Participation in community groups increases uptake of HIV testing services in Zimbabwe

Membership of community organisations is associated with increased rates of HIV testing and uptake of services to prevent mother-to-child transmission, according to the results of research conducted in Zimbabwe and published in the online edition of AIDS.

However, there was some evidence that testing rates were highest among individuals who were members of organisations that had grassroots origins, rather than those linked to non-governmental organisations (NGOs) from outside the community.

“We found the most consistently positive effects in community organisations that had not received sponsorship from an external source,” write the authors. “Outside organisations wishing to engage with local community organisations must proceed with sensitivity, so as not to dilute the localism that may be the key to their beneficial effects.”

Many HIV infections in sub-Saharan Africa are undiagnosed. Both UNAIDS and WHO recommend endorse community mobilisation as a strategy to increase engagement with HIV services, including testing.

An international team of researchers therefore wished to see if membership of grassroots community organisations was associated with increased rates of HIV testing and uptake of prevention of mother-to-child transmission (PMTCT) services among adults in the Manicaland province of eastern Zimbabwe.

The investigators analysed results from surveys conducted in 2003 and 2008 which enquired about membership of community organisations, discussion of HIV-related issues at club meetings, and HIV testing history.   

Community organisations included church groups, women’s groups, cooperatives, farmers’ groups, credit societies, burial clubs, youth groups, AIDS support groups and political parties.

A total of 5260 individuals interviewed in both 2003 and 2008 were eligible for inclusion in the study. At baseline, 6% of men and 10% of women reported a previous HIV test.

Some 16% of men and 47% of women reported participating in the activities of a community organisation.

Rates of participation were higher among more educated individuals, those from Christian churches, individuals from less poor households and those who had previously had an HIV test.

Among the men in community organisations, 57% belonged to groups that had discussed HIV and 36% were members of organisations that received external sponsorship. The corresponding figures for women were 58 and 35%.

The sponsors of community groups included churches (46%), NGOs (16%), political parties (8%) and employers (2%).

Organisations that had an external sponsor were more likely to discuss HIV-related issues (68 vs 53%) than those who did not had a funder.

In the period between the 2003 and 2008 surveys, 10% of men and 32% of women were tested for HIV.

Rates of testing were higher for men in community organisations compared to other men (15 vs 9%; p = 0.007). Testing rates were also higher among women who were members of community groups compared to other women (37 vs 30%; p = 0.008).

The investigators then examined the impact of discussion within groups about HIV-related issues.

For men, they found that testing rates were slightly lower when groups discussed HIV.

“For men, discussion about HIV was not an important mechanism for increasing [testing] uptake amongst those who participated in community organisations,” comment the investigators, who suggest this could be reflect “negative effects that dialogue can have in spreading false information and in entrenching unhelpful social norms.”

However, there was an opposite effect for women, with discussion of HIV boosting testing rates (p = 0.002).

Testing uptake increased for men in community organisations that did not have external sponsorship (17 vs 9%), but this was not the case for sponsored organisations (12 vs 9%). For women, increased testing was seen in both sponsored (p = 0.026) and unsponsored organisations (p = 0.026).

Pregnancy was reported by 993 women and 37% reported use of services to prevent mother-to-child transmission. Uptake of these services was higher among women who participated in community organisations compared to women who did not belong to grassroots groups (42 vs 34%). However, this difference was not significant. Service uptake was also higher for women who were members of groups without an external sponsor (45 vs 34%) compared to women who belonged to groups with an outside funder (38 vs 34%).

“Uptake of HIV testing and counselling and PMTCT…was higher in members of community organisations than amongst non-members,” conclude the investigators. “Community mobilisation through indigenous grassroots organisations could be an effective strategy for increasing uptake of HIV services.”