Executive summary
Concern Worldwide – Zimbabwe has been implementing the “Community Empowerment for Prevention
and Mitigation Services against Impacts of HIV and AIDS” programme since 2007 in three districts:
Nyanga, Gokwe north and Gokwe south. The programme goal is to reduce the prevalence and impact
of HIV and AIDS through community empowerment (of women and girls, men and boys) in these three
districts. After two years of implementation, Concern commissioned a Mid-term Review (MTR) to
assess and document the process, approaches and level of achievement of the HIV programme
outputs. The Mid Term Review used a participatory learning process, applying mainly qualitative
approaches. The process was lead by an external consultant as the team leader, with support from
programme staff at different levels.
Results from the review indicate that significant achievements have been accomplished by the
programme interventions. STAR Circle activities have taken prominence in the programme
interventions and have had positive effects in enhancing interpersonal communication and interactional
social strategies for safe sexual behaviours. A total of 164 STAR Circle clubs have been established,
with an average of 30 members and their activities are among the main pillars for the programme
interventions towards behaviour change in the Concern HIV and AIDS programme. Using methods
such as Theatre for Development (TFD), music, dance and drama, poems, and individual testimonies,
STAR Circles have enabled communities to discuss their perceived negative cultural practices and are
encouraging behavior change. Reportedly, STAR circles have increased the capacity of communities to
recognize and deal with these negative cultural practices that increase the spread of HIV such, as
kuzvarira (marrying off a girl in exchange for food), himutsamapfihwa, chimhandara, Widow
inheritance, Child pledging, Polygamy, Chisahwira, Appeasing spirits, Divisi (Sleeping with daughter as
a means to realize a bumper harvest, Chiramu etc. In effect, STAR has improved communication and
openness about matters related to sexuality and rights as they have created ‘spaces of dialogue’,
where community members could articulate themselves and voice their concerns. It has had a
positive impact in opening up in both domestic and public spaces. Through facilitation, reflective
dialogue and learning, STAR circles are contributing to positive behaviour change among its members.
In addition, STAR circles have promoted formation of community networks, which have improved and
interactions and solidarity, thus social capital among participants in the programme.
However, despite the promising change, the process is slow. The lack of specific activities to sustain
behavior change may raise questions about the extent to which the achieved changes can be
maintained. Often, people may behave differently immediately after realizing the problem and the need
to change, but their behavior may also be different/change again after some time (may back slide).
Similarly, some messages promoted in STAR Circle activities are negative, for example, “AIDS Kills, if
you don’t change you will die”. Similarly, some STAR members are yet to recognize that STAR
activities should be fully owned by them (community) but regard the groups as belonging to ‘Concern’.
In addition to STAR circles, AACs were formed to promote life skills and AIDS education in schools as
a strategy to reduce early sex debut among school children. By the time of the review, 73 AACs have
been formed and 146 teachers have been trained, which is above the target. These have increased
sources of information on HIV and AIDS among school going children. While AACs have increased
AIDS awareness, they have done little in life skills training, to equip young people in schools to deal
with the different problems facing them such as inter-generational sex, peer pressure and their
consequences. Patrons of AACs are still using a teaching approach, and children were less involved in
leading AAC activities.
Impressions from the review indicate that AACs have not yet registered changes in behaviour in
schools – and the associated indicators of pregnancy and school drop-out. The programme plan
included formation of out of school youths AACs. However, this has been one of the least successful
activities. Youth groups were mobilized but never took off. The dynamics of out of school youth,
including their social economic concerns contribute to the difficulties in participating in programme
activities. Meanwhile, the programme component of social marketing of condoms has led to a
distribution of about 50,000 condoms (both male and female) by the MTE time. There were testimonies
of married women who used condoms for the first time with their partners as a result of the programme.
The use of trained community based personnel in condom distribution is a good approach in ensuring
that condoms are distributed with the right messages. However, there was a general focus on married
people, while young people still have limited access to condoms. This is particularly due to negative
attitudes, even by condom vendors.
