Local Perceptions of the Forms, Timing and Causes of Behavior Change in Response to the AIDS Epidemic in Zimbabwe
- 296 Downloads
Quantitative studies indicate that HIV incidence in Zimbabwe declined since the late 1990s, due in part to behavior change. This qualitative study, involving focus group discussions with 200 women and men, two dozen key informant interviews, and historical mapping of HIV prevention programs, found that exposure to relatives and close friends dying of AIDS, leading to increased perceived HIV risk, was the principal explanation for behavior change. Growing poverty, which reduced men’s ability to afford multiple partners, was also commonly cited as contributing to reductions in casual, commercial and extra-marital sex. HIV prevention programs and services were secondarily mentioned as having contributed but no specific activities were consistently indicated, although some popular culture influences appear pivotal. This qualitative study found that behavior change resulted primarily from increased interpersonal communication about HIV due to high personal exposure to AIDS mortality and a correct understanding of sexual HIV transmission, due to relatively high education levels and probably also to information provided by HIV programs.
KeywordsZimbabwe HIV decline Behavior change Qualitative research Prevention programs Program mapping
We thank the participants in focus groups discussions across Zimbabwe for their invaluable contributions. We are also grateful to the Ministry of Health and Child Welfare (MOHCW) and to the National AIDS Council (NAC) for convening meetings and—through District AIDS Coordinators—helping to organize focus groups. We thank the providers of various forms of data such as evaluations, reports and others documentation, in particular MOHCW AIDS/TB Unit, NAC, SAfAIDS, Hazel Chinake in the Swedish International Development Agency, Karin Hatzold, Noah Taruberekera and Kumbirai Chatora in PSI/Zimbabwe, Sunday Manyenya in UNFPA and others. We also thank Kevin Kelly, Leonard Maveneka, Barnet Nyathi, Denford Madhina, Fatima Mhuriro, Felix Tarwireyi and Charlie Davies for the ground work done during programmatic review processes conducted before this study. We also acknowledge the important contributions of participants in the national stakeholders’ meeting held in Harare in May 2008. When conceptualizing this study, we benefited from inputs from other members of the Steering Group for this research including Kwame Ampomah, Stacey Greby, Dan Rosen, Roeland Monasch, and Helen Jackson. We would like to thank UNFPA Zimbabwe for financial and logistical support, and we thank Godfrey Woelk, Jim Shelton and Ann Swidler for their valuable assistance and comments.
- 1.UNAIDS. Report on the global HIV/AIDS epidemic. Geneva: UNAIDS; 2008.Google Scholar
- 2.UNAIDS. Evidence for HIV decline in Zimbabwe: a comprehensive review of the epidemiological data. Geneva: UNAIDS; 2005.Google Scholar
- 3.Gregson S et al. HIV decline due to reductions in risky sex in Zimbabwe? Evidence from a comprehensive epidemiological review. Int J Epidemiol. 2010. doi: 10.1093/ije.
- 6.Zimbabwe Central Statistical Office. Zimbabwe demographic and health survey, 2005–2006. Harare: Zimbabwe Central Statistical Office and Macro International; 2007. p. 298.Google Scholar
- 7.Population Services International. Knowledge, attitudes, beliefs and practices on HIV/AIDS in Zimbabwe survey reports, 1997–2007. Harare: University of Zimbabwe; 2007.Google Scholar
- 9.Bernard R. Research methods in anthropology: qualitative and quantitative approaches. Thousand Oaks, CA: Sage; 1994.Google Scholar
- 10.SAfAIDS and Zimbabwe Ministry of Health and Child Welfare. Annotated bibliography of research on STIs/HIV/AIDS in Zimbabwe. Harare: SAfAIDS; 1998.Google Scholar
- 11.Zimbabwe National AIDS Council and UNFPA. Comprehensive review of behavioural change as a means of preventing sexual transmission of HIV. Harare: UNFPA; 2006.Google Scholar
- 12.Nyathi BB, Madhina D. Review of the Zimbabwe national sexually transmitted infections programme. Harare; 2007.Google Scholar
- 13.Zimbabwe Central Statistical Office. Zimbabwe demographic and health survey, 1994. Zimbabwe Central Statistical Office; 1995.Google Scholar
- 14.Zimbabwe Ministry of Health and Child Welfare, et al. The Zimbabwe young adult survey 2001–2002. Harare, Zimbabwe: Zimbabwe Ministry of Health and Child Welfare and Centers for Disease Control and Prevention; 2004.Google Scholar
- 19.Mbizvo MT, Adamchak DJ. Condom use and acceptance: a survey of male Zimbabweans. Cent Afr Med J. 1989;35(10):519–23.Google Scholar
- 22.Mutambirwa J. Aspects of sexual behaviour in Zimbabwe. In: Dyson T, editor. Aspects of sexual behaviour in local cultures and the transmission of sexually transmitted diseases including HIV. Liege: Ordina; 1992.Google Scholar
- 24.Bourdillon MFC. Where are the ancestors? Changing culture in Zimbabwe. Harare: University of Zimbabwe; 1993. p. 129.Google Scholar