University of Zambia Medical Library

Socio-Behavioural Aspects: Information, Education and Communication, Mass Media
(AIDS in Zambia Bibliography #141-53)

(#141) "A study to determine communication patterns among HIV/AIDS clients at the University Teaching Hospital, Lusaka"
Bwalya, K. (1991) unpublished
Geographical area: Lusaka; Keywords: Counselling; Location:

During the past few years, increasing interest has been expressed by many countries, including Zambia, regarding partner communication and notification in issues pertaining to human immunodeficiency virus (HIV) and acquired immune deficiency syndrome (AIDS). The interest and efforts are directed at preventing transmission of the HIV to sexual partners, reducing the morbidity and mortality associated with HIV infections, and as a method for targeting information, education and counselling to those at highest risk of HIV infection.

The aim of the study was to determine the number of clients who communicate their HIV serostatus to significant others. The study was descriptive and qualitative in design and examined patterns of communication among HIV/AIDS clients at UTH Lusaka. Professional preparation of counsellors for HIV was explored. Data collection instruments involved non scheduled structured self administered interview and the focus group discussions. The findings in this study are highly suggestive of considerable gaps in the counselling services. The need for equipping counsellors with relevant knowledge and skills to enable them to function competently should not, therefore be taken for granted.

(#142) "Feasibility Study: Parental/Guardian Responsibility for Youth Education on HIV/AIDS and Youth Project Against HIV Infection"
Mudenda, S. (1992) unpublished
Geographical area: Lusaka; Keywords: KAPB, health education; Location: FLMZ, Institute of African Studies, Family Health Trust

This study examines the role of parents on HIV/AIDS education for the youth in urban setting of Lusaka. A sample of 1,286 (685 females and 601 males) was recruited from 425 households. The age range of study population was between 13 to 44+ classified into two broad categories of: (a) adults (>25) and (b) youth as those <25 years. An interview schedule was used to collect information. The findings reveal that knowledge of AIDS differs among males and females. The adult sample indicates male 43.0 per cent and 25 per cent female, similarly youth population showed 78.6 per cent higher than females (26.3 per cent). The parents' education on HIV/AIDS shows very little role in this study. The suggestion on parental education has to be emphasised. The appropriate age for introducing sex education was indicated to begin at early age of 13-15 years by both adults and youth. The contents should include physical maturity, sexual attraction to the opposite sex, sexual intercourse, pregnancy and sexually transmitted diseases (STDs). Data on sexual behaviour still indicate higher expectation of premarital sex among boys (78.6 per cent) than girls (69.4 per cent). The need to strengthen sex education was suggested by both groups of the study population. There is still a resistance to sexual behaviour change and the use of protective measures against HIV/AIDS.

(#143) " A study of the impact of health education methods used in the prevention and control of HIV/AIDS among a cross-section of sexually active population in Lusaka urban"
Mulwila, M.K., Himoonga, J.M., Namakando, E.S., (1992) unpublished
Geographical area: Lusaka; Keywords: Health education, KAPB, awareness ; Location: unknown

Objectives:

• To determine the impact of health education methods used in an HIV/AIDS prevention and control programme.
• To identify the factors that influence the effectiveness of health education methods.
• To determine the health education method that is most effective in dissemination of information to the public on HIV/AIDS.
• To assess whether health education campaigns have brought change in people's behaviour.

Methods:
A structured questionnaire designed to assess the sexual behaviour, knowledge, attitudes and practices was distributed to a randomly selected sample of 473 respondents which was drawn from 16 different sites.

Results:

• 33.4 per cent of the participants were between 21-25 years of age; 1.5 per cent were above 50 years of age. 51.7 per cent of the participants were male while 48.3 per cent were female.
• 26.5 per cent (125 out of 251) of the participants who were married had extramarital sexual relationships.
• Knowledge about the modes of transmission of HIV was moderate with 91.3 per cent knowing that the virus was mainly transmitted through sexual intercourse; 5.6 per cent through blood transfusion; 1.1 per cent through unsterilised needles.
• 45 per cent of the respondents were of the view that HIV/AIDS was a serious health problem affecting their communities.
• Almost all the respondents (91.2 per cent) knew of someone with HIV/AIDS. However, most of the respondents felt that they themselves were not at risk of acquiring HIV.
• 34.6 per cent felt that the most effective method of disseminating information about HIV/AIDS was through the mass media. As such, 48.8 per cent of the respondents feel that health education campaigns, such as the Anti-AIDS, have brought about awareness about HIV/AIDS to a number of people in the communities.

