WILD4LIFE PROJECT
28 December 2024CHIP Project
28 December 2024
Story 1
Addressing the needs of young MSM through the provision of safe spaces for young people. A case study of the Shaping the Health of Adolescents in Zimbabwe (SHAZ! HUB), Chitungwiza.
In Zimbabwe, men who have sex with men are often unable to access health services because of fear of stigma and discrimination. Oftentimes, they are asked questions as to why they are having sex with other men and are ostracized because of this. As a result, young MSM face challenges of where to go and access treatment services in environments that accommodate them. In addition to this, there is also the challenge that homosexuality is criminalized in Zimbabwe and so they are afraid that if they go and access services the health care providers will report them to the police.
In light of this Pangaea Zimbabwe AIDS Trust with funding from ViiV set up a safe space for adolescents and young people in their diversity as well as complement existing services at the SHAZ! Hub to include key populations. Combination HIV Prevention Champions were identified and recruited to create demand for services amongst the different priority groups of adolescents including MSM. Within the CHIP champions, there was the inclusion of an MSM. The CHIP champions conduct community-based activities and create demand amongst the different populations.
Since the inception of the CHIP project, healthcare workers have been trained in the delivery of key population-friendly services as well as in creating an environment that is conducive to the needs of key populations. There has been a significant number of young MSM coming to access services at the SHAZ! Hub. During client satisfaction in-depth interviews conducted with young MSM, they reported the following:
“When my friend who works at the Hub as a CHIP champion encouraged me to go and get treated after I had developed anal warts, I was hesitant as I was afraid that the nurses would shout at me. However, he escorted me and when we got to the Hub, I was greeted by friendly staff. When I went to the nurse consultation room, I was not comfortable sharing information but after she assured me that she would not judge me and that she wanted to help me, I felt at ease and I shared my story. She performed a physical exam and explained in detail what genital warts were and the course of treatment she would administer. She also assured me that if I faced any challenges I should beep her and she would call me. I felt like a king because of the treatment I got and am now referring my friends for PrEP services” Young MSM, 17 years, Chitungwiza.
“The nurses at the Hub are old but young at heart. The first time I saw them my heart skipped as one of them was old enough to be my mother. After interacting with her, I became comfortable telling her my secrets. I now regularly go to the Hub to interact with other young people my age although I don’t disclose to them that I am an MSM. The staff have never treated me differently from the other young people who will be accessing services” MSM, 24 years, Hatfield.
Having a place that accepts you as an MSM and does not judge you has been the best thing they have done at the Hub.I have been initiated on PrEP and come to collect my refills for the past 4 months and I have never been treated unfairly. The nurses call me regularly to check on my well-being and I feel supported in my PrEP journey.” MSM, 21 years, Chitungwiza
Story 2
The socio-economic hardships in Zimbabwe have pushed women and girls to engage in transactional sex for survival. Studies show that women and girls experiencing food insecurity were 28% more likely to engage in high-risk sex (unprotected sex) or forced sex before the age of 15 years (Unicef, 2022). As a result, their risk of contracting HIV increases. Whilst Zimbabwe has made great strides in HIV prevention which resulted in a decline in prevalence rates from 25% (2002) to around 11.58% (2022), females are still at a higher risk (6 times higher than men) (Unicef, 2022). The highest HIV incidence is in females between the ages of 15-29. Yet due to cultural, social, and economic barriers as well as fear and stigma associated with this, these younger women have minimal access to HIV prevention services. Taking this into account, Pangaea Zimbabwe through funding from ViiV set up safe spaces foradolescents and young people in their diversity to receive youth-friendly HIV prevention services. Combination HIV Prevention Champions were identified and recruited to create demand for services and provide peer-to-peer support services amongst the different priority groups of adolescents including FSW. The CHIP champions conduct community-based activities and create demand amongst the different populations. Through the CHIP project, healthcare workers have been trained in the delivery of key population-friendly services as well as in creating an environment that is conducive to the needs of key populations. There has been a significant number of AGYW coming to access services at the SHAZ!Hub. During a client satisfaction in-depth interview conducted with AGYW selling sex, one shared the following: “My mother passed away. My sister brought me up