2016
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HIV stigmatisation still rampant…Early disclosure encouraged

By Shamiso Yikoniko (Published In the Sunday Mail) December 13 2015

Despite the strides in the fight against HIV, stigmatisation is still rampant and unfortunately it is not sparing children who are born with the virus.

When one acquires the virus through peri-natal transmission and lives with it through adulthood, they usually have to go through various dilemmas, ranging from status disclosure to stigmatisation. Worst still, in some communities contracting the virus is still regarded as a death sentence.

For 20-year-old Tanyaradzwa Moyo (not her real name) who shared her life experiences during the recently held International Conference on AIDS and STIs in Africa (ICASA), the journey has been a tough one.
Tanyaradzwa found out that she was living with HIV in 2007 when she was in Grade Seven.

“Having grown up a sickly and frail child, I always thought I was different from other children. The sad thing is that even my mother did not suspect HIV to be the reason behind my health problems.”

“I was attacked by herpes zoster twice, first on my right hand in 2005 and then on my left leg. On both occasions, my mother was advised to have me go for an HIV test but she ignored the advice,” added Tanyaradzwa.
Nevertheless, Tanyaradzwa’s health continued to deteriorate as she was always afflicted by several opportunistic infections.

Tanyaradzwa’s mother then took her for an HIV test at the Highfield Polyclinic and she was found to be HIV-positive.
“After being diagnosed with HIV, my mother did not tell me of my condition.

“My condition was only revealed to me when I was referred to Harare Central Hospital. Then, I didn’t know what having HIV meant, all I cared about was being well and being ‘normal’ like my peers,” Tanyaradzwa said.
She was first given cotrimoxazole for about a week while receiving counselling sessions so that she could understand her condition. Thereafter, she was put on first line treatment.
And she was well again!

But at secondary school, Tanyaradzwa faced discrimination from her peers and teachers.

“I suffered from a persistent dry cough and everyone at school suspected that I was suffering from HIV and from then on, I started facing stigma. I couldn’t make any friends at school, l couldn’t participate in any school activities and teachers would always shout at me because I was not performing well.”

“I kept asking myself why this happened to me. During that time, I thought I was the only child living with HIV. At one time I stopped taking my medication for about three to four months and I got sick again.”

Tanyaradzwa would go for treatment advice and counselling without her mother and there, she would lie that she was taking her antiretroviral medication. However, her CD4 count was telling a different story as it had dropped dramatically, which in itself is a sign of non-adherence.

“I became suicidal and all I wanted was to die. That is the reason l stopped taking medication. I was asked to bring my parents but lied that I was staying alone. I was then advised to join a support group. At first I was hesitant since I was thinking that I was the only young woman living with HIV,” she said.

It took several counselling sessions for Tanyaradzwa to agree to join a support group. She however, was pleasantly surprised to discover that people of various ages where living with HIV.

“Attending the support group restored my hope. I regained my confidence and felt that life had to go on,” Tanyaradzwa said.

“In 2009, I was put on second line treatment since first line treatment had failed. Although I had received a new lease of life, I was being monitored for adherence by a Community Adolescence Treatment Supporter.”

The Community Adolescence Treatment Supporters (CATS) programme, which is administered by an organisation called Africaid Zvandiri, was established in 2009 with the aim of providing community-based treatment, adherence, monitoring and counselling for youths living with HIV. Tanyaradzwa’s mother also got tested and was found to be HIV-positive.

“It was explained to my mother that the only way I could have contracted HIV was through mother-to-child transmission,” said Tanyaradzwa.As Tanyaradzwa grew into a woman, another challenge presented itself.

“I became interested in starting a relationship but the dilemma was how I was going to reveal my status to my partner. I have been dating this guy for three years now and I only managed to disclose my status after one-and-a half years of dating,” she explained.

“One day when I was coming from collecting my medication, my boyfriend insisted on carrying my bag. I was afraid he would open the bag and see the ARVs,” Tanyaradzwa added.

“After a week, I shared with him my life experiences and disclosed to him that I was HIV-positive. He accepted me as I am and we have bigger plans for the future together. We, however, agreed to abstain from sex until we are married.”

After realising that being HIV-positive is just a condition and not a death sentence, Tanyaradzwa dreams of becoming an HIV/Aids counsellor.

Currently, she is a volunteer with the CATS programme. In Zimbabwe, about 170 000 children below the age of 15 are living with HIV.

