The innovative project in Zimbabwe was an
attempt to develop an intervention that would engage with heterosexual men as
active agents in HIV prevention. Beer halls often play a key role in the social
life of working class Zimbabwean men (few of the customers are female) and are
seen as venues in which male bonding, alcohol consumption and sexual risk
taking are intertwined.
Seeing beer halls as a key site for HIV
prevention activities with men, the researchers designed the ‘Sahwira’ peer
education programme. It centred on
the Zimbabwean cultural concept of the sahwira, a particularly close and
trusted friend. The intervention promoted the idea that men can and should take
responsibility for their friends’ well-being by helping each other avoid high risk
Beer halls are venues in which male bonding, alcohol consumption and sexual risk taking are intertwined.
Peer educators were
recruited as pairs of good friends who regularly attended the beer hall
together and who wished to take part. Although the training to be a peer
educator was time-consuming (three days initial training plus refresher
courses) and there was no financial compensation, there was strong interest in
becoming a peer educator, with some men having to be turned away.
The programme was
based on the information-motivation-behavioural skills
model. Moreover, the researchers used the diffusion of innovation theory to calculate
the number of peer educators required (just over 400) in order to spread
information to clientele of the twelve beer halls that received the
To evaluate the programme, 24 beer halls
were randomised to receive either the peer education intervention or just
condom supplies and advertisements. There were no significant differences
between the customers of intervention and comparison beer halls.
In order to avoid the risk that customers
of the comparison beer halls had also participated in intervention activities
at another beer hall, the venues selected were all in residential
neighbourhoods, away from large markets and transport hubs, with a mostly local
Surveys of beer hall customers were
conducted before and after the fifteen month intervention. In contrast to the
South African study, the men responding to the second survey were not
necessarily the same individuals who had completed the first.
Customers’ average age was 30, around
two-thirds were educated to O-level or higher (an exam typically taken at age
16) and over half were married.
In the second survey, customers at the
intervention beer halls were aware of the project activities: 60% knew that
others had been trained as a peer educator, 38% had seen a condom demonstration,
28% had seen an HIV prevention video, 27% had seen an educational presentation,
13% had attended a quiz show. Very few customers of comparison beer halls had
come across these activities.
But the activities only seemed to have a
minimal impact on the customers’ personal interactions around HIV and sexual
risk. Whereas 77% of customers at the intervention beer halls said they had
helped a friend avoid HIV risk, 72% of comparison group customers had done so.
The difference is statistically significant, but remains slight. On some other
measures, such as having a one-to-one discussion about risk behaviour, there
was no difference between the two groups.
Moreover there was no effect on actual
sexual behaviour. The primary outcome the researchers were looking for was a
reduction in the number of times men had recently had unprotected sex with someone
apart from their wife – but the average was five occasions in both groups.
Similarly, there was no difference in the number of sexual partners, whether men
had had sex when drunk, whether men had been faithful to their wives or in HIV
While there was some evidence of a
reduction in risk behaviour between the two surveys, this was the case in both
the intervention and comparison beer halls.