Godfrey Woelk

The Association Between Alcohol Use, Sexual Risk Behavior, and HIV Infection Among Men Attending Beerhalls in Harare, Zimbabwe

HIV testing and a behavioral survey were conducted with a cross-sectional sample of 324 men recruited at beerhalls in Harare, Zimbabwe, to examine the relationship among alcohol use, high-risk sexual behavior, and HIV infection among male beerhall patrons and to evaluate the feasibility of using beerhalls as venues for male-centered HIV prevention activities. Recent HIV seroconversions were identified using the less-sensitive enzyme immunoassay. HIV education activities were provided inside beerhalls and qualitative methods were used to assess the acceptability of conducting HIV prevention activities and research at beerhalls. The prevalence of HIV infection was 30%; the prevalence of recent seroconversion was 3.4%. Having sex while intoxicated in the previous 6 months was reported by 31% of men and was strongly associated with recent HIV seroconversion as well as unprotected sex with casual partners and paying for sex. Acceptability of prevention and research activities was high among beerhall patrons, managers, and owners. Beerhalls present an environment associated with high-risk sexual behavior and concomitantly high rates of HIV seroconversion. Beerhalls are appropriate and feasible venues for delivering HIV prevention programs targeted at men in many regions of sub-Saharan Africa and the world.

Cultural and structural influences in the creation of and participation in community health programmes

Community participation in health care programmes is considered axiomatic in health development. Cultural and structural influences are discussed in relation to community participation with the intention of highlighting some critical issues affecting its generation and sustainability. These influences include structurally defined perspectives and perceptions of community participation, limitations of the necessary supportive systems, the structural and cultural factors of marginalization, community stratification and organization, mobilization, and the political context. It is concluded that given these factors against a situation of a financial and economic crisis, of economic restructuring and the values of competition and individualization, community participation will be increasingly difficult to generate and sustain.

The Regai Dzive Shiri Project: a cluster randomised controlled trial to determine the effectiveness of a multi-component community-based HIV prevention intervention for rural youth in Zimbabwe – study design and baseline results

Objective  To assess the effectiveness of a community‐based HIV prevention intervention for adolescents in terms of its impact on (1) HIV and Herpes simplex virus type 2 (HSV‐2) incidence and on rates of unintended pregnancy and (2) reported sexual behaviour, knowledge and attitudes.

The Regai Dzive Shiri project: results of a randomized trial of an HIV prevention intervention for youth

Background:HIV prevention among young people in southern Africa is a public health priority. There is little rigorous evidence of the effectiveness of different intervention approaches. We describe findings of a cluster randomized trial of a community-based, multicomponent HIV, and reproductive health intervention aimed at changing social norms for adolescents in rural Zimbabwe. Methods:Thirty rural communities were randomized to early or deferred implementation of the intervention in 2003. Impact was assessed in a representative survey of 18–22-year-olds after 4 years. Participants self-completed a questionnaire and gave a dried blood spot sample for HIV and herpes simplex virus-2 (HSV-2) antibody testing. Young women had a urinary pregnancy test. Analyses were by intention-to-treat and were adjusted for clustering. Findings:Four thousand six hundred and eighty-four, 18–22-year-olds participated in the survey (97.1% of eligible candidates, 55.5% women). Just over 40% had been exposed to at least 10 intervention sessions. There were modest improvements in knowledge and attitudes among young men and women in intervention communities, but no impact on self-reported sexual behavior. There was no impact of the intervention on prevalence of HIV or HSV-2 or current pregnancy. Women in intervention communities were less likely to report ever having been pregnant. Interpretation:Despite an impact on knowledge, some attitudes, and reported pregnancy, there was no impact of this intervention on HIV or HSV-2 prevalence, further evidence that behavioral interventions alone are unlikely to be sufficient to reverse the HIV epidemic. The challenge remains to find effective HIV prevention approaches for young people in the face of continued and unacceptably high HIV incidence, particularly among young women.

The burden of polyparasitism among primary schoolchildren in rural and farming areas in Zimbabwe

A cross-sectional study was conducted in Zimbabwe among 1303 primary schoolchildren from a rural (53.3%) and a commercial farming area (46.7%) to determine the prevalence of co-infection by helminths and Plasmodium falciparum. Urine was examined on three successive days using the filtration method. Two stool specimens were processed using the Kato-Katz method and a third specimen was processed using the sedimentation method. Plasmodium falciparum was diagnosed from thick blood films. The prevalence of Schistosoma haematobium in the rural and farming areas was 66.8% and 52.3%, respectively, and for S. mansoni the prevalence was 12.4% and 22.7%, respectively. Plasmodium falciparum, hookworms, Ascaris lumbricoides and Trichuris trichiura occurred only in the farming area, with a prevalence of 27.9%, 23.7%, 2.1%, 2.3%, respectively. Co-infection and triple infection with schistosomes, P. falciparum and soil-transmitted helminths occurred in the commercial farming area only. Hookworm and S. mansoni infections were associated with P. falciparum malaria (P<0.001, OR=2.48, 95% CI 1.56-3.93 and P=0.005, OR=1.85, 95% CI 1.20-2.87, respectively). Overlap of helminths with malaria is a concern among primary schoolchildren and incorporating helminth control in programmes aiming to control malaria will improve funding and increase the efficiency of control for neglected tropical diseases in identified co-endemic settings.

The cost of home-based care for HIV/AIDS patients in Zimbabwe

From a study on the cost and quality of community home-based care (CHBC) for HIV/AIDS patients in Zimbabwe, programme and household costs were estimated. Interviews, using a structured questionnaire, were held with 60 patients and caregivers sampled from six types of established CHBC schemes. Detailed cost information was collected from four home care programmes, two urban and two rural. The cost of a home visit in the two urban programmes studied was estimated to be Z

Acceptability of adult male circumcision for sexually transmitted disease and HIV prevention in Zimbabwe

129 (US

Validation of the Edinburgh Postnatal Depression Scale among women in a high HIV prevalence area in urban Zimbabwe

16) in one, and Z

Alcohol Use and High-Risk Sexual Behavior Among Adolescents and Young Adults in Harare, Zimbabwe

183 (US

Translating research into policy: lessons learned from eclampsia treatment and malaria control in three southern African countries.

23) in the other. In one of the two rural schemes, the cost of a home visit was Z