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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.
II.Country Program Description C.Accomplishments and Outcomes III.Lessons Learned & Recommendations IV.Subproject Highlights VI.Attachments IV. Subproject Highlights (continued) Intervention Program for AIDS Prevention in Bulawayo In 1989, the Bulawayo City Health Services Department (BCHS) initiated a project with AIDSTECH support to reduce risky behavior among commercial sex workers (CSWs), their clients and STI patients in Bulawayo, Zimbabwe's second largest city. Success with peer education and condom distribution led to expansion of the project in 1991. BCHS maintained an intensive intervention for vulnerable groups while expanding to a comprehensive community HIV/AIDS prevention program which included IEC activities based in workplaces (including uniform services) and church/community centers. A 1992 survey of CSWs showed that the project reached 80 percent of community and bar-based CSWs and that condom use was positively associated with the number of project educational sessions attended. Based on this success, a one year extension was granted to increase the capacity of BCHS to provide HIV/STI prevention services among vulnerable groups through collaboration with other agencies as well as expansion of existing activities. BCHS was the lead agency of a multi-sectoral HIV/AIDS prevention approach which included participation from the Bulawayo City Council, GOZ ministries, NGOs and organizations within the private sector. Accomplishments The project continued its peer education program, expanding to reach CSWs and clients who had not been reached through earlier efforts. Peer education strategies included the use of drama and music as well as education and counseling. The project also strengthened the STI prevention and outreach programs in Bulawayo's city clinics by working with health providers to improve their attitude toward CSWs, update their knowledge on HIV/AIDS, and encourage/teach methods for condom promotion. Additionally, BCHS provided a positive environment for collaboration by holding meetings with key stake holders and assisting with negotiation of key issues.
Baseline KABPs on Triangle Limited's and NRZ Target Groups AIDSCAP provided support and technical assistance to Dexter enterprises, a Zimbabwe consulting firm to conduct research on knowledge, attitudes, behaviors and practices relating to the transmission and control of AIDS. Dexter Enterprises has experienced researchers who have undertaken research in the area of AIDS, family planning, and population policy. TRIANGLE, Ltd. The sample size was 1,512 individuals of reproductive age comprised of 499 adult males, 508 adult females, 184 male youth, 76 female youth and 242 CSWs. Key Findings While 99 percent of respondents reported that they had ever heard of AIDS, about 79 percent knew that a healthy person can be HIV positive. Men are slightly more knowledgeable than women, and knowledge is positively related to age, education, media exposure and being Christian. Those who are married are slightly disadvantaged. Apparently women perceive themselves more vulnerable to HIV infection than men, with married women perceiving a higher risk than single women. Generally, married women are least able to assess their level of risk. That is particularly so because most women feel that since they are monogamous, they are infected by promiscuous men whose behavior they are not aware of. Unlike married women, single women reported that they are able to negotiate protection with their sexual partners who cannot force them to engage in unprotected sex. The proportion of respondents who knew at least two methods of preventing HIV infection was very low. It ranged from five percent of adult males to 55 percent of CSWs. Generally the youth were more informed than the adult population. Those with higher knowledge were less likely to report access to condoms. Twelve percent of CSWs and 92 percent of married males said they had access to condoms. Respondents who reported having at least one sexual partner other than their regular partners was highest among male youth (28 percent) and adult males (25 percent). About ten percent of women reported other sexual partners. Respondents who reported urethritis in the past twelve months were male youth (54 percent) and adult males (44 percent). National Railways of Zimbabwe The sample size was 1,132 adult males, 337 adult females, 64 male youth and 5 female youth. Key Findings Approximately 100 percent of the adult population had heard of HIV/AIDS and 93 percent of them knew a healthy person could be infected. There was a low perceived self risk. Approximately 43 percent of the adults reported that they had no chance of getting infected; the same proportion reported that they had a moderate to good chance of getting infected. Males had a lower perceived risk than women. Women were more likely than men to be able to assess their risk of infection. The perceived risk peaked with those aged 25-40 years. While all respondents reported that they knew at least one method of prevention, only about 29 percent of the adults knew of two. Ninety-three percent of respondents reported that they could have access to condoms on the day of the survey. Respondents in Harare were least likely to know where to access a condom, with only 52 percent reporting they could. Women were more likely to know where to get condoms than men. While 24 percent of men reported they had a partner other than the regular one, 11 percent of women and 51 percent of youth reported they had non-regular partners. STIs were common with 47 percent of the sample having reported they had ever had one. Baseline Research and AIDS Media Training Module for Although Zimbabwe was more than ten years into the AIDS epidemic, there remained a gap in HIV/AIDS reporting and coverage. Most of the local journalist admitted their lack of confidence in handling HIV/AIDS issues in their reporting. In Zimbabwe, as in other countries, the media play an important role in the prevention and control of HIV/AIDS. The English Department of the University of Zimbabwe recognized the importance of training graduate journalists in the area of HIV/AIDS reporting, hence the interest in incorporating HIV/AIDS issues in the Diploma in Mass Communications in the Department of English. The Communication and Mass Media Studies Programme aimed to build AIDS communication so that it became a significant component of course offerings student could opt to take. The long term goal was to generate four kinds of AIDS communicators:
