Understanding adolescent girls\u27 protection strategies against HIV: An exploratory study in urban Lusaka

This report provides a descriptive analysis of how adolescent girls and young women in Lusaka, Zambia construct notions of risk and safety, perceive reproductive health and HIV risks, and identify behaviors and actions they can take to protect themselves. Findings suggests stronger social support networks, improved access to the range of reproductive health services and products, and safe and supportive spaces for girls would be beneficial. The report points to several areas for potential program attention, including more focused attention on the structural and environmental drivers of girls’ vulnerability

Effects of sun-drying and exogenous enzymes on nutrients intake, digestibility and nitrogen utilization in sheep fed Atriplex halimus foliages

This study was conducted to assess effects of sun-drying and/or addition of an exogenous enzyme (ENZ) preparation on intake, digestibility of nutrients and recovery values of secondary metabolites (SM) in the gastrointestinal tract of sheep fed Atriplex halimus (AH) foliages. A randomized block design for 28 d was used for four experimental treatments based on either fresh (AH-F) or sun-dried (AH-S) A. halimus foliages in the absence (−ENZ) or presence (+ENZ) of 10 g/sheep/d of the exogenous of ZADO® enzyme preparation. Three adult sheep weighing 51 ± 2.7 kg were fed for each experimental treatment. The ENZ was added daily with a small amount of concentrate to help balance the dietary metabolizable energy concentration. Nutrient intake and digestibility, N balance and recovery of SM (i.e., total phenolics (TP), saponins (SP), alkaloids (AK), aqueous fraction (AF)) in the gastrointestinal tract were determined. Levels of most nutrients did not differ between AH-F and AH-S foliages, but the AH-S contained less than half of the SM in AH-F. Drying of A. halimus and ENZ addition increased (P=0.001) intake as well as OM and NDFom digestibility (P=0.02). Feed intake and digestibility were higher (P=0.01) in AH-S with ENZ addition. Intake of N by sheep fed the treatment diets depended on DM intake as the dietary concentration of N in the diets was similar. Thus AH-S sheep supplemented with ENZ had higher (P=0.001) N intake. Digestibility of N was similar to DM and OM digestibility, and was higher (P=0.03) in AH-S sheep supplemented with ENZ. Drying and ENZ addition to the diet increased (P=0.004) recovery of all SM. The fate of these compounds in the rumen needs to be evaluated considering that SM have been implicated in fiber and protein degradation in the rumen. The study showed that there are beneficial impacts of sun-drying and/or dietary exogenous enzyme addition for sheep fed A. halimus

Success in Africa: People with disabilities share their stories.

BACKGROUND: Whereas most narratives of disability in sub-Saharan Africa stress barriers and exclusion, Africans with disabilities appear to show resilience and some appear to achieve success. In order to promote inclusion in development efforts, there is a need to challenge narratives of failure. OBJECTIVES: To gather life histories of people with disabilities in three sub-Saharan African countries (Kenya, Uganda and Sierra Leone) who have achieved economic success in their lives and to analyse factors that explain how this success has been achieved. METHODS: Qualitative research study of economic success involving life history interviews with 105 participants with disabilities from both urban and rural settings recruited through disabled people's organisations and non-governmental organisation partners, framework analysis of transcripts to chart success and success factors. RESULTS: Participants had faced barriers in education, employment and family life. They had largely surmounted these barriers to achieve success on an equal basis with others. They were working in private and public sectors and were self-employed farmers, shopkeepers and craftspeople. CONCLUSION: The findings of this study suggest that, given the right support, disabled people can achieve economic success, with the implication being that investment in education or training of disabled people can be productive and should be part of overall development efforts for economic reasons, not solely to achieve social justice goals

Empowered Worldviews: Assessing the Persistence of Psychosocial Intervention Effects in Zambia

