The Population Council implemented and evaluated an innovative community-based approach to HIV prevention in Zambia.
In Zambia, the National AIDS Council is committed to reducing new HIV infections. It has identified structural, community-level factors that remain largely unaddressed by HIV programs, including alcohol abuse, gender inequality, harmful gender norms, and sexual and intimate partner violence—as well as taboos and social barriers regarding communication between couples. The National AIDS Council has urged programs to address these structural factors and add to the evidence base on the effectiveness of structural interventions.
The Population Council collaborated with Project Concern International to implement Community Mobilization for Preventive Action (COMPACT), a four-year HIV intervention to develop, implement, and scale-up community “compacts” and evaluate its feasibility and effectiveness as an HIV prevention strategy.
Community compacts are agreements between service providers and recipient communities that are intended to increase the effectiveness of services by promoting community ownership. COMPACT works directly with communities to design and implement the first compacts in Zambia.
The compact approach engages community leaders and other stakeholders and enables communities to identify HIV prevention targets, develop interventions to achieve those targets, identify community-based organizations to implement the interventions, and measure results. In Zambia, study staff work with communities to ensure that interventions are evidence-based, community-specific, targeted to primary drivers of the epidemic, and contribute substantially to project results. When a specific intervention achieves a target, the implementing CBO receives a reward in the form of community goods. The goods, chosen by community leaders, are intended to contribute to the intervention’s overall goals—for example, while one community received a refrigerator for storing vaccines, another received goats and chicks for income-generation activities.
COMPACT will measure changes in behavior in project communities using a knowledge, attitudes, and practices survey that examines topics such as gender norms, gender-based violence, alcohol use, sexual behavior, HIV counseling and testing, acceptance of male circumcision, and disclosure of HIV status. It will also provide HIV testing.
COMPACT has documented community participatory assessments, lessons, and challenges in developing and implementing community compacts. The feedback will be disseminated to district and national HIV program managers and policymakers, as well as globally, to share lessons learned about this innovative approach.