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This report comprehensively summarizes the FHI/AIDSCAP program in Zimbabwe (1992-1997). The report includes a country context description, accomplishments, constraints, and outcomes of the program, and a series of lessons learned and recommendations.
Table of Contents II.Country Program Description C.Accomplishments and Outcomes III.Lessons Learned & Recommendations IV.Subproject Highlights V.Non-Subproject Highlights (See Below) VI.Attachments
V. Non-Subproject Highlights The Meeting Point (a News Column on HIV/AIDS) A weekly column designed to facilitate communication with people who are affected or infected by HIV/AIDS was supported in two national newspapers, the Herald (English) and Kwayedza (Shona). Mutandwa, who writes the column in the Herald, is a veteran journalist who has worked in the Office of the President and is now a senior public service person with the Ministry of Information. Themes of the columns ranged from human interest stories, to updates on research to social/political issues, such as creating a national policy and whether or not to legalize prostitution. The Meeting Point column in the Herald alone generates about 50 letters a week and the journalist has trouble answering them all in a timely fashion. A total of 52 were printed over the life of the project. KABP for NECTOI & CFU This survey was conducted by Troparg Consultants, a team of local social science research consultants familiar with Zimbabwean culture. Field work was completed in April 1997. Results were shared at a Dissemination Workshop held in June 1997. The objectives of this evaluation were to examine the change between baseline and post intervention surveys in key prevention indicators (e.g. the proportion of the population able to cite at least two acceptable ways of protection from HIV infection). The populations surveyed were those targeted by the CFU and NECTOI AIDS control programs. Baseline surveys in these populations were done in July 1995, with the post intervention survey carried out in March and April of 1997. Focus group discussions were also held. Among the CFU target population (farm workers and their families), knowledge levels about HIV/AIDS (as measured by the proportion of the population able to cite two acceptable ways of protection against HIV) remained above 90 percent for adults, but showed a drop among youth from about 80 to 75 percent. The proportion of persons who can acquire a condom dropped for adult females and for youth by ten percent or more, but remained stable at 77 percent for adult males. Condom use remained stable for adults (at 50 to 57 percent with last non-regular partner), but for youth fell from 53 to 41 percent for males and from 39 to 27 percent for females. Perceived risk went up among adults, as shown by a decrease in the proportion reporting no chance of HIV infection, and an increase in the proportion reporting some chance of HIV infection. Interpreting these results is complicated by the fact that the two samples (1995 and 1997) differed considerably. In order to increase the power of the study a much larger sample was obtained in 1997, necessitating sampling from additional farms than were sampled in 1995. In order to obtain the numbers of youth which were needed the age cut off was lowered, skewing the age distribution. Even taking this into account, the results noted above are far from reassuring. While knowledge levels remain high, they have not increased, and condom use as well as condom availability does not appear to have been impacted by the intervention. The trends for youth in particular are disturbing, as this age group is the "window of opportunity" for keeping future cohorts free of the AIDS virus. The target population for NECTOI is truck drivers and their assistants and commercial sex workers (CSWs). Knowledge levels went up for drivers from 88 to 94 percent, but for sex workers showed a non-significant trend downwards, from 92 to 84 percent. Condom availability went up for both groups, with reported availability for CSWs increasing from 61 to 81 percent. Reported condom use went up for drivers (non-significant) but down for CSWs, from 82 to 73 percent. Perceived risk went up for both groups. The meaning of these results is not clear: Why should condom use go down for CSWs and up for drivers, when availability is increasing for both groups? The results of the focus group discussions for both CFU and NECTOI highlighted barriers to condom use such as beliefs that condoms are painful and cause AIDS, and that suggesting the use of a condom with a regular partner indicates lack of trust. Peer educators also expressed fatigue and demoralization, stating that they were unable to continue their level of activities without more incentives or additional income. CSWs said that financial issues were a major determinant of the number of sexual partners and whether or not condoms were used. Assessment of HIV/AIDS Media Reporting A local consultant was contracted to do a survey of mass media reporting on HIV/AIDS in Zimbabwe. Print and electronic media reports were surveyed and key informants interviewed, including hosts and participants of preceding AIDS media workshops. Reporting on HIV/AIDS was found to be sporadic, often taking a blaming attitude towards PLWAs. Local stories tended to present statistics and general statements on AIDS without addressing underlying issues. The following barriers to effective reporting were identified:
