Evidence for a contribution of the community response to HIV decline in eastern Zimbabwe?

Figures & data

Figure 1. Dose effects of multiple community group membership on (a) HIV incidence and (b) reducing or maintaining low-risk behaviour, for women, 1998–2003. The scale bars in the histogram show the numbers of women by number of groups joined for each outcome. The square boxes with whiskers show the estimates and 95% confidence intervals, respectively, for HIV incidence (graph (a)) and adoption of lower risk-behaviour (graph (b)).

Table 1. Comparison of effects of community group membership^a: 2003–2008 versus 1998–2003.

	2003–2008						1998–2003
	Members		Non-members		Test for difference		Members		Non-members		Test for difference
Outcome	%	N ^c	%	N ^c	aOR^b (95% CI)	p	%	N ^c	%	N ^c	aOR^b (95% CI)	p
Females
HIV incidence (aIRR)	1.13	4682	1.29	4510	1.25 (0.87–1.80)	0.23	0.97	3607	2.19	3424	0.64 (0.43–0.94)	0.024
Adoption of low-risk behaviour	90.37	1671	84.69	1398	1.25 (0.98–1.59)	0.07	96.18	1073	90.13	871	1.85 (1.21–2.83)	0.005
Self-efficacy	82.82	1653	79.95	1651	1.39 (1.11–1.73)	0.003	82.10	1570	82.51	1555	1.06 (0.88–1.28)	0.55
Males
HIV incidence (AiRR)	1.47	1228	0.94	3830	1.39 (0.82–2.35)	0.23	2.60	1539	1.71	3388	1.46 (0.95–2.24)	0.08
Adoption of low-risk behaviour	80.68	414	76.10	975	1.04 (0.77–1.42)	0.79	78.30	434	72.90	896	1.36 (1.05–1.76)	0.020
Self-efficacy	94.67	450	93.29	1341	1.22 (0.76–1.96)	0.41	96.81	658	96.83	1420	0.92 (0.57–1.48)	0.74

Notes: ^aFor consistency with previous reports (Gregson et al. PDR 2011), individuals are taken to be participating in community groups if they were members of at least group they considered to be functioning effectively at the start of the period of observation.

^bOdds ratio adjusted for age, location, education, employment, religion, marital status and poverty.

^cPerson-years of exposure for HIV incidence.

Figure 2. Frequencies of different group characteristics reported by members of community groups, 2003–2005. Note: Social spaces – group discusses HIV prevention; bridging – group assists or meets other groups; single sex – single sex versus mixed sex group; sponsorship – funding from an external source (e.g., NGO, employer or a government source).

Table 2. Characteristics of community groups associated with HIV risk, 2003–2008.

	Effects of group characteristics amongst group members																Members^a versus non-members
	Social spaces (discuss HIV prevention)				Bridging (assist or meet with other groups)				Single sex versus mixed sex membership				Sponsorship				Members		Non-members		Test for difference
Outcome	aOR^b	p	%	N ^c	aOR^b	p	%	N ^c	aOR^b	p	%	N ^c	aOR ^b	p	%	N ^c	%	N ^c	%	N ^c	aORb	p
Females
HIV incidence (aIRR)	0.54	0.28	0.62	813	0.51	0.19	0.65	922	1.52	0.50	1.35	816	1.63	0.48	1.07	560	1.01	1683	1.25	7509	0.96	0.89
Adoption of low-risk behaviour	0.96	0.89	90.88	307	2.77	0.001	92.98	342	0.87	0.64	88.82	304	0.64	0.21	88.52	209	89.87	622	84.04	777	1.22	0.27
Self-efficacy	1.79	0.013	86.84	304	0.89	0.66	83.78	333	1.43	0.17	84.83	290	1.11	0.72	84.39	205	82.98	605	79.55	978	1.52	0.022
Males
HIV incidence (aIRR)	0.59	0.51	1.99	201	1.53	0.66	2.64	228	0.89	0.91	2.55	118	1.85	0.44	3.14	127	2.03	395	0.86	3109	1.88	0.12
Adoption of low-risk behaviour	0.69	0.41	68.57	70	0.46	0.22	64.47	76	1.03	0.97	64.71	34	0.78	0.73	65.22	46	73.53	136	76.70	764	0.68	0.11
Self-efficacy	1.17	0.90	94.44	72	0.56	0.57	92.68	82	6.31	0.32	92.68	41	2.18	0.54	95.74	47	93.66	142	92.82	1086	0.94	0.86

Notes: ^aIndividuals taken to be participating groups if they were members at baseline and still at follow-up; reference group comprises individuals who were neither members at baseline nor at follow.

^bOdds ratio adjusted for age, location, education, employment, religion, marital status, poverty and (for effects of group characteristics) other group characteristics.

^cPerson-years of exposure for HIV incidence.

Table 3. Types of community groups that provide social spaces for dialogue on HIV prevention, 2003–2005.

	Females					Males
	Members reporting social spaces			Test for difference		Members reporting social spaces			Test for difference
Type of community group	n	N	(%)	aOR^b (95% CI)	p	n	N	(%)	aOR^b (95% CI)	p
Women's group	26	45	(57.8)	1.32 (0.69–2.53)	0.40	–	–	–	–	–
Co-operative	20	32	(62.5)	1.02 (0.50–2.07)	0.96	1	2	(50.0)	–	–
Farmers group	32	72	(44.4)	0.79 (0.47–1.33)	0.37	13	22	(59.1)	1.46 (0.52–4.09)	0.47
Burial society	103	269	(38.3)	0.49 (0.36–0.69)	<0.001	22	43	(51.2)	0.81 (0.34–1.93)	0.63
Rotating credit society	28	64	(43.8)	0.73 (0.42–1.26)	0.26	3	8	(37.5)	–	–
Youth group	8	10	(80.0)	3.78 (0.67–21.20)	0.13	5	12	(41.7)	0.59 (0.15–2.28)	0.45
Sports club	9	16	(56.3)	1.21 (0.40–3.70)	0.74	13	31	(41.9)	0.47 (0.15–1.43)	0.18
Political party	15	33	(45.5)	0.88 (0.42–1.84)	0.74	14	23	(60.9)	2.36 (0.83–6.72)	0.11
AIDS group	74	80	(92.5)	13.40 (5.66–31.72)	<0.001	2	2	(100.0)	–	–
Any group	316	632	(50.0)	–	–	74	145	(51.0)	–	–

Notes: Results based on individuals reporting membership of at least one community group at baseline and again, after 3 years, at follow-up.

^aOdds ratio for reporting dialogue on HIV prevention for group members compared with reports from members of all other types of groups, adjusted for age, location, education, employment, religion, marital status and poverty.