Health Promotion And HIV

wellness Promotion And human immunodeficiency virusThe origins of wellness furtherance lie in the 19th century when epiphytotic unwellnessiness correcttu eachy light-emitting diode to pressure for sanitary reform for the overcrowded industrial towns. Alongside the health figurehead emerged the idea of educating the public for the steady-going of its health (Naidoo and Wills, 2000). In 1977 the World health Assembly at Alma Ata committed tout ensemble member countries to the principles of health for all 2000 (HFA 2000) that on that point should be the attainment by all the quite a little of the atomic offspring 18na by the tear 2000 of a level of health that ordain leave them to lead a affablely and economically productive life Naidoo and Wills, 2000). The capital of Canada ch finesseer held on the 21st of November 1986 was the first international conference on health advance and provided the basis for the current pr identification numberice of health publicit y. It defined health forward motion as the process of enabling hoi polloi to amplify take hold over, and to improve, their health. To reach a state of complete physical, mental and loving well- beingness, an respective(prenominal) or group must be able to constitute and to realize aspirations, to satisfy wishings, and to neuter or cope with the environment (WHO, 1986). wellness is, in that respectfore, seen as a resource for e rattlingday life, non the objective of living. Health is a positive concept emphasizing sociable and private resources, as well as physical capacities. in that locationfore, health promotion is not yet the responsibility of the health sector, but goes beyond healthy life-styles to well-being. It went ahead to come upon strategies for health promotion namely build healthy public policy, bring into being wearive environment, strengthen federation actions, sustain personal skill and reorientate health services (WHO, 1986).human immunodeficien cy virus/acquired immune deficiency syndrome BACKGROUND AND ZIMBABWEThe human immunodeficiency virus virus is the ca theatrical role of the Acquired immune deficiency syndrome (AIDS). in all countries of the world ar right a government agency affected with about 39.5 cardinal mint living with the ailment globally. 2.1million of the global 2.9million deaths collectible to AIDS in 2006 occurred in Africa ( UNAIDS/WHO, 2007). The extent of the Human Immunodeficiency Virus (HIV) epidemic in Africa make believes it qualitatively contrary from another(prenominal) regions. check to UNICEF (2005), the HIV/AIDS epidemic in sub-Saharan Africa has already orphaned a multiplication of children and it projected that by 2010, 18 million Afri go off children less than 18 geezerhood atomic number 18 likely to be orphaned by HIV. Africa has the worlds one-year-oldest population, with the youthfulnessfulness constituting 33% of the totalpopulation. SubSahara Africa is home to 70% of raw muckle living with HIV/AIDS and90% of the AIDS orphans in the world. photograph to HIV/AIDS is compounded by genderand age, making two-year-old citizenry and women in particular untold likely to contract the virusthan others. The age dispersal of HIV infection in Africa is skewed towards jr.females, with infection rates among teen girls five times higher than teenage boys in close to countries.Zimbabwe is not spared this burden. One in six African is a Zimbabwe which has a population of about estimate of 140 million people. The first case of the Acquired immune deficiency syndrome (AIDS) was identified in Zimbabwe in 1986. HIV prevalence then rose steadily from 1.8% in 1998 to 5.8% in 2001. even, in the 2003 survey, the depicted object HIV prevalence had dropped to 5%. At a current level of 5.6%, HIV/AIDS prevalence is highest amongst young people less than 30 years (World Bank, 2006).Several factors pay off been identified as the most important in driving the HIV e pidemic in Zimbabwe. These include early labor union of females and inadequate access to condoms and contraceptives especially for young people. Young peoples wish of access to contraceptives is exacerbated by the age-structured society where children and young people guard little or no control over their health, specially ro intakeual health. There is besides inadequate cozy fosterage in instills as well as a restricted handleion of sexual health matters in public and even in families. Zimbabweans can agree multiple wives as they think they can afford to take fear of. This is very ambiguous and the result is that a lot of women are abuse and left to take care of themselves without actually being empowered to do so. Other factors implicated are the presence of other sexually convey infections (STIs), stigmatization and the inadequacy of health care frames (APIN, 2006). In addition, various ethnical praxiss and surveys influence the health practices and sexual deme anour of our centering group. This makes them specially vulnerable. Vulnerability can be defined as the degree to which an individual or a population has control over their jeopardize of acquiring HIV, or the degree to which those people who are infected an affected by HIV are able to access appropriate care and support. (AIDS Vancouver, 2005)Zimbabwe being a male-dominated society, women are observeed as inferior to men, in some areas in particular in campestral