Accomplishments
Constraints Project dates coincided with term time so research was pushed back to the holiday period. The effect of this delay and the nature of the university calendar led to the project requiring two time extensions. Ideally, the module should have been servicing a fully fledged HIV/AIDS media training course at the University by the end of the project. However, rules regulating the introduction of new courses into the program necessitate long lapses of time between submission of course proposals and final approvals. There were lapses in teamwork brought on as a result of other commitments and occasional differences within institutional hierarchies both in the AIDSCAP country office and the English Department. All of the above resulted in the inability to hold workshops that were designed to share the module with media practitioners and information officers in technical agencies and NGOs. Recommendations Besides conducting training workshops with partners in media and with technical agencies, the training program should conduct ongoing research that monitors trends in media coverage and audience perceptions of the various messages. Updating the module in a manner that keeps it abreast with new trends in research and other activities should be considered a priority. Country Office Comments Although the module was intended for postgraduate diploma students in mass communication, it will benefit a wider population, including NGOs, governmental agencies and AIDS service organizations as the material can be broken down into materials that would be appropriate for smaller workshops. Baseline KABPs on NECTOI, CFU, AFZ, and ZNA Target Groups Key Findings NECTOI A total of 619 transport workers were interviewed, 265 male drivers and 354 assistants. The mean age was 30.4 years and 91 percent of drivers and 50.8 percent of assistants were married. About 80 percent of respondents could acquire a condom when needed. The condom use prevalence in the most recent sexual encounter for transport workers was 16.7 percent for drivers and 39 percent for assistants. A total of 482 CSWs were interviewed. The mean age was 27.8 years and 94 percent were not married. Knowledge was high with 97.3 percent knowing two or more preventive measures. The radio was the main source of information about HIV/AIDS. Condom use prevalence with a recent sexual partner was 82.2 percent. Condoms were easily accessible with the main source being the health center. CFU A total of 817 adults were interviewed, 406 males and 411 females. The mean ages were 26 years for men and 25 years for women. Knowledge on AIDS ranged from 53.6 percent to 92.3 percent on all aspects of protection from HIV/AIDS, with more males (95 percent) than females (90 percent) citing at least two acceptable ways of HIV protection. Sixty-six percent of adults said the radio was their main source of information on AIDS. Condom use prevalence with recent sexual partner was 30 percent for males and 22 percent for females. Condom use with non-regular partner in the most recent sexual encounter was 12 percent for males and six percent for females. Eighty percent of respondents said they could acquire condoms when they wanted them. A total of 452 youth, 279 males and 173 females were interviewed. A youth was defined as an unmarried person aged 15-19 years, with the mean age for males 17.3 years and 16.6 years for females. More males (91 percent) than females (85 percent) were able to cite at least two acceptable ways of HIV prevention. The radio was the main source of information on AIDS for 66 percent of males and 65 percent of females. The mean age of first sexual intercourse was 15.3 years for males and 15.7 years for females. Seventy-seven percent of all youth said they could acquire a condom. Fifty-one percent of males and 55 percent of females used a condom in the last sexual encounter. AFZ The total number of people interviewed was 400, 272 were male and 128 were female (281 were service people and 119 were spouses.) The mean age was 28.1 years. Ninety-two percent of respondents were able to cite two ways to protect themselves from HIV/AIDS. The main source of information was the radio (70.4 percent). Sixty-five percent of respondents who said they had no chance of acquiring HIV infection had had multiple partners, had used condoms inconsistently or had had sexual intercourse recently with non-regular partners. Ninety-seven percent who correctly identified condoms said they could get them if they needed them. The main source of condoms was the base hospital. Thirty nine percent said they had been involved with non-regular partners. (Discussions with respondents indicated that male respondents trusted non-regular partners as regular partners.) Thirty-eight percent said they had had a recent sexual intercourse of risk yet only 20.8 percent of these respondents reported using a condom in these sexual encounters. ZNA A total of 801 respondents were interviewed; 550 were members of the ZNA and 251 were spouses. Ninety-nine percent were able to identify at least two ways of preventing HIV. The main sources of information were the radio and TV. 81.6 percent of respondents who reported that they had little or no chance of being infected by HIV had multiple sexual partners, used condoms inconsistently or had sexual intercourse recently with non-regular partners and did not use a condom. 96.4 percent of the 796 who correctly identified condoms indicated that they could obtain them if they needed them, identifying the camp hospital as the main source; 29 percent of respondents reported a recent sexual encounter of risk yet only 44 percent of that number reported using a condom. 37.7 percent reported being involved with non-regular partners with only 11.6 percent indicating that they had an STI in the last 12 months. (Since STIs are a punishable offense, respondents could have avoided reporting an infection) |
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