Regarding the programme output of increased capacity of institutions to recognize and deal with
incidences of male-dominated, negative, cultural practices that influence the spread of HIV and AIDS,
training has been conducted with different structures to support efforts towards realization of this
output. In its interventions, Concern has recognized variation by gender as a significant issue, which
requires explicit treatment during interventions. The programme’s core businesses are adapted towards
coping with the realities of gender inequalities and HIV and AIDS and partners have mainstreamed
gender and HIV in their respective plans. However, there are variations in actual implementation. For
example, there was limited demonstration of HIV and AIDS mainstreaming in ASAP activities, although
its IGA activities seemed to consider gender.
Conversely, about 400 Community Popular Opinion Leaders (CPOLs) of which 34 are traditional court
holders (chief and headmen) have been trained on gender based violence, child sexual abuse, wife
inheritance and the legal framework as how it relates to HIV&AIDS. The training was appreciated by
those CPOLs interacted with during the review process, that it has enabled them to improve their
understanding of legal particularly regarding GBVs and child abuse, it was difficult to assess the extent
to which they had implemented it. This was because of insufficient and sometimes no records at all on
the cases of GBV and CSA that had been arbitrated, and what were the outcomes.
Increasing access to HIV and AIDS preventive services through outreaches is one of the programme
outputs that has been most accomplished. Concern capacitated the five partner mission hospitals by
training and re-tooling. This has enabled them to provide the planned services in a total of 40
outreaches (once a month in each). By the time of the MTR, 8,385 clients had been tested by the 5
Mission Hospitals and 729 by Batsirai, a collaborating partner in Gokwe North and South. The
outreach activities have facilitated not only an increase in availability, access but also uptake of the
services such as PMTCT and STIs treatment. However, there are still some limitations for this output.
For example, mothers have not yet adopted the practice of delivering at health facilities which might
limit the benefits from PMTCT. A number of those who sought VCT services and tested positive, were
enrolled on cotrimaxozole, however, there is still inadequate follow-up services. On the other hand,
while by the review time, a total of 277 patients, both male and female, had received STI treatment from
outreaches, some staff from Concern considers this as a low figure compared to what they would
expect. This possibly indicates low uptake of STIs services which could also be a result of a stronger
focus on VCT and PMTCT by staff during outreaches and less on STIs. There is still a limited use of
IECs that particularly promote STIs prevention, treatment
and management.
The programme design directly linked access to income to the strategy of empowerment women and
girls. There are two approaches used by the programme for IGA support. In Nyanga, ASAP has used a
strategy of self mobilization of resources, through Internal Savings and Lending (ISL). In Gokwe north
and south, Concern took the approach of giving goats as grants to individuals, using a ‘pass-on’
strategy. As result of these variations, there were significant differences in achievements between the
two regions. The general impression by the MTR team combined with stories from participants, indicate
that IGAs in Nyanga have made significant impact in the lives of participating women in particular, and
their families in general. The approach of groups has enhanced community cooperation and networks,
and has given autonomy to the women (and male participants) to control their income. As a result,
women participants have been able to solve socio-economic needs in their homes including school
fees, purchase of household utensils and construction of houses, leading to more recognition of what
women and men together can do for their families. In the Gokwes on the other hand, preparatory work
on promotion of safer and sustainable IGA commenced at the beginning of 2009. By the review time
goats had been recently given to beneficiaries and some wards had not yet received goats. It was
therefore early for the review team to make any assessment if the IGAs had brought intended changes
in the lives of the beneficiaries. Nevertheless, working through organized animal committees in the 2
Gokwes has potential for sustainability of the project.
The review assessed the appropriateness of the methods employed by the programme in realizing the
intended outcomes. The multiple interventions by the programme enable covering various sectors.
Similarly, the design of operating from multiple levels (individuals, groups, communities and formal
institutions) is a good approach which creates an opportunity for increasing individual and group
competencies, increasing avenues for communication and motivation for behavior change. However,
the review team observed a gap between the programme name: “Community Empowerment
and Services to Prevent HIV Transmission and Mitigate the Impact of HIV and
AIDS”, and the real focus. While ‘Impact Mitigation’ is part of the programme title, it is not part of its
focus. Nevertheless training is an appropriate strategy in transferring and improving the functional skills
and capacity of partners, community facilitators, volunteers and communities. Training is vital in
ensuring that communities access quality information on HIV and AIDS prevention. However, there is
need to focus on ToT for sustainability (expansion) rather than focusing on only direct knowledge
transfer (e.g., for STAR facilitators and teacher patrons).