Bureaucratic and policy issues, such the referral of all questions regarding HIV/AIDS within the Ministry of Health to the Permanent Secretary, were also found to hamper effective AIDS reporting. Following this study, AIDSCAP held a mass media workshop in March 1996 to present findings and determine the next steps. Media Workshop Following the critical analysis of print and electronic media, a strategic planning workshop for gatekeepers, journalists, editors and relevant NGOs was held in March 1996. Participants included senior government officials and senior personnel in media and training institutions. Key persons in the media were identified and methods of establishing linkages between media and AIDS service organizations were established. Design of AIDSCAP/Zimbabwe print and electronic media interventions were based on the outcomes of the workshop. Mass Media Program Evaluation This evaluation of AIDSCAP/Zimbabwe mass media interventions was conducted in March and April of 1997 by Farai Samnhungu (a local consultant) and Parkie Mbozvi of the University of Zambia. Results were presented at the June Dissemination Workshop. Composite Baseline KABP Analysis Local consultants developed a composite report based on data collected during the baseline studies on workplace interventions. These baseline surveys were conducted by the University of Zimbabwe Department of Community Medicine (NECTOI, CFU, ZNA, and AFZ) and by Dexter Enterprises (Triangle and NRZ). The purpose of these surveys was twofold: to serve as a baseline for later evaluation of AIDS control programs in these communities, and to provide data to enhance AIDS control program design and implementation. In addition to the questionnaires, data was gathered using focus group discussions, key informant interviews, and observation. The results of the KABP surveys were combined and a composite analysis was done using SPSS. Despite the high levels of knowledge on HIV/AIDS, the respondents in all the study populations underestimated their chances of getting infected with HIV. Approximately 60 percent of adults, 68 percent of youths, and 24 percent of CSWs thought they had no chance of being infected. Overall, 3.7 percent of non CSW-adults who had recent unprotected sex with a non-regular partner classified themselves as "no risk", with a range from 0.9 percent (ZNA) to 6.7 percent (NRZ). Behavior was measured through reported condom use and number of sexual partners. Condom use during the most recent sexual encounter with a non-regular partner ranged from 16.5 percent (NRZ) to 71.0 percent (NECTOI), with an average of 46.5 percent. The reported number of sexual partners in the last three months ranged from 0 to 46, with a pooled mean of 1.19. Most persons reported one partner. Youth had an average of 3.3 sex partners since beginning sexual activity. Respondents indicated that they were changing their behavior since hearing about AIDS, primarily by using condoms and by staying with one faithful partner. Condom availability was good, with 90.7 percent of persons saying they could acquire a condom when needed, ranging from 80.4 percent (CFU) to 97 percent (AFZ). Sources of information on HIV/AIDS varied considerably depending on the population sampled. Generally, more urban and more highly educated non-CSW populations tended to use television and newspapers as sources of information, while more rural and less educated populations relied on radio, friends, and health workers. Among the armed forces population, the AFZ showed a high reliance on newspapers relative to radio and other sources. Overall, radio was the most important source with 65 percent of respondents naming this as a main source of information, followed by television, friends, and newspapers (30-38 percent). CSWs reported health workers as a significant source of information, but still rated radio the highest. Youths also reported radio as a significant source, but rated television, newspapers, health workers, friends, and school as important. Several points were raised in the discussion following the presentation. The high level of newspaper readership found in the AFZ relative to other groups may be partly due to an urban bias, since all the AFZ bases are in urban areas where access to newspapers is high. While the report mentions the military policy of disciplining persons found to be infected with STIs, a participant from the ZNA pointed out that no one has ever been discharged from the army due to repeated STIs. Participants from the CFU commented that the survey presented a true and informative picture of their population and their program, which is attempting to reach a large disadvantaged rural population with