areas and some townships.Womens traditional usance is to put one across children and be responsible for the home. Their low status, lack of access to education, and certain loving and ethnical practices extend their vulnerability to HIV infection. Many marriage practices smash womens human rights and contribute to increasing HIV rates among women and girls. Zimbabwe has legal nominal age for marriage, however in some areas early marriage is cognize to be allowed by parents, as they consider it a way to hold de ar their young daughters from the outside world and maintain their chastity. Girls whitethorn get hook up with among the ages of 14 and 15, and a large age gap normally exists between husbands and wives. Young married girls are at attempt of assure HIV from their husbands be drift it is considered acceptable for men to have sexual partners outside of marriage and even for some men to have to a greater extent than one wife. Because of their age, lack of education, and low status, young married girls cannot negotiate condom use to encourage themselves against HIV and other STIs. Practices such(prenominal) as female genital mutilation alike contribute to the scourge (APIN, 2006).COMPARATIVE STATISTICSFrom Appendix 1(behind), the tables show WHO statistics (2007) and compares different parameters from Zimbabwe, brazil-nut tree and South-Africa. It estimates Zimbabwes population, for 2005, at 131.5 million. This is compared to South Africas figure of 47.4 million and 186.4 milli on for Brazil. Zimbabwe and Brazil are classed as developing countries while South Africa is a middle-income African country. All these countries have secured varying degrees of success in the fight against HIV/AIDS. Deaths referable to HIV (per 100,000) are 8 for Brazil, 167 for Zimbawe and 675 for South Africa. Figures for HIV prevalence in adults aged 15 years and preceding(prenominal) show that the prevalence is reduced in Brazil (454 per 100,000 people), but Zimbabwe (3,547 per 100,000 population) and South Africa (16,579 per 100,000 population) still have very high numbers. This buttresses the fact that Africa still has major problems in the fight against HIV/AIDS.HIV/AIDS POLICY IN ZIMBABWEAccording to the Federal giving medication of Zimbabwe, the overall goal of the HIV/AIDS Policy is to control the banquet of HIV, to provide equitable care and support for those infected by HIV and to mitigate its touch to the point where it is no longer of public health, social and e conomic concern, such that all Zimbabweans will be able to achieve socially and economically productive lives free of the disease and its cause. (Federal Government of Zimbabwe, topic Policy on HIV/AIDS, 2003 pp. 13-14). The objectives of the policy include, among others to foster doings swap as the main means of controlling the epidemic and to visualise that legal community programmes are developed and conducted at vulnerable groups such as women and children, adolescents and young adults, sex workers, long distance commercial vehicle drivers, prison inmates and migrator labour. The target is to improve the companionship, attitude, behaviour and practices of high-risk populations, including youths and adolescents, to HIV/AIDS by 20 percent by the year 2005 and 40% by 2010. With the WHO statistics, there seem to be a lot of work to be do in achieving the above target.YOUTH mandate MODEL THE INTERVENTIONThe modelling was developed by a combination of two existing model s of health promotion namely Caplan Holland (1990) and Beattie (1991) (Naidoo and Wills, 2000). Beatties model uses criteria of mode of discourse (authoritative-negotiated) and concenter of intervention (individual-collective) whereas Caplan and Holland use theories of knowledge and theories of society (Naidoo and Wills, 2000). From Caplan Holland (1990) the following components were taken radical human-centered perspective (empowerment advance) and humanistic perspective (educational approach). From Beattie (1991) were taken health Persuasion (educational approach) and personal advocate (behavioural approach). This model thus comprises of the 4 components namely Radical humanitarian/Empowerment approach where individuals are encouraged to form social and organizational networks including self- benefactor groups, Humanist/Health Education approach this involves confederate education and sensation campaigns, including activities such as dramas, role plays and debates, Heal th Persuasion which is essentially behaviour modification and life skills, Personal counselling which is client led and focus on personal development. The health promoter is a facilitator rather than an expert. (Naidoo and Wills, 2000).APPROACHESThe components of this model made use of three main approaches to health promotion behavioural, educational and empowerment approaches. The empowerment approach is based mainly on the institution of social and organisational networks including self- table service groups, peer groups, abstinence clubs etc. The emphasis of this approach is to foster people to localise their own concerns and gain the skill and confidence to act upon them Naidoo and Wills, (2000), and the behavioural approach aims at behaviour modification. It also uses personal counselling as a means of promoting healthy sexual behaviour, therefore aiming to re bend dexter life skills to the students, which would teach them to communicate, to learn to say no to casual sex, to clutches till the right time and to make the right decisions.The educational approach aims to provide knowledge and information with the hope that this information would enable the students to make the right and conscious choices (Naidoo and Wills, 2000). This would be achieved by means of awareness campaigns, debates, lectures, dramas, role plays, posters and other information, education and confabulation (IEC) materials. A disclose part of the education of these students would be peer education. Over the years, there have been various studies and theories backing the use of peer education as a successful health promotion strategy. Peer pressure can be quite capacious and influential particularly in the focus age group.APPLYING THE COMPONENTS OF THE MODEL railleryAs earlier mentioned, there are four main components of this health promotion model health education, health persuasion, empowerment and personal counselling.EMPOWERMENTEmpowerment in the broadest sense is .the p rocess by which disadvantaged people work together to increase control over events that determine their lives(Laverack, 2004). This entails meridian consciousness of both the primary and auxiliary audiences emphasis is on the exploration of personal responses to health issues. The students are encouraged to form social networks such as self-help groups and peer-educator-led groups. These social networks can lead to self-empowerment. The WHOs definition of health promotion as increasing peoples control over their health places it alongside the key concept of community empowerment (Laverack, 2004). friendship empowerment can be viewed as both a process (something used to accomplish a particular goal or objective) and an outcome (in which empowerment is the goal or objective itself). There is considerable overlap between community empowerment and other concepts such as community participation and community development. community of interests empowerment builds from the individual to the group to the broader community (Laverack, 2004). Health promoters have conventionally viewed community empowerment as a part of bottom-up approached. In this the outside agent act to support the community in the identification of issues which are important and relevant to their lives, and to enable them to develop strategies to resolve these issues. fraternity empowerment includes personal (psychological) empowerment, organizational empowerment and broader social and political changes.Community empowerment has been viewed in health promotion publications as a five-point continuum model comprising the following elements personal action, the development of small mutual groups, community organizations, partnership, social and political action.Each point on the continuum can be viewed as an outcome in itself, as well as a get alongion onto the next point. If not achieved the outcome is stasis or even a move back to the preceding point on the continuum (Laverack, 2004). The latter goes on to say the dichotomy between top- strike down disease measure and modus vivendi change and bottom-up community empowerment approaches is not as wintry as it is sometimes portrayed. As applied in this youth empowerment model, both approaches were used.HEALTH EDUCATIONHealth promotion is rooted in the narrower, more established field of health education. Health education is communication military action aimed at enhancing positive health and hindering or diminishing ill-health in individuals and groups, by means of influencing the dogmas, attitudes, and behaviour of those with power and of the community at large (Downie et al, 2006). subroutine of education in health promotion has to do with communication aimed at enhancing well-being and preventing ill-health through influencing knowledge and attitudes. The purpose is to provide knowledge and information, and to develop the indispensable skills so that a person can make informed choice about their health behaviour (Na idoo and Wills, 2005).Health education interventions are valued because they empower people, enabling them to make desired changes and increase their control over their health. It involves working directly with them, enabling communication and feedback that in turn can be used to fine-tune the intervention, enhancing its effectiveness (Naidoo and Wills, 2009). This can be carried out in classrooms, and clubs aiming to empower the students. The peer educators will also be used at this stage as well as PLWHA. The limit for education in HIV prevention will include issues such as meaning and cause of HIV/AIDS, means of transmission non-transmission, modes of prevention, for sale treatment and management for PLWHA.HEALTH PERSUASIONHealth persuasion in this initiative forms a part of the Prevention Education. These are intentions directed at individuals and involve mainly health professionals, trained counsellors and peer educators, all performing as facilitators. The aim of this is to influence the development of positive health behaviour in the students, so that as they grow older, they can have good sexual health. mess Living with HIV/AIDS are also involved as they are some of the greatest champions of HIV prevention as earlier mentioned. The ultimate aim of health persuasion is boost people to travel along healthy and careful lifestyles. The emphasis is on abstinence, safer sex and faithful partnership. The avenues include classrooms and School HIV/AIDS prevention clubs, distribution of fliers and Information, Education and Communication (IEC) materials and involvement of People Living with HIV/AIDS. individualized COUNSELLINGThis focused on personal development and students (one-on-one or in groups) are helped by a facilitator to identify their health needs to increase their confidence and life skills.Peer EducationThis is the teaching or sharing of information, values and behaviours between individuals with shared characteristics such as behaviour, expe rience, status or social and cultural backgrounds (Macdowall et al, 2006). It is a prevention strategy for reaching youth either in school settings or for marginalized out of school youth, mainly through community based out reach programmes. Approaches to recruiting peer educators have included providing information about a project and then ask for volunteers (Macdowall et al, 2006) identifying and approaching popular opinion leaders from among target groups and asking members of the target groups to nominate peers.HEALTH PROMOTION RATIONALEZimbabwe for obvious reasons verbalise above has a problem in tackling the scourge of HIV/AIDS and this necessary a multi-pronged approach in order to make an impact. Thus, developing a health promotion model targeted at the youth is in place. According to WHO, it is imperative to focus on young people because they have a high risk of contracting HIV since once they become sexually active, they a good deal have several, usually consecutive, s hort-term sexual relationships and do not consistently use condoms. Likewise, IV drug use spreads at an terrible rate in this age group. Furthermore, young people often have insufficient information and understanding about HIV/AIDS they whitethorn not be aware of their vulnerability to it or how best to prevent it. They also often lack access to the means of protecting themselves (WHO, 2004). The National HIV/AIDS policy specifically focuses on adolescents and youths, with a view to changing their sexual behaviour and practices, particularly in the lead they become sexually active. School based programmes are logical avenues to provide most youth with preventive health education which should include helping the youth to identify their personal values and to promote positive self -esteem to enable them to hold up pressure to engage in risky sexual behaviour.Zimbabwe practices a 7-2-3 system of education. Here individuals are expected to spend 7 years in the primary school, 2 years in sixth form 3-4 years in the University. The indirect school age in Zimbabwe is between 12-18 years. The focus for the model is in high school students aged 12 to 18. There were several reasons why the school is a key arena for health promotion. First, in accordance with a prevention is transgress than cure philosophy, it is better to encourage young people to adopt healthful lifestyles than to try to change unhealthful behaviour patterns in adulthood. Secondly, there is evidence that risk factors for disease in adulthood often originate early in life. Thirdly, schools provides a unique opportunity to augment other influences on health-related behaviour with by rights plotted programmes of health education (Downie et al, 2006). As early as 1982, it was inform that the age of first sexual intercourse had continued to drop in Zimbabwe and was then such that 50% of 16 year kids were already sexually active (Nwokocha and Nwakoby, 2002). Thus, the age range for the study is approp riate to equip them before they become sexually active.Mzikazi High School Bulawayo, Zimbabwe was the chosen high school.Mzilikazi is in Matebelaland, second capital city of Zimbabwe with an estimated population of 1.2 million residents. The city has a rich tourism culture and hospitality. Current research estimates the prevalence of HIV in Bulawayo at 6.19% , making it the second highest of all the states in Zimbabwe (The foretell News, 2006).Its easy access to Victoria Falls makes it a centre for visitors from different parts of the world. All these aid the sex trade in a country so rich yet poverty is the order of the day.People who do possess some knowledge about HIV often do not protect themselves because they lack the skills, support or incentives to adopt safe behaviours. High levels of awareness among the youth, a population group particularly vulnerable and subscribeificant as regards the spread of HIV/Aids, have not led, in many cases, to sufficient behavioural change. Y oung people may lack the skills to negotiate abstinence or condom use, or be fearful or embarrassed to sing with their partner about sex. leave out of open discussion and guidance about sexuality is often scatty in the home, and many young people pick up misinformation from their peers instead.PARTNERS IN THIS HEALTH PROMOTIONThe key partners in this initiative were the primary the students, and the secondary parents, teachers, school nurse and other members of the school community including staff. Other partners included professionals such as all clinical health practitioners such as doctors, nurses, and others health professionals who will act as facilitators, the local School Authorities, and bestower agencies that are focused on HIV/AIDS issues they play a very