Early disclosure encouraged PARENTS and guardians have been urged to disclose their children’s HIV statuses from as early as five years so as to avert adolescents’ HIV mortality rate.

Thousands of young children and adolescents living with HIV have died in recent years as their parents failed to initiate them on treatment.

Lack of access to healthcare services due to either late or non-disclosure by parents has been identified as a leading cause of child mortality.Such children would have acquired the virus through peri-natal transmission.

According to the data released by Unicef last month, the number of adolescents who died from HIV-related infections has tripled in the past 15 years.

Among HIV-affected populations, adolescents are the only group whose mortality figures are not decreasing.
Experts attending the 18th edition of the International Conference on AIDS and STIs in Africa (ICASA) made a plea to guardians taking care of children living with HIV to disclose their HIV statuses early.

Dr Johnface Mdala from IntraHealth International, Namibia, said disclosure is as important as adherence.

“Earlier disclosure helps young people to learn about their condition, to develop skills to cope with their condition and to be involved meaningfully in their care and decisions about their health,” said Dr Mdala.

“In Namibia, we have developed tools aimed at tackling the matter which includes partial disclosure by the age of five years and make it a gradual process up until full disclosure by the time they reach 10 years.”

Full disclosure involves giving a child all the information about their HIV status. The information is more detailed in terms of what HIV is and how it affects the body.

“It’s encouraged for parents to use illustrations, drawings or cartoons to explain in simple ways what HIV is, how it affects the body and how ARVs work,” added Dr Mdala.

Aids is the number one cause of death among adolescents in Africa and the second leading cause of death among adolescents globally.

Africaid-Zvandiri director Ms Nicola Willis said although disclosure is a difficult process, more people are realising that the earlier, the better.

“We have come a long way in terms of people’s understanding about when is the right time to inform a child that he or she is HIV positive. A few years ago, it was commonly thought that disclosure should be done in late adolescence,” she said.

“We generally advocate that there is no set age at which disclosure should take place as every child has individual needs, experiences and circumstances. Most importantly, they should know their HIV status, particularly if they are on ARVs as this helps to adhere better.

“However, this must be done carefully in the best interests of the child and led by the child’s family. Health care facilities across the country are being trained to support and counsel families in the disclosure process.”
Support groups have also been cited as helpful as this is a place where adolescents can come together to learn more about growing up with HIV, including adherence to ARVs.

The adolescents will also share their experiences. A Unicef official based in Tanzania, Ms Alison Jenkins weighed in to support that disclosure is the key.

“It’s important to start the disclosure process early so that the child doesn’t hear their HIV status from other sources rather than the parents or caregivers,” she said.

Disclosure is the process of informing a person about his or her HIV status.
According to the Ministry of Health and Child Care estimates, 6 176 children out of 156 718 living with Aids in the zero-14 years age group died in 2014.

In 2013, 8 741 died of HIV-related diseases.

2016
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Sex & relationships in the lives of young women living with HIV

By Sungano Bondayi

A woman living with HIV hopes to have her own family. She wants her children to be born without the virus and this is now possible with the right treatment. But when that service is non-existent in her local area, where does she stand?

Living in a world where you must rely on the people around you to accept you and your status is difficult. Sometimes you just know that it is never going to happen. For women, it is a necessity to stand together and fight for the rights of women living with HIV. This was the dialogue which was facilitated by Africaid Zvandiri on 3 December 2015, at a session during the International Conference on AIDS and STIs in Africa, focusing on sex and relationships for women living with HIV.

Maximina Jokonya , a young woman openly living with HIV, facilitated the discussion with a panel of young women from countries such as Burundi, South Africa, Uganda and Zimbabwe, who were advocating for those living with HIV. In a move to empower young HIV positive women, they discussed challenges faced by women in their diverse communities and the possible ways forward.

Addressing HIV stigma

In Uganda, the environment is sometimes not welcoming to women living with HIV, especially pregnant women living with HIV. Services for prevention of mother to child transmission of HIV have improved over the past few years, with more attention to and availability of medication for pregnant women living with HIV. However, stigma remains a real issue in the community, including in health facilities where women go to get the care and support they need to stay healthy.

There was a strong call for women living with HIV to involve their partners since for some, it could lessen the burden and helps their partners better understand the different issues women face. Lebohang Motsumi, the South Africa ambassador for non-governmental organisation ZAZI, (a Nguni word meaning “know yourself”), highlighted challenges women living with HIV face in their relationships.

