VCT Day 2011

VCT Day arrived and there were a few hiccups along the way - the marching that kicks off every one of these commemoration days started about 90mins late - but in the end the day was definitely a success. In terms of figures: around 500 people attended the actual event; 398 people went for counselling and testing at the site; and 68 couples also went for VCT. The aim of taking the event deeper into the community (and not at a central venue) was certainly worthwhile as the longer the event went on more local people showed an interest and came to see what was happening. However, most of the people there were probably under 21, an important target group for HIV, but as the event was held on a weekday many of their parents and adults in general were away working elsewhere. The number of couples tested was very encouraging, especially as that was the main message that we had been promoting for the day.

At the event there was the usual mixture of drama, singing, dancing and speeches. The Guest of Honour was Chieftainess Mwenda (one of four chiefs in the district) who as I have learnt is a passionate and committed activist on HIV issues, not just in her chiefdom but more widely in the district. She gave a very good speech and as she finished announced that she was off to receive her own counselling and testing at a tent (see the photo below). This leadership and actions (not just words) are critical given the strong hierarchical structure of society, particularly in rural areas, in Zambia. The disappointing thing was that none of the other senior figures at the event (from Government, NGOs, FBOs, CBOs and other organisations) followed her lead and also went for VCT. One observation from my time here is that leaders from these organisations are very good at telling the community how they should behave and what they should and should not be doing, but often ignore their own advice.

Meeting with NAC - Small steps

No system is perfect and as I have found out there are a number of limitations with the Monitoring & Evaluation system that is being used by the National AIDS Council (NAC). The issues are not going to be solved overnight but the meeting today was the first encouraging (small) step where myself and another VSO volunteer (working at the provincial level in Livingstone) on M&E were given the opportunity to present to the Director of M&E and other colleagues at NAC. We talked about our experiences to date working at district and provincial levels and what this means to M&E. And then set out how some of the weaknesses in a lack of understanding of what HIV stakeholders are doing in each district and the quantity and quality of the data being collected can be improved. At first from the faces of the people present it seemed that we had pushed a bit too far in our criticism but the comments back, particularly from the Director, were very positive and in agreement we what we had said; in one case adding further issues to the list. As a result we were promised a meeting with the overall Director General of NAC to get buy in to reallly start addressing these issues.

More on VCT - Get Tested Together, Get Tested Today

A week to go and I thought that for whoever does read this blog (I think there are one or two out there) then it would be helpful to explain a bit more about the messages for this year’s VCT day. National Voluntary, Counselling and Testing (VCT) Day is celebrated on 30th June every year and it plays an important role in the response to HIV and AIDS. The day is all about increasing awareness of and access to VCT, and other HIV prevention measures.

The theme for the 2011 is “Get Tested Together, Get Tested Today”. This theme focuses on the family, with a special emphasis on couple counselling and testing. The goal of couple counselling, particularly in relation to HIV prevention, is to bring two people together so that they can be empowered to prevent HIV acquisition or its spread, and share their support and love for each other. Here are some of the benefits and possible outcomes of couple counselling and testing:

What are the benefits of couple counselling?

• Testing together improves communication in your relationship and makes it easier to make decisions about your future plans
• Testing together will help you take appropriate steps to prevent infection or re-infection
• Going for counselling and testing can be scary, but when you go as a couple it is easier
• Receiving results together means less burden and less stress: trained counsellors will help you disclose your status to each other
• Getting tested with your partner will help you receive information together on how best to take good care of yourselves, your children and the family as a whole.

What are the possible outcomes of HIV test results among couples?

• HIV tests results can be negative for both, or positive for both couples – concordant results
• HIV results can have one partner positive and the other one negative – discordant results
• When couples are discordant, infection may have occurred before or after they become a couple
• What is important is to support each other to stay together and prevent future infections by using condoms consistently.

Good shot, bad shot

There’s not normally much to do in Maz at the weekends (aside from the occasional party!) but for the second time in a couple of weeks we headed to the golf course. This time of the year seems perfect for golf– warm weather but without the humidity that will be back come in October to frustrate us. And if we go mid morning there tend to be only a few players out on the course so we do not disrupt them too much with our slow play and wayward shots. There were six of us this time so we played as three pairs and overall we were not bad. Admittedly there was the odd hooked or topped shot and a few lost balls but we avoided the water feature on one hole and each of us managed a number of drives, irons or putts that were half decent. Even the odd par so there is some potential there.

VCT prep

It is only a few weeks to go and our preparations for this year’s VCT Day are beginning to get going. The organising committee has met a couple of times already and we are working through all the usual issues such as venue, guest of honour, programme for the day, resource mobilisation, banners, publicity, invitation letters, tents, chairs . . . The list goes on and on. We have decided to take the main district VCT event into the heart of one the compounds of the town called the Ndeke community. Last year at a more central location the majority of the people present were workers and volunteers from our stakeholders (so they should already get the VCT message). This time we want to get more of the community involved so on 30th June the field pictured below will hopefully be alive with tents, drama, marching and singing.

Male Circumcision Research

The Tonga tribe dominate the Southern Province of Zambia where Mazabuka is one of the major towns in the area. In terms of HIV and AIDS activities two important Tonga customs play a significant influencing role in the epidemic. Sexual networks, or multiple concurrent partners, are where a person has a sexual partner but then one or both of those partners also have other sexual partners. Then these other individuals may have more than one sexual partner themselves, hence the networks grow and the risk of someone becoming infected with HIV is much greater if these sexual relationships are all being carried out at the same time. In ‘Tonga-land’ polygamy is part of the custom and multiple concurrent partnerships are not illegal. The phrase ‘Tonga bull’ is often mentioned by men where they are proud to be engaging sexually with more than one woman at the same time.

The second HIV and AIDS issue is that across Zambia the rate of male circumcision is low – men are traditionally not circumcised either at birth or as part of the rights of passage to manhood. There are exceptions such as in the North Western part of Zambia where for the Luvale tribe around 71% of men are circumcised. However, in the Southern Province the figure is only 4%. Studies are shown that male circumcision can reduce HIV infections by up to 60% (beneficial though still not the level of protection offered by wearing a condom but availability, access and then the actual wearing of condoms remains a major challenge).

I am giving this bit of background because one HIV and AIDS stakeholder in Mazabuka, Women Empowerment Alliance (a small community based organisation), was awarded funding to carry out some research in Mazabuka concerning the acceptability of male circumcision in the area. They want to interview around 1,000 people in rural, peri-urban and urban areas of the district to try and understand what people already know about male circumcision, their views on the advantages and disadvantages, who should carry out the operations and what challenges or issues exist at the moment which would affect the take-up of male circumcision in this area. So I have been helping them to design the questionnaire, train the researchers and then go out in the field (briefly) to get a sense of how people are responding to our questions; the hard work of the 1,000 interviews has been left to the interview team. Aside from it being good to be out doing some research work, the results could potentially be both interesting and very useful for policy making. The next challenge will be the data entry and analysis . . .