Evidence on the persistence of psychosocial outcomes of interventions over the medium and long term, and in the face of shocks and stressors, is limited. We examined the extent to which empowerment associated with a psychosocial, faith-based approach, Empowered Worldview (EWV) persisted 3–5 years post-delivery of the intervention in Zambia among smallholder farmers. The EWV intervention in Zambia was delivered as part of THRIVE, an integrated livelihoods programme. We followed a previous study to disaggregate individual-level empowerment associated with EWV into three domains: internal (which relates to ‘power within’), localised (typically participation and access), and structural (e.g. institutional, environmental, and social structures). To explore the persistence of EWV effects on empowerment, we used mixed methods and longitudinal data collected in 2020 and 2023, which were the midline and endline points of the THRIVE programme. Empirically, we used descriptive and regression analysis to compare internal and localised empowerment levels between the survey rounds (2020 and 2023) across study groups – including groups that received EWV before and after 2020 – and to the control group. We also re- interviewed a subset of EWV participants interviewed in 2020 to understand how empowerment has changed at the individual level over time . The results show levels of internal empowerment associated with the EWV intervention persisted between the midline and endline surveys, especially when combined with THRIVE livelihood interventions. At the midline, 80.0 per cent of THRIVE with EWV participants were empowered, compared to 82.3 per cent at the endline. In contrast, 72.6 per cent and 73.07 per cent of the control sample participants were empowered at the midline and the endline, respectively. Quantitative results further show that localised empowerment significantly improved between survey rounds among participants who received EWV training and is positively associated with internal empowerment, consistent with literature that suggests localised enablers (supporting social environments) are crucial to sustaining internal empowerment. The qualitative data shows that persistent internal and localised empowerment was observed mostly among households in the non- poor wellbeing category, suggesting that additional interventions are needed to reach the poorest participants. Results also show internal and localised empowerment are positively associated with indicators of household resilience. We conclude the paper with recommendations for programming

Engaging communities in supporting HIV prevention and adherence to antiretroviral therapy in Zambia

In Zambia, the prevalence of HIV is estimated at 16 percent among 15–49-year-olds. This brief presents findings from an operations research study to access the outcomes of the Antiretroviral Community Education and Referral (ACER) project in two urban areas in Zambia—Lusaka and Ndola. The ACER project was implemented by the International HIV/AIDS Alliance, based in England, and the Alliance’s Zambia office, in conjunction with local Zambian partners. Launched in mid-2004, the two-year project built on previous formative research that examined knowledge and attitudes about prevention and treatment. The research was conducted by the Institute of Eco­nomic and Social Research in Zambia and the Horizons Program. The study documents many positive trends among people on ART and community members in the research sites, including increased knowledge about HIV prevention and ART, greater uptake of HIV test­ing, increased use of peer networks as an information source, and reduced stigma. Despite these improvements, there were few statisti­cally significant differences between the intervention and comparison sites

Food on the table: The role of livelihood strategies in maintaining nutritional status among ART patients in Kenya and Zambia

As understanding of the multidimensional nature of HIV epidemics improves, it is increasingly recognized that policy and program interventions, whether focusing on prevention, treatment and care, or impact mitigation, must take into account the integral role of food and nutrition security. More broadly, interventions need to consider how people’s livelihoods evolve and adapt to deal with the multifaceted nature of HIV. In eastern and southern Africa, evidence pointing to a vicious cycle between HIV and food and nutrition insecurity is mounting. Programs are now being implemented that link HIV to food and nutritional security, as well as to livelihoods. However, additional evidence on the effectiveness of these interventions is needed to inform policy and program efforts to improve treatment and strengthen resilience to the impacts of HIV. To build this evidence base, the Horizons Program conducted a study in Kenya and Zambia to understand the role that livelihood strategies play. In addition to presenting findings from the study that explored the livelihood strategies of people on antiretroviral therapy (ART), this brief presents recommendations on how to transition people on ART from therapeutic and supplementary feeding to sustainable, long-term livelihood security

How HIV/AIDS scale-up has impacted on non- HIV priority services in Zambia

Background: Much of the debate as to whether or not the scaling up of HIV service delivery in Africa benefits non-HIV priority services has focused on the use of nationally aggregated data. This paper analyses and presents routine health facility record data to show trend correlations across priority services. Methods: Review of district office and health facility client records for 39 health facilities in three districts of Zambia, covering four consecutive years (2004-07). Intra-facility analyses were conducted, service and coverage trends assessed and rank correlations between services measured to compare service trends within facilities. Results: VCT, ART and PMTCT client numbers and coverage levels increased rapidly. There were some strong positive correlations in trends within facilities between reproductive health services (family planning and antenatal care) and ART and PMTCT, with Spearman rank correlations ranging from 0.33 to 0.83. Childhood immunisation coverage also increased. Stock-outs of important drugs for non-HIV priority services were significantly more frequent than were stock-outs of antiretroviral drugs. Conclusions: The analysis shows scale-up in reproductive health service numbers in the same facilities where HIV services were scaling up. While district childhood immunisations increased overall, this did not necessarily occur in facility catchment areas where HIV service scale-up occurred. The paper demonstrates an approach for comparing correlation trends across different services, using routine health facility information. Larger samples and explanatory studies are needed to understand the client, facility and health systems factors that contribute to positive and negative synergies between priority services