Local Perceptions of the Forms, Timing and Causes of Behavior Change in Response to the AIDS Epidemic in Zimbabwe
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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.
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