Stigma and discrimination: coping behaviours of people living with HIV and AIDS in an urban community of Mabvuku and Tafara, Harare, Zimbabwe.

OBJECTIVES: To assess how people living with HIV and AIDS reacted to the knowledge of the infection and how they are coping with stigma and discrimination. SETTINGS: The study was conducted in the two high density urban suburbs of Mabvuku and Tafara in Harare, Zimbabwe. DESIGN: The study was a descriptive cross sectional survey. SUBJECTS: A total of 600 participants (160 men and 440 women) who had received their HIV results after Voluntary Counselling and Testing for HIV at the Zimbabwe AIDS Prevention and Support Organization (ZAPSO) Mabvuku/Tafara Voluntary Counselling and Testing Centre were interviewed. MAIN OUTCOME MEASURES: Reactions to the diagnosis of HIV, disclosure of sero-status, experiences of self, family and community induced stigma and discrimination, coping mechanisms and desired interventions to reduce stigma. RESULTS: The majority, 61.7%, had been diagnosed HIV positive less than two years at the time of the study. While 33.3% felt hurt, 41% were immediately depressed when they discovered they were HIV positive. Eighty five percent had not disclosed their sero-status to anyone. While 55% experience self induced stigma, 56.7% experienced family induced and 38.3% experienced community induced stigma. People living with HIV and AIDS were coping with stigma through withdrawal (60%); joining support groups (83.3%); seeking counselling (95%) and praying (86.7%). Encouraging community counselling and HIV testing with disclosure of status was perceived by 98.3% of the respondents as an effective method to reduce HIV and AIDS related stigma and discrimination. CONCLUSION: While non disclosure of sero status is still high, self, family and community induced stigma pose a big challenge. Withdrawal (used mostly by men), seeking counselling and joining support groups (used mostly by older women) are the common coping behaviours being used by HIV positive clients. There is need to improve counselling capacities so as to meet the demands from a stigma reduction perspective as well as from a coping perspective.

Perceptions and barriers to cervical cancer screening in a rural district of Mutoko, Mashonaland East Province, Zimbabwe.

In the World Health Organization's (WHO) report on the International Conference on Population and Development (ICPD), member states of the African region committed themselves to implement the new concept of reproductive health that is centred on human needs and development throughout the life cycle. The ICPD's programme of action gave a further impetus to reproductive health by recognising reproductive and sexual rights as important factors in development. The major thrust areas which included cervical cancer screening, were also adopted by the World Health Assembly in its resolution WHA 48.10 and the Regional Committee at its 44th session in Brazzaville in its resolution AFR/RC44/R11.

Production, distribution and problems experienced with health education materials in two districts of Mashonaland East Province, Zimbabwe.

OBJECTIVE: To identify the production, distribution and problems experienced with health education (HE) materials in two districts of Mashonaland East (Mash East) province of Zimbabwe. DESIGN: A descriptive survey conducted in the rural districts of Mutoko and Murewa within the Province. METHODS: The researcher interviewed four doctors, 30 nurses and 10 allied health workers who had been conveniently sampled. MAIN OUTCOMES MEASURES: The types of health education materials available, whether field-testing and distribution of materials had been done locally, the problems experienced and unmet needs. RESULTS: It was found that most of the HE materials were printed on paper, and that 93.2% of the health workers indicated that the materials had not been field-tested in their local areas and did not address local problems. While all the respondents commented that the materials were always few, 77.3% noted that the materials were in English. Most of the health workers (90.9%) indicated that they needed print materials, radio and video cassettes. All of them desired to have materials in the local languages and addressing local problems. It was also noted that in almost 73% of the health facilities, the materials were being kept in the storerooms. The majority of the HE materials in the two districts were print materials that had not been field-tested in the local areas, were not in the local languages, did not address the local problems and were kept in storerooms. Material production protocols need to be followed and the management should ensure that HE materials reach the intended audience.

Implementation of the prevention of mother-to-child transmission of HIV programme in Zimbabwe: achievements and challenges.

