title: Community resistance to a peer education programme in Zimbabwe.
abstract: BACKGROUND
  This paper presents community perceptions of a state-of-the-art peer education programme in Manicaland, Zimbabwe. While the intervention succeeded in increasing HIV knowledge among men and condom acceptability among women, and reduced HIV incidence and rates of unprotected sex among men who attended education events, it did not succeed in reducing population-level HIV incidence. To understand the possible reasons for this disappointing result, we conducted a qualitative study of local perspectives of the intervention.
  
  
  METHODS
  Eight focus group discussions and 11 interviews with 81 community members and local project staff were conducted. Transcripts were interrogated and analysed thematically.
  
  
  RESULTS
  We identified three factors that may have contributed to the programme's disappointing outcomes: (1) difficulties of implementing all elements of the programme, particularly the proposed income generation component in the wider context of economic strain; (2) a moralistic approach to commercial sex work by programme staff; and (3) limitations in the programme's ability to engage with social realities facing community members.
  
  
  CONCLUSIONS
  We conclude that externally-imposed programmes that present new information without adequately engaging with local realities and constraints on action can be met by resistance to change.
authors.affiliation: Department of Social Psychology, London School of Economics and Political Science, Houghton Street, WC2A 2AE, London, UK. c.campbell@lse.ac.uk.
authors.forename: Catherine
authors.initials: C
authors.lastname: Campbell
authors.affiliation: Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA. kscott26@jhu.edu.
authors.forename: Kerry
authors.initials: K
authors.lastname: Scott
authors.affiliation: Biomedical Research and Training Institute, Harare, Zimbabwe. zietawana@yahoo.co.uk.
authors.forename: Zivai
authors.initials: Z
authors.lastname: Mupambireyi
authors.affiliation: Biomedical Research and Training Institute, Harare, Zimbabwe. mnhamo@googlemail.com.
authors.forename: Mercy
authors.initials: M
authors.lastname: Nhamo
authors.affiliation: Biomedical Research and Training Institute, Harare, Zimbabwe. c.nyamukapa03@imperial.ac.uk.|School of Public Health, Imperial College, London, UK. c.nyamukapa03@imperial.ac.uk.
authors.forename: Constance
authors.initials: C
authors.lastname: Nyamukapa
authors.affiliation: Department of Public Health, University of Copenhagen, Copenhagen, Denmark. m.skovdal@gmail.com.
authors.forename: Morten
authors.initials: M
authors.lastname: Skovdal
authors.affiliation: Biomedical Research and Training Institute, Harare, Zimbabwe. sajgregson@aol.com.|School of Public Health, Imperial College, London, UK. sajgregson@aol.com.
authors.forename: Simon
authors.initials: S
authors.lastname: Gregson
mesh_terms: D000293:Adolescent; D000328:Adult; D001290:Attitude; D017280:Condoms / Q000706:statistics & numerical data*; D005260:Female; D017144:Focus Groups; D015658:HIV Infections / Q000453:epidemiology / Q000517:prevention & control*; D006293:Health Promotion / Q000379:methods*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D010353:Patient Education as Topic / Q000379:methods*; D010379:Peer Group; D011639:Public Opinion; D036301:Qualitative Research; D011477:Sex Work / Q000523:psychology*; D060386:Sex Workers / Q000193:education*; D057545:Social Stigma; D055815:Young Adult; D015030:Zimbabwe