Evidence for a contribution of the community response to HIV decline in eastern Zimbabwe?

C Campbell,M Skovdal,L Sherr,C Nyamukapa,S Magutshwa-Zitha,S Gregson,R Yekeye,C Schumacher

doi:10.1080/09540121.2012.748171

Abstract

Membership of indigenous local community groups was protective against HIV for women, but not for men, in eastern Zimbabwe during the period of greatest risk reduction (1999–2004). We use four rounds of data from a population cohort to investigate: (1) the effects of membership of multiple community groups during this period; (2) the effects of group membership in the following five years; and (3) the effects of characteristics of groups hypothesised to determine their effect on HIV risk. HIV incidence from 1998 to 2003 was 1.18% (95% CI: 0.78–1.79%), 0.48% (0.20–1.16%) and 1.13% (0.57–2.27%), in women participating in one, two and three or more community groups at baseline versus 2.19% (1.75–2.75%) in other women. In 2003–2005, 36.5% (versus 43% in 1998–2000) of women were members of community groups, 50% and 56% of which discussed HIV prevention and met with other groups, respectively; the corresponding figures for men were 24% (versus 28% in 1998–2000), 51% and 58%. From 2003 to 2008, prior membership of community groups was no longer protective against HIV for women (1.13% versus 1.29%, aIRR = 1.25; p = 0.23). However, membership of groups that provided social spaces for dialogue about HIV prevention (0.62% versus 1.01%, aIRR = 0.54; p = 0.28) and groups that interacted with other groups (0.65% versus 1.01%, aIRR = 0.51; p = 0.19) showed non-significant protective effects. For women, membership of a group with external sponsorship showed a non-significant increase in HIV risk compared to membership of unsponsored groups (adjusted odds ratio = 1.63, p = 0.48). Between 2003 and 2008, membership of community groups showed a non-significant tendency towards higher HIV risk for men (1.47% versus 0.94%, p = 0.23). Community responses contributed to HIV decline in eastern Zimbabwe. Sensitive engagement and support for local groups (including non-AIDS groups) to encourage dialogue on positive local responses to HIV and to challenge harmful social norms and incorrect information could enhance HIV prevention.

Highlights

Zimbabwe has experienced one of the biggest HIV epidemics globally and one of the largest most sustained declines in HIV prevalence (Zimbabwe National AIDS Council, 2011)
Qualitative studies suggest that interpersonal communication could have played a key role in mediating the effects of these factors on behaviour (Muchini et al, 2010), a finding supported by results from an early analysis of data from our prospective cohort survey in Manicaland in eastern Zimbabwe
Participation in community groups was fairly high in 1998Á2000 with 43% (N 05149) of all women interviewed at baseline and 29% (N 04330) of men reporting membership of at least one effective community group (Gregson et al, 2011)

Summary

Introduction

Zimbabwe has experienced one of the biggest HIV epidemics globally and one of the largest most sustained declines in HIV prevalence (Zimbabwe National AIDS Council, 2011). This initial analysis showed evidence for a causal link between the community response to the HIV epidemic, in the form of participation in local community groups (Putnam, 2000), and reductions in the incidence of HIV infection and associated risk behaviour in women (but not men) from 1998 to 2003, the period of reduction in sexual risk behaviour (Gregson et al, 2011).

Results

Conclusion