Normas de seguridad aplicables en la obra

The general hypothesis of this study is that in a given population, the socio-economic and political conditions in the country determine the perceptions of risk, susceptibility, benefits and barriers to the effectiveness of HIV and AIDS behavioural change strategies. Based on the Health Belief Model (HBM) predictions for perceived threat, this thesis hypothesis that the higher the perceived threat of contracting the HIV virus, the higher the likelihood of engaging in

prevention behaviour. If an individual does not believe that he or she can carry out preventive measures to avoid contracting the virus, there is little motivation to engage in that behaviour. Therefore, there is a direct relationship between self-efficacy and prevention behaviour. If perceived self-efficacy is high, the likelihood of engaging in prevention behaviour will also be high.

I agree that the HIV prevalence rates have declined in recent years. However the decline is not entirely as a result of the success of the Zimbabwean Government‘s HIV and AIDS prevention strategy through sexual Behaviour Change (BC) programmes . This thesis argues that several factors might have contributed to this decline, factors that have resulted from the state‘s collapsing systems. There need to be an understanding of tensions between the socio-economic welfare of individuals to survive during crisis times and health prevention strategies.

There is therefore the need to look at the possibilities of being open-minded about the potentialities of alternative policy implementation strategies that are relevant at any given time. HIV prevention strategies‘ effectiveness and sustainability depends on political stability, and the state‘s ability to sustain an economic process that can generate better standards of living for the people. There must be a harmonised approach between the socio- economic status of any given population and the type of health prevention strategies implemented to them. There are five obstacles referred to as five lacks which are, commitment, conceptualisation, capacity, infrastructure and accountability²⁷, which undermine the fight against HIV and AIDS. Each of these represents a different dimension

27Campbell, 2003.

of failure of political will to bring about the behavioural changes necessary to create health–enabling community contexts

There is also a generalized assumption in HIV and AIDS prevention policies that the approach is if people know, people will change. The net effect is that there are mixed cues leading to simple, one-size-fit-all programmes, geographically haphazard with no regard for HIV prevalence or vulnerability and poorly coordinated responses whose effectiveness is never fully evaluated because of limited capacity to do operational research (Institute of Development Studies in Zimbabwe, 2003). Evidence still shows that most of the responses on the ground are purposely or otherwise still being largely driven by this health perception. The ABC²⁸ prevention package is a typical example. While this prevention package has its role to play and is one of the easiest to propagate to the nation, the overall HIV and AIDS challenge is much more complex and rooted much deeper in how the population perceives the risk of contracting the virus during various socio, economic and political phases in their lives. Information and knowledge should be positively associated with prevention behaviour, because as information and knowledge increase the person has stronger tools to engage in prevention.

This thesis supports the hypotheses developed from the Health Belief Model, which will be discussed in the next chapter, which argues self-efficacy, perceived threat, perceived knowledge quantity, and information receptivity influence health prevention behaviours change. Behavioural patterns have multi-layered determinants with culture, individual actions and socio – political factors having differing degrees of importance on the spread of disease at different places at different times. This investigation of the transmission of

28 Abstain, Be faithful and use Condoms

HIV in Harare between different groups would yield a complex list of reasons for that particular unprotected sexual act.

Zimbabwe, apparently without any intervention whatsoever, experienced a declining HIV incidence due to lack of transport, money, food which are contributing factors to the number of sexual partners one can have. There is currently no evidence of a decline in infection rates in other relatively stable regional countries which had incidences as high as Zimbabwe such as Swaziland, Botswana and South Africa's KwaZulu-Natal province. The survival strategies of many in Zimbabwe at present entail giving higher priority to obtaining food, clothing and shelter than concerns with healthy living issues or safe sexual practices.

Yet it is an oversimplification of the Zimbabwean Government in having the same prevention programmes to all its people. In theory, every citizen makes up his mind on public questions and matters of private conduct.

My hypothesis therefore argues that the Zimbabwean Government has the ability to succeed in fighting HIV and AIDS in its critical economic meltdown. Due to variations of the impact of HIV and AIDS amongst different countries, the strategic approaches to combat this disease must be designed to respond to the epidemiology of the disease in individual countries. This can be achieved by borrowing some, but not all international ideas, and formulate its own relevant and achievable indigenous prevention theories, tailoring them to specific relevant populations than basing prevention messages on any one generalised approach to behaviour change. What is clear is the fact that different individuals and groups will require different motivations, information, or structural change to sustain sexual behaviour change.