Behaviour patterns which may predispose to HIV infection or further transmission and possible intervention strategy in the City of Harare. Part II.

The proportion of people with AIDS is increasing rapidly in Zimbabwe. Several strategies have been adopted to check the further spread of the disease. This paper discusses the behaviour patterns which may predispose to HIV infection and possible intervention strategies that may be taken in the City of Harare. Over a third (33.9 pc, n = 1,526) of the married respondents reported that they were living separately from their spouses. There was a high proportion (76.6 pc, n = 564) of single respondents who admitted to engaging in premarital sex. Fifteen pc of total respondents were engaging in casual sex. The proportion of single respondents (31.2 pc) engaging in casual sex was higher than among the married (11.1 pc). More single respondents (10.9 pc) had been paid for sex than the married (4.1 pc) whilst the proportion that had been paid for sex was similar for the single (21.2 pc) and the married (22.9 pc). The median age for starting sex was 17 years (range = three to 26) for the single and 18 years (range = four to 35) for the married respondents. Sixteen pc stated that they had an STD in 1989. Condom usage was low with only 9.2 pc always using a condom. Forty eight pc of the married respondents who have engaged in casual sexual relationships never use condoms. The main source of information on AIDS/HIV was the radio (74 pc). Most parents (66 pc) had not talked about AIDS to their children.

PIP: HIV transmission is spread in sub-Saharan Africa mainly through heterosexual intercourse, with most infected people in the age group 20-39 years. Findings are reported from a 1989 knowledge, attitudes, and practice study conducted in the city of Harare, Zimbabwe, among 2109 adults undertaken to identify and document behavior patterns which may predispose individuals to HIV infection and possible intervention strategies. The median age for initiating sex was 17 years among single respondents and 18 years for those married. 33.9% of married respondents reported living away from their spouses, 76.6% of singe respondents admitted to engaging in premarital sex, and 15% of all respondents were having casual sex. Only 9.2%, however, reported always using a condom, while 48% of the married respondents who have engaged in casual sexual relationships never use condoms. 16% reported having a sexually transmitted disease in 1989. 10.9% of single respondents and 4.1% of married respondents had been paid for sex. 66% of parents had not talked about AIDS to their children and the main source of information on HIV/AIDS was the radio at 74%. All types of education/prevention campaigns should be encouraged as long as health education messages do not further stigmatize people with HIV or AIDS. The poorly educated and illiterate should be specially targeted.

Knowledge and attitudes on AIDS relevant for the establishment of community care in the city of Harare.

Part I: Because of the increasing number of people with the HIV infection or AIDS, health resources and facilities are becoming over burdened. Many projects are looking towards involving communities more in caring and supporting those living with HIV/AIDS. In view of this, features of knowledge and attitudes have been drawn out of a main study on knowledge, attitudes and practices on 2 109 respondents in the City of Harare, to demonstrate areas where urgent preparation is needed to facilitate community care. The majority of respondents (96 pc) were aware that AIDS is a sexually transmitted disease. About 70 pc of the respondents thought that there were many people infected with HIV in Zimbabwe. Most of the respondents (83.3 pc) were frightened by the idea of catching AIDS. However, 82 pc would want to know if they are infected with the AIDS virus. About nine pc of the respondents said that they would commit suicide on discovering that they had HIV. Only 10 pc would have another child after becoming infected. A quarter of the respondents would not be supportive of people with AIDS. They stated that they would evict lodgers with AIDS, would avoid either neighbour, coworker or school mate with AIDS. People were generally more willing to look after their own children (76 pc) and less supportive of other relatives (68 pc) who had AIDS. Gender differences are also highlighted.

Alcohol problems among patients attending five primary health care clinics in Harare city.

Modified versions of the CAGE and WHO AUDIT (Alcohol Use Disorders Identification Test) questionnaires were used to investigate drinking habits of patients attending primary care clinics in Harare in 1989. The questionnaires were administered to 483 consecutive patients of whom 63 pc were male and 37 pc female. The results showed that 41 pc of the patients were current drinkers, and over 60 pc of them were drinking to and beyond "safe limits". Thirty nine pc of the current drinkers drank at least three or more times per week. On an average drinking day 66 pc of the male drinkers consume 10 or more units of alcohol per day. On heavy drinking days 38.5 pc of the drinkers or 16 pc of the total sample consume more than 21 units per day. These sessions occurred around paydays. Thirteen (13.2 pc) of those who consume more than 10 units per heavy drinking session exceeded the recommended frequency levels i.e. not more than three times per week. Seventy five pc of drinkers stated that they drink to socialize or for recreational purposes. About 60 pc of the current drinkers had tried unsuccessfully to cut down or stop drinking. The main reason for such an attempt reported by 92 pc of them was health problems. More current drinkers presented with STD and work-related injuries compared to non-drinkers. None of the current drinkers were asked about their drinking habits by the health workers who attended to them at the clinic. No diagnosis of alcohol dependence or an alcohol problem was made by the Primary Health Care worker at the clinic.

