Culture Matters in Communicating the Global Response to COVID-19.

Current communication messages in the COVID-19 pandemic tend to focus more on individual risks than community risks resulting from existing inequities. Culture is central to an effective community-engaged public health communication to reduce collective risks. In this commentary, we discuss the importance of culture in unpacking messages that may be the same globally (physical/social distancing) yet different across cultures and communities (individualist versus collectivist). Structural inequity continues to fuel the disproportionate impact of COVID-19 on black and brown communities nationally and globally. PEN-3 offers a cultural framework for a community-engaged global communication response to COVID-19.

Patterns of HIV/AIDS in Zimbabwe: implications for health education.

Current patterns of HIV/AIDS in Zimbabwe are examined using national surveillance data reflecting four main variables: age, gender, marital status, and residence. The data show that the distribution of cases by age and gender is consistent with the literature on the rest of sub-Sahara Africa. Distribution of cases by age is bimodal with incidence highest among sexually active young adults (20-39 years) and the very young (0-4 years), and the male-to-female ratio is nearly 1:1 among adults. However, among adolescents 15-19, the incidence among females is six times greater than their male counterparts. The data also show that married persons have the highest rate of HIV infection (51%), greater than single persons (34%). These patterns highlight the significance of heterosexual and perinatal transmission. These data suggest a need for expanded HIV testing, counseling, and education across gender and marital status in order to detect HIV infection earlier in the spectrum of the disease. Promotion of monogamy and proper condom use should be a major focus of the empowerment process. Further recommendations are provided for planning, implementation, evaluation, and coordination of a comprehensive national prevention strategy.

Cataloging blood alcohol level and alcohol consumption data in field settings: feasibility and findings.

A team of two female interviewers, two male interview assistants, and one or two additional male observers were stationed in front of targeted drinking establishments to survey individuals about their drinking practices and to collect blood alcohol levels (BALs) using portable breath testers. Of the 176 individuals asked to participate, 156 (88%) consented to be interviewed and 141 (90%) provided breath samples. Of those tested, 40 (29%) were legally intoxicated (BAL greater than or equal to 100 mg/dl) while 68 (49%) registered a BAL of 50 mg/dl or greater. The mean BAL was 72 mg/dl. Individuals reporting that they were going to drive had significantly lower BALs than those planning not to drive. Subjects who thought they were legally intoxicated, on average, had BALs greater than the legal level of intoxication, and BALs significantly greater than those who felt they were not intoxicated. These data suggest that the collection of BAL, in combination with self-reported alcohol data, is an important component of methodologically sound alcohol field research.

Drug use and anticipated parental reaction among rural school pupils in Zimbabwe.

Study participants included 285 secondary school pupils in Zimbabwe who responded to a questionnaire assessing alcohol, tobacco, and marijuana use, and anticipated parental reaction to the pupil's drug-taking behavior. Results showed nearly 17% of the sample had used alcohol, 8% used tobacco, and 5% had used marijuana during the past seven days prior to questionnaire administration. Results regarding intentions to use alcohol, tobacco, and marijuana in the future show pupils' interest highest in using alcohol. Nearly 34% indicated intentions to use alcohol during the next year, while 16% reported intentions to use tobacco, and 12.9% indicated intentions to use marijuana. Nearly 17% reported they felt their parents would be favorable to their use of alcohol. Anticipated parental approval for tobacco and marijuana was 13.6% and 10.8%, respectively. Though current use and future intentions among the sample are not as high compared to similar populations in developed countries, this study suggests Zimbabwe should consider expanding its drug education effort in the school setting. Research to identify effective educational strategies to curb further increases in adolescent drug taking behavior also needs to be explored and identified.

Effectiveness of health instruction provided by student nurses in rural secondary schools of Zimbabwe: a feasibility study.

This demonstration project used student nurses (n = 12) on community deployment to provide health instruction among rural school-age populations in Zimbabwe. A quasi-experimental (pre- and post-test), non-equivalent control group design was used and consisted of 141 school pupils in the intervention group and 144 pupils in the comparison group (N = 285). The curriculum focused on prevention of STDs, HIV/AIDS and drugs (alcohol, tobacco and marijuana). A gain in health knowledge scores among the intervention group was reported at post-test. More than 70% of the pupils who received health instruction from student nurses gave a high approval rating of student nurses' performance. Further, student nurses, teachers and tutors all support school health instruction by student nurses although tutors and teachers differ on teaching about condoms.

