O. Mundida National Behaviour Change Coordinator Zimbabwe

1. The Making of Zimbabwe’s National Behaviour Change Strategy 2006-2010: Towards National Co-ordination of Evidence-based HIV PreventionTowards Universal Access To Prevention O. Mundida National Behaviour Change Coordinator Zimbabwe

2. Zimbabwe National Behavioural Change Strategy2006 – 2010For Prevention of Sexual Transmission of HIV A vision that requires all Zimbabweans to join – women and men, youths and adults, HIV negative and HIV positive, unmarried and married

3. Overview of this presentation • Background information • Rationale for BC Strategy • Intervention/Response • Results and lessons learnt • Recommendations.

4. Regional efforts in scaling up HIV prevention. • Know your epidemic initiatives launched • Expert think tank meeting on HIV prevention held in Maseru (Lesotho) • Social Mobilisation Communication meeting held in Swaziland • Regional opportunites for cooperation explored in the area of HIV prevention.

5. Background for Behavioural Change (BC) Review in Zimbabwe. • New national strategic framework on HIV and AIDS was to be developed for 2006 - 2010 • Despite previous efforts (‘Beyond Awareness’ initiative) no national HIV BC strategy was in place • A multitude of stakeholders were implementing behavioural change programmes without clear strategic guidance • Past BC programmes were not consistently based on analysis of underlying factors for vulnerability

6. Rationale : Why a specific BC strategy within the new National HIV and AIDS Strategic Plan? • Current Zimbabwean context: BC promotion expected to be the key prevention strategy (while new medical alternatives such as vaccines are still under development and others like male circumcision under discussion) • Refocus on underlying vulnerability factors such as imbalanced gender relations and stigma • Establish framework for national and decentralized BC promotion to overcome scattered targeting and increase coverage

7. BC Technical Working Group. • NAC Chair. Civil society-PLWHIV, MOH&CW, Min of Education, Min of Gender, UN partners, Donors and FBOs. Responsibilities; • To oversee a comprehensive review of behavioural change approaches and interventions in Zimbabwe, as part of the review of the national HIV framework 2000-2004 • To prepare the presentation of the research findings to a broader group of stakeholders; • To draft a national behavioural change strategy as a component of the National Strategic Framework on HIV and AIDS; • To support strategic planning of behavioural change interventions, • To offer technical advice to policy makers and implementers on BC

8. Challenges for implementation • Selection of representatives from networks such as FBOs and PLWAs who have several networks. (Strengthening of Networks) • Agreeing on broad areas of focus due to the diverse nature of implementers. • Conflict of interest • Ensuring consistency in membership attendance to the meetings.

9. Intervention • BC TWG coordinated the BC review • Results of the review were shared • TWG coordinated the development of the National Behaviour Change Strategy 2006-2010. • Regular review meetings are held to discuss the progress made and latest research findings on BC

10. Re-focusing BC on key drivers of HIV: The ‘Highway of HIV Transmission’ • Multiple Concurrent • Partnerships • Combined with: • Low risk perceptionin long-term relationships • Low condom usein long-term relations • Low levels of male • circumcision Unprotected casual sex “Dry sex”? Early debut Sex workers MTCT STIs (HSV-2) Cross-generational relations Underlying vulnerability factors: Gender imbalances Stigma Mobility

11. BC strategy guiding principles: All stakeholders make a commitment to … • Use consistent messages and avoid any negative statements about any effective HIV prevention method(ABC); • Combat stigma and increase meaningful involvement of PLWHA; • Lead by example and involve leaders as advocates and role models; • Increase participation of men, address gender relations and reduce the vulnerability of women; • Empower target groups (incl. married couples) to understand their personal risk; • Facilitate decentralized planning of BC promotion and full involvement of district structures, FBOs and communities; • Develop BC programmes on the basis of epidemiological and behavioural information on target groups.

12. Promoting community participation and ownership of prevention programs. • Scaling up of HIV prevention efforts to ensure maximum coverage • Utilization of the multisectoral structures( AIDS Action Committes from National to village levels) to disseminate the strategy and ensure realignment of prevention programs. • Engagement of legislators to seek their commitment in BC. Motion on BC moved in parliament.

13. Interventions cont. • Recruitment MIPA officers (Professionals openly living with HIV) • Development tools eg leadership calendars and certificates • Linkages with other services eg ART, TC. • Development of HIV polices by FBOs

14. One national umbrella FBO body was formed comprising of UDACIZA, ZENERELLA, ZCC,ZBCC, EFZ, Interfaith, HOCD Recommendations; - Role out of BC messages Pulpit messages Community outreach In counseling sessions Theological colleges In visits to hospitals FBO involvement

15. Lessons learnt • An appreciation that BC is a professional field and that a systematic approach is basis for success. • A detailed review forms a basis for an effective intervention. • BC programs need to be guided by research and not approach from a common sense. • It is easy for members to have a buy in if they are involved from the start. • There is need for clear identification of different roles in prevention so that everyone feels has an active role in prevention.

16. Recommendations • A behaviour change situation and response analysis is necessary to identify current drivers of HIV and ensure a systematic approach. • A multi-sectoral approach is critical in the national response so as to create ownership of prevention programs • A strategic framework on BC is critical so as to guide a broad range of players to focus on the current drivers. • Regular reviews for strategic frameworks is required so as to keep abreast with current trends of the epidemic.

17. Thank You