BMC Health Services Research
(Accessed 22 November 2014)
http://www.biomedcentral.com/bmchealthservres/content

Research article
Community resistance to a peer education programme in Zimbabwe
Catherine Campbell1*, Kerry Scott2, Zivai Mupambireyi3, Mercy Nhamo3, Constance Nyamukapa34, Morten Skovdal5 and Simon Gregson34
Author Affiliations
BMC Health Services Research 2014, 14:574 doi:10.1186/s12913-014-0574-5
Published: 19 November 2014
Abstract (provisional)
Background
This paper presents community perceptions of a state-of-the-art peer education programme in Manicaland, Zimbabwe. While the intervention succeeded in increasing HIV knowledge among men and condom acceptability among women, and reduced HIV incidence and rates of unprotected sex among men who attended education events, it did not succeed in reducing population-level HIV incidence. To understand the possible reasons for this disappointing result, we conducted a qualitative study of local perspectives of the intervention.
Methods
Eight focus group discussions and 11 interviews with 81 community members and local project staff were conducted. Transcripts were interrogated and analysed thematically.
Results
We identified three factors that may have contributed to the programme’s disappointing outcomes: (1) difficulties of implementing all elements of the programme, particularly the proposed income generation component in the wider context of economic strain; (2) a moralistic approach to commercial sex work by programme staff; and (3) limitations in the programme’s ability to engage with social realities facing community members.
Conclusions
We conclude that externally-imposed programmes that present new information without adequately engaging with local realities and constraints on action can be met by resistance to change.