Major household study helps to get
The results of the survey will help to inform national programmes in sub-Saharan Africa and to gauge their effectiveness
It’s a pale wintry day in June. Lincoln Ruguwa* (35) shifts in his chair, laughing uncomfortably. “Have you used a condom to protect yourself against unsafe sex?” asks the middle-aged woman sitting on the verandah at the back of his house. Ruguwa only met her a few minutes earlier when she came knocking at his door in Kuwadzana, a high-density suburb on the southwestern side of Harare, Zimbabwe’s capital.
“My God, what sort of a question is that?” he exclaims, but then relents under her steady gaze. “Not here at home,” he confides. “Stopping to put on a condom is embarrassing and by the time it is on, the passion will be gone.”
Sex is not discussed openly, especially not with strangers. But on this morning, four months ago, Ruguwa found himself not only opening up about his sex life, but also undergoing sophisticated tests for HIV and syphilis in his own home. Within minutes he knew the results.
“It is better testing here at home,” he says after the healthcare provider has counselled him. “Nobody asks me what I have gone to do at the clinic.”
Ruguwa is one of hundreds of thousands of people across Africa who will find out their status in a $125-million project to conduct population-based HIV assessments (Phia) in sub-Saharan Africa, including Zimbabwe, Malawi, Zambia, Uganda, Tanzania, Swaziland, Lesotho, Namibia and Cameroon.
The household surveys will provide a snapshot of the HIV pandemic and guide HIV programmes in the participating countries over the next decade, according to the International Centre for Aids Care and Treatment Programmes (Icap) at Columbia University in the United States.
Icap, which provides technical support for the campaign, works in partnership with governments. Funding comes mainly from the President’s Emergency Plan for Aids Relief through the United States Centres for Disease Control.
Between 20 000 and 30 000 people in each country will be interviewed, tested and counselled by teams of healthworkers.
The aim of the Phias is not only to estimate the magnitude of epidemics but also to measure access to prevention, care and treatment services in the various countries.
The survey will assess the effect HIV programmes have had on the trajectory of epidemics and determine how such information could be used to adjust methods and projects to fight HIV in the coming years, according to an Icap press release.
The Zimbabwean project, known as Zimphia, and the first of the household surveys in the programme, started in October last year.
More than 100 nurses, as well as 15 laboratory scientists and 40 interviewers were given special training. The field teams systematically made their way through the country, moving from province to province.
The fieldworkers were armed with tablets containing questionnaires, picking preselected houses at which to speak to people.
About 15 000 households i n Zimbabwe have participated and more than 30 000 individuals have been interviewed and tested, says Icap.
Zimphia measured HIV prevalence in children, as well as what percentage of HIV-infected people on treatment have become resistant to antiretroviral drugs, says Mutsa Mhangara, strategic information coordinator in the HIV and tuberculosis unit of the ministry of health and childcare. It also assesses what percentage of adults have syphilis.
“We give them prevention information regardless of them being HIV positive or negative,” Mhangara explains.
“We have been able to link clients with other social service providers. When we identify that someone is a