Understanding Men who have Sex with Men (MSM) using Human Centered Design Approaches in Zimbabwe

Summary:
Background: Like many African countries, Zimbabwe has a paucity of research on key populations such as men who have sex with men (MSM). PSI Zimbabwe sought to gather insights using human-centered design techniques to understand MSM behaviors and to co-create solutions to improve uptake of HIV services. We explored the MSM service pathways and key barriers and motivators determining behavioral traits of different MSM segments.

Description of Methods: We used HCD techniques through focus group discussions, one on one interviews, hotspot immersions, and observations across the two largest cities in Zimbabwe. Thematic analysis was used to analyze the data.
Results: We identified 6 distinct archetypes and a journey map detailing how the archetypes access services. These included:

• The Glass Box - A person who identifies as gay only within the MSM community;
• The Subtle Champion - An advocate within the MSM community;
• The Flag Bearer - Openly gay and unconcerned with societal stigma;
• The Dual Life - Leads a double life as a heterosexual man and as a gay man; and
• The Conflicted Heart - Has just realized his gay feelings and still confused.

The MSM community is complex given the risky environment. Accessing HIV services not only threatens to expose the MSM's sexuality it threatens his social ties, amplifying his fear of getting tested.

Implications for the Field: We identified opportunity areas likely to offer an impact in improving MSM uptake of HIV services. The archetypes, barriers, and motivations including journey mapping evidence generated can inform future interventions among MSM.

Background/Objectives:
Like many African countries, Zimbabwe has a paucity of research on key populations such as men who have sex with men (MSM). Against this backdrop PSI Zimbabwe set out to gather insights using human centered design techniques to understand the lives of MSM and to co-create solutions to improve their uptake of HIV services. We explored the journey MSMs take to access services inter alia identified the key barriers and motivators determining behavioral traits of different MSM segments.

Description of Intervention and/or Methods/Design:
Hybrid methods were employed during the project phases, with traditional stage-gated processes for the predictive phases and agile methods for the exploratory phases. These complemented the already iterative and incremental Human Centred Design and Action Design Research processes employed by the design and research teams.

A highly collaborative approach that involved the entire team was taken in setting team dynamics, ways of working, culture, transparency, predictability and explicit process policies.

Results/Lessons Learned:

• Traditional Project Management processes and policies with the iron triangle metrics of schedule, scope and cost fall short for Innovation Work
• Organisational processes, team culture and dynamics, co-location and trust play a critical role in project success and project management success
• Processes and policies should serve the work and not vice-versa.
• Teams closest to delivery require agency and autonomy to contribute and to change process and policies to maximise value delivered
• Contextual conditions are a key factor in determining a management approach for innovation work
• There is need to maintain a balance to ensure creativity and innovation is not affected by bureaucracy
• The success of a project is independent of the success of the project management approach.

Discussion/Implications for the Field:

• Project Managers need specific skills for Innovation Management that differ from the traditional ones that contribute to the iron triangle metrics
• Highly collaborative approaches that involve the entire team in delivery contribute greatly to project management success and project success
• It is possible for a project to be successful with an unsuccessful project management approach
• Teams should strive to meet the traditional constraints of schedule, scope and cost, but as secondary to the value derived from the innovation project.

Abstract submitted by:
Kumbirai Chatora - Population Services International Zimbabwe
Nigel Kunaka - Population Services International Zimbabwe
Hardwin Sithole - Population Services International Zimbabwe
Malvern Munjoma - Population Services International Zimbabwe
Carey Johnson - Population Services International
Noah Taruberekera - Population Services International Zimbabwe