volunteer coordinators and peer educators. The data on sources of information regarding HIV/AIDS stimulated several questions. Peer education was represented by "friends" in the questionnaire, and only among youth was this highly rated as an important source of information. Since most intervention programs rely on peer education, this was felt to be a significant finding. A source of information (friends or peers) viewed as less important by the target populations may be getting disproportionate support from donors and programs. Despite their wide distribution and influence in the community, churches were not reported to be significant sources of information. Country Level Literature Review Southern Africa AIDS Information Dissemination Service (SAfAIDS) was contracted to conduct a country level literature search of locally produced papers, both published and unpublished, on HIV/AIDS research in Zimbabwe. Topics covered included: adolescents/youth, attitudes, behavior change, condom use, coping behavior among HIV-infected persons, sexual behavior, discrimination, diagnosis and management of HIV/AIDS/STIs, the female condom, and integration of family planning and HIV/AIDS prevention. SAfAIDS reviewed 125 studies. The review summarized findings and identified gaps in local research. Major gaps include lack of:
The review was completed in April 1997 and results were presented at the Dissemination Workshop in June 1997. Networking Seminar for Implementing Agencies FHI/AIDSCAP Zimbabwe held its first seminar for implementing agencies (IAs) in conjunction with the Zimbabwe National AIDS Control Program (NACP) in November, 1995. The goals of the workshop were to:
Network Strengthening Workshop A second network strengthening workshop was held for IAs in November, 1996. The workshop was again held in collaboration with the Zimbabwe National AIDS Control Program (NACP). The purpose of the workshop was to strengthen networking skills, and provide a forum for networking. Representatives from non-USAID funded organizations working in AIDS prevention and control joined USAID-funded IAs for the workshop. In addition to presentations and discussions on networking, representatives from the AFRO and Headquarters offices gave presentations on capacity building and the stages of behavior change. By the end of the workshop, participants had listed and discussed the benefits and constraints of networking as well as general programmatic constraints and developed a list of areas that required stronger emphasis. Participants included representatives from the IAs as well as from USAID, FHI/AIDSCAP Regional Office, NACP, UNICEF, WHO, Harare City Health Department, ZNFPC, and ZAN. Pre-Lessons Learned Workshop A one-day workshop was held for IAs in January 1997. The objectives of the workshop were to:
Lessons Learned and Close-out Workshop A three-day workshop was held for IAs in March 1997. Objectives were to:
A report on the workshop details lessons learned and makes recommendations for the future. Gender Workshop A workshop for gender analysis and development of gender oriented programs for HIV/AIDS prevention was held in April, 1997. By the end of the workshop, participants were expected to:
Participants included representatives from the Ministry of Health, Zimbabwe Women's Resource Center & Network, Women & AIDS Support Network, Zimbabwe AIDS Network, National AIDS Coordination Program, World Health Organization, Zimbabwe AIDS Prevention Program, and HI/AIRSPACE Implementing Agencies. Rapid Response Fund
Workshops, Conferences November 1994: Southern Africa Conference on AIDS and Employment February 1995: UNESCO workshop on AIDS Prevention in School. April/May 1995: Community and Home-Based Care Conference in Montreal, Canada, attended by representatives of the CFU subproject. The Civil Military Alliance Conference in Harare. (Participants from East, Central, and Southern Africa attended to asses the complementary relationship between the military and civil organizations dealing with AIDS prevention.) Jan-March 1995: The CFU Retreat in Nyanga The UNESCO workshop on AIDS Education in Primary Schools Policy Workshop on AIDS July-Sept. 1995: Two persons from the CO, one from CFU, two from Army and NECTOI subprojects, attended USAID AIDS Prevention Conference in Washington, DC. Oct.-Dec. 1995: Representatives from CO, NECTOI, ZNA, AFZ, NACP, NRZ, ZAHEC attended IX International Conference on AIDS and STDs in Uganda. April - June 1996: Resident Advisor attended Gender and AIDS Workshop held from 12-16 May,1996 in Mombasa Kenya. (Follow-up to Regional Gender and AIDS workshop held October, 1995) July 1996 Resident Advisor attended the XIth International Conference on HIV/AIDS/STDs in Vancouver, BC. August 1996: The IEC/NGO Officer attended the Communication Officers' Summit organized by AFRO in Mombasa, Kenya. December, 1996: RA attended the SWAA conference, Gaborone, Botswana. March 1997: The RA and the Accountant attended a workshop on NGO formation organized by Headquarters/AFRO in Nairobi, Kenya. |
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