Power of peer-led interventions

In Binga district, lives of adolescents and young people with HIV were in disarray because of negative attitudes and behaviours from members of the community. Adolescents and young people were in a difficult situation given that there was no one of their age who could give them support, encouragement in adhering to their medication, offer psychosocial support, or provide, and a place where they could meet and discuss issues that affect them on daily basis.

Adherence was a major challenge for this age group, as some were taking medication without an understanding of what it was for; in other cases, caregivers delayed telling their children about their HIV status and why they were taking ARVs.

Mr Musiabwe Lizadi, a Primary Counsellor who is based at Siadindi Clinic, described the ordeal, as he was responsible for attending to adolescents and young people with HIV during their clinic visits.

It is important to note that before the introduction of the Zvandiri model in Binga, Primary Counsellors were finding it difficult to offer tailored physical, social and mental services to adolescents and young people because of the differences in age and life situation.

The Community Adolescent Treatment Supporters (CATS) training provided a solution by empowering HIV positive mentors to provide the needed services, or refer adolescents and young people to needed medical care. UNICEF, the Ministry of Health and Child Care (MoHCC), the National AIDS Council of Zimbabwe (NAC) and other stakeholders, supported the CATS trainings. Adolescents and young people with HIV are now able to interact with the CATS during home visits, where CATS provide HIV and adherence counselling, monitor adherence and pill count, and offer clinical reminders. Adolescents now have a dedicated day on weekends to visit the health facility for review and refill.

Currently, adolescents and young people with HIV in Kotokoto Village have formed a support group with 35 programme beneficiaries; at this support group, participants discuss issues and challenges that they face in both private and public spaces, and how best they can overcome them.


Tafadzwa: Transforming the life of a young woman

“The Zvandiri program has helped me to realize how l should live as l am. l am now ready to go into the community in order to help other children, adolescents, and young people to adhere well to antiretroviral treatment and fight all forms of stigma and discrimination,“ said Tafadzwa.

Tafadzwa is a 22-year-old, double-orphaned young woman who was born with HIV. She stays with her grandmother in Mount Darwin, in Mashonaland Central province.

In 2004, she was bedridden as a result of continuous illness.

Tafadzwa stayed at Karanda Hospital for so long that it was declared as her second home. Her grandmother decided to tell her about her HIV-positive status while Tafadzwa was hospitalized. While this helped Tafadzwa to understand her persistent illnesses, she lacked the necessary information, counseling, and support she needed. She struggled to come to terms with her diagnosis and to adhere to her new ARV medication. At the same time, she faced stigma and discrimination from her peers and in her community.

In October 2016, Africaid scaled up its Zvandiri model of differentiated service delivery for children and adolescents in Mount Darwin district with financial and technical support from PEPFAR through USAID and Management Sciences for Health (MSH). This is when Tafadzwa’s life was transformed. She was selected by Chitse Health Facility in Mount Darwin to be trained as a Community Adolescent Treatment Supporter (CATS). In November 2016, she participated in the week-long CATS training, together with 28 other adolescents and young people living with HIV. However, Tafadzwa did not participate in this training on her own initiative. She became involved in the program to fulfill the wishes of her caregiver.

On the first day of training, Tafadzwa did not interact with anyone, even with other new CATS, who she already knew from her health facility. She spent most of her time crying, without disclosing why she was so upset. Africaid staff members attempted to engage her, but Tafadzwa would only say that no one cared about her and that the solution to her current situation was death.

During the training, Tafadzwa engaged in a participatory exercise in which the CATS share their life experiences. She found the process of reflecting and sharing painful memories and experiences to be extremely difficult, and was unable to speak without bursting in tears. Her struggle was apparent in everything that she did—how she reacted, how she carried herself, and the way she isolated herself from others. Her distress was so intense that she was unable to eat during the first two days of the CATS training.

During the training sessions, Tafadzwa slowly began to listen to and benefit from the life experiences of other CATS. She identified with their stories and emotions shared through role plays and meaningful and honest discussions, and began to engage in counseling with the training facilitators. As the training progressed, the training facilitators observed a dramatic change in Tafadzwa’s overall behavior. She began actively participating in all sessions, speaking openly about past events in her life, leading group presentations, and reflecting on her own experiences to develop coping strategies with other CATS. Tafadzwa became an active, strong member of the new Mount Darwin CATS team. She explained that she now realizes that she is not alone and that she is loved and valued. She is no longer just waiting for death.