significant roles in community HIV prevention programmes. bestower agencies were involved in the prep of funds that were used in put to death the project. PLWHA (People living with HIV/AIDS) have very important i mpact as people see for themselves living testimonies of the HIV scourge. It must be verbalise that stigmatization and discrimination against PLWHA are common in Zimbabwe. Nevertheless, some progress has been made more recently because of increased national campaigns and more ocular and vocal societies and support groups for people infected with or affected by HIV. Their efforts have helped educate the public about HIV/AIDS, dispelling myths and giving the disease a human face (APIN, 2006). A potential reason for loser of school health promotion is that of culture clash between the school and the home and elsewhere (Downie et al, 2006) hence the inclusion of the parents in the secondary audience. However while the concepts of outcome succees were addressed to some degree in the study, there was nevertheless, a lack of firm and consistent evidence that positive outcomes had been achieved by the partnership come to.Partnership working is seen as providing benefits that are achieva ble, improve health of whole population through working in partnerships with groups and individual to systematically address health needs within a community, (Coles and Porter, 2009). The science and art of preventing disease, prolonging life and promoting health through the organised efforts of society, (Achenson, 1998). Wilson and Charlton (2004), claim that culture clashes in partnership working can often expected between people from different social background. In this study the barrier between the partners was the cultural background for the children , parents and the leaders. In this instance the NGOs were the leaders of the health promotion. The break down in communication and understanding of the intended education started when the educators told the students it is advisable to use condoms whenever you have sex. In Zimbabwe there is a deep-seated unwillingness to talk openly about sex, partly due to rules of respect that lie at the heart of family and kinship structures, wh ich limit communication across generation and sexual divides. original prevalent cultural norms and practices related to sexuality contribute to the risk of HIV infection. Negative attitudes towards condoms, as well as difficulties negotiating and following through with their use. Men in southern Africa regularly do not pauperization to use condoms, because of beliefs such that flesh to flesh sex is equated with masculinity and is necessary for male health. Condoms also have strong associations of unfaithfulness, lack of trust and love, and disease. current sexual practices, such as dry sex (where the vagina is expected to be small and dry), and unprotected anal sex, carry a high risk of HIV because they cause abrasions to the lining of the vagina or anus. In cultures where virginity is a check out for marriage, girls may protect their virginity by engaging in unprotected anal sex.The importance of fertility in African communities may hinder the practice of safer sex. Young wome n under pressure to prove their fertility prior to marriage may try to fall pregnant, and therefore do not use condoms or abstain from sex. Fathering many children is also seen as a sign of virile masculinity.Polygamy is practised in some parts of southern Africa. notwithstanding where traditional polygamy is no longer the norm, men tend to have more sexual partners and to use the services of sex workers. This is condoned by the widespread belief that males are biologically programmed to need sex with more than one woman, ( ). urbanization and migrant labour expose people to a variety of tonic cultural influences, with the result that traditional and modern values often co-exist. Certain traditional values that could serve to protect people from HIV infection, such as abstinence from sex before marriage, are being wear away by cultural modernisation. ( ).However the NGOs wanted to continue with this education even the other secondary partners could tell it is affecting the whole process, with advice to first haul teaching the children, educate the parents first so when the children are taught it does not cause conflict. This dilemma here appears largely about power who has it, who needs it, and how practically? Successful partnership requires leaders to redefine the boundaries of power in the organisation, and this can prove challenging, ( ). Careful design of the organisations decision-making processes and the setting of clear boundaries can help you tackle the leadership dilemma. Therefore with partnership, effective communication enables us to discuss each others concerns, acknowledge our different points of view and strive to understand those views. right-hand(a) communication is especially important when there are strong views or feelings about an issue. The key thing to remember is that communication goes in all directions. Effective communication isnt just about telling people things. Its by and large about listening to each other. Consequently g ood communication is crucial to partnership. Lack of communication often creates an information vacuum. This vacuum is sometimes make full with rumour and speculation.. paygradeTwo different views of rating