She said: “When a guy asks you out, the first thing you think of is your HIV status.” This should not be the case, and the fact that women have to constantly think of their status in these kinds of situations is due to the stigma.

Disclosing HIV status

Claudia Nizigiyimana from Burundi spoke about women understanding their rights. “If people know your status and they see you in a relationship they start saying that you want to kill your boyfriend with your virus.” Most young women in Burundi want to disclose their status to their partners but they are afraid. Even if the partner accepts it, in the end the relatives will reject the young woman based on her status, as a result these young women opt not to disclose. The fear of being the subject of gossip in the community is not flattering and they end up just flowing with the tide.

The panellists all advocated for changes in attitude towards women living with HIV. But how to make this happen is an ongoing debate.

One point agreed upon, is that the empowerment of young women living with HIV starts by sensitising the communities so that they do not threaten and discourage women from having sexual relationships. More information needs to be provided so that communities have a deeper understanding about HIV, including how it is transmitted and what services are available to support women living with HIV and their partners to enjoy fulfilling sexual relationships. And communities should advocate for youth-friendly services.

Improving sexual and reproductive health information

Young women living with HIV also need to be informed about their sexual and reproductive health, and how they can use preventive measures to avoid the transmission of HIV, the acquisition of sexually transmitted infections (STIs) and unplanned pregnancies. Health workers also need to know that women living with HIV have rights to quality and integrated sexual and reproductive services just like anyone.

Young women living with HIV need support to accept their HIV status, support each other and work together with the community. When holding support groups they should not be more focus only on those infected by HIV as this will cause them to stigmatise themselves but these groups should involve all women, it is important to include other members of the community who are negative because everyone is affected by HIV.

Ending HIV is not an individual concern, it requires a team effort. As Motsumi said: “Do not shut yourself from the world, work with the world.”

2015
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New HIV & AIDS Treatment Guidelines

HARARE – The World Health Organisation (WHO) has set new HIV and AIDS treatment and prevention guidelines to allow for early interventions once the condition is detected.

The latest information released on September 30 titled: Guidelines on when to start ART and PrEP (Pre-Exposure Prophylaxis) for HIV requires one to start anti-retroviral drug treatment upon testing HIV-positive regardless of their CD4 cell count.

It also advises countries to use HIV treatment as a prevention choice for people at high risk of infection.

Previously, ARVs were only given to HIV-positive people whose CD4 cell count had dropped to 500 and below and to vulnerable people such as children below five years, pregnant women, tuberculosis patients, and discordant couples regardless of their CD4 count.

Under the early guidelines, the first recommendation on ART initiation was based on evidence that many lives could be saved if people start treatment early, while the second guideline was based on further evidence of tenofovir — a first line ARV drug used in most countries — that it was effective in preventing HIV acquisition from an infected partner if taken as a pre-exposure prophylaxis.

“The first of these recommendations is based on evidence from clinical trials and observational studies released since 2013 showing that earlier use of ART results in better clinical outcomes for people living with HIV, compared with delayed treatment.

“The second recommendation is based on clinical trial results confirming the efficacy of the ARV drug, tenofovir for use as PrEP, to prevent people from acquiring HIV in a wide variety of settings and populations,” reads part of the guidelines.

The latest development will form part of the WHO’s revised and updated consolidated 2016 guidelines on the use of anti-retroviral drugs for treating and preventing HIV infection expected to be released during the International Conference on AIDS and STIs in Africa (ICASA) taking place here in Zimbabwe in December.

“The full update of the guidelines will consist of comprehensive clinical recommendations together with revised operational and service delivery guidance to support the implementation,” said the WHO.

Head of AIDS and TB Unit in the Ministry of Health and Child Care Dr Owen Mugurungi, said Zimbabwe welcomed these guidelines but now awaited the release of the 2016 comprehensive guidelines at ICASA.

Dr Mugurungi said the test and treat guidelines required wide consultations with stakeholders, on Monday including people living with HIV and the donor community.

If we are to adopt these guidelines, it means everyone has to be committed because this will definitely push up the figures (of people demanding ARVs),” Dr Mugurungi said.

He said there would be need for more people to get tested and to link all those tested to treatment and care.

Other stakeholders involved in HIV response also commended the WHO for the latest development, saying the guidelines would go a long way in reducing the impact of HIV and AIDS.

The executive director for Avac, a non-governmental organisation involved in HIV and AIDS advocacy, Mr Mitchell Warren, said there was need to swiftly and comprehensively fund and implement the new guidelines to begin the process towards ending AIDS.

“We can’t let these ground-breaking guidelines sit on a shelf. If taken seriously, they can help ensure that millions of people with HIV live long and healthy lives, and that millions more women and men at high risk can remain uninfected,” said Mr Warren.

He, however, said there was need for enough funding to ensure effective implementation of the guidelines.

“If fully funded and implemented, the recommendations will greatly simplify ART for people living with HIV and revolutionise prevention for people at risk. But there is much work ahead to translate them into practice, from securing resources to revamping HIV guidelines in country-after-country, to implementing comprehensive treatment and prevention programmes,” he said.

Director of Medicines Sans Frontiers’ Southern Africa medical unit, Dr Tom Ellman, said there was need for increased support from donors and governments to turn these recommendations into reality.

“HIV care has to move out of clinics and into the communities with mobilized, empowered and engaged people living with HIV that actually are part of the response. This will need effort and money, said Dr Ellman.

Dr Ellman said from his experience in Southern Africa in HIV programmes in the past 10 years, about a third of people diagnosed with HIV but not eligible to start treatment, never returned to the health facility.

“Offering such individuals treatment once they test positive could substantially reduce the number of people who may never return,” he said.

National HIV estimates show that one million people are living with HIV in Zimbabwe although infection rates are reportedly declining.

The country’s HIV prevalence rate, however, remained static at 15 percent while the number of people on anti-retroviral treatment is pegged at 63,4 percent for adults and 55 percent for children.

Source: Herald

2015
By

CATS LEADS A SESSION AT THE PSS FORUM 2015

VICTORIA FALLS,ZIMBABWE-ZIMBABWE-4 Community Adolescents Treatment Supporters will be leading a skills building workshop on “Adolescent-led treatment literacy and counselling for children and young people living with HIV” at the Pyschosocial Support Forum 2015 which will be held at Elephant Hills in Victoria Falls from the 1st of September to the 3rd of September 2014.

As part of the methodology for the skills building workshop,a team of 4 Community Adolescent Treatment Supporters (CATS) will facilitate a skills training workshop for conference delegates during which they will provide a background to the work that they are doing to promote adherence amongst their peers. They will then demonstrate the “Our Story” book, “Our story” counselling game and a short film on adherence. These have all been developed by young people living with HIV and seek to improve young people’s understanding of HIV and ART and adherence skills. Delegates will be trained how to utilize these tools within their own practice.

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It is to this background that the delegates are anticipated to develop new understanding of the role of young people living with HIV in developing and implementing their own treatment literacy and counselling interventions. They will then acquire new skills in providing child and adolescent-focused information and counselling for young people initiating ART, on ART or with adherence challenges.

2015
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AFRICAID ZVANDIRI TO HOST A TRACK AT THE REGIONAL CONFERENCE

HARARE-Africaid Zvandiri will be hosting a track on:” Exploring challenges and opportunities in providing prevention, ART and positive living services for adolescents and young people living with HIV to improve quality and productivity of life.” at the Southern African Regional Students and Youth Conference which will be held in Harare (Harare International Conference Centre) from the 27th to the 30th of August 2015.

It is important to note that AIDS-related deaths in adolescents continue to increase as a result of poor linkage and retention in care, sub-optimal adherence and a lack of prioritization of adolescents in service delivery.

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There is a critical need to hear the voices of young people living with HIV so that they themselves can shape the way services are delivered across the region.

In this track, adolescents and young people from organisations across the region will come together to share the successes and challenges from their respective countries and organisations, including the views of young key populations and young people living with HIV and disabilities.

Key issues will include positive health, dignity and prevention, access to ART and adherence, stigma and discrimination, retention challenges and sexual and reproductive health, drawing on experiences from different settings. Examples of different programme models and participatory approaches will be shared.

In this interactive session, they will discuss and make recommendations for the delivery of prevention, ART and positive living services in order to improve quality of life for their peers across the region.

The Southern African Regional Students and Youth Conference on sexual and reproductive health (SARSYC) will be held under the theme, YOUTH SRHR AND THE POST2015 AGENDA: A TIME TO INVEST IN YOUNG PEOPLE TO HARNESS THE DEMOGRAPHIC DIVIDEND IN SOUTHERN AFRICA.

The theme of the conference is founded primarily on the proposed incoming Sustainable Development Goals (SDGs) of the post 2015 development agenda and informed by the Millennium Development Goals (MDGs).