PIP: In Zimbabwe, as part of a demonstration project, nursing schools sent 12 student nurses to five rural secondary schools in Masvingo Province to provide health education over a seven-week period to 141 students (9.33 hours/student). Community deployment of student nurses to rural areas, aiming to provide them with primary health care experience, is required for graduation in Zimbabwe. 144 students comprised the control group. Curriculum topics included AIDS, other sexually transmitted diseases (STDs), and drugs (alcohol, tobacco, and marijuana). AIDS/STD educational materials concentrated on modes of transmission, prevention methods, control of transmission, psychosocial issues, responsible sexual behavior, and problem-solving and decision-making strategies. Drug use and abuse materials focused on short- and long-term effects; social influences of acquisition, maintenance, and cessation; and social pressure resistance training through problem-solving and decision-making strategies. Students in the intervention group increased their post-test scores in 24 of 27 health knowledge items (for 14 of 24 items, p 0.01). More than 70% of students rated the student nurses' performance in health education high. Both the student nurses' tutors and the school teachers supported the concept of using student nurses to provide health education in schools while on community deployment. Tutors were more likely than teachers to support student nurses' teaching about condom use.

Attitudes of teachers toward implementing AIDS prevention education programmes in secondary schools of Zimbabwe.

Eighty-three secondary school teachers and headmasters from Masvingo Province in Zimbabwe responded to a questionnaire eliciting their opinions toward implementation of AIDS prevention education programmes in the school setting. Results show that although 79 teachers (95.2 pc) supported implementing AIDS prevention programmes in the school setting, teachers were divided as to what should be taught (content) and when it should be taught (timing). Specific content areas such as the use of condoms was found to be controversial and supported only by 53 teachers (63.9 pc). Further, the 53 teachers could not agree as to what educational level this should be taught. These findings suggest that teachers alone cannot determine the "what" or "when" of an AIDS prevention programme in the school setting. Formation of a health council comprising of community members, school and health officials within each school district is proposed in order to receive community input.

PIP: Questionnaire data from 83 school teachers in Masvingo Province in Zimbabwe participating in and HIV/AIDS awareness workshop were analyzed to examine their attitudes toward starting AIDS prevention education programs in secondary schools. 79 teachers (95.2%) claimed to support such a program. 53 teachers (63.9%) agreed that AIDS prevention education should include discussions about condom use. 29 teachers (34.9%) believed teaching about condom use should begin in Form I (junior) level while the other 24 teachers (28.9%) thought it should begin in Form III level. Male teachers were more likely to want discussions about condom use included in the program than female teachers (39 male vs. 14 females; p=.028). 67.4% and 25.3% of teachers thought that AIDS prevention education should begin at Form I and Form III levels, respectively. It appeared that female teachers need to attend reorientation sessions about prevention education concerning reproductive health especially since female teenagers begin sexual activity at a younger age than do male teenagers. Based on these findings, it is suggested that a health council consisting of community members and health and school officials in each school district be formed to identify and satisfy health needs of students and community expectations. The council should develop a plan to garner community support and participation for starting HIV/AIDS education and that the program mirror community values. The sensitivity of HIV/AIDS must not deter schools from implementing the program because AIDS does exist.

Planning a programme to trace sexually transmitted disease contacts in Zimbabwe: input from local health clinic nurses.

The purpose of this study was to elicit, from city health department clinic nurses in Zimbabwe, opinions regarding what they perceive as priorities in developing and implementing a programme to trace active STD contacts in the city.

Perceived vulnerability to HIV/AIDS in the US and Zimbabwe.

The majority of nurses in the US and Zimbabwe feel they have sufficient knowledge to protect themselves from acquiring AIDS, according to a study conducted by the authors, leading them to recommend that nursing students be allowed to openly discuss their feelings about vulnerability to contracting AIDS in the workplace.