Caught between Scylla and Charybdis: Exploring the Effects of Zimbabwe’s Political Crisis on HIV and AIDS Behavior Change Communication Programming A thesis presented to the faculty of the Center for International Studies of Ohio University In partial fulfillment of the requirements for the degree Master of Arts Titus M. Gwemende August 2010 © 2010. Titus M. Gwemende All Rights Reserved. 2 This thesis titled Caught between Scylla and Charybdis: Exploring the Effects of Zimbabwe’s Political Crisis on HIV and AIDS Behavior Change Communication Programming by TITUS M. GWEMENDE has been approved for the Center for International Studies by Rafael Obregon Associate Professor of Media Arts and Studies Rafael Obregon Director, Communication and Development Studies Daniel Weiner Executive Director, Center for International Studies 3 ABSTRACT GWEMENDE, TITUS M., M.A., August 2010, Communication and Development Studies Caught between Scylla and Charybdis: Exploring the Effects of Zimbabwe's Political Crisis on HIV and AIDS Behavior Change Communication Programming (pp. 143) Director of Thesis: Rafael Obregon The twin challenges of HIV and the political crisis had debilitating effects on the communication efforts of health organizations in Zimbabwe. This study explores the effects of the Zimbabwean political crisis on the implementation of behavior change programs by eight implementing organizations in Zimbabwe. This thesis is a product of triangulation of methods, that is, ten interviews, two focus group discussions and documents review. Drawing from the structural intervention approach, this study analyzed political obstacles to successful health programming in Zimbabwe and highlighted the bi-directional causal connections between HIV and conflict. Key findings for the study are the government ban of field operations of NGOs, widespread violence against beneficiaries and staff, collapse of public health delivery system, migration, decline in funding and abuse of power by political leaders. The study raises questions of program design of the behavior change programs, dealing with an intransigent government, donor funding in conflict zones, human resources capacity of NGOs and civil society’s role in development in Zimbabwe. This study recommends safe participatory communication strategies, capacity strengthening, creative partnerships and 4 the positive deviance approach as alternative and potentially effective measures for health programmers in conflict settings. Approved: __________________________________________________________ Rafael Obregon Associate Professor of Media Arts and Studies 5 ACKNOWLEDGMENTS “As we express our gratitude, we must never forget that the highest appreciation is not to utter words, but to live by them.” John Fitzgerald Kennedy I wish to sincerely thank my thesis Chair Professor Rafael Obregon whose insightful comments and reflections informed the writing of this thesis. Many thanks for being my academic advisor for the two years l have been a student of the program. Indeed l have grown as a scholar. Furthermore, a special thanks to Dr Chikombero for believing in me even before l became a student in Ohio has bee. Thank very much for the mentorship and keen interest in my studies and dreams Dr Andrew Ross opened my eyes in many ways during the courses l have taken with him and l wish to thank him for his much needed insight for this study. As an interdisciplinary study, he has been infinitely helpful each time l have dealt political science theory. I remain indebted to the advice, support and mentorship of the following professors who have not just taught me the last two years, but have inspired me to be a better person; Steve Howard, Lawrence Wood, Michael Burton, Vibert Cambridge, Patricia Weitsman, Matthew Adeyanju, Karen Riggs, David Mould, Daniel Weiner, Ghrimay Negash, and Duncan Brown.Many thanks to Lilia Krasteva and Idrissa Fane,friends who were supportive in the decisive moments. I will always cherish my time at Ohio University. Finally yet importantly, l thank my family, an awesome and supportive family for making me who l am; Mom, Dad, Sharai, Norman, Kuziva, Tadiwa and Vimbai. 6 DEDICATION To the memory of the brave men and women who lost their lives before and after the 2008 Presidential elections in Zimbabwe for the defense of democratic ideals 7 PREFACE My interest in the political crisis in Zimbabwe and its impact on HIV and AIDS communication programming comes from my personal experiences living and working in Zimbabwe and seeing relatives and friends dying of the dreaded disease. I had an aunt whose death could have been delayed had the government run hospital in which she died been more resourced and information been more accurate and efficient. For the almost four years l have worked in the NGO sector in Zimbabwe, l have come to realize how much of the health system in Zimbabwe is dependent on the efforts of NGOs hence one could argue that had it not been for the NGOs over the years, the epidemic would have taken many more lives. Consequently, witnessing state sponsored obstructionism and even violence against the very sector that protects and maintains the lives of millions of Zimbabweans affected me in significant way. I felt the need to do my part to confront the politics of Zimbabwe and to suggest ways NGOs could consider so that they continue their work even in repressive environment like Zimbabwe and this research is a modest effort to have the field at large to have a greater and more accurate appreciation of the nature and multi faceted effects of the Zimbabwean crisis. I have worked with organizations that were reasonably cooperative to the government and rarely confronting its excesses yet they were not necessarily spared from the ramifications of the crisis. One could argue that this experience has influenced my disapproval towards the current Zimbabwean government in general. However, this research tries to balance its critique of the government and it has a significant portion of an exploration of programming options for NGOs. 8 TABLE OF CONTENTS Page Abstract ............................................................................................................................... 3 Acknowledgments............................................................................................................... 5 Dedication ........................................................................................................................... 6 Preface ................................................................................................................................. 7 List of Tables .................................................................................................................... 10 List of Figures ................................................................................................................... 11 Chapter 1: Introduction ..................................................................................................... 12 Research questions ........................................................................................................ 14 Rationale and significance of the study ........................................................................ 15 Operationalization of terms .......................................................................................... 16 HIV Prevalence in Sub-Saharan África ........................................................................ 17 HIV and AIDS Situation in Zimbabwe ......................................................................... 18 Zimbabwean Government Response to the AIDS Crisis .............................................. 21 Comparative Analysis of Government Responses in the Southern African Region .... 23 Background to the Political Crisis in Zimbabwe .......................................................... 24 State and Civil Society Relations .................................................................................. 32 Summary ....................................................................................................................... 35 Chapter 2: Literature Review and Methodology .............................................................. 36 Literature Review ......................................................................................................... 36 Methodology ................................................................................................................. 55 Chapter 3: Caught Between Scylla and Charybdis: Exploring Effects of the Political Crisis ................................................................................................................................. 64 Organization of Chapter ................................................................................................ 64 Overview of the Effects of The Political Crisis ............................................................ 65 Public Health Delivery System ..................................................................................... 68 Repressive Regulatory Environment ............................................................................ 70 Abuse of NGOs Equipment .......................................................................................... 73 Migration and Internal Displacement ........................................................................... 78 Damned If You Leave; Damned If You Stay ............................................................... 81 9 Structural