The year 2015 marks the end of the lifeline of the MDGs and marks the beginning of the SDGs; hence the conference will focus on calling the young people from Southern Africa to take the lead in the post 2015 SRHR Development Agenda through spearheading the attainment of SDGs that uphold young people’s SRHR.

2015
By

HEALTH:Of Students Living with HIV

By Jephiter Tsamwi (Publisher : The SUNDAY MAIL)

ZIMBABWE-“I am a student at Hillside Teachers College and was initiated for ART in Mberengwa. When I wanted to access medication I was told to go back to Mberengwa. I spent some time raising the money and eventually managed to travel to Mberengwa. Unfortunately, when I got there, the nurses told me they were out of supply. I had to come back to Bulawayo empty-handed.”

Recently, our sister paper Chronicle quoted a student from Hillside Teachers College narrating her ordeal during the Anti-Retroviral Therapy (ART) Advocacy Meeting that was held in Zimbabwe’s second largest city.

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Indeed, they say every adversity, every failure, every heartache carries with it the seed of an equal or greater benefit, but the story is different for students living with HIV. It is a different story not because they are not trying, not because they are putting less effort, but because of the existence of an interplay of flawed systems and mechanisms that are ironically supposed to at least rekindle a light of hope to the destiny of this often forgotten tribe.

Getting education provides a window of hope and opens many doors of opportunities for every hardworker. The majority of students living with HIV have defied all odds to clinch that hope and make it to college.
It, however, seems they are at the right place at the wrong time. The system has failed to protect them and cater for their sexual and reproductive health rights.

It is not enough to expose the sexual and reproductive health challenges of young people without dissecting the fundamental questions of why the situation is like that and what needs to be done.

Zimbabwe is undoubtedly a classical example of a nation that has demonstrated commitment and determination to stamp down the adverse effects of HIV and Aids and in the process, making it one of the first African countries to witness a sharp decline in HIV prevalence rate.

In recent times, we have seen different countries sending delegates to learn from Zimbabwe in terms of HIV prevention, management and even administration strategies and programmes. It is a good thing for the country.

However, the gains made thus far are at the verge of serious collapse if key emerging issues are not seriously addressed.

What the student quoted above raised is a classic example of the difficult circumstances and challenges that young people living with HIV are facing in colleges.

Many times, we have also read about these students engaging in risky sexual behaviours because of economic challenges. Of course, it is public knowledge that not all students are going astray because of lack of basic necessities at college, but truth be told, most Zimbabwean students are struggling to make ends meet. The burden is even more to the students living with HIV. But why is that so?

Below are some of the key issues:

College clinics are not accredited and/or licensed

This may sound unbelievable to the majority. But it is pretty disturbing that with all the advancement and the progress made so far by the country, only University of Zimbabwe is initiating ART. Universities like Midlands State University, itself a mega-varsity with a total population close to 25 000 is only a follow-up site for Anti-Retroviral Treatment.

Definitely as a country we have to be ashamed of this. There is certainly no excuse for this, either colleges are not serious or the policies are not dealing with this matter. Where are the students supposed to get their ARVs if institutions that house them for three to four months are not providing such?

Under-staffing and limited capacity

Whether it is Government policy or the colleges’ policy, it is unfortunate that only one nurse is often available at most colleges’ clinics. This means that if that nurse is not available for any reason, the college clinic is closed.

In other words, colleges are operating under a deceptive assumption that this one and only college nurse is forever available, every hour and every minute when students are in need of their services! To worsen the matter, the college clinics are sometimes opened only for a limited number of hours.

The reality is that most colleges are enrolling more students than their carrying capacity, yet only one individual is serving the whole college.

In the above mentioned ART advocacy meeting that this writer was part of, it emerged that very few of the college nurses are actually trained in ART initiation, especially according to the 2013 guidelines set by the Ministry of Health and Child Care

Then what after getting tested?

Research has shown us that the most used and accessed service in the college clinics is HIV testing and counselling. Perfect! Such can be used as entry points to begin dialogue with students on sexual and reproductive health matters considering their vulnerability.

However, there is no comprehensive support for students living with HIV who would have been referred to Central Hospitals or those who would have tested HIV positive.

The viral load machines at Mpilo Hospital, for example, are currently not working, yet this is one of the main hospitals where students who would have tested HIV positive are supposed to get help.