Conclusions:

• The health education methods used in the prevention of HIV/AIDS have had some impact on the people as they have increased the awareness of the people concerning the disease.
• People have, however, continued to practise unsafe sexual practices despite the increase in knowledge about the modes of HIV transmission.
• Health education coverage has not reached all the people as most still do not have the basic knowledge about HIV/AIDS. There is a need therefore to intensify the Anti-AIDS campaigns to all areas through identified effective channels of communication.

(#144) "A Study of the Effect of Dr. Kalulu AIDS Booklets on School Children's Sexual Behaviour"
Zyambo, G. (1992) unpublished
Geographical area: Lusaka; Keywords: KAPB, school students; Location: UNZA Medical Library, MOH

Although AIDS education has been implemented in Zambian schools, the campaigns seem to have made school children less able to respond effectively to AIDS. Sexual freedom stretching to multiple contacts has become the norm in Zambian school children. The aim of the study was to determine the effect of Dr. Kalulu booklets on school children's sexual behaviour. A sample of 182 school children from Jacaranda and Kamwala basic Schools was systematically selected and a structured interview schedule was set. The design was descriptive. Interviews were conducted and data was analysed manually. Despite the knowledge of AIDS (obtained from Dr. Kalulu booklet) school children still indulged in unsafe sexual intercourse. It was recommended that there was need to review Dr. Kalulu AIDS to evaluate and update the curriculum and pave the way for transition from the traditional teaching methods to progressive teaching methods.

(#145) "Peer education in the workplace by members of the Positive and Living Squad in Lusaka, Zambia: baseline attitudes and knowledge about HIV"
Baggaley, R., Mukosha, J., Chipanta, D., Edwards, J., Kelly, M., et al. (1993) Paper presented at the VIIIth International Conference on AIDS in Africa, Marrakech, 1993
Geographical area: Lusaka; Keywords Peer education, workplace, KAPB, condoms: Location: Kara Counselling

Objectives:

• To employ HIV-positive people to run HIV education outreach programmes in workplaces in Zambia.
• To collect baseline KAP information from those attending the outreach sessions with the view to determining the role of HIV education in this group and planning focus of follow-up outreach.

Method:
The "Positive and Living Squad" (PALS) was established in August 1991. They are individuals who are openly and positively living with HIV. Some members of PALS have undergone training in HIV education and counselling and conduct outreach programmes at local workplaces. Anonymous self-administered, pre-tested questionnaires were distributed to the workers prior to the outreach sessions and collected in before the start of the sessions.

Results:
We analysed the first 397 questionnaires from 11 companies in Lusaka. 100 per cent of the questionnaires were returned, but not all sections were completely filled in, with missing data in 1-10 per cent of the sections. 50 per cent had had some previous HIV education: 23 per cent at work, 10 per cent at school or college and 3 per cent from chatting with friends. Knowledge regarding transmission was generally good: 85 per cent knowing that HIV was transmitted in semen, but there was some confusion regarding non-transmittable sources with 25 per cent thinking that mosquitoes transmitted HIV and a further 18 per cent not knowing whether they did. Only 27 per cent of the people knew no one with HIV. 23 per cent had had a relative die of HIV and 43 per cent had a colleague with HIV.

Despite this they were still many people with negative attitudes to those with HIV: 21 per cent felt that people with HIV had led immoral lives, 28 per cent felt that they should be isolated and 45 per cent did not like the idea of sharing cups with HIV-positive people. However, 65 per cent felt that people with HIV should have equal opportunities. Only 15 per cent felt that they were definitely at risk of HIV, with 38 per cent not being sure. 64 per cent felt that condoms should be distributed at work and 49 per cent said they would use them if they were, though 40 per cent felt that using condoms reduced sexual pleasure. 52 per cent of people had ever used them, 6 per cent using them always with their regular partner and 12 per cent with other partner/s.

Conclusions:

• HIV education is appropriate and acceptable in the workplace.
• A large percentage of those questioned have contact with people with HIV and programmes should be directed at improving attitudes to those who already have HIV and reducing the stigma of HIV as well as encouraging safer sex practices.
• Subsequent visits from the PALS outreach worker will determine whether attitudes and practices have changed.