since when I was young. Since my sister was unemployed, I stopped going to school in Form 2. I started doing sex work in bars. That is how I earn a living. I support my younger siblings through this work. That’s how I am getting food on the table. I was always afraid of getting HIV. Not all clients agree to use a condom during sex, and they pay more for unprotected sex. I got a SHAZ!HUB flier from another young lady in our community who works as a CHIP Champion, which talked about PrEP as an option for HIV prevention. I was a bit hesitant to go but after a scary encounter with a client, I decided to just visit the clinic. I remember how I was so scared but the friendly staff at the hospital made me feel so welcome. They were not judgemental of the life that I was living. Instead, they told me of all the available options that I had to protect myself from HIV. I had never heard of oral PrEP before. Ever since I started going to the hub for services, I have felt so supported. I have even invited friends like me for STI treatments.” Young FSW, 19 years, ZengezaStory 3
Zimbabwe achieved HIV epidemic control and the 95-95-95 targets. However, geographic areas and sub-population groups such as adolescents and young women (AGYW) and adolescent boys and young men (ABYM) (15-24) are lagging and disproportionately affected. Mazowe and Seke are districts with a higher annual HIV incidence compared to the national average of 1.41%. Key drivers of the epidemic in these communities include poverty, early sexual debut, and limited comprehensive knowledge about SRHR and HIV coupled with limited access to youth-friendly service provision.
Pangaea Zimbabwe (PZ) through funding from ViiV introduced a Safe-Spaces Model to improve access to comprehensive youth-friendly HIV prevention and SRH services among adolescents and young people in their diversity in the Mazowe and Seke districts. The hubs were capacitated and accredited to offer HIV Prevention and SRH services. 18 Combination HIV Prevention (CHIP) Champions, AGYW and ABYM were trained to provide peer-to-peer support. They were engaged and supported to conduct community dialogues, literacy sessions, referrals, and follow-ups.
Through the CHIP project, there has been a significant number of AGYW and ABYM coming to access services at the hubs. During client satisfaction interviews conducted with clients at the hubs, some clients shared the following about how they felt about the services provided at the hub:
“I am a married mother of one. Although my husband works, I enjoy being independent, so I sell pre-owned clothing. That’s how I earn my money. I only got to know about the hub and services provided there when a CHIP Champion invited me. I had fallen sick, I had an STI. I could not access treatment in the local clinics because they needed me to buy some of the medication myself. One drug was not available at the clinic, and it was very expensive at the pharmacy. The Champion invited me and explained that I could get the treatment for free. The staff at the hub are very friendly. I was treated very well, and I would appreciate it if they remained the same. The hub gave free medication which is very rare. If you go to the clinics, they do not give you free medication they will prescribe medication for you to buy. This is why most people are not getting seen when they are sick. They cannot afford the medication, and they end up not going to the clinics. Since then, I have been to the hub more than twice, I would love to go there more times but sadly it is so far from where I stay. I have recommended my friends to visit the hub. I wish you could change your target population though so that many more people I know who are suffering could get services here. It’s such a nice place.” Young mother, 21 years, Nzvimbo
“I am a 23-year-old young man who sells various wares to make a living. As a salesperson, I socialise with people. It’s through these interactions that I met with some young men and women, the CHIPs who go around in the community talking about HIV prevention. They are the ones who told me about the hub. After I got to know about this place, I have been coming whenever |I need services. I think I have been here over five times. It’s so easy for me to come to the hub and get help. It’s where I come for HIV testing and to get condoms. It’s the way I am received here that keeps me coming back, from the people at the reception to the staff attending to you. They are all so hospitable. They are there to serve you and ensure that your needs are met. When you leave this place, you feel empowered. I have condoms to use, and I have information about PrEP and protecting myself even after an unplanned sexual encounter. I have invited friends who started using PrEP. It would be nice if the hub could provide PrEP refills in the community though because sometimes people do not have money for transport to return for resupply. I have spread the word about this place. I always tell people you should come and experience the special treatment they give at the hub. Please keep up the good work. In the same way, you have welcomed me here, please do the same for everyone else. We really need more of that|” Young man, 23 years, St Mary’s
