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
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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.

2015
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MINISTRY OF HEALTH AND CHILD CARE (SHURUNGWI) LAUNCHES ZVANDIRI SUPPORT GROUP

MIDLANDS PROVINCE,ZIMBABWE-Recently, Africaid ?Zvandiri? in collaboration with Ministry of Health and Child Care, the Department of Child Welfare & Protection Services and the local community established a support group for children and adolescents living with HIV at Tongogara Clinic which is located about 40 kilometres out of Shurugwi town in Midlands Province,Zimbabwe.

A total number of 36 children and adolescents, Zimbabwe Republic Police Victim Friendly Officers, officals from the Ministry of Health and Child Care (Shurugwi District), Department of Child Welfare and Protection Services Officers, Community Case Care Workers (CCCWs),Child Protection Committee members and Care givers attended the launch of the support group.

In addition to this, the training of CCCWs also contributed meaningfully to the establishment. A follow up visit was made to the clinic in May 2015 during the training of CCCWs for Shurugwi Rural. Trained CCCWs from the area also worked with Village Health Workers in mobilizing children.

The support group members will meet once every month at the clinic and it is felt that this will go a long way in building the confidence of these children and adolescents so that they live happy,healthy and fulfilled lives.

2015
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‘Incorporate children’s rights in mainstream programmes’

Newsday-16 June 2015

LOCAL children’s rights lobby group, Africaid, has bemoaned communities’ perpetuation of stereotypes against children and their failure to integrate children’s rights into the mainstream programmes.

Africaid’s call coincided with today’s commemorations of the Day of the African Child (DAC).

This year’s edition of the DAC will be held under the theme 25 Years After the Adoption of the African Children’s Charter: Accelerating Our Collective Efforts to End Child Marriages in Africa.

Africaid spokesperson Tinashe Rufurwadzo said: “Some of the children and adolescents do not know their HIV status of which it is their right to be tested for HIV and know their status.”

He said they were also advocating for more participation of young adults in issues to do with sexual reproductive health.

Africaid implements the right to participation with attention on children and adolescents living with HIV through the Zvandiri Community Adolescents and Treatment Supporters (CATS) Programme.

CATS provides direct psychosocial and health support services to peers living with HIV, to caregivers and to young HIV-positive parents. It also seeks to implement innovative ways of communicating and creating awareness to reduce stigma and discrimination.

“This is in accordance with the African Youth Charter Article 11 which stipulates that every young person shall have the right to participation in all spheres of society,” said the Africaid spokesperson.

Each year on June 16, African countries celebrate and recognise children all over the continent despite their differences, in remembrance of the sacrifices made by South African youths in 1976 who protested the inferior quality of their education and demanded equal rights. Thousands of children were injured and more than 100 people were massacred.

Last week visiting UNAIDS executive director Michel Sidibe said challenged society to safeguard the rights of children and adolescents.

2015
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Fulfilling the Right to Participation for Children and Adolescents living with HIV.

DAY OF THE AFRICAN CHILD:PRESS RELEASE

HARARE- Each year on June 16, African countries celebrate and recognize children all over the continent despite their differences, the Day of the African Child commemorates sacrifices made by South African youth in 1976 who protested the inferior quality of their education and demanded equal rights. Thousands of children were injured and more than hundred people were massacred.

As a result of this background, Africaid joins the rest of the nation in commemorating the Day of the African Child with special attention on children and adolescents living with HIV who faces unprecedented challenges including lack of HIV & AIDS Information, Stigma and Discrimination, limited access to SRH services, treatment default due to faith healing among others. Some of the children and adolescents do not know their HIV status of which it is their right to be tested for HIV and know their status.

Africaid is a community private voluntary organisation in Zimbabwe through which its Zvandiri Programme integrates community prevention, treatment care and support for children and adolescents living with HIV.

As an organisation we envision that HIV positive children and young people have the knowledge, skills and confidence to cope with their HIV status and to live happy, healthy fulfilled lives. The organisation also offers a wide range of services including HIV Testing and Counselling, Post Test Counselling, support and linkage to care, Antiretroviral Treatment & Adherence, Clinical Monitoring & Support, Training & Support for Personal Growth and Development, Adolescent Sexual and Reproductive Health and Transition in to Adult Care.

With this in mind, it is of paramount significance to note that Africaid implements the right to participation with attention on children and adolescents living with HIV through the Zvandiri Community Adolescents and Treatment Supporters (CATS) Programme and this is in accordance with the African Youth Charter Article 11 which stipulates that every young person shall have the right to participation in all spheres of the society. This peer led intervention ensures that adolescents and young people living with HIV participate in their own development.