(#146) "Impact of a radio drama about AIDS in Zambia: a programme called Nshilakamona"
Yoder, S., Liskin, L., Chirwa, B.C. (1993) unpublished
Geographical area: Copperbelt, Northern Province; Keywords: Health education, radio, condoms, evaluation; Location: Chainama Hills Hospital, USAID

This report evaluates the impact of the broadcasting of a radio drama on knowledge and behaviour related to AIDS among Bemba speakers in northern Zambia. The radio drama called Nshilakamona, written and broadcast in Bemba, portrayed two families in Lusaka and their friends as they respond to problems of raising teenage children, friendships, making ends meet, sexual relations, and AIDS. The design team hoped that by portraying typically Zambian characters responding in ways consistent with certain messages chosen from research results, listeners to the programme would improve the accuracy of their knowledge about AIDS and reduce their risky behaviour. Those messages included: everyone is at risk for AIDS, you can prevent HIV transmission, people should talk to their spouse and children about AIDS, condoms protect against HIV transmission, and it is safer to have only one sexual partner. The planning and broadcast of the radio drama was a joint effort between the Ministry of Health of Zambia, the Zambia National Broadcasting Corporation, and the AIDSCOM project financed by the U.S. Agency for International Development. The programme began in August l991 and lasted for nine months.

The evidence for programme impact comes mainly from the results of two surveys conducted in Copperbelt and Northern provinces: a baseline survey shortly before the broadcasts began, and a follow-up right after the broadcasts ended. More than 1600 men and women from l5 to 45 years of age in randomly selected households were interviewed in each survey. The surveys examined knowledge about the transmission and prevention of AIDS, reported condom use and attitudes towards condoms, and reported behaviour related to reducing the risk of HIV transmission.

The principal research question to be answered was: what evidence is there showing that broadcasting of Nshilakamona resulted in changes in knowledge or behaviour about AIDS in the population? The evaluation process consisted of the following stages:

• Verifying that the two samples were comparable;
• Examining changes in the samples between 1991 and 1992;
• Comparing the changes from 1991 to 1992 for those most likely to have listened to the programme, the 'high access' sample;
• Examining the 1992 cross-sectional association between exposure to Nshilakamona and the outcome variables which showed a greater 'high access' rate of change at the previous step.
• Determining whether those cross-sectional associations hold up once access to radio is controlled.

The comparison of the two samples showed there were no important differences in the samples with regard to demographic and economic issues such as age, gender, languages spoken, wealth, education, reading ability and listening to the radio. Results from the two samples can thus be compared without weighting or other adjustments.

The 1992 survey found that a little more than half (53 per cent) of the sample had heard of the radio drama programme, that 47 per cent had ever listened to that programme, and that one-fourth had listened quite often. In general, urban populations listened more than rural ones, and men more often than women. However, if only those who reported having a radio at home are considered, women were slightly more likely to have listened to the programme than men.

A pattern of improvements was found in many areas of knowledge, attitudes and behaviour between 1991 and 1992. However, those increases were equal for those who were radio owners and listeners (the 'high access' sub-sample) and those who were not. The high access subsample were much more likely to be in the regular audience for Nshilakamona than were others. If Nshilakamona was a major cause of the pattern of improvements in knowledge, attitudes and behaviour, we would have expected them to be changing more rapidly than the population at large. Since they were changing at the same rate, we have concluded that, most likely, factors other than exposure to Nshilakamona led to the observed changes.

This inference was reinforced through cross-sectional analysis of the 1992 sample. There was some association between exposure levels and scores on many of the outcome variables. However, once level of access to radio was controlled, these associations essentially disappeared. Those with high exposure to the programme were not different in knowledge, attitude or behaviour from those who had no or low exposure, among the population who owned and listened to radio.

There were five measures for which the high access group had showed at least a trend toward more rapid change in the over-time analyses: knowledge of the extended period of infection; willingness to speak to an infected relative in public; having talked with spouses and with children about AIDS, and, among women, the belief that they were vulnerable to AIDS. A small cross-sectional association was found between the measure of exposure to the programme and each of these outcome measures in the overall sample. The fact that that the associations disappear when we control for radio indicates that other factors besides Nshilakamona appear to be having an impact on peoples' ideas about AIDS.

