This document discusses Zambia Emory HIV Research Project's (ZEHRP) use of a "web of influence" model to combat stigma towards HIV/AIDS. The model trains community influential leaders and agents to recruit couples for voluntary counseling and testing through their social networks. Since adopting this model in 2004, the number of couples tested has increased significantly. Key findings show the model is successful in building trust and changing attitudes by utilizing community leaders. The document recommends a community-based, multi-sectoral approach drawing on influential leaders to spearhead HIV/AIDS sensitization and voluntary counseling and testing promotion.

1. Web of Influence as a Tool in
Combating Stigma Towards
HIV/AIDS
Chilumba Sikombe
INA/INL Trainer
Zambia-Emory HIV Research Project

2. Organisation
Zambia Emory* HIV Research Project
(ZEHRP)
Postnet 412,P/B E891,
Emmasdale, Lusaka, Zambia
Telephone Contact:260-966-710913
*Emory University, Atlanta, Georgia, USA

3. Key Terms
• CVCT – Couples Voluntary Counseling
and Testing
• CLO – Community Liaison Officer
• INL – Influential Network Leader
• INA – Influential Network Agent

4. Background Information
• In 2004 ZEHRP adopted an innovative
promotional strategy of inviting couples for
voluntary counseling and testing (CVCT).
• This model uses community Influential Network
Leaders (INLs) from four sectors
– Health
– Religious
– NGO/CBO
– Private
• These influential persons are responsible for
selecting Influential Network Agents (INAs) who
are responsible for CVCT recruitment.

5. Selection Strategy
Community Liaison Officers
Influential Network Leaders
Influential Network Agents

6. Multi-Sectoral Approach
• Health Related
– Clinics, Home-based Care, Community Health
Workers
• Religious
– Pastors, Church Elders, Christians/Muslims
• CBO/NGO
– Schools, Clubs
• Private
– Markets, Trading Centers

7. INL Roles
• INLs provide feedback to ZEHRP on concerns
arising in their communities.
• INLs receive intensive training on community
sensitization methods for the endorsement of
CVCT.
• INLs are responsible for identifying Influential
Network Agents (INAs) from their sectors.

8. Sensitization Strategies
• One-on-one within the community
• Door to Door
• Public Endorsements
– Churches
– Market Places
– Bars/Taverns
– Sporting Events
– Women’s Groups
– Work Places

9. INA Roles
• Attend an intensive 4 day training on
CVCT and recruitment methods.
• Responsible for CVCT recruitment through
use of an anonymous invitation system.
• Reimbursed per couple that chooses to
attend CVCT (whether or not they decide
to test).
• Given a 4 month contract.
– Exhaust their “Web of Influence”

10. Agnes ChilufyaMother
Wife
Community
Member
Church Member
Business Woman
PTA
Husband’s
Work
Fellow Parents
Teachers
Business
Association
Neighboring
Businesses
Customers
Suppliers
Husband’s
Friends
Political /
neighborhood
Leaders
Neighbors
Woman’s
Association
Farmer’s
Cooperative
Church
Leaders
Chorus
Woman’s
Association
Husband’s
Football Club
Football
Association
Fellow Parents
Church Group
Relatives
Youth Groups
One INA’s Web of Influence, , , .

11. Stigma in Zambia
• HIV is a stigmatized disease world wide and has
proven to be a challenge in Zambia.
• High levels of stigma discourage people from
testing, disclosing status, and accessing and
adhering to interventions such as ARVs and
PMTCT.
• ZEHRP faces the additional challenge of
convincing couples of the benefits of testing and
being counseled together.

12. Couples Tested 2003-2007
* 2008 projection based on first quarter uptake and targets
0
2,000
4,000
6,000
8,000
10,000
12,000
2003 2004 2005 2006 2007 2008*

13. Key Findings
• In 2007 a total of 429 INAs and INLs were
trained.
• In 2007 over 9,280 invitations were distributed
by the INA/INLs. Out of these invitations 1,407
couples attended CVCT and 67% of couples
tested at ZEHRP.
• In 2008 INAs have already delivered 10,515
invitations with the target of testing 10,000
couples.
• In 2008, over 2,800 couples have attended
CVCT with over 2,300 choosing to test.

14. Key Findings cont.
• Through the utilization social networks and
community leaders, ZEHRP has built trust
and helped to change attitudes on
HIV/AIDS in the communities.
• The increase in CVCT uptake when the
INA/INL model was introduced, indicates
that this model is successful and that the
community based model is combating
stigma.

15. Lessons Learned
Promotional strategies where community
leaders are the predominate
spokespersons of HIV/AIDS prevention
and treatment messages are most likely to
be successful and sustainable.

16. Recommendations
If stigma towards HIV/AIDS is to be
eliminated, a community-based, multi-
sectoral approach should be adopted that
draws influential leaders of the
communities to spearhead the
sensitizations on HIV/AIDS and the
promotion of VCT.

17. Thank You
The Victoria Falls, Zambia