International Food Policy Research Institute (Byron), Zambia Agriculture Research Institute (Hamazakaza), International Food Policy Research Institute (Gillespie)

From the Abstract:

"The HIV prevention strategies and programs that are widely promoted in sub-Saharan Africa in large part target HIV awareness and individual behavioral modification – conventionally through the ABC (Abstain, be Faithful and use Condoms) approach to prevention. Yet barriers remain to the successful implementation of such strategies at the individual-level. In order to implement effective policy and programs approaches to curb the AIDS epidemic, it is essential that greater consideration be given to the reality of what is happening on the ground in terms of risk behavior.

Within the economic and social climate, this includes customs and tradition, gender norms of behavior, and levels and types of resource access and control. More focused attention is needed on how people actually behave or perceive the issues of susceptibility, risk and HIV spread, and what they are doing to avoid infection.

Using qualitative data collected in four rural communities in southern Zambia, we examine a) the ways in which the risks posed by HIV are locally perceived and acted upon at different levels, b) structural obstacles to lowering susceptibility and avoiding infection, and c) local perceptions of existing prevention approaches. We conclude by assessing what these findings collectively imply for future prevention programming in this region and beyond.

Evidence from in-depth interviews with households and key community and institutional stakeholders suggests the need to improve and alter the structural and environmental context – both the push and pull factors underlying risk of HIV infection. Few prevention strategies deconstruct the barriers to successful implementation by individuals. Inadequate attention is paid to individual agency, or the lack of agency, as an obstacle to implementing prevention strategies.

The perceptions and beliefs about susceptibility to HIV infection and prevention in our study communities suggest that both women and men need to be directly involved, with male roles in risk behavior and prevention requiring greater attention. The gender inequities that underlie vulnerability and agency must be addressed within prevention strategies. More integrated approaches to lowering susceptibility are necessary, combining HIV awareness and education with strategies that address structural constraints (e.g. poverty alleviation through income generating projects for women and youth).

A major challenge is the need to maximise scale while simultaneously addressing the local drivers of risk in thousands of different communities. A multi-pronged strategy is required – one that combines awareness and sensitisation with more practical interventions that promote lower risk economic activities and enhance people’s ability to make choices based on sound information. Resources should be invested in strategies that are effective, culturally appropriate, and sustainable over time – recognising the long-wave nature of the AIDS epidemic and reflecting local need and priorities."

IFPRI website on Oct 12 2006.