Understanding factors that cause low male involvement in Community HIV programs for effective design of gender inclusive programs An Operations Research Report submitted to THE Regional AIDS Training Network
At institutional level, men have pointed out that available institutions did not promote privacy. Current emphasis on confidentiality does not do much to bring privacy to the whole process of HIV service provision. Self-stigma and discrimination is still high among men to the extent that the same men sacrifice their health needs at the altar of upholding personal privacy. The majority of men still admitted that stigma at least self stigma and discrimination was still rampant to the extent that using public services was not an option. Emerging from this revelation is the fact that male involvement in HIV programming is still affected by inter linked interrelationships between institutional, individual and societal pressures. While privacy further perpetuates stigma and discrimination, an attempt to make HIV a simple public issue will see more men digging in. So long as society still pressures men to act in a strong and infallible manner most men will reinforce similar thinking by minimizing recourse to health seeking behaviour. Also emerging clearly from this study was the fact that HIV work like any another work should be paid for in order for more men to participate. Again societal expectations were identified as forcing men to demand that HIV work come with material and monetary rewards. Most people interviewed including women pointed out the fact that men should be the bread winners. Consequently, voluntary work should be minimised. While the study revealed the need to restructure institutions, it is crucial to note that at the same time, the study revealed that there is a lot to be done in terms of eradicating stigma and discrimination.
On a more positive note the study revealed that it is possible to engage men in the delivery and utilisation of HIV services. This can only be possible if certain changes are factored in the current programming. First, the study noted that for as long as men continue to be regarded as bread winners, most men will remain formally employed to the extent that most HIV programmes will miss them. In response to this, the study realised the need to intensify work place programs. In so far as the issue of privacy and negative peer pressure is concerned, the study noted that it was important to narrow down HIV programming to household levels. Household approach will minimize peer pressure while at the same time offering specialised services that will respond to the fears and needs of most men. Current HIV programming was rather too community centred to the extent that community stigma and discrimination and associated peer pressure tend to override personal benefits associated with early health seeking behaviour. Other issues raised by men included the provision of HIV services mainstreamed to other health related issues. Men pointed out that current attempts at specialised response and treatment of HIV needs fanned resentment and avoidance. Men felt that specific dates, specific queues, and specific rooms for consultation and support availed to PLWHIV somewhat reinforced stigma and discrimination. Such stigma and discrimination could be self or community driven. Most men felt the need to fully mainstream HIV services within the other ongoing health services as a way to stop the consequent labelling associated with the provision of specialised and segregated services for PLWHIV. To read more on this research please click here... |
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Household coping mechanisms with the economic costs of HIV in Zimbabwe An operations research report submitted to the National AIDS Council (NAC)
Households affected by HIV experience a host of challenges and opportunity costs that are
partly unique and in a way reflective of their status. This study sought to solicit
understanding of how HIV infected households, new and old have reacted, responded and In addition, case studies were used to gather in-depth understanding of underlying factors and conditions explaining variations in coping exhibited by respective households. A cross comparative analysis was adopted as a means to gather and analyse responses from interviewed households. Consequently, responses from 177 households, 10 focus groups and 7 case studies were compared and analysed leading to the following findings and insights recorded in this report. A two week study of sampled households populations from Nyagundi, Mafararikwa, Chipfatsura, Odzi and Marange in Mutare and Tanganda, Chiriga, Samhutsa and Chipinge town in Chipinge District of Manicaland province was carried out to solicit information on households’ coping mechanism to the economic costs of HIV. For this study, focus has largely been on urban and rural households relying on public ART support programme being run through council, mission and government clinics and hospitals. Largely the study gives a summary of mostly rural, peasant households who have displayed varying magnitudes of coping in the face of economic costs of HIV.
The study noted with increasing certainty that the majority of households, both rural and urban were experiencing a significant rise in economic costs which were not matched by corresponding successful response. More than 80% of the households living with HIV accessed by this study are increasingly struggling to cope with the economic demands of HIV. Ensuing economic costs seem with certainty to rise over time to the level that affected households ultimately submit to erosive means of coping leading in some cases to permanent asset depletion and in the worst case destitution. More than 80% of the households had at some point engaged in erosive coping means of some kind. 30% were now permanently surviving through an assortment of erosive means while 2% had succumbed to destitution. Destitution was prevalent among the elderly and widowed. In addition, these had an extra burden of dependants. HIV has thus proved to be a significant consumer of community resources to the extent that some households have had to delay, forgo, substitute and in some cases work extra hard to respond to the new economic demands brought in by their sero-status. The majority of such responses proved to be successful short term measures.
However, respective responses adopted by households compromised future and long term capacity to cope. All except four households interviewed reflected on the extended demands brought in by HIV. The exception came from households receiving regular financial, material, medical and other related forms of support from nuclei families. The study has noted that coping mechanisms adopted and followed by such households reflects strong influence of several factors. At the same time it is such factors that determine whether a household will successfully cope or not. By and large, the study has noted the additional influence issues such as seasonality that coping success vary with the time of the year, the education level, health status, marital status, age of the infected person, dependents size, local natural endowments and the distance from the nearest ART and OI centres.
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EED_FACT 2010 End of Project Evaluation Report Compiled by Pemberai Zambezi and assisted by Dr Vhumani Magezi
FACT's Regional training programme promotes training and capacity building of individuals and organisations across Eastern and Southern Africa. The training is largely limited to HIV and AIDS service organisations and individuals with key responsibility in fighting the AIDS pandemic. Regional training programme interventions are driven by the need to minimize and ultimately eliminate the impact of HIV and AIDS.
The study was of limited extent. Focus was largely limited to Zimbabwe, Malawi and Zambia. Though limited, the study has managed to gather significant insights into how individuals and organisations have changed as a result of the training programmes offered. This was possible through case studies, key informant interviews, focus group discussions, document review and one-on-one interviews with past participants and managers from participating organisations.
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