Zvandiri is founded for children and adolescents living with HIV being at the heart of the programme .These young people are directly involved in planning the programmes, they deliver the interventions and they work in clinics and communities.

Zvandiri has developed a theory of change approach that encourages reflection, adaptation and incorporation of new ideas and evidence into its evolving programme. Psychosocial support and health services are provided through community support groups, community outreach and Zvandiri centres attached to health clinics.

In addition, the programme influences the home, school and overall community environment to raise awareness and reduce stigma and discrimination, and contributes substantially to training and to policy and guideline development nationally and internationally.

At the core of Zvandiri are trained HIV positive adolescents and young people known as Community Adolescent Treatment Supporters (CATS). Supported and mentored by Zvandiri staff and supervised by primary health care counsellors, CATS provide direct psychosocial and health support services to peers living with HIV, to caregivers and to young HIV positive parents.

CATS also, together with Zvandiri staff and other adolescents in the programme, propose and implement innovative ways of communicating and creating awareness to reduce stigma and discrimination, and they help develop and test training tools. CATS are powerful advocates and role models who contribute to training health care providers (amongst others) to understand the holistic needs of HIV positive children and adolescents, supporting overstretched clinic staff to address these needs. Young people in the programme have regular opportunities to share experiences, ideas and challenges and to contribute to programme modification and development.

2015
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Zvandiri in the Global Fund Incentive Funding Proposal.

By Gemma Oberth

In incentive funding request, Zimbabwe prioritizes young people.

New funding model early applicant Zimbabwe submitted a $40.2 million request for incentive funding on 18 May, seeking additional financial support for interventions that specifically target people under age 24: the fastest growing demographic group in sub-Saharan Africa for new HIV infections.

Zimbabwe will receive some $437.2 million from the Global Fund through 2016 for its HIV response; this incentive funding request — which is not guaranteed — will supplement that sum. A concept note submitted in April 2013 for the total $311.2 million also included a request for additional support with $274.4 million that was not fulfilled. Grant implementation began in January 2014, and continued throughout the year with interventions focusing on treatment monitoring, prevention of vertical transmission and recruitment and retention of health workers. An additional $126.1 million was awarded to Zimbabwe in 2015, after the Global Fund’s country allocation methodology was updated. This top-up went towards expanding existing Global Fund-supported interventions, especially HIV testing and counseling and storage capacity for medicines at facility level.

The additional incentive funding request is arranged along four strategic areas namely Laboratory & Pharmaceuticals,Youth & Adolescents,Community & Key Population and Monitoring and Evaluation.

The additional money for laboratory and pharmaceuticals would specifically work to improve pediatric HIV diagnosis and care. In Zimbabwe, treatment coverage is much lower among children (46.1%) than it is among adults (76.9%), according to the country’s 2014 Global AIDS Response Progress Report.

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The second strategic area is youth and adolescents, which includes activities such as girls’ mentoring clubs, based on the UNFPA’s Sista2Sista program, and peer counselors, based on the success of the Zvandiri Model. Recent evidence from Zimbabwe (Mavhu et al.; Dunbar et al.) suggests that interventions that incorporate gender-focused HIV education, guidance counselling and integrated psychosocial support can reduce risky transactional sex, increase condom use, and improve treatment adherence among young people.

“The youth programs that ended up being part of the incentive funding proposal are programs that have already been rolled out, and have been documented to be impactful,” said Definate Nhamo, an advocacy and evaluation specialist for adolescent sexual and reproductive health at Pangaea Global AIDS.

The third strategic area is community and key populations, with core activities such as community ART refill groups. These groups develop a rotating schedule for members to travel to facilities to collect prescriptions, a way to ensure adherence to the drug regimen and address some of the reasons people with HIV may default on treatment.

Activities envisioned in this area also include skills training for healthcare workers on how to respond to the particular needs of people with disabilities. A national disability survey revealed that people with disabilities are twice as likely to self-report having HIV compared to those without disabilities, and have lower levels of HIV knowledge.

The concept note also provides for an overarching emphasis on monitoring and evaluation. This area includes interventions to develop and launch a new HIV data warehouse, link community information systems with the HMIS, and conduct an in-depth assessment on adolescents.

With Zimbabwe’s current Global Fund grant cycle ending in 2016, the development of the country’s next HIV concept note is on the horizon for early next year. In light of this timeline, the CCM regards the incentive funding request as a forward-looking process. If priorities in the incentive funding concept note are not funded, they will likely be carried over into the next application.