Although observed changes are not attributable to Nshilakamona, they are of some interest. The results showed increases in knowledge of AIDS transmission and prevention in a number of areas. Virtually everyone (99.5 per cent) had heard of AIDS in 1992; the percentage who said AIDS was a serious health problem in the community increased from 7 per cent to 23 per cent of respondents. There were small but significant increases in the percentages of those who mentioned correct ways and decreases in the percentage of persons who mentioned incorrect ways of HIV transmission. More people (24 per cent versus 19 per cent) knew in 1992 that the disease may develop years after infection. The proportion of the sample who talked to their spouse and to their children about AIDS increased significantly. Large increases were found in the percentage saying they would care for someone with AIDS without any hesitation (66 per cent to 87 per cent).

The percentage of both men and women who reported having changed their behaviour to avoid AIDS increased significantly. There was no change in the proportions of men (18 per cent) and women (3 per cent) who stated they had sexual partners outside marriage. Nor was there any change in the proportions who mentioned using a condom as a means of preventing HIV transmission. However, the percentage of respondents who had ever used a condom increased from 38 per cent to 43 per cent for men and from 14 per cent to 23 per cent for women. As many as 30 per cent of all men reported having used a condom during the last intercourse with a non-marital partner.

As was found with knowledge of AIDS, neither the reporting of having changed behaviour or the increase in those who had ever used a condom could be linked to listening to the radio. No evidence was found to indicate that the programme had an impact on reported behaviour change.

It appears as though the whole population in northern Zambia is increasing in knowledge of AIDS and that multiple sources of information have contributed to that process. In that context, a comparison of the results of two surveys did not find changes that could be ascribed to the programme. This result may have been due to the form of the messages in the episodes, or the multiplicity of other messages in the social context of Zambia, or to the fact that the research design was not able to pick up the small effects the programme may have produced.

(#147) "Protecting future generations: Educating children about AIDS using the Zambian Club Model"
Chitomfwa, P., (1993), Paper presented to the IIIrd Southern Africa Network of AIDS Service Organisations, Windhoek, 1993.
Geographical area: National; Keywords: Health education, adolescents, students ;Location: Family Health Trust

Introduction:
Educating young people on AIDS using the Zambian Club Model is one way the Anti-AIDS Project has taken to protect the future generation.

Objectives:
The main objective of the Anti-AIDS Project is to enable young people protect themselves against AIDS through providing basic AIDS information to young ones at primary school level which provides a general understanding about the disease, encouraging young people to think about attitudes and behaviour that will keep them safe at a time they are vulnerable to peer pressure and sexual experimentation, and turning as many young people as possible into AIDS educators.

Methods:
The Anti-AIDS Projects encourages the formation of Anti-AIDS Clubs in primary and secondary schools among young people. These clubs are run by the children with the assistance of a patron who is a teacher. Clubs are also formed in communities and such clubs are run by elderly persons. AIDS education is far more likely to be effective and to result in sustained behaviour change if it is done by the young people (child-to-child education) talking to their friends rather than teachers, parents or other figures in authority. This removes fear and shyness among the young people and makes them enjoy belonging to the club. Clubs carry out activities such as lectures, dramas, discussions, dances, visiting clinics and hospitals and AIDS patients and assisting AIDS patients at home. The Anti-AIDS Project's Health Education Officer and other staff visit schools and other clubs throughout the country to talk and show videos on AIDS to young people.

Results:
As evidenced from the reports on needs, aspirations and attitudes about social behaviour carried out in November 1992, boys and girls become sexually active from the age of 10 to 15 years. 392 female and 400 male secondary school pupils were asked about problems they experienced in their school life. 12 per cent of the girls and 13 per cent of the boys mentioned problems in the area of sexuality. Research further showed that in the group of secondary pupils, 90 per cent said that they had heard about the clubs, 14 per cent are members of an Anti-AIDS club in either their schools or their communities. From the data it is evident that Anti-AIDS club members in small numbers have given advice to their peers on pregnancies, sexual intercourse, sexually transmitted diseases and AIDS.

Conclusions:
Research has shown that significant numbers of pupils have received information about AIDS from Anti-AIDS club members. School pupils think Anti-AIDS clubs are an important source of information and that club members are more likely to possess correct knowledge about AIDS and to understand that everyone, including themselves, are vulnerable to the disease.

