POSITIVEPOSITIVE WOMEN:WOMEN: voicesvoicesandand choiceschoices ZimbabweZimbabwe ReportReport AA projectproject ledled byby positivepositive womenwomen toto exploreexplore thethe impactimpact ofof HIVHIV onon theirtheir sexualsexual behaviourbehaviour, , well-beingwell-being andand reproductivereproductive rightsrights, , andand toto promotepromote improvementsimprovements inin policypolicy andand practicepractice InternationalInternational CommunityCommunity ofof WomenWomen livingliving withwith HIV/AIDSHIV/AIDS (ICW)(ICW) Positive Women: Voices and Choices Positive Women: Voices and Choices – Zimbabwe Report A project led by positive women to explore the impact of HIV on their sexual behaviour, well-being and reproductive rights, and to promote improvements in policy and practice by Rayah Feldman, Jo Manchester and Caroline Maposhere Positive Women: Voices & Choices Zimbabwe Report © International Community of Women living with HIV/AIDS June 2002 Positive Women: Voices and Choices – Zimbabwe Report A project led by positive women to explore the impact of HIV on their sexual behavour, well-being and reproductive rights, and to promote improvements in policy and practice Written by: Rayah Feldman, Jo Manchester and Caroline Maposhere The authors assert their moral rights in respect of this publication Published by the International Community of Women Living with HIV/AIDS Layout and design by Fontline Electronic Publishing, Harare, Zimbabwe Printed by Préci-ex, Les Pailles, Mauritius ISBN: 0-7974-2430-X iv Positive Women: Voices & Choices Zimbabwe Report Contents Acknowledgements ........................................................................................................................ vii Preface ............................................................................................................................................ ix Executive Summary........................................................................................................................ xi 1. Introduction ............................................................................................................................... 1 1.1 ICW – Strengthening the voices of HIV positive women ............................................... 1 1.2 Reproductive rights and health ......................................................................................... 2 1.3 Project aims and principles ............................................................................................... 3 1.4 Methodology ..................................................................................................................... 3 1.5 Structure of the report ....................................................................................................... 5 2 Voices and Choices, Zimbabwe................................................................................................. 7 2.1 Introduction....................................................................................................................... 7 2.2 HIV prevalence and social and demographic impact ....................................................... 7 2.3 Development of the project .............................................................................................. 8 2.4 Project methodology ......................................................................................................... 9 2.5 Project areas...................................................................................................................... 9 2.6 Characteristics of the study population ........................................................................... 11 2.7 Developing the study ...................................................................................................... 12 2.8 Data collection and analysis ........................................................................................... 15 2.9 Advocacy ........................................................................................................................ 17 2.10 Project impact on team leaders ....................................................................................... 17 2.11 Challenges and constraints.............................................................................................. 18 2.12 Conclusion ...................................................................................................................... 19 3 Dealing with an HIV diagnosis ...............................................................................................21 3.1 Introduction..................................................................................................................... 21 3.2 Women’s experience of testing and diagnosis ................................................................ 22 3.3 Women’s reactions to diagnosis ...................................................................................... 23 3.4 Implications of disclosure and non-disclosure................................................................ 24 3.5 Partners’ and families’ reactions..................................................................................... 27 3.6 Helping each other to cope – benefits of support groups ............................................... 29 3.7 Conclusion and summary ................................................................................................ 31 v Positive Women: Voices & Choices Zimbabwe Report 4 Changing relationships and livelihoods ................................................................................ 33 4.1 Introduction .................................................................................................................... 33 4.2 Relationships ................................................................................................................... 33 4.3 Emotional impact of HIV ............................................................................................... 36 4.4 Economic impact of HIV on households ........................................................................ 37 4.5 Conclusion and summary ................................................................................................ 41 5 Women’s experience of health services .................................................................................. 43 5.1 Introduction..................................................................................................................... 43 5.2 Health problems ..............................................................................................................44 5.3 Use of health care systems .............................................................................................. 44 5.4 Quality of care and discrimination in health care ........................................................... 46 5.5 Conclusion and summary ................................................................................................ 48 6 Exploring sexual and reproductive health.............................................................................. 49 6.1 Introduction..................................................................................................................... 49 6.2 Recognising the risk of HIV before an HIV diagnosis ................................................... 49 6.3 Contraception before being affected by HIV .................................................................. 53 6.4 Conclusion and summary ................................................................................................ 56 7 Choices in childbearing ............................................................................................................ 57 7.1 Introduction..................................................................................................................... 57 7.2 HIV and pregnancy ......................................................................................................... 57 7.3 Infant feeding .................................................................................................................. 64 7.4 Conclusion and summary ................................................................................................ 66 8 Conclusions and recommendations ......................................................................................... 67 8.1 Reproductive and sexual health ...................................................................................... 67 8.2 Counselling and testing, care and support ...................................................................... 69 8.3 Livelihoods ..................................................................................................................... 70 8.4 Impact on participants ..................................................................................................... 71 8.5 Limitations of the project methodology and lessons learnt ............................................ 71 Bibliography................................................................................................................................... 73 vi Positive Women: Voices & Choices Zimbabwe Report Acknowledgements This project would not have been possible without the support, commitment and collaboration of a large number of people in a wide range of capacities. Unfortunately, it is not possible to acknowledge by name all the people who contributed in some way to the project. Above