In recognition of the importance of mainstreaming gender and HIV in its interventions, Concern applied
the ‘Harm’s framework’. It has trained its technical and support staff, on HIV and AIDS at workplace, so
as to be aware of the consequence of personal involvement in activities that could increase
consequences of HIV infections. Staff have been trained not ‘do harm.’ Concern conducts regular
discussions on HIV and AIDS, and has made preventive aspects such as condoms, provides a good
context for the programme implementation, to ‘preventing harm’. Similarly, the program provides
appropriate medical aid support with ‘adds on’ to address staff needs is a form of redressing harm.
Deliberate inclusion of PLWA in the intervention activities was identified as one of the mainstreaming
aspects in the external domain.
The utilization of partners by Concern in implementation of some of the HIV programme interventions is
good for comparative advantage and increase efficiency and effectiveness in programme
implementations. Partners have brought in experiences and new innovations to the programme. For
example, ASP has brought in its experience of mobilizing savings from the community, while FACT has
a long-term BCC
STAR circle performance in Gokwe North
Case study – HIV Programme
Community empowerment to assist men and women realise their human rights and
prevent HIV
African culture has diverse backgrounds and in modern-day Zimbabwe, traditional practices still
have a strong foothold in many areas. Chifambe village in Nyanga north is one place where
women are still vulnerable to entrenched customary practices which restrict victims access to a
normal life including education or marriage and leave them at risk of contracting HIV.
It is against this background that Concern Worldwide through its partner organization Family
AIDS Caring Trust (FACT) is implementing the Community Empowerment and Services
Programme to prevent HIV transmission. One strategy used was to ensure duty bearers
understand their responsibility to uphold the rights of communities to safety from harmful cultural
practices which increase the spread of HIV. FACT embarked on training which supported
traditional leaders to give correct information and promote safe practices around HIV. Local
leaders were also trained on the Zimbabwean legal framework including the Domestic Violence
Act which advances gender equality and reduces women’s vulnerability to HIV infection.
Ingrosi Ngoma is the second village head in Chifambe and a STAR circle facilitator. STAR
(Societies Tackling AIDS through Rights) is an innovative participatory method that aims to
enable communities to analyse and tackle issues that affect them within their communities.
Ingrosi highlighted that before STAR, women and girls were offered as compensatory payment in
inter-family disputes and in the appeasement of avenging deceased spirits (kuripa ngozi). An
avenging spirit is appeased by offering a young woman in a spiritual marriage covenant, and any
male member of the family being compensated can be sexually involved with the offered girl. This
greatly increases the risk of HIV transmission. The offered girl is deprived of the right to decide
when and whether to have sex, and whether to use contraception. While there are laws aimed at
enhancing rights and countering these traditional practices, systematic problems and lack of
education often mean that people do not report matters to police.
In Chifambe, an avenging spirit usually demands ten cattle and a young girl. After the training
from FACT to the STAR circles and community leaders it was agreed that in Chifambe
arrangements would be made to add more cows in replacement of the girl. Ingrosi recalls how
recently a spirit demanded seven cows and a young woman but after consultations, the spirit
accepted seven more cows instead of the girl.
STAR also empowered the community to engage the police for services in extreme cases where
consensus is not reached. The community liaison office of the police is currently making a follow
up on a reported case of child appeasement in the Chifambe community. Realising their
opportunity, the local police are also rolling out crime awareness campaigns throughout the
community with emphasis on human rights protection, discouraging negative traditional practices
and encouraging reporting through suggestion boxes or in person.
Ingrosi is now taking every village gathering as an opportunity to sensitize villagers against
offering girls to appease spirits. Ingrosi says ‘Dai pasina FACT wana wedu wangadai wakapera
kuripiswa ngozi.’ (Without this FACT programme many of our young girls would have been
offered to appease avenging spirits). Ingrosi is one example of many traditional leaders in
Nyanga North who have spoken out and acted against negative traditional customary practices
which are spreading the HIV virus.
Ingrosi Ngoma discourages men on negative cultural practices.