Abstract
BackgroundDespite numerous programs to combat the global HIV and AIDS pandemic, infection rates remain high, especially in sub-Saharan Africa, where two-thirds of all people living with HIV reside. Here, we describe how we used rigorous program evaluation methods to assess the effectiveness of a community-based natural resource management program that “mainstreamed” HIV awareness and prevention activities within rural communities in Namibia.FindingsWe used data from two rounds of the Namibia Demographic and Health Surveys (2000 and 2006/2007) and quasi-experimental statistical methods to evaluate changes in critical health-related outcomes in men and women living in communal conservancies, relative to several non-conservancy comparison groups. Our final dataset included 117 men and 318 women in 2000, and 170 men and 357 women in 2006/2007. We evaluated the statistical significance of the main effects of survey year and conservancy residence, and a conservancy-year interaction term, using generalized linear models. Our analyses show that community-based conservation in Namibia has significantly reduced multiple sexual partnerships, the main behavioural determinant of HIV/AIDS infection in Africa.ConclusionsOur results demonstrate the effectiveness of holistic community-based approaches centered on the preservation of lives and livelihoods, and highlight the potential benefits of integrating conservation and HIV prevention programming in other areas of communal land tenure in Africa.
Highlights
Despite numerous programs to combat the global HIV and AIDS pandemic, infection rates remain high, especially in sub-Saharan Africa, where two-thirds of all people living with HIV reside
We used Demographic and Health Surveys (DHS) data from 2000 and 2006/2007 to evaluate whether changes in numbers of sexual partners were related to exposure of rural Namibians to the community-based HIV/AIDS program [8]
While DHS data are globally recognized and utilized in the development of public health policy [9], we acknowledge the limitations of using self-reported data on the number of sexual partnerships, especially where interventions of the type we consider may lead to underreporting
Summary
Our results demonstrate the effectiveness of holistic community-based approaches centered on the preservation of lives and livelihoods, and highlight the potential benefits of integrating conservation and HIV prevention programming in other areas of communal land tenure in Africa. We use rigorous program evaluation methods [2] to show that a national community-based conservation program in Namibia has significantly reduced multiple sexual partnerships, the main behavioural determinant of HIV infection in Africa. This holistic program raised awareness of the disease through radio broadcasts, written material, and traditional song and dance; trained peer educators; drafted HIV policies and plans; and disseminated condoms [7]. In addition to community-level work, capacity, policies, and support activities were enhanced within national-level CBNRM support organizations
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