By Sifelani Tsiko
Harare, Zimbabwe (Oct 16 2006)

"I'm HIV positive and I train teachers who teach children who are mentally retarded. I'm proud of my work and I don't regret being HIV positive. I've been taking ARVs and I'm happy to say that my CD4 count is now 400," says Mr David Mazodze, a lecturer of the United College of Education in Bulawayo during the launch of the Population Services International behaviour change communication programme in Highfield recently. Highfield, is a ghetto about 12km south of the capital Harare. (This is where the struggle for Zimbabwe's independence began in the late 1950s)

It has not been easy for Mr Mazodze. For him, the road from the doldrums of despair and distress to the road of hope and positive living has been winding and rocky.

"I faced many challenges as a person suffering from Aids," he says boldly with a spirit of determination. "I was discharged from Hospital because of stigma and neglect.

"My relatives thought I would die soon and were interested in accessing my pin number (for the bank card). My family was very ignorant and community stigma was very raw.

"I felt all alone. I was isolated. I was fighting despair and today, many people are dying not because of lack of drugs but they succumbing to the disease because of despair and stress," he said to a standing ovation from the participants who had gathered for the launch in this high density suburb.

His presentation was thought provoking and laid bare the difficult circumstances which most people living with HIV and Aids face in various parts of the country.

It was not the unveiling of the 20 million British pounds Department for International Development (DFID) five year programme to help scale up HIV and Aids prevention and behaviour change services in the country that captivated the people who had gathered for the launch.

It was Mr Mazodze's heartrending and inspiring speech that tugged at the hearts and minds of the participants, dignitaries who included Health and Child Welfare Minister Dr David Parirenyatwa, the British ambassador to Zimbabwe Dr Andrew Pocock, health experts, HIV and Aids activist and donor representatives who attended the launch.

The UK DFID programme to be co-ordinated in partnership with PSI was also co-funded by the United States Agency for International Development.

This new funding will allow PSI to develop behaviour change communication programmes that will tackle HIV-related stigma and the underlying social issues that contributed to the escalation of the epidemic in the country.

Human behaviour change is a complex process and a myriad of psychological, socio-cultural and structural factors are at play when it comes to HIV and Aids intervention and mitigation.

Just how do you get people already infected with HIV to help prevent the spread of infection through such practices as safer sex and safer drug use is a difficult and sensitive issue for many people.

How can people be influenced to avoid behaviour that put others at risk of contracting this disease which has no cure?
These are some of the pressing questions which arise when it comes to the implementation of behaviour change programmes.

It's not easy to have people living with HIV to come out in the open and take the lead in the fight against the raging pandemic which is claiming the lives of up to 2, 600 people a week in the country.

"I hope my story will help the community to demonstrate love and care for those living with HIV," said Mr Mazodze. "I saw my condition as a resource and I also hope to use it to promote the rights of people living with Aids."

He said it was critical for Zimbabweans to change schools, colleges, universities and all other institutions of learning into channels of hope rather than those of despair and stigma.

"I've not lost even one lecture this year and I'm being productive to my country," he said. "Being HIV positive does not mean you are dead. You can make a significant contribution to the country as well. I've told my students and other lecturers my story and the letters of support I'm receiving are quite amazing. These letters are giving me a new lease of life."

A variety of related and overlapping behaviour approaches have been used to inform the development of prevention and intervention programmes.

Sexual behaviour, however, is not easy to change. Simply telling people that certain behaviour puts them at risk of STIs and HIV is generally not enough.

Even though its very difficult to take certain statistical indicators as a sign that behaviour change has taken place, good signs are there for many to see in Zimbabwe at least.

Zimbabwe's prevalence rate has declined from 20.1 percent to 18.1 percent this year in the 15-49 age group, which was the most vulnerable and most productive group.

This has put Zimbabwe among a handful of African nations that include Kenya and Uganda where the prevalence rate are declining.

The 2005 UNAIDS Epidemiological Review acknowledges significant behaviour change in terms of uptake of safer sexual practices including the doubling of condom use among non-regular partners and over 25 percent reduction in the number of multiple partners.

Condom use among both men and women averages 82 percent with non-regular partners and peer approval of condom use has risen to 85 percent making Zimbabwe one of the highest users of male condoms in the region.

Between 2001 and 2005, PSI sold over 163 million 'Protector Plus' male condoms and over 3.8 million 'Care' female condoms in Zimbabwe.

This represents one of the highest per capita condom sales in Africa and the highest number of female condoms sold in the world.

In the last five years, more than 550, 000 Zimbabweans underwent voluntary counselling and testing at PSI centres dotted around the country.

This represents 21 percent of the sexually active population in the country.
PSI country director Michael Chommie says his organisation aims to sell more than 250 million male condoms and 5,5 million female condoms in the next five years, an increase of over 156 percent.

He says PSI will also aim to allow more than 800, 000 individuals to undergo voluntary testing and counselling in the same period as well as offer post-test support to more than 200, 000 people who are HIV positive.

"We will not slow down until the prevalence rate is reduced to a single digit figure," says Chommie. "We can clap hands to our achievements but we cannot afford to rest. We must continue to address new areas of intervention. This project is all about the community and we will continue to involve the local community."

PSI has trained hair dressers, community health volunteers and other people in their high impact communication programmes that aim to change behaviour in the community.

"Both married women and young girls are eager to know more about the female condom," says Maud Nhimura, a hairdresser from Highfield. "Some married women are even coming to our salon with their partners to hear more about the female condom.

"I feel proud that I'm doing something about HIV and Aids in my community."
Zimbabwe began a co-ordinated campaign to prevent HIV and aids in the 1990s and fostered a multi-sectoral approach response prioritising it in all government programmes and enlisting other international partners in the fight against the pandemic.

This is now yielding positive results and the HIV prevalence is declining owing to real changes in behaviour leading to lower exposure to the virus by high risk groups.

Health experts say interventions must ensure that people know what to do to protect themselves, must feel that they have the ability to effect change and must have the skills and resources to do so.

Most important, they say, people must have willing partners and a supportive environment. People tend to move fluidly and relapse to a positive behaviour is always  possible. Changing behaviours especially intimate and private behaviours is a complex process.

So looking beyond individual behaviour that make people vulnerable to STIs and HIV infection and at issues that influence behaviour such as social norms, gender inequalities and poverty is also critical.

"With no medical vaccine is sight, behavioural change has to be our social vaccine and within modest means," one health expert aptly summed it up.