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 

I.Executive Summary

II.Country Program Description

A.Introduction

B.Country Context

C.Accomplishments and Outcomes
  -Page 1
  -Page 2
  -Page 3
  -Page 4

III.Lessons Learned & Recommendations

IV.Subproject Highlights
  -Page A
  -Page B (See Below)
  -Page C

V.Non-Subproject Highlights

VI.Attachments

 

IV. Subproject Highlights (continued)

Prevention of STDs /HIV Among Railway Workers in Zimbabwe
National Railways of Zimbabwe
Zimbabwe AIDSCAP
FCO#: 53675
Implementing Agency Type: OGA
Contract Type: Subagreement
Life of Project: 06/15/95 - 07/31/97

Prior to AIDSCAP support, the NRZ implemented Phase 1 of a program that demonstrated its commitment to reducing HIV transmission and its capability to do so. The program purpose was to reduce the impact of HIV/AIDS on employees and their families. The program activities included counseling to persons with AIDS and their families and launching awareness campaigns through a corps of peer educators.

The target population of the AIDSCAP-supported project was railway employees with a secondary target group comprising their families. The railway employs 12,346 people and together with their dependents make up a railway "community" of 46,370. The workers most vulnerable to HIV are those in the category of "running staff" due to the amount of time they must spend away from home. Running staff are those workers actually working on the trains, who comprise about 18 percent of railway employees. In addition, three other categories of workers, office staff, engineers and manual staff, were targeted.

The goal of the project was to stabilize or reduce STI prevalence in the railway community. The purpose was to reduce high risk sexual behavior.

Leveraging

NRZ contributed Z$ 800,000 to the counseling and awareness campaign that this subagreement supported. They dedicated staff time, transportation cost, office support and rent and communication costs to the project.

Accomplishments

• 60 sites ( 100% of target) participated in activities.

• 1,805 T shirts, 12,606 booklets, and 5,364 posters were produced and distributed as well as other materials distributed.

• 75 drama performances were held with 13,607 people attending.

• Condom distribution, though it increased ten fold, was less than expected

• STI cases treated per month by NRZ at their 16 clinics have increased from beaten 50-100 in the first eight months of the project to between 100-150 for the last 10 months, with one month (January 1997) exceeding 150. This may mean that education on the importance of treating STIs is having some effect. (Mostly lower grade employees attend these clinics, upper levels seek treatment outside NRZ facilities.)

• AIDS slogans were printed on all pay slips.

• 350 peer educator satchels and 200 caps with AIDS slogans were purchased and distributed.

Networking was an important aspect of the program:

• WASN, NECTOI, ZNA, AFZ and Triangle exchanged IEC material

• UNICEF and ZAN supplied IEC material

• NACP invited project staff to workshops and seminars

• LUBANCHO House in Bulawayo assisted in training and facilitation

• ZNFPC assisted with condom supplies and facilitating at workshops

Constraints

• Peer educator dropouts were experienced especially in the follow-up workshops due to lack of interest and incentives.

• The project manager was the only full-time staff and some site coordinators failed to fulfill their tasks due to other commitments.

• A ratio of 1:50 peer educators is too large for PEs to interact with all of employees regularly

• Transportation remained a big problem.

• Counseling services were underutilized.

• Middle management had a tendency to distance themselves from AIDS issues. Some peer educators found the offices and supervisors offices in accessible. They were also not very cooperative with the selection of peer educators and some did not release staff for training or education.

Recommendations

• Behavior change is slow. More emphasis has to be placed on behavior change modules.

• Only 26 women were trained as peer educators; more dependents should be trained as dependent wives have little or no access to information or help with empowerment issues relative to sexual decisions.

• Awareness campaigns should be targeted to couples, especially in small exclusive neighborhoods to encourage communication on sexuality between sexes.

• Youth should be targeted as they not only have multiple partners but do not use condoms consistently.

• Syllabus for peer educators needs to include counseling, and reproductive heath.

• There is a need for more paid field staff to help coordinators carry out activities, in addition to better transportation.

• NRZ charges personnel for STI treatment. As a result staff only come when the disease has advanced. STIs should be treated like other ailments and treated without charge.

• Incentives for peer educators should be considered as they give up lunches and teas to fulfill their tasks.

• Condoms should be placed in male and female toilets and female condoms should be made available for sale.

• More seminars should be conducted for middle management who still are not as informed despite all the campaigns.

Country Office Comments

The NRZ peer education program was very active during the life of the project and continues to be so. Management remains supportive and contributions have increased tremendously for NRZ AIDS prevention activities. The program shows great promise for sustainability. It will however require more dedicated staff to strengthen program management.

The Health and Community Affairs Division through its AIDS Action Committee (AAC) was undertaking AIDS-related activities among selected groups within the Triangle community prior to support from AIDSCAP.

The project goal was to stabilize or reduce STI prevalence among CSWs and their partners, and men and women at Triangle Ltd. The project purpose was to reduce high risk sexual behavior in the target populations. The two outputs were to implement targeted behavior change communication interventions and condom promotion and distribution on the Triangle Estate.

The primary program methodology was peer education. Based on evolving needs over the life of the project, a well-woman's clinic was established and training was conducted for teachers and counselors.

Leveraging

Triangle added hospital staff to handle STI services and purchased condoms, distributing them free throughout Triangle District. They also donated a truck to be used for AIDS activities.

Accomplishments

• 52 ( 60% of target) paramedicals were trained which was less than anticipated as Triangle thought it more efficient to train a smaller group.

• 17 sites were involved in peer education activities.

• Four workshops were conducted with religious leaders in the community to sensitize them to the project as they were creating resistance. Gradually resistance decreased, apart from continued negative feelings about condom use.