pervade the literature on health promotion. From the first view point, military rating involves assessing an activity in terms of the aims or specific objectives of that activity. William (1987) has written as follows .the purpose of evaluation is that it should demonstrate whether an activity has been successful or to what degree it has failed to achievee some stated aims.Before we can evaluate, then, we need to be clear about the aims of the activity in relation to the degree of attainment of these aims. From the second view point, evaluation is a broader process. It involves assessing an activity by measuring it against a standard which is not necessarily related to the specific objectives or purpose of the activity. This approach has been advocated by Green et al. (1980). F rom the second view point, evaluation is a broader process (Downie et al, 1996).Evaluation can be defined as the critical assessment of the value of an activity (Macdowall et al, 2006).Evaluation is needed to ensure that health promotion activities are having the intended effects. Evaluating activities helps inform future plans and contributes to the building up of a knowledge base for health promotion. It also helps prevent the reinvention of the wheel, by informing other health promoters of the effectiveness of different methods and strategies (Naidoo and Wills, 2000).Downie et al (1996) identifies reasons for evaluating health promotion activities. These are to assess the extent to which projects are achieving their stated objectives, to inform the development of materials and methods, to ensure ethical practice, to optimize use of resources and to assess the place of health promotion within overall efforts to achieve health gain.Evaluation includes assessments of different kinds of events at varying time periods. A distinction is often made between process, impact and outcome evaluation.Process evaluation this involves assessing the process programme implementation. It addresses participants perceptions and reactions to health promotion interventions. It is therefore a useful means to assess acceptability and may assess the appropriateness and equity of a health promotion intervention (Naidoo and Wills, 2000). In doing this in our health promotion study, inputs (time, IEC materials, money) self-evaluation (self-reflection) feedback from primary and secondary audience (victimization questionnaires, question and answer sessions, individual discussions) will be used. touch on and Outcome evaluationEvaluation of health promotion programmes is usually concerned to identify their effects. The effects of an intervention may be evaluated according to its impact ( the immediate effects such as increased knowledge or shifts in attitude) and outcome ( the longer-term effects such as changes in lifestyle). equal evaluation tends to be more popular because it is easier to do. Outcome evaluation more difficult because it involves an assessment of long-term effects (Naidoo and Wills, 2000).Evaluation of the impact could be planned or unplanned.Planned impact can be assessed using pre-session and post-session questionnaires or a review session with the target audience. Some of the planned impact/outcomes would include increasing attendance to activities, increase in the number of people taking part in voluntary counselling and testing (VCT), increase in age of first sexual encounter and lessening in HIV prevalence rate.Unplanned impact/outcome will include counselling for other issues such as drugs and alcohol use, provision of support for PLWHA within the school community by referrals to NGOs and other support groups that can provide treatment and help them cope with other effects of living with HIV/AIDS.LimitationsThere are limitations to the im plementation of this health promotion model. There is an ethical dilemma with regards what will be too much sexual information for the teenagers considering the cultural background. Many parents will object to some information given to their children.Issues pertaining to funds for running and sustaining the programme need to be considered. There could also be some logistics problems in terms of accessing rural areas power, security, mobility and communication facilities all have to be provided and these are all functions of funds.acceptability of the programme by the primary audience may be in question. The students may view the activities as being prescriptive rather than participatory, also, they may view the health professionals and facilitators as being old school in terms of age or social background or socioeconomic status and this could be a barrier which might face the programme. This is where the peer educators come in and may go a long way in overcoming this problem. If the students are able to see the project/activities as theirs, it would help to sustain the efforts after the health professionals may have left. Such persistence could be anchored on peer educator groups, abstinence clubs and other social networks.Long-term assessment of empowerment and change in behaviour is difficult. Is there any behaviour change? If so, is the behaviour change due to this Health Promotion activity alone?. These are pertinent questions which will need to be addressed at the long run.The model focuses mainly on empowerment without addressing other socio-economic determinants of sexual hea