Community-level HIV prevention among sexually vulnerable groups and the general population in Gweru; Zimbabwe

ABSTRACT

Mathematical models show that members of groups especially vulnerable to HIV including prostitutes; clients; STD patients; and very mobile groups - contribute disproportionately to HIV transmission. Several studies demonstrate the cost effectiveness of interventions targeting vulnerable groups. However; in areas of high HIV infection; an optimal strategy may be to combine intensive targetted intervention among vulnerable groups with community-wide outreach. Since 1989; the Bulawayo City Council; supported by the University of Zimbabwe; have recruited and trained members of sexually vulnerable groups as peer educators; who inform their peers about AIDS; counsel at STD clinics; organize meetings; present educational drama/music perfomances; spearhead community outreach programmes and distribute condoms. To date; 80 peer educators have been recruited; 1;51 million condoms have been distributed and 2732 meetings have been held; attended; (including repeat participants) by 236 533 males; 8 000-10 000 of whom may be clients and 30 896 of whom are STD patiens and 52 974 women; of whom 1 500-2 000 maybe prostitutes and 3774 are STD patients and distributed 151 2857 condoms. The Bulawayo programme has learned key lessons about interventions among vulnerable groups and developed a sound training capacity. It has since been replicated in several sites; most recently in Mutare; where; within four months; 40 peer educators have been recruited; almost 500 000 condoms distributed and over 1000 meetings held; attended by over 50 000 people. Thus; whereas the original intervention reached per capita meeting attendance figures of 13 and condom distribution of 1.51 after 12 months; the most recent replication reached per capita meeting attendance levels of 12 and a condom distribution of nearly 51 after 4 months. However; while these interventions have excellent educational outreach; their STD interventions have been more cautious. [abstract terminated]