NYU Master's Program in Global Public Health Capstone Program UNDERSTANDING THE CONTEXT OF HIV RISK IN ZAMBIA A Study of Mongu, Senanga, and Kaoma Districts in the Western Province Rebecca Adeskavitz, MPA Donovan Jones, MA Moneesha Kamani, MSc, MS Erin Murphy, MMS, PA-C Janet Vessotskie,
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NYU Master's Program in Global Public Health Capstone Program
UNDERSTANDING THE CONTEXT OF HIV RISK IN ZAMBIA. NYU Master's Program in Global Public Health Capstone Program. A Study of Mongu, Senanga, and Kaoma Districts in the Western Province. Rebecca Adeskavitz, MPA Donovan Jones, MA Moneesha Kamani, MSc, MS Erin Murphy, MMS, PA-C - PowerPoint PPT Presentation
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NYU Master's Program in Global Public Health Capstone Program
UNDERSTANDING THE CONTEXT OF HIV RISK IN ZAMBIA
A Study of Mongu, Senanga, and Kaoma Districts in the Western Province
Social NetworksStructural Violence & Discrimination
Policy Environment
Legal Structures
Behavior
Individual Characteristics
Socioeconomic Position
POVERTYSource: Adapted from Poundstone, Strathdee & Celentano, 2004
THEORETICAL FRAMEWORK
DATA COLLECTION
DataCollection
Mongu Senanga Kaoma
Focus Group Discussions
6 2 2
No. of FG Participants
46 13 14
In-depth Interviews
8 0 0
Key Informant Interviews
10 1 7
Total Participants 54 14 21
Data collection took place over a two-week period
Focus Group Participants
47 Average Age (years)
54 % Male
46 % Female
48 % Married
30 % of participants who reached secondary level education
Interviews •NGO leaders• Government officials• Local/tribal leaders• Traditional healers• Church leaders• Community Health Workers
A tree provides shade for a focus group in Itufa, Senanga District.
Analysis
ANALYSIS
Secondary DataZambian DHSOther studies
Focus Group Discussions
In-depth and Key Informant
Interviews
Triangulation
RESULTS
What are the factors driving the epidemic?In-depth analysis of interview and focus group transcripts revealed a number of social and structural factors that act as both barriers and facilitators for HIV risk behaviors.
5 meaningful themes emerged:
Traditional Norms & Practices
Gender, Power & Inequality
Social Factors
Prevention & Disconnected Messages
Infrastructure & Service Delivery
Major Findings - Learning:• Cultural norms and practices are contributing to the spread of HIV in the Western Province
• Some traditional practices have a positive effect and are helping to protect against HIV transmission
• Harmful practices are slowly changing in response to HIV
It is a symbol in our culture that if you have more that one wife, you must be a very powerful person
or a very rich person who is able to look after those wives
—Senior Government Official, Mongu
TRADITIONAL NORMS & PRACTICES
Major Findings - Learning:
• Women are socially and economically disadvantaged in the Western Province
• Gender inequality is manifested in sexual coercion, reduced condom negotiating power and partnering with older men, all practices that heighten risk for HIV
• Transactional sex is widespread
…Wearing a condom is regarded as taboo even for family planning. Women are unable to
negotiate condom use even when the partners are HIV positive
—Grace Hamukwala, Mongu District HIV Manager, Concern Worldwide
GENDER, POWER & INEQUALITY
…It is normal for a man to have multiple sexual relationships. The community will not say anything.
It is just normal that you have a girlfriend apart from your wife - these cultural issues are still being
highly practiced in rural areas
—Brian Kayongo, Executive Director, Adolescent Reproductive Health Advocates
Major Findings - Learning:
• Multiple partnerships are generally accepted in Zambia (more for men than women) and are practiced widely in the Western Province
• Widespread alcohol use contributes to risky behavior, particularly lack of condom use
SOCIAL FACTORS
Major Findings - Learning:
• Prevention messages are coming from all levels of society and are often contradictory
• Tension exists between abstinence-only messages and messages promoting condom use
• There has been a lack of leadership on a number of issues
PREVENTION & DISCONNECTED MESSAGES
Apart from coming out on radio supporting HIV and AIDS programs they have not been proactive…if the
King stands and says no one will marry a 11 year girl no one will do that because there is so much
respect for the King
—Brian Kayongo, Executive Director, Adolescent Reproductive Health Advocates
In terms of accessibility, most of our rural areas do not have access to condoms. They are only
concentrated in the township area.
—Senior Health Official, Mongu
Major Findings - Learning:
• Condom access is inconsistent and misconceptions are pervasive
• HIV Testing services have increased, but gaps still exist
• Community members report adequate ART coverage, community leaders report rural gaps
• Lack of communication / coordination between NGOs, Church leaders and Local Government departments
INFRASTRUCTURE & SERVICE DELIVERY
RiskLow
Medium
High
Low
Medium High
Female initiation
Polygamy
Traditional leader influence
Religious influence
MigrationVenues for sex
Stigma
HIV Risk Factors in the Western Province
Gender inequalityDry sex
Multiple sexual partnersSex workers
Rural-urban gap: service & practices
Poverty
School prevention programs
Sexual cleansing
Multiple circumcisions with one knife
Widow inheritance Media influence
Traditional medicine
Misconceptions of condoms
Alcohol abuse
Early sexual debutInability to
negotiate condom use
Lack of government support
Limited access to HIV testing
Lack of access to ART
Lack of access to condoms
MSM
Lack of family dialog on HIV
RECOMMENDATIONS
INDIVIDUAL
STRUCTURAL
SOCIAL
Increase HIV education efforts, targeting misconceptions and considering the local context
Introduce programs that address gender norms and empower women
Increase commitment and cooperation among leaders at all levels
Increase condom distribution partnered with education and directed at HIV “hot spots”
Expand reach of HIV testing and treatment services
• Increasing involvement of Traditional Leaders
• Increasing sensitization of young women in rural areas on HIV risk reduction
• Expanding HIV mainstreaming responses through existing community structures – community action teams (CATs) using the ‘community conversation’ methodology
• S/BCC through HH approach – focusing on: - VCT information
- service referral - increasing male involvement
- reducing stigma and discrimination
• Establishing Western Province NGO Forum for advocacy to national level
PROGRAMME RESPONSES
to the people of Zambia and all participants who agreed to take part in this study
We are also grateful to the entire Concern Zambia staff for their support.
We would particularly like to thank Maurice Sadlier, Friday Mwamba, Nalisa Mufuzi, Francis Wakumelo,
Grace Hamukwala and Edna Kalaluka
A special thank you to Dr. Kristin Bright of New York University