It is so unfortunate that during the meeting indicated above, the chairperson of the Parliamentary Portfolio Committee on Health and Child Care, Dr Ruth Labode, was the most shocked when she heard about the prevailing situation at Mpilo. Do policy makers really care about these things?

Flawed system in management, catering for transfers

It is outrageous to realise that in this digital world, Zimbabwe currently does not have a computerised system that tracks and monitors clients’ ARV uptake for effective and convenient record keeping.

What this means is that a student at National University of Science and Technology who was initiated on ART in Siakobvu, Gandanzara or Bocha is expected to go back to the site he/she was first initiated to get supplies of his or her medication.

If he/she wants to try with the nearest hospital, the client is expected to produce a transfer letter. You can imagine the inconvenience. The system does not even have a mechanism for at least using cellphones to confirm these transfers.

Where will a poor student who is already struggling to get at least one meal a day get the money to go back to Siakobvu mid-semester?

Inconsistent ARV supplies and defaulting

You can imagine the ultimate result of such a myriad of challenges that young people are facing in their efforts to access ART. Obviously, a lot end up defaulting taking their medication.

Some are losing their lives as a result. What is also a colossal challenge to the students is that sometimes they get only two months’ supply of medication at a time when they are supposed to spend at least 3-4 months at university or college.

Even if they manage to go back and collect the drugs, other clinics will be out of stock, thus requiring students to have multiple trips as they seek to access the ARVs. With all the hustles and processes that are needed for them to get their ARVs, this will result in them spending more time out of lectures as they go back to collect their medication.

How then are we supposed to produce quality graduates as a nation if students are day by day exposed to such harsh conditions?

Recommendations

That we have a lot of these challenges does not mean the future is bleak. Zimbabwe has done so well in health interventions before and solving these issues can be an easy thing to do with utmost commitment by the duty bearers.

More staff at public hospitals and college clinics

Why are we having shortages of staff in public hospitals and college clinics when the country is rich with unemployed trained nurses? It is high time Government relaxes the freezing of posts, especially within the health sector, to solve staff shortages.

The number of college nurses per college must be proportional to the number of students per enrolment if youth-friendly and quality sexual and reproductive health services are to be given to our young generation, especially those in colleges.

Procurement of drugs with longer shelf life

If young people, including the general populace, are getting two months’ supply of drugs because the available stock will be nearing its expiry dates, then Government, through NatPharm, must ensure that drugs that are being procured have a longer shelf life.

People of Zimbabwe will be able to get at least 6 months’ supply of drugs and this will make life easier for the people living with HIV.

Health service delivery package for colleges

It is pleasing to note that some colleges have set up initiatives where the college nurse can collect the medication on behalf of the students from the public hospitals. Although this is not sustainable and does not empower the student to be in full control of his/her health needs, at least they are trying.

However, what could be more sustainable would be for the Government, through relevant line ministries, to consider coming up with a minimum package for sexual reproductive health service provision that is tailor-made to cater for the college students.

This will ensure that the services are student-friendly with high chances of meeting students’ satisfactions and expectations.

Quality and rights focused service delivery

The health sector must adopt a quality and rights focused approach in service delivery, especially with regards to ART. There is need for a complete overhaul of the “one-size fits all” approach when delivering ART to the people.

Therefore, Government can consider segmenting different sub-groups and strive to cater for their specific and sensitive sexual and reproductive health needs, for example, students and many other sub-groups that may need specialised focus in service delivery.

Capacity building on youth friendly service delivery

The time for our nurses to be given names like “horrible nurses” is over. Nurses in public hospitals are notoriously known for the wrong reasons; ill-treatment of patients, shouting at clients, laziness and mean statements.

Of course, this could be a product of different factors, but the nurses need capacity building, especially on patient-friendly service provision. If the nurses, especially those in colleges are not trained in ART initiation, then colleges and Government must ensure that the nurses are equipped with these critical skills.

Digitalisation of the health system

In recognition of the critical role played by ICTs in development, Zimbabwe has done the right thing by having a stand-alone ministry focusing on that noble cause.

It is, however, surprising that the health sector is stuck in the 1920s, much to the disadvantage and inconvenience of patients. The absence of a systems approach and a digitalised way of data capturing has led the sector to rely on transfer letters as support documents for those who wish to change their collection sites.
In the process, some are being recorded as defaulters when in actual fact they are failing to access their medication due to barriers associated with the primitive systems. It is high time all Government ministries and parastatals move with time and make computers a basic tool of work in their operations.