caucasian's world views fit into the international context. In the future, we plan to post more comparisons of this sort.

Intravenous Drug Users in Tbilisi | Survey Data

As part of a four part series, Save the Children in cooperation with a host of other organizations have released reports from survey data they have collected from Female Sex Workers (FSWs) and Intravenous Drug Users (IDUs). All of the surveys are funded by USAID. This entry reviews the Tbilisi report on IDUs. If you are interested in the other reports, please contact us.

It has been a conundrum for many why the number of HIV infected is not higher in Georgia (Georgia is low prevalence country, less than 5%, as defined by UNAIDS, but data is weak, since surveillance is bad), since it is estimated that there are 250,000-280,000 IDUs in Georgia, which accounts for around 5% of the total population -- an astounding figure. To understand the dynamics of IDUs and its relation to HIV infection other diseases a Behavioral Surveillance Survey (BSS) has been carried out three times -- in 2002, 2004 and 2006. The survey methodology uses a referral method, since sampling IDUs is no easy task. While providing good information, it does no present a representative sample of these people and when discussing the data, one must keep in mind various biases in the data, which may be present. However, the data points to trends that are generally positive, and it may be that Georgia will be able avoid a much larger HIV crisis.

So, what did the 2006 data show? Similar to 2004, the report found stability in the type of drugs injected. Most IDUs in the sample report injecting Subutex and also having started to use Antihistamines. In 2002, however, most users reported using heroin.

Also, in terms of good news, 96% of those who reported having paid sex (30% of the male sample -- about the same as in 2004), reported using a condom. The number who pay for sex and use a condom is substantially up from 2004, which hopefully indicates and increase in awareness of the dangers of unprotected sex. However, males users report not using condoms with their stable sex partner. In other good news, knowledge about HIV among drug users is also rising, at least in the sample, however remains low overall. Only 37% of the sample could correctly identify the six mechanisms of transmitting HIV. However, only 15% of the sample in 2002 could do so.

On the bad news front, respondents who inject seems to be getting younger and younger. There was a 10% jump from 2002 to 2006 in the those who started injecting between 15 and 19 years old.

Again, if you are interested in the whole report, please get in touch.

HIV/AIDS: Azerbaijanis' Attitudes and Knowledge Explored

There has been growing concern about HIV/AIDS in the South Caucasus. But what kind of knowledge and attitudes about the disease exist in the region? By using data from the CRRC 2004 Data Initiative (DI) and conducting focus groups Gulshan Tagiyeva analyzed the knowledge and attitudes about HIV/AIDS in Azerbaijan.

Based on the results from 2004 CRRC DI survey, the fellow showed that the population in Azerbaijan is less informed about HIV/AIDS and other sexually transmitted diseases than Georgians and Armenians. Additionally, a large percentage of Azerbaijanis, particularly women, are unsure about how people become infected with HIV/AIDS. There is also very low social acceptance of those who are HIV positive. For example, of respondents in Baku only 8.9 % do not mind doing business and 5 % being friends with people who have HIV/AIDS (2004 CRRC survey).

This research demonstrates more work clearly needs to be done in Azerbaijan to increase HIV/AIDS awareness and social acceptance of those who have HIV/AIDS, particularly among women. The author has drafted a manual (in Azeri) to help promote AIDS education. Her report and a presentation (both in Azeri) can also be downloaded.