As a CATS, Tafadzwa is now complementing Zimbabwe’s national efforts to achieve its 90-90-90 targets by accelerating the initiation of children, adolescents, and young people with HIV on ART, as well as providing subsequent support for those on treatment. Under the PEPFAR-funded Game Changer program, she currently supports a cohort of 120 children and adolescents on ART in their health facilities and communities with adherence monitoring, counseling, and support. She identifies adherence challenges, traces patients lost to follow up., and proactively identifies and refers children and adolescents in need of further investigation for possible opportunistic infections, treatment failure, child protection issues, and their psychosocial support, sexual, and reproductive health needs.

Tafadzwa is now ready to work within her team to collaboratively reach 1,600 children, adolescents, and young people with HIV to be linked to and supported by CATS in Mount Darwin.

*Name changed to protect identity Read More


Takudzwa: l am not the only adolescent who is living with HIV

Harare| Takudzwa, a 19-year-old from Harare, never thought that he would be able to interact with other young people. Like most adolescents he wanted to hang out with his friends, to identify with them, and to feel a sense of belonging in his peer group. Like many HIV-positive adolescents, Takudzwa felt lonely, isolated, and afraid when he learned his status in 2016. He feared his peers’ response if they learned that he was HIV-positive, so he withdrew from social interactions and worked hard to conceal his antiretroviral (ARV) medicines. At home, Takudzwa’s siblings looked down on him and called him derogatory names, damaging his confidence and self-esteem. Although Takudzwa’s nurse advised him to carefully adhere to his treatment, he felt hopeless and began to default from his medication, weakening his health.

But Takudzwa’s life began to change in 2016 when he joined Africaid’s Zvandiri program. In support of Zimbabwe’s efforts to achieve its 90-90-90 targets (90% of HIV-positive individuals knowing their status, 90% of those who know their status receiving AntiRetroviral Therapy (ART), and 90% of those receiving ART achieve viral suppression)and with financial support from USAID and capacity building from Management Sciences for Health (MSH), Africaid is currently scaling up the Zvandiri model of differentiated care for children, adolescents, and young people with HIV. Takudzwa is one of 68,000

Our Story counselling game being used by CATS in adherence counselling

of Africaid Zvandiri’s beneficiaries from 24 districts in Zimbabwe.

Takudzwa’s nurse referred him to one of the Zvandiri program’s Community Adolescent Treatment Supporters (CATS). The CATS began visiting him at home to ensure he had adequate information regarding HIV and ART, as well as to provide regular adherence monitoring, counseling, and support. Receiving support from the CATS—someone who understood his experiences and needs—encouraged Takudzwa and motivated him to adhere to his treatment. During the home visits, the CATS interacted with Takudzwa’s siblings and caregiver, improving the support he received at home. The CATS attended Takudzwa’s clinic visits to follow up with him and to liaise with the clinic nurse regarding his progress. Takudzwa also attends the Zvandiri support group in his local community.

Today, Takudzwa adheres to his treatment and his health continues to improve. He now has a much more positive outlook on life and aims to be a lawyer to assist orphaned and vulnerable children.

“When l first knew my HIV status, l thought my dreams to be a lawyer were shattered. But because of peer support, l then realized that being HIV positive does not mean that l am going to die. Joining Zvandiri support groups has restored my high self-esteem and l learned that l am not the only adolescent who is living with HIV. At the support group we discuss various topics, and l now know more about HIV and AIDS,” said Takudzwa.


Gracious: DREAMS has given me hope for a brighter future

Makoni | “I want to thank DREAMS for helping me to pay my school fees from last term and also registering for my subjects. All hope was lost when I failed to obtain my Ordinary General Education Certificate in 2015, but DREAMS has given me hope for another future,“ says Gracious.

