ICA Zimbabwe - HIV/AIDS Peer Educator Training report

Background

Since 2009, ICA Zimbabwe has been providing training and support for the Rotary 3H Grant 66890, Community Empowerment in Zimbabwe. The project is collaboration between Rotary Clubs in Zimbabwe and the United States, the Mufakose Communities and ICA Zimbabwe. It aims to train over 4,000 people in four years, working with communities to meet their self identified needs. ICA has been training Self Help Groups (SHG) in Mufakose, Kambuzuma, Rugare, Crowborough North, Kuwadazana, Budiro and Glen View - all high density areas in the city of Harare. The women within the SHG have been trained in savings management, basic business skills, communication and leadership skills and proper record keeping.  ICA also does a 13 week follow up to the training, and some visits to the group thereafter. Women within each SHG are selected to participate in specific trainings like focused training on advanced business skills, living well with AIDs, and the HIV/AIDs peer educator training.

The second round of the HIV/AIDS peer educator training was held on October 17 to 20 in Kambuzama, Harare. The trainers included Seva Gandhi, Beauty Mangere, Mary Mtambo and Dr. Robert True. There are plans for two more rounds of training before the program is completed.

The HIV/AIDS epidemic has hit Sub Saharan African particularly hard. In Zimbabwe  (population estimated at 12.5 million with over 70% under age twenty), 1.2 million are HIV+, and of those individuals, about 150,000 are children. There is a recorded 83,000 deaths per year due to AIDS. Infection rates for those 15 years of age and older was at 14.7 %, in 2009, down from a high of 26.5% in 1997.

In a related problem, Zimbabwe is one of the top 20 countries with the highest rates of TB infection. International and Zimbabwe governmental efforts are resulting in improved availability of testing and treatment, but mobilization and involvement of local people in prevention remains a great challenge. 

The HIV/AIDS peer educator program developed by the ICA uses participatory processes to engage participants in learning about all aspects of the HIV/AIDS epidemic, and also trains them in methodology to become more effective peer educators. This Peer Educator Training has taken place in over 9 countries within Africa. Parts of the program include information on prevention, care and treatment. Each participant is given a manual containing 15 lessons and a lesson plan for training others within their self help groups.

Objectives
The main objectives of the HIV/AIDs peer educator training are to train participants in:

1. the basics of HIV prevention, care and treatment
2. knowing how to teach the materials and lessons learned to others
3. ways to encourage others to use safe practices
4. the importance of knowing your status

Participants
Participants of the October 2011 training were members of SHGs that were started in February 2011 and March 2010.  Sixty women and two men attended the training. Their ages ranged from 18 to 65, with an average individual income bracket estimated to be US$360 to US$600 a year.  Some participants were HIV+ and already receiving ARVs, and many of the participants did not know their status at the beginning of the training. Most of the participants were comfortable reading and speaking both Shona and English. 

Methodology
We began the training by creating a list of expectations the participants had and started each morning thereafter by checking off each one we met, making sure that by the end all had been met. The participants spent time in both small and large groups. In small groups, lessons were covered and discussed and participants prepared to share the information with the larger group. Each lesson was taught to the larger group by participants themselves. Demonstrations of the lessons were given using a role-play technique, highlighting the main points of each section. Participants selected the parts they found most important, and created plays to share the information. Each night participants were given homework assignments that had them use the materials they learned within their communities. They were encouraged to ask as many questions as necessary until the material was understood.

What Worked Well/Successes

There were many successful parts of the training. Some of them include:

• Special presentation by local experts, including testimony from HIV+ SHG member, male circumcision presentation, a local nurse familiar with current practices, and Population Service International with Voluntary Counseling and Testing.
• Presentations to the larger group by participants helped them gain confidence and provided the necessary practice for them to get more comfortable with the material.
• The manual and visual aids helped during the lessons, and the participants found them helpful to take back to teach their SHG’s.
• Hands-on male and female condom explanation and demonstration, using stone models.
• Homework assignments where participants practiced using the materials they had learned that day. It helped to normalize the topic and made participants feel more comfortable talking to people and bringing them along to testing.
• Role plays and small group work helped participants feel more comfortable with the material, provided a creative outlet and successfully demonstrated the practical implications of each lesson.

• Providing an opportunity at the end of the training for participants and their friends and loved ones to get tested.
• Having them explicitly state their expectations at the beginning of the course.
• Meals were excellent, and participants appreciated them.
• Certificates, photographs and the closing celebration.
• Having a preparation meeting before the event
• Having a trained medical professional (Dr. True) helped immensely. Technical questions were answered correctly and confidently.
• Singing , Prayers and Energizers

What didn’t work
There were some things that didn’t function as well as they could have. Some of them are:

• Not having the proper amount of materials - stone models, manuals & notebooks.
• The Registration Process - not having a pre-evaluation form, name tags.
• Language limitations on the first day
• Insufficient staff – need for a logistics person or for all trainers to rotate on logistics coordination.
• There was too much activity on the last day– with insufficient time to do an overview of all the lessons.
• Population Services International, logistical breakdowns on day of testing, unclear information, not all people who wanted to get tested were able to, and people were not able to receive CD4 counts as promised.
• Unclear how many participants were from the same SHG group, and which groups were represented.
  
  

Achievements
Some of the achievements:

• 80 individuals got tested and received pre- and post-test counseling
• Participants learnt about the proper use of condoms
• 3,000 condoms were distributed
• Many women used female condoms for the first time
• Many people invited a spouse, relative or friend to get tested
• By the end of the training almost all participants could speak effectively and openly about sexual matters, HIV/AIDS and issues that affect women in general
• Over the three days, most if not all of the participants were able to demonstrate that they could teach a lesson
• A supportive dynamic was cultivated between participants
• All the expectations listed at the beginning of classes were met by the end, and all the questions participants had were answered.
• The training team was able to communicate and work effectively together.

Recommendations
Some things we believe can be altered for a more functional and fluid program:

• The material be taught over 4 days and a 5th day be set aside for testing and having outside local experts come in and give testimonies/explanations to the participants. Keep the celebration but do it after the testing is over.
• The training team be responsible for creating and providing the certificates.
• ICA Zimbabwe create a relationship with the local clinic to provide accurate information or have someone from the clinic do a presentation to the participants.

When the training is over 5 days (including the last day set aside for testing), a participant should attend for at least 3 days in order to receive a certificate.

• The manual needs many changes. It needs to be reviewed and edited - the training team is willing to collaborate and work on this.
• Do a follow up with the participants, have a visit to the SHG and see how it is going. The CZEP program and ICA-Zimbabwe need to agree on what this will look like. Maybe one individual from each group could go together.
• Pre-test & Post-test. At registration, participants should complete a questionnaire on the following: name, SHG group and some questions on their HIV/AIDS knowledge. The post test would help to assess the difference in knowledge. During their introductions, participants should be asked what is going on in their SHG groups.
• Make a more direct and explicit link between the SHG groups, and how this training will fit into the group.
• Make sure there is a more clear understanding between PSI and the training team on their expectations of the testing day. Understand what is happening with the CD4 counts, have a clear agreement in writing about what will happen on that day.
• ICA would like to know at least 30 days before the training who has been recruited – where they are from, how many of them and from which SHG groups. It is the only way to plan an effective training session.
• Start each day with a team meeting where the plans for the day are discussed.
• Many of the women recommended a similar but separate training for the men in their community. They said the idea of condoms would be better received if more men were informed on the topic and they would not have such a hard time getting men to listen to them about the topic.

Conclusion
A lot of information was absorbed by the participants, and most of them were very happy with the training.  They were able to articulate the information they had learned, and all understood the importance of HIV prevention, proper care and treatment. A collaborative relationship between women from various SHG groups was formed. Overall, the training team found the program a great success. Most of the women who attended got tested and brought someone along to get tested. There were some hiccups along the way but these can be avoided in the future with more collaborative and thorough planning, and more time for the training. The trainers and participants were all happy with the final outcomes of the training.