Recent scientific developments have led to feasible and effective interventions to reduce the risk of mother to child transmission of HIV. Even in resource poor countries, PMTCT programmes are being articulated as a priority in the national strategic frameworks. Thus PMTCT programmes are moving from being pilot projects to national programmes comprehensively integrated into other reproductive health programmes or HIV and AIDS prevention, care and support programmes. In Zimbabwe the prevention of mother-to-child transmission (PMTCT) of HIV infection has become an important national task. The 2001 national survey of HIV prevalence among women attending antenatal care revealed that 29.5% of the women were HIV positive. While an effective PMTCT programme using nevirapine can reduce the rate of this transmission by 50%, the Zimbabwe PMTCT National Expansion Programme has had its share of achievements and challenges since its launch in 2002.

Cancer of the cervix: knowledge, beliefs and screening behaviours of health workers in Mudzi District in Mashonaland East Province, Zimbabwe.

OBJECTIVE: To assess the knowledge, beliefs and screening behaviours on cervical cancer among health workers in Mudzi District. DESIGN: Cross sectional survey. SETTINGS: Mudzi District Hospital and all the 20 rural health centres in Mudzi District of Mashonaland East. SUBJECTS: Sixty health workers in Mudzi District. MAIN OUTCOME MEASURES: Knowledge of cervical cancer risk factors, screening methods and treatment options. Beliefs and screening behaviours. RESULTS: The knowledge levels were lower for many of the predisposing factors of cervical cancer except for the use of vaginal herbs or chemicals, which 85% of the health workers knew. Though 50% of the respondents knew of the Pap smear as a screening method for cervical cancer, 86.6% did not know the human papiloma virus screening and 90% did not know of the visual inspection of the cervix using acetic acid. There were also very low knowledge levels for most of the treatment options for pre-cancer with all health workers not knowing the leep and the Laser options. The majority 73.3% believed that they where not at risk of developing cervical cancer. Most of the respondents, 81.7%, had not undergone any form of cervical cancer screening. However, the main reason for non screening was that there were no cervical cancer screening facilities in Mudzi District. CONCLUSION: The study revealed low knowledge levels, negative beliefs about the risk of developing cervical cancer and poor screening behaviours among health workers in Mudzi District. Training in cervical cancer is, therefore, recommended for the health workers. However, the training should be combined with setting up facilities for cervical cancer screening.

Health workers' participation in voluntary counselling and testing in three districts of Mashonaland East Province, Zimbabwe.

OBJECTIVES: To determine the proportion of health workers who had undergone VCT for HIV in three districts of Mashonaland East Province and to further explore reasons for non-participation in those who had not been tested. SETTINGS: The study was conducted in the rural Districts of Murewa, Mutoko and Mudzi in Mashonaland East province. DESIGN: The study was a descriptive cross sectional survey. SUBJECTS: All categories of health workers in Murewa, Mutoko and Mudzi. MAIN OUTCOME MEASURES: Participation in VCT, and reason for non-participation. RESULTS: Out of 200 questionnaires sent out 183 (91.5%) were completed and returned. The majority of the respondents were nurses 142 (77.6%), female 113 (61.7%), married 135 (73.8%). The median age was 33 (Q1; 28: Q3; 38) and they had attained a high school education 137 (74.9%). Of the respondents 160 (87.4%) had not gone for VCT; 141 (77%) did not want to have an HIV test. The reasons for not being willing to have an HIV test included not being ready to go for VCT 154 (84.2%); could not cope with the results, 143 (78.1%), do not have the courage to go 133 (72.7%); no need for testing as there is no cure for HIV/AIDS 106 (57.9%). One hundred and twenty six (69%) indicated that they needed counselling for them to be able to go for VCT. CONCLUSION: HIV/AIDS programmes have been directed at the community at large neglecting the health worker. This study, therefore, recommends programmes specifically tailor-made for health workers. These programmes should have a strong counselling component and should focus on self-efficacy so that health workers can finally be ready, be able to cope with HIV results and have the courage to participate in VCT.