(#148) "Peer education in the workplace by members of the Positive and Living Squad (PALS) in Lusaka, Zambia: Is it effective?"
Baggaley, R., Mukosha, J., Chipanta, D., Zulu, W., Bennett, J., et al. (1994) Paper presented at the Xth International Conference on AIDS, Yokohama, 1994.
Geographical area: Lusaka; Keywords: Education, PWA, workplace, KAPB, condoms; Location: Kara Counselling

Background:
The "Positive and Living Squad" (PALS) was established in August 1991. They are individuals who live openly and positively with HIV. Some members of the PALS have undergone training in HIV education and counselling and conduct outreach programmes at local workplaces. During 1992-1993, the PALS visited over 850 workplaces and spoke to more than 85,000 people about HIV. Objective: 1. To collect baseline knowledge, attitudes and practices (KAP) information from those attending outreach sessions in a sample of workplaces. 2. To develop appropriate HIV education in this setting and plan the focus of follow up outreach. 3. To see if HIV KAP changes following HIV outreach.

Methods:
Anonymous self-administered, pre-tested questionnaires were distributed to a sample of workers prior to the outreach sessions and collected in before the start of the sessions. 3-6 months later a second outreach sessions was carried out and the same questionnaire technique was repeated. Results: We analysed 146 questionnaires from 5 companies in Lusaka prior to the introduction of an education programme and 187 questionnaires from the same companies 3-6 months following the education programme. All questionnaires were returned. There were no significant differences in the demographic details of the respondents in the pre and post education groups. Knowledge about HIV transmission was good at the start of the project but improved significantly. There was also improvement in attitudes to HIV. Prior to the education, 34 per cent of the people felt that those with HIV had led immoral lives, this fell to 16 per cent following the education programme. 26 per cent of the people felt that those with HIV should be isolated and fell to 10 per cent following education. 66 per cent thought that people with HIV should have equal opportunities, this rose to 86 per cent post education. Condom use increased from 46 per cent to 64 per cent but use with regular partner remained low. Prior to HIV education 39 per cent thought that condoms reduced sexual pleasure and this attitude was unchanged.

Conclusions:

• Knowledge about HIV transmission is high in the working population surveyed and improved with HIV education.
• Attitudes to those with HIV improved significantly following outreach programmes conducted by the PALS.
• Although condom usage increased many people continued to express negative attitudes towards condoms.

(#149) "Evaluation of Crash Course for the Out of School Youth on the Copperbelt, Zambia"
Mulenga, C., Phiri, J. (1994) UnpublishedUNICEF
Geographical area: Copperbelt Province; Keywords: Adolescents, peer education, evaluation;

This is a report of the evaluation of the crash course for the out of school youth which was carried out in the Copperbelt. The study was commissioned to assess the impact of the crash course on the participants in terms of whether it has led to changes in their attitudes and behaviour regarding casual sex and other issues relating to HIV/AIDS. In addition, the evaluation of the crash course sought to establish whether the course had helped to promote peer education on HIV/AIDS amongst the youth. Further, the evaluation also sought to provide feedback on the quality of education provided under the programme, as well as identify grey areas in the course, which require improvement. Hence, the study throws some light on what needs to be done to ensure the attainment of the aims of the crash course.

Unstructured interviews, simple observation, and questionnaire surveys were used to evaluate the crash course. The unstructured interviews and simple observations were primarily used during the first phase of the study, which involved getting acquainted with the organisational set-up and management of the crash course. The unstructured interviews were conducted with the CHEP officials involved in the crash course so as to find out their vision, and rationale for the crash course, as well as its objectives. The course contents and the selection procedures or criteria used to select participants were also discussed. The primary aim of the simple observations was to observe and assess the teaching methods used as well as the interaction between the resource-persons and the course participants. The interviews were used to collect data and information from the course participants because it was the fastest and most reliable method of collecting accurate socioeconomic data, attitudes, and views from the course participants.

