PROJECT OVERVIEW
Having access to comprehensive sexual and reproductive health (SRH) services is imperative to a person’s health. Pangaea Zimbabwe provides SRH services to adolescents and young adults through the SHAZ!HUB. SHAZ!, which stands for “Shaping Adolescent Health in Zimbabwe is a youth drop-in centre and comprehensive sexual health clinic for adolescents and young adults aged 16-24 years located at CitiMed hospital (Ward B) in Chitungwiza. The hub has been operating since 2003, first as an NIH research clinic, and now as a “safe space” for all young people in the greater Chitungwiza area to relax and have fun, to study and gain life skills, and to access health services in a welcoming and discreet environment. The hub offers the following services:
Free comprehensive sexual health and HