Focus group discussions and interviews were held with 40 orphans, 25 caretakers and 33 other community workers from a rural area near Mutare, Zimbabwe. Orphan concerns included feeling different from other children, stress, stigmatization, exploitation, schooling, lack of visits and neglect of support responsibilities by relatives. Many community members, while recognizing their limitations due to poverty, were already actively helping orphans and caretakers. Extended family networks are the primary resource for orphans, though some relatives exploit orphans or fail to fulfil their responsibilities. Interventions are suggested which support community coping mechanisms by strengthening the capacities of families to care for orphans. Outside organizations can develop partnerships with community groups, helping them to respond to the impact of AIDS, by building upon existing concern for orphan families. They can help affected communities to develop orphan support activities which encourage caring responses by community leaders and relatives and which discourage property-grabbing and orphan neglect. Material support channelled through community groups to destitute families at critical times can strengthen family coping mechanisms. Income-generating activities should build upon communities' existing capabilities and benefit the most vulnerable orphan households. Some communities are responding to the AIDS disaster by adaptations to cope with devastating changes taking place in their communities.

There is an urgent need for programmes to be established to support the growing number of orphans in countries severely affected by AIDS. Most orphans are being cared for by extended families under difficult circumstances. Few descriptions of community-based orphan support programmes exist. We describe one such programme established in Zimbabwe in 1993. Twenty-five volunteers identified 300 orphan households. During one year, volunteers made 1725 home visits and 123 households received an average of $11 in material support or school fees. In 292 orphan households there were 702 orphans, 14.7% of children under 15 years in the area. The rate of parental deaths was increasing with 3.5% of households in the area having a parental death in 1994. Forty-five per cent of caregivers were grandparents and 33% of caregivers were over 60 years. Three per cent of orphans were cared for by adolescent siblings. The poorest orphan households were those in receipt of school fees, with out-of-school children or with an older sibling as caregiver. Community members initiated activities to help orphans. The programme described is targeted, effective and replicable. Community-based organizations such as local churches and women's groups can be mobilized to administer programmes which provide support to the poorest orphan households.

ObjectivesThe European Centre for Disease Prevention and Control (ECDC) supports countries to monitor progress in their response to the HIV epidemic. In line with these monitoring responsibilities, we assess how, and to what extent, the continuum of care is being measured across countries.MethodsThe ECDC sent out questionnaires to 55 countries in Europe and Central Asia in 2014. Nominated country representatives were questioned on how they defined and measured six elements of the continuum. We present our results using three previously described frameworks [breakpoints; Joint United Nations Programme on HIV/AIDS (UNAIDS) 90‐90‐90 targets; diagnosis and treatment quadrant].ResultsForty countries provided data for at least one element of the continuum. Countries reported most frequently on the number of people diagnosed with HIV infection (37; 93%), and on the number in receipt of antiretroviral therapy (ART) (35; 88%). There was little consensus across countries in their approach to defining linkage to, and retention in, care. The most common breakpoint (>19% reduction between two adjacent elements) related to the estimated number of people living with HIV who were diagnosed (18 of 23; 78%).ConclusionsWe present continuum data from multiple countries that provide both a snapshot of care provision and a baseline against which changes over time in care provision across Europe and Central Asia may be measured. To better inform HIV testing and treatment programmes, standard data collection approaches and definitions across the HIV continuum of care are needed. If countries wish to ensure an unbroken HIV continuum of care, people living with HIV need to be diagnosed promptly, and ART needs to be offered to all those diagnosed.

As a result of the severe HIV/AIDS epidemic in sub-Saharan countries such as Zimbabwe, where between 25-30% of the adult population are estimated to be infected, there are a growing number of orphans requiring care and support. Traditionally, orphans have been absorbed within the extended family but this is becoming more difficult because of the large number of young adults dying. The burden of care and support is falling on the very young and the very old. A number of strategies have been introduced to provide this care and support. Institutions, though popular, are very expensive to run, have limited capacity and only really cater for physical needs. Interventions which simply react to those who present to them may not reach the most needy and may encourage dependency. Community-based orphan care has been identified as the best and most cost-effective way of caring for orphans. An example of a community-based orphan visiting programme is presented. In the last six months of 1996, the FOCUS programme's 88 volunteers made a total of 9,634 visits to 3,192 orphans in 798 families at an average cost of US+1.55 per visit. The key elements of such programmes have been identified. They need to be implemented by a community-based organization (CBO) within a defined community. Volunteers should be selected from within the community. They need to be trained and supported as they enumerate orphans, identify the most needy and carry out regular visits. The volunteers should keep records of all their activities. These records can then be used as a basis for monitoring the programme. In order to cope with the increasing number of orphans in resource-poor settings like Zimbabwe, it is essential that such programmes be replicated and scaled up. This not only an economic necessity but is also a way of providing appropriate and effective services to those who need them.

There are many challenges in evaluating international networks within the fields of health and international development. Use of conventional tools is not only difficult but may fail to provide the kind of information that is developmentally useful. Social network analysis tools offer many benefits for network evaluators. In particular, they allow documentation and analysis of interrelationships between individuals and organizations, pointing to potential gaps as well as areas of development. This article describes the use of such tools in the evaluation of Sexuality Policy Watch (SPW), a global forum of organizations and individuals active within the field of sexuality, health and rights. It highlights the potential of these tools to provide visual representations of complex relationships within networks. In this case, the tools enabled the representation of SPW as a complex but ordered network, focused on sexual and reproductive rights, composed of individuals with a multiplicity of organizational affiliations.