The evaluation of the crash course shows that, while there is demand and support for the course among the youth and the targeted communities at large, the prevention of HIV/AIDS, which is the primary aim of the course, was not readily perceived by both the resource persons and the course participants. This situation was largely a result of the ad-hoc organisation of the course, and the failure to link the various subjects offered in the course to the prevention of HIV/AIDS. The crash course does also not seem to have made any significant contribution to the destigmatisation of HIV/AIDS and creation of an environment in which issues relating to HIV/AIDS could be discussed openly with honesty, compassion, and understanding. Nevertheless, the crash course seem to have contributed to the spread of knowledge of how HIV/AIDS could be transmitted and prevented, although there was also a gap between having the knowledge and sexual behaviour.

It was recommended that the crash course be continued with wide ranging changes in the organisation and subject matter. In this regard, it is essential to appoint a coordinator for the crash course. The coordinator would have the responsibility of overseeing the transformation of the course into a well organised entity, in which all the subjects would be linked through a common broad objective, the prevention of HIV/AIDS among the out of school youth. A reconstitution of the curriculum is also recommended. In particular, the objectives of the Social and Economic Situation in Zambia and Staying within the Law should be harmonised and be sought through one subject to called Civic Education. Thus, Civic Education need not merely be a public relations exercise for the police, but should focus on the rights of the youth, and the obligations of citizenship. Also recommended was the incorporation of ethical issues and destigmatisation of HIV/AIDS in the Health Education course offered in the crash course.

(#150) " HIV/AIDS Information Censorship - The media"
Daka, G.C. (1994) unpublished
Geographical area: National; Keywords: Health education, media, churches; Location: NASTLP/MOH

This study was commissioned by the National Aids Prevention and Control Programme, under the auspices of Morehouse School of Medicine Cooperative Agreement. The main objective of the study was to analyse HIV/AIDS information censorship, specifically with regards to assessing opinions and attitudes on what constitutes pornography in the Zambian context with a view of identifying acceptable channels of communicating the HIV/AIDS information to a heterogeneous population. National, institutional and social regulatory frameworks with regards to information dissemination were explored, from the perspective of media personnel, anti-AIDS campaigners and the churches. To meet these objectives focus group discussions were conducted in Lusaka with a total of 149 participants. Also in-depth interviews were carried out with media personnel, anti-AIDS campaigners, and the churches involved in information, education and communication of HIV/AIDS.

The findings established that people's conceptions of pornography are relative and context bound. The intention behind a sexually explicit demonstration was found to be critical in defining a situation as pornographic or educational. Also the extent of reach of the sexually explicit information (i.e. public or private), the size and group mix in which the information is being disseminated, were all found to be important elements in social conceptions of pornography. These contextual requirements are important to media personnel and others involved in the dissemination of sexually explicit information.

The importance of face to face group encounters of people with similar interests and/or experiences in information dissemination was also highlighted with these findings. Schools and places of work show great potential in meeting these contextual requirements. It was also established that the impact of what was considered pornographic was felt more in a medium where there was a visual presentation such as on television, rather than print or audio. The findings also show that within the family context, there is a great deal of information censorship by parents to the children. Lack of trust and inhibitions arising out of traditions were the reasons found for parental control of information. A gap in the dissemination of sexual information within the family was found. Traditional practices such as initiation ceremonies and pre-wedding teachings could be exploited for the dissemination of HIV/AIDS information dissemination if well organised. The study also established that there is need to shift focus from giving out hard facts on transmission as prevention to real life issues such as the impact of HIV/AIDS on persons and on the communities in which they live. The media has a role to play in this by bringing these issues to the surface and removing the negative stigmatisation of those with HIV/AIDS.

(#151) "Evaluation survey of women's peer education project from three areas in Kasama"
Mugala, G., Mulenga, E., Cooper, U., Chitalima, F. (1994) Paper presented at the 4th National AIDS Conference, Lusaka, 1994
Geographical area: Kasama, Northern Province; Keywords: Peer education, KAPB, condoms, evaluation; Location: Family Health Trust

Objectives:
An evaluation survey of the impact of the women's peer education project on knowledge, attitude and practices related to AIDS in communities where projects have been operating.

Methodology:
Interviews with 442 randomly selected respondents took place in three villages. Focus group discussions also took place.

Results:
Knowledge on AIDS is very good, with high awareness of HIV transmission, including perinatal (92 per cent). 25 per cent of women had had casual sex in the past month, and condom use in these encounters was 40 per cent. 72 per cent of the women knew where to purchase condoms. Condom use was not correlated with religious affiliation. The greatest source of information is through informal education contacts such as friends and family members, accounting for 39 per cent. Mass media accounted for 27 per cent and health workers 20 per cent. 58 per cent of male respondents stated that their major source of information is the mass media, whilst 60 per cent of female respondents indicated personal informal meetings among friends and family. This implies that there is peer education going on in the community.

