Humana People to People South Africa : evaluation of the TCE programme in Mpumalanga and Limpopo : evaluation report

Humana People to People responded to the epidemic in South Africa by creating the Total Control of the Epidemic (TCE) program in 2000.  The TCE program is a grassroots one-on-one communication and mobilization program that has run since 2002 with the aim of reaching every person in a community with information, education, and HIV/AIDS counselling and testing.  The aim of creating TCE was to mobilize people for action, so that they could take control of HIV & AIDS and help each other to deal with the consequences of the epidemic.  The ultimate goal of the TCE program is to contribute to the reduction in the incidence of HIV infections.  The anticipated outcomes of the TCE program are articulated in terms of changes in knowledge, attitudes, behaviours and skills.  These include: (1) changed attitudes and behaviour of community members and members of most at risk groups, manifest as community members consistently use HIV prevention services, community members have undertaken HCT and know their HIV status, community members avoid risky sexual behaviour and use condoms correctly and consistently, and community members no longer discriminate against People Living with HIV/AIDS (PLWHA); (2) increased knowledge around HIV transmission and HIV and AIDS prevention and treatment; (3) the capacity of local leaders built regarding HIV and AIDS prevention, care and support and stigma reduction; and (4) local leaders develop facilitation and counselling skills.  The evaluation sets out to assess: (1) the extent to which the TCE program led to changes in knowledge, attitudes and behaviour with regards to the HIV and AIDS epidemic, as well as the extent to which Humana TCE is responsible for measured effects in a multi-intervention environment; (2) whether the capacity of local leaders has been built to facilitate HIV and AIDS prevention in their communities; and (3) what additional impacts, both positive and detrimental, that may be attributed to the Humana TCE programe.  Humana TCE is undoubtedly effective in increasing knowledge about HIV and AIDS, improving attitudes of personal responsibility, and significantly improving health seeking behaviours amongst beneficiaries.  It achieves these results through a robust theory of change, program design that relies on innovative behaviour change and monitoring mechanisms, and a compelling message of assuming personal responsibility for your behaviour, your status, your health and that of other members in your community.  However, despite this apparently comprehensive program design and strong effects on every other measure, the key objective of changing sexual behaviour is elusive.  Perceptions of the effectiveness of Humana TCE are at risk of being undermined by an inconsistent system for registering households reached.  Specific evaluation findings, conclusions and recommendations are provided with detailed analysis for each assessment objective.  (Excerpt, modified)