PIP: The proportion of individuals who abuse alcohol is growing rapidly in developing countries, especially in Zimbabwe. The authors used modified versions of the CAGE and WHO AUDIT questionnaires to investigate the drinking habits of 483 consecutive patients attending primary care clinics in Harare in 1989. 63% were male and 41% were current drinkers of whom more than 60% were drinking to and beyond safe limits. 39% of current drinkers drank at least 3 or more times per week. On an average drinking day, 66% of the male drinkers consume 10 or more units of alcohol. On heavy drinking days, however, 38.5% of the drinkers or 16% of the total sample consume more than 21 units. These latter sessions occurred around payday. 13.2 of those who consume more than 10 units per heavy drinking session exceeded the recommended frequency levels of not more than 3 times per week. 75% of drinkers stated that they drank to socialize or for recreational purposes. Further, 60% of the current drinkers had tried unsuccessfully to end or reduce their levels of drinking largely due to health problems. More current drinkers than non-drinkers presented with sexually transmitted diseases and work-related injuries. It is noted that none of the current drinkers were asked about their drinking habits by the health workers who attended to them at the clinic and that no diagnosis of alcohol dependence was made.

An activity sampling study of primary care staff of two Harare polyclinics.

PIP: As part of an exercise in which clinical operations were examined, an activity sampling study was carried out at the primary care units of 2 polyclinics in Harare, Zimbabwe. 1 clinic served a population of 59,791 in a newly developed area, receiving 187,240 primary care visits, 90,830 of which were initial visits. The other clinic, situated in a more established area, served a population of 23,546, experiencing 47,705 initial primary care visits out of a totsl of 148,912 visits in 1983. The work measurement technic involved making instantaneous observations of staff member activities. 7 consecutive days were spent by the research team at each of the clinics, observing the activities of state registered nurses (SRNs), medical assistants (MAs), clinic orderlies (upgraded literate domestic workers given in-service training), and maids. 50 observation times were randomly selected daily between 7:30 a.m. and 4:00 p.m. from Monday to Friday; and 33 random times between 7:30 a.m. and 1:00 p.m. on Saturdays and Sundays. The study found that at the clinic where MAs were engaged more in consulting patients, the SRNs and sister-in-charge had more time to supervise and administer staff, and screen patients (they spent 12.4% of their time in administration, as opposed to the other clinic, where they spent 2.3%). It is suggested that increasing the delegation of duties to the MAs can improve clinic operations.^ieng

Immunization status of children living in Harare, Zimbabwe.

PIP: Surveys to ascertain the immunization status of children living in Harare, the capital of Zimbabwe (population 658,364 as of the 1982 census) were carried out over a period of 10 days in May/June 1982 and a period of 6 weeks in October/November 1983, using World Health Organization prescribed cluster sampling methods. 206 children were examined in 1982 and 234 in 1983. 82.5% of children were found to have record cards in the 1982 survey, 88.5% in 1983. 47.6% were considered fully immunized in 1982, 55.6% in 1983. In 1982, 74.0% of children were recorded as having BCG scars, 79.4% in 1983. 64.6% and 71.4% had measles innoculations respectively. DPT (dyptheria, pertussis, tetanus) injections had been given to 69.9% in 1982 and 76.5% in 1983. Figures for 2nd and 3rd DPT boosters were 65.5% and 58.7% for 1982 and 76.5 and 75.6% for 1983. Figures for 1st innoculations with OPV (polio) were 69.9 and 76.5% for 1982 and 1983 respectively. 2nd and 3rd polio booster figures were 66.0 and 57.8% for 1982 and 76.5 and 74.8% for 1983. The study was part of an evaluation of immunization integrated with maternal and child health services in the city, administered by nursing personnel, health visitors, and medical assistants in various clinics. Dropout rates for 1st to 2nd dose and 1st to 3rd dose for DPT and OPV improved markedly. Increased usage of immunization probably reflects publicity generated by the 1982 program launching. The extent of infection by these 6 diseases in Zimbabwe is not known, although most are frequently encountered. Survey studies will be required to ascertain reasons for nonimmunization, in order to attain total immunization by 1990.^ieng