Gracious is an 18-year-old girl who was diagnosed with HIV at the age of 13. However, her family was afraid to tell her about her HIV status and instead told her that she had a heart condition. Gracious told her friends at school that she was on medication for her heart condition. However, the friends suspected that she was HIV positive because she was sick so often. Gracious took her medication to school in order to prove her friends wrong. However, her teacher saw the ARV medication and informed Gracious that it is for people living with HIV. This experience devastated Gracious, who stopped adhering to her ARVs.

In February 2016, the head of guidance and counseling at Gracious’ school attended a DREAMS Initiative training on Comprehensive Sexuality, HIV, and AIDS Education, presented by SAfAIDS, Africaid, and the National AIDS Council of Zimbabwe. Following this training, the teacher referred Gracious to the Zvandiri program for counseling and support and be linked to other services for young people living with HIV. Gracious began attending the local Zvandiri support group and learned that she was not alone in her experiences. She became a regular member of the support group, where she acquired information and skills from her peers on growing up with HIV, including the importance of treatment adherence. She received a pill box to manage and monitor her medication, improving her health.

Gracious’ pill box helps her to keep track of her medication

Gracious’ pill box helps her to keep track of her medication

Gracious’ local clinic nominated her for Community Adolescent Treatment Supporter (CATS) training. Following the training, led by Africaid and the Ministry of Health and Child Care (MoHCC), Gracious connected with young people in her community to provide counseling, support, and follow up so that they could also be helped to adhere to their ARVs. Gracious is mentored by the Zvandiri Mentor and during CATS coordination meetings, and receives daily supervision from the nurse at her designated health facility, who also attended Africaid and MoHCC trainings to provide child and adolescent HIV testing services for children, adolescents, and young people.

“I benefited from being a CATS because I had been defaulting a lot on my medication. After the training, I am now taking my medications well,” said Gracious.

With financial assistance from the Family AIDS Counselling Trust to pay her school fees, Gracious repeated the two subjects she failed the previous year. The school’s head of guidance and counseling also invited Gracious to help plan and implement a school-wide anti-stigma campaign. Following this campaign, two students shared the challenges they faced as adolescents living with HIV as they struggled with adherence and their deteriorating health. Gracious connected with each of them to support their treatment adherence and contribute to their improved health. Gracious also identified a student facing severe food shortages at home and worked together with the school to plan a fundraising day to provide her with assistance.

“Besides me, there are also other children that are benefiting from me. I helped a girl who was being discriminated at our school and the training from Africaid has helped me to help her. I also give thanks to Africaid for helping us,” she explains.

In November 2016, Gracious completed her final exams to earn her Zimbabwe General Certificate of Education at Ordinary Level (ZGCE O-Level). She can now pursue further studies and hopes to study law, with the long term goal of offering free legal assistance to organizations that implement programs for orphans and vulnerable children, including adolescents and young people living with HIV.

Through the DREAMS and Game Changer program, Africaid seeks to improve outcomes for children and adolescents throughout the HIV care cascade by improving the uptake of HIV testing services, linkages, adherence, and retention in care.

Gracious’ story illustrates how the DREAMS program, with funding from USAID through Management Sciences for Health (MSH), offers multiple services for adolescent girls and young women. Trained, supported teachers initially identified and referred Gracious to Zvandiri for peer-led community treatment support. Together with trained, mentored health care workers, Zvandiri CATS supported her to adhere to her medication, resulting in her being AIDS-Free. She received psychosocial support, assisting her to become resilient. Educational assistance transformed the likelihood of Gracious being able to pursue further education. She is now determined to become a lawyer. Now as a trained, mentored CATS, she has been empowered to support her HIV positive peers so that they, too, are Determined, Resilient, Empowered, AIDS free, Mentored, and Safe.

In Year 1 of the DREAMS Initiative in Makoni, 7,440 individuals between the ages of 15 and 24 received HIV testing and counseling (HTC) services and learned their test results, with 310 individuals testing positive for HIV. In financial year 2017, quarter 1, under the Game Changer program, 273 children, adolescents, and young people are currently on ART, and 274 are receiving community-based care through the CATS program.

In the six DREAMS implementing districts in Zimbabwe, 60,372 individuals received HTC services and got their results. In financial year 2017, quarter 1, 4,327 children, adolescents, and young people are currently on ART in 24 Game Changer districts, while 4,371 are receiving care in their communities from CATS. Through these programs, Africaid will continue to support girls like Gracious to be empowered and to empower others.