(#152) "Community peer education to prevent STD/HIV/AIDS among women in Zambia and Zimbabwe"
Kathuria, R., Wilson, D. (1995) unpublished
Geographical area: Lusaka; Keywords: Peer education,condoms, costs, evaluation; Location: UNICEF

The paper describes community peer education projects in Zambia. The projects cover George, Gwembe and Kanyama in Lusaka, Kitwe and Monze. An intervention strategy was devised to target primarily HIV- vulnerable communities of single women in low-income areas, and men whose sexual behaviour contributes to rapid HIV transmission, including men with highly mobile lifestyles, men who visit bars and men who seek STD care. A parallel project was undertaken in Zimbabwe.

Stated Goals and Objectives of the Intervention:
The main objectives of the intervention were to:

• Provide STD/HIV/AIDS education and condoms to the most HIV-vulnerable communities.
• Reduce STD/HIV transmission among the most HIV-vulnerable groups of men and women and the wider community.
• Mitigate the impact of HIV among the most HIV-vulnerable groups of women.

Major Components of the Interventions:
The major components of the intervention were: rapid formative research and mapping; recruitment and training of peer educators; educational outreach; condom distribution; and provision of medical, psychosocial and economic support. Methods for Process and Outcome Evaluation Related to Project Activities: The methods and measures used for process evaluation related to project objectives are summarised in table 1.

Measurable Achievements Relating to Project Objectives:

• Outputs: Output data from George compound indicate that from Aug.1993 to Oct. 1994 4,044 meetings were held, 79,991 people were reached through face-to-face education and 559,330 condoms were distributed.
• Unit Costs: The cost for the George project (Aug 1993-Oct 1994) was estimated as US$30,000. The unit costs for George average US$7.42 per community meeting held, US$0.38per person reached through face-to-face education and US$0.05 per condom distributed.
• Reduce STD/HIV Transmission Among HIV Vulnerable men and Women STD Trends RPR positivity data for George are presented in table 2 below. Results indicate significant declines have occurred, but these must be interpreted with great caution.

  RPR Seropositivity in George, Lusaka, from October 1993-July 1994

  Month/Year	%RPH
  October 1993	32.0%
  November 1993	20.6%
  December 1993	20.9%
  January 1994	14.2%
  February 1994	14.9%
  March 1994	14.1%
  April 1994	14.0%
  May 1994	14.4%
  June 1994	6.3%
  July 1994	6.6%

Conclusion:
Peer education projects that invest in the energy, capability and voluntarism of low-income women can achieve unequalled levels of efficiency and coverage that are associated with reported sexual behaviour change and ostensible declines in STD cases. Horizontal capacity approaches contribute singularly to the improvement of projects. The challenge now is to utilise the opportunities and resources generated by these ostensible and partial successes to deepen commitment to community human resource development and to the building of community capacity, structures and institutions to respond to AIDS.

(#153) "Communication of HIV/AIDS"
Daka, G. (1995) Paper presented to the Fifth National AIDS Conference, 8-10 May 1995. Mulungushi Conference Centre, Lusaka.
Geographical area: National; Keywords: Media, Health Education; Location: Family Health Trust

This is a descriptive paper which examines the role of the media in the fight against HIV/AIDS, the media's current performance in HIV/AIDS dissemination, current media initiatives to increase media capacity to deal with HIV/AIDS, and what could be done to enhance the role of the media in HIV/AIDS communication efforts.

The author states that over the years, there has been a progressive increase in media interest on HIV/AIDS by showing HIV/AIDS-related stories published in newspapers in 1986, 1993, and 1994. In 1986, there were about 96, 309 in 1993 and 321 in 1994, and that the media generally regard AIDS as a serious topic which needs to be treated with seriousness. The weakness, however, is the reluctance of the media to promote AIDS as an agenda to which the public should direct their attention, and the significant dearth of editorials on the subject. The quality of the output leaves much to be desired, and most stories are hidden on the inside pages. Despite these weaknesses, the author outlines interventions being carried out to strengthen media coverage of HIV/AIDS issues.

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