• Three schools out of 8 in Triangle asked for and received training for their teachers.

• 30 counselors were trained.

• 6,500 posters, pamphlets and AIDS resource packs were distributed.

• A well women's clinic was established as the more women learned about STIs, the more they sought early treatment and asked for a facility where they could be examined for other female problems.

• A home care program, run by the coordinator of this project, started due to need in the community. Financial and material support came from fundraising activities and well wishers in the community such as the Lion's Club of Triangle.

• Both mixed sex and single women's peer educator clubs were established and have proven to be extremely valuable in maintaining motivation and knowledge levels among peer educators.

• Use of incentives such as T-shirts, carrying bags, and badges also helped to keep peer educator morale high.

• Voluntary HIV testing was established and Triangle was in the process of acquiring an ELISA machine to replace the HIV CHEK screening test now in use.

• A resource center was established and used by students from local teachers' colleges and universities.

Constraints

• The project started activities in January 1996 (when funds were transferred) but the subagreement was effective in November 1995.

• Triangle is isolated resulting in difficulty networking with other organizations.

• Staff turnover in the second quarter of FY 96/97 affected the operation of the project.

Recommendations

• Integrate AIDS education into organizational health education and in-house training programs.

• Conduct more meetings between Triangle senior management and AIDSCAP/Zimbabwe management.

• Target youth and married women.

• Incorporate counseling into the AIDS program.

• Conduct pre- and post- intervention studies.

• Institutions should have a clear AIDS policy.

Country Office Comments

Despite the constraints of remoteness, staff turnover, and the need to operate within the agricultural cycle, the Triangle AIDS Action Committee did tremendous work. Future efforts will emphasize strategies to encourage behavior change, and will increase efforts among crucial populations such as women and youth. Expanded access to HIV testing and STI treatment is also planned. Financial and administrative support from Triangle management is excellent, and the company has pledged to continue the project beyond donor funding. A post-intervention KABP study was not done due to the short length of time of project operations

Early intervention among girls who are not yet sexually active may be crucial in changing the course of the epidemic. The Women and AIDS Support Network (WASN) was established in 1989. It aims to share information about how AIDS affects women with organized groups and clubs, to support women with HIV infection and to assist women in helping each other protect against HIV infection.

Based on the Gender and AIDS Workshop held in Mombasa, Kenya in October 1995, the Zimbabwe team developed a plan of action to empower adolescent girls through provision of adequate and correct information and equipping them with appropriate interpersonal skills central to HIV/AIDS and STI prevention. The objectives were to:

• Advocate for a policy review of the plan of the NACP to be more gender sensitive;

• Provide information about sexual and reproductive health, including STIs/HIV to adolescent girls;

• Train mothers and daughters in communication skills on reproductive health/STIs/AIDS;

• Create and provide a supportive environment within schools for the initiation and sustenance of positive interpersonal skills;

• Advocate for female-controlled preventive methods;

• Encourage providers to administer STI management in a "girl friendly" environment.

Accomplishments

• A preliminary needs assessment was conducted in six schools in urban and rural areas to understand what girls think about relationships, sexual health and HIV/STIs. The results were used to design workshops.

• Workshops were held in five of the six schools involved in the study. Topics covered included gender issues, assertiveness, communication, sexual health, a woman's body, HIV/AIDS, contraception, and setting up support systems.

• A four day gender training workshop was held for 13 teachers (65% of target) from the five schools.

Constraints

Some teachers and parents thought that sex should not be discussed. They think abstinence should be the only message. Some school heads still do not see the relevance of sex/family life education. There were also complaints that the program only targeted girls and not boys.

Recommendations

It is important to continue working with young girls as the gender power issues between girls and boys make it difficult for girls to assert themselves.

Country Office Comments

WASN has played a major role in gender mainstreaming at the community level; they have supported government efforts to bring sex education into schools. They are trying to influence traditional norms and values that negatively influence women and children by working with leaders in the communities they support.

Through this project, ZBC conducted weekly Radio 3 and ZTV programs. The objectives were to:

• Develop and air a 30 minute "phone and write in" HIV/AIDS weekly question and answer program called "AIDS Is Here" on Radio 3 during prime time for a period of four months.

• Develop an eight part 30 minute discussion-based program in each of the four major regions of Zimbabwe (Mashonaland, Matebelelland, Masvingo and Manica land) and discussions in Shona and Ndebele to be televised on ZBC's two TV channels during prime time for a period of two months.

Accomplishments

• Twenty thirty-minute phone in HIV/AIDS programs aired on Radio 3.

• Eight thirty-minute community-based discussions held in the major provinces in Zimbabwe were aired on ZTV channel 1.

• Knowledge gaps in the rural population were identified.

Constraints

• Apathy among the youth concerning HIV/AIDS issues hindered discussions with that age group.

• Traditional and social norms affected condom use.

• Poor knowledge level of some of the participants limited the depth and breadth of discussions.

• Some technical questions could not be answered by the radio/TV staff conducting the discussions/interviews.

Recommendations

• Rural communities require further targeting.

• Radio is accessible to rural communities and talk shows can be a good medium to correct myths and misconceptions about HIV/AIDS.

Country Office Comments

The thirty minute phone-in radio program often deviated from its focus of HIV/AIDS to discussions on other health issues such as diabetes or goiter. The TV program was basically a series of focus groups held in rural communities to find out what the people knew about HIV/AIDS. The focus group discussions revealed a general lack of knowledge and unhealthy attitudes about HIV/AIDS and should be followed up with programs that are developed in response to these findings. Additionally, future programs should have a medical representative on the team to answer technical questions.

 

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