I am pursuing my dreams despite my HIV status: Maximina Jokonya

In 2004, her health deteriorated to a point where she was usually bed-bound and the hospital became her second home.


“I fell very sick in 2004. During that time, I could not walk and I was in and out of hospital as a result of different sicknesses,” said Jokonya.

She then got to know about Africaid Zvandiri in 2005 and was initiated on antiretroviral therapy treatment (ART) in 2006 at Newlands Clinic and since then her health has greatly improved.

“I got to know Africaid Zvandiri in 2005. The organisation has shaped who I am today,” she said.

“My family and the community have shaped my life to not only develop a passion for working with children, adolescents and young people who are infected and affected by HIV and TB co-infected, but to live an exemplary positive life for the community to embrace interventions and to shun stigma and discrimination.

“Even if you look at me now, you cannot even tell that I am HIV-positive because I adhere well to my medication. I am pursuing my dreams despite my HIV-positive status.”

ART and social support have given her hope as she now leads a normal life that has become an inspiration to her peers.

Jokonya has moved from being a beneficiary and she is currently working for Africaid as the Zvandiri mentor for Mutare district.

“I work with children, adolescents and young people living with HIV, making sure that they have full access to treatment, care and support through community-based approaches, resulting in them attaining happy, healthy fulfilled lives,” she said.

Jokonya believes that she was born for a purpose. She managed to turn her pain into passion and it has driven how she works every day to improve the lives of children, adolescents and young people living with HIV.

“My aim by disclosing my status was to make other adolescents who are out there and looking down upon themselves know that they have a right to be healthy and they can achieve so much in life,” she said.

“The best thing is that HIV is not in our brains and we are able to dream big and achieve the best in life. My aspiration in life is to see young people, particularly vulnerable orphans and those living with disabilities, leading happy and healthy lives regardless of their HIV status.”

Through her desire to learn about HIV and find ways to help communities, Jokonya was incorporated into the University of Zimbabwe-University of California San Francisco (UZ-UCSF) collaborative research programme in 2007 as a community advisory board member, as well as into the community delegation to the Global Fund. She is also one of the Women Deliver Young Leaders as well as a Mandela Washington Fellowship member, among many other representations.

Upon completion of the Mandela Washington Fellowship, she is planning to continue working with Africaid Zvandiri in the field of HIV and Aids, improving on innovative ideas, strengthening community systems and developing research gaps on how to end Aids by 2030.

Africaid is a community-based organisation in Zimbabwe, which is committed to helping HIV-positive children, adolescents and young people to develop knowledge, skills and confidence to cope with their HIV status and to live happy, healthy, fulfilled lives. Through its Zvandiri model, Africaid provides differentiated care for HIV-positive children, adolescents and young people through community-based health services, psychosocial support and care, training and advocacy. These services are integrated within the clinical care provided by government and private clinics. This integration creates a robust continuum of care for children and young people with HIV and aims to improve their access to HIV-testing services, linkage and retention in care, adherence, psychosocial well-being, mental health and sexual reproductive health.



Treat All initiative: All HIV positive adolescents & young people to get on treatment

Mutare | Recently, Africaid in partnership with Organisation for Public Health Interventions and Development (OPHID) participated at this year’s 9th edition of Jibilika Dance Festival which was successfully held at Meikles Park with support from United States President’s Emergency Plan for AIDS Relief (PEPFAR). Africaid had the prerogative to sensitise adolescents and young people about the Treat All initiative through Diamond FM to about 1000 people who were enthralled by music and dance which was provided at the scene.

Young people from Jibilika Dance Trust providing edutainment at the cypher HIV awareness campaign through dance and music in Mutare

Young people from Jibilika Dance Trust providing edutainment at the cypher HIV awareness campaign through dance and music in Mutare

Treat All initiative allows all HIV positive people to get on treatment regardless of their CD4 count. As a recommendation from the previous Treat All meetings which have been conducted, Africaid was tasked to sensitise adolescents and young people in Zimbabwe about the Treat All initiative using adolescent-friendly and peer-led innovative interventions.