The Behaviour Change Strategy

Behavior definition

Behavior change is often a goal for staff working directly with constituents, organizations, governments, or communities. Individuals charged with this task can be thought of as “interventionists” whose goal it is to design and implement programs or interventions that produce the desired behavioral changes1 (Glanz, Lewis, & Rimers, 1990, p. 17).

National Behavioural Change Strategy

In Zimbabwe HIV is mostly transmitted through sexual contact. It is estimated that around 4 in 5 HIV infections in Zimbabwe are due to sexual transmission. HIV is now also found in all groups of people in the population, implying that all sexually active people are at risk of contracting HIV. Hence, promoting safe sexual behaviours has to be at the heart of HIV prevention in all communities of Zimbabwe. This strategy offers guidance on what actions can be taken to promote and sustain safe sexual behaviours. Behavioural change concerns everybody and over the coming five years we will continue saying: Today all Zimbabweans can make a difference in preventing HIV.

What drives HIV transmission in Zimbabwe

Frequent change of sex partners or having more than one partner at the same period of time, are important drivers of HIV in Zimbabwe. Concurrent partnerships (more than one partner over the same period of time like for example in unfaithful marriages) expose sex partners to very high levels of infection. This is because the risk of passing on HIV to a sexual partner is higher if the HIV positive partner has just been newly infected within the past months. Newly infected persons have a high viral load, which makes HIV transmission very likely.

Therefore newly infected persons who have more than one partner (e.g. a so-called “small house”) or short breaks between partner change have high chances of passing HIV to the other partners right after their own infection. Although condom use with casual partners is relatively high in Zimbabwe, it is partially inconsistent. Condom use in longer-term and marriage relationships remains low despite the fact that most couples do not know their HIV status and unfaithfulness is reportedly high. This means that marriage does not protect from HIV.

As compared to other countries the majority of Zimbabwean youth do not start sex very early. What exposes young women to high HIV risk is that they start sexual relationships with men who are several years older, sexually more experienced and therefore more likely to transmit HIV to them.

Basic knowledge on HIV and infection risk in Zimbabwe is high, but many Zimbabweans (both youth and married adults) underestimate their personal risks - frequently because they do not consider the current and past infection risk of their partner.

A number of other practices and values are underlying factors that make Zimbabweans vulnerable to HIV. This includes imbalanced relations between men and women as well as stigma associated with HIV, which can lead to a lack of open communication about HIV.

An overview of key activities proposed in the Strategy:

Outcome area 1: Create an Enabling Environment for Behavioural Change

Safe sexual behaviours can only be adopted and maintained in an environment that supports them. The following aspects of our environment are crucial:

Traditional, religious and political leaders must be involved in speaking out in favour of responsible behaviours such as faithfulness and share their own experiences and HIV status. Leaders should be empowered and trained to become AIDS activists themselves

Respect for women and girls and their equal role in marriage and other relations should be emphasized. During pre-marriage counseling open communication about HIV and marriage problems as well as gender equality should be promoted. Activities to address women’s vulnerability and promote positive male role models need to be included in all district and community action plans for behavioural change.

A non-discriminatory environment for people living with HIV must be created. This change in the environment is an important first step. Only in such an environment can people living with HIV feel secure and comfortable to openly discuss their status. NAC and NGOs will support employers to develop HIV and AIDS workplace policies to strengthen the organizational support for people living with HIV. At community level, Ward and Village AIDS Action Committees (WAACs, VAACs) must be empowered to monitor and speak out against discrimination of people living with HIV.

Outcome area 2: Reduction in Risk Behaviour and Increased Adoption of Safer Sexual Behaviour

The main focus and first priority of the national behavioural change strategy is to promote a reduction in the number of partners and increase faithfulness both in marriage and other relationships. While having many sex partners is an undesirable risk behaviour, persons who had more than one partner or “small house” relations shall not be stigmatized, but offered opportunities to change. Faithfulness and the values of the family should be offered as positive alternatives. Advocacy with employers and work place policies should focus on minimizing separation of spouses and on allowing spouses to join their working partners or minimize long-term travel.

Married women need to be supported to understand their HIV infection risk. Their negotiation skills for monogamous relations and safer sex must be increased through health and family planning service providers. Specific attention should be given to men by addressing their responsibility as husbands and fathers. Pre-marriage counselling needs to be offered across Zimbabwe at district and ward level.

We need to cater for the different needs of young people. Those who are not yet sexually active need support to delay first sex. Among those who are already sexually active access to information and skills building for safer sex is required, including facilitating access to condoms. There is a need to address HIV transmission risk in relationships among younger women and adult men. Young women need to be made aware of the risk of engaging in regular or casual relations with new partners, in particular if they are older and sexually experienced.

There is a need to make condom use more consistent. The existing male and female condom programmes will be strengthened and further scaled up. While promotion of faithfulness will be the most important message for married couples, more attention needs to be given to male and female condom use in marriage and