IS THERE EVIDENCE FOR BEHAVIOR-CHANGE IN RESPONSE TO AIDS IN RURAL ZIMBABWE

This article reports on evidence for behaviour change in response to A IDS among women in two rural areas of Manicaland Province, Zimbabwe. I t examines self-reported data on two overlapping areas of behaviour: ( 1) actions taken to avoid HIV-1 infection; and (2) fertility practices . The latter were used to assess the validity of the former, given tha t self-reported behaviour data are notoriously problematic. It is conc luded that while self-reported behaviour change is exaggerated, the tr ue level of change has nonetheless been significant and includes delay ed onset of sexual relations, increased use of condoms and, possibly, increased monogamy. Reported actions taken to avoid HIV-I infection an d differentials in fertility practices were correlated with data on de mographic, social and psychological factors. Differentials in fertilit y practices were associated with heightened risk perception-particular ly when based on personal acquaintance with AIDS patients-but not with greater knowledge of HIV-1/AIDS. Results from the study suggest that effective behaviour change in Manicaland is facilitated by greater kno wledge, experience and personal risk perception but obstructed by low female autonomy, marital status and economic status, and by male labou r migration and alcohol consumption. Gaps in knowledge included miscon ceptions about the distinction between HIV-1 and AIDS, the influence o f STDs, perinatal transmission, and incorrect modes of transmission; B etter knowledge was associated with education, religion, travel and me dia exposure. Personal risk perception was quite high (42%) and correl ated with non-marriage, media exposure and contact with medical servic es. Few respondents knew close relatives with HIV/AIDS (4%) but nearly a quarter of those who felt in danger of infection said this was beca use friends and relatives were dying of AIDS. Many reported credible b ehavioural responses, some of which would only be effective given thei r partner's co-operation. Intensified behaviour interventions are need ed which should include peer-education initiatives targeting men and i ndividuals without access to modern media. The epidemic may accelerate fertility decline in rural Zimbabwe through behavioural as well as bi ological change. (C) 1997 Published by Elsevier Science Ltd. All right s reserved.