Web of Influence as a Tool in Combating Stigma Towards

HIV/AIDS

Chilumba SikombeINA/INL Trainer

Zambia-Emory HIV Research Project

Organisation

Zambia Emory* HIV Research Project (ZEHRP)

Postnet 412,P/B E891,

Emmasdale, Lusaka, Zambia

Telephone Contact:260-966-710913

*Emory University, Atlanta, Georgia, USA

Key Terms

• CVCT – Couples Voluntary Counseling and Testing

• CLO – Community Liaison Officer

• INL – Influential Network Leader

• INA – Influential Network Agent

Background Information

• In 2004 ZEHRP adopted an innovative promotional strategy of inviting couples for voluntary counseling and testing (CVCT).

• This model uses community Influential Network Leaders (INLs) from four sectors– Health– Religious– NGO/CBO– Private

• These influential persons are responsible for selecting Influential Network Agents (INAs) who are responsible for CVCT recruitment.

Selection StrategyCommunity Liaison Officers

Influential Network Leaders

Influential Network Agents

Multi-Sectoral Approach

• Health Related– Clinics, Home-based Care, Community Health

Workers

• Religious– Pastors, Church Elders, Christians/Muslims

• CBO/NGO– Schools, Clubs

• Private– Markets, Trading Centers

INL Roles

• INLs provide feedback to ZEHRP on concerns arising in their communities.

• INLs receive intensive training on community sensitization methods for the endorsement of CVCT.

• INLs are responsible for identifying Influential Network Agents (INAs) from their sectors.

Sensitization Strategies

• One-on-one within the community• Door to Door• Public Endorsements

– Churches– Market Places– Bars/Taverns– Sporting Events– Women’s Groups– Work Places

INA Roles• Attend an intensive 4 day training on

CVCT and recruitment methods.

• Responsible for CVCT recruitment through use of an anonymous invitation system.

• Reimbursed per couple that chooses to attend CVCT (whether or not they decide to test).

• Given a 4 month contract.– Exhaust their “Web of Influence”

Agnes ChilufyaMother

Wife

Community Member

Church Member

Business Woman

PTA

Husband’s Work

Fellow Parents

Teachers

Business Association

Neighboring Businesses

Customers

Suppliers

Husband’s Friends

Political / neighborhood

Leaders

NeighborsWoman’s

Association

Farmer’s Cooperative

Church Leaders

Chorus

Woman’s Association

Husband’s Football Club

Football Association

Fellow Parents

Church Group

Relatives

Youth Groups

One INA’s Web of Influence, , , .

Stigma in Zambia

• HIV is a stigmatized disease world wide and has proven to be a challenge in Zambia.

• High levels of stigma discourage people from testing, disclosing status, and accessing and adhering to interventions such as ARVs and PMTCT.

• ZEHRP faces the additional challenge of convincing couples of the benefits of testing and being counseled together.

Couples Tested 2003-2007

* 2008 projection based on first quarter uptake and targets

0

2,000

4,000

6,000

8,000

10,000

12,000

2003 2004 2005 2006 2007 2008*

Key Findings

• In 2007 a total of 429 INAs and INLs were trained.

• In 2007 over 9,280 invitations were distributed by the INA/INLs. Out of these invitations 1,407 couples attended CVCT and 67% of couples tested at ZEHRP.

• In 2008 INAs have already delivered 10,515 invitations with the target of testing 10,000 couples.

• In 2008, over 2,800 couples have attended CVCT with over 2,300 choosing to test.

Key Findings cont.

• Through the utilization social networks and community leaders, ZEHRP has built trust and helped to change attitudes on HIV/AIDS in the communities.

• The increase in CVCT uptake when the INA/INL model was introduced, indicates that this model is successful and that the community based model is combating stigma.

Lessons Learned

Promotional strategies where community leaders are the predominate spokespersons of HIV/AIDS prevention and treatment messages are most likely to be successful and sustainable.

Recommendations

If stigma towards HIV/AIDS is to be eliminated, a community-based, multi-sectoral approach should be adopted that draws influential leaders of the communities to spearhead the sensitizations on HIV/AIDS and the promotion of VCT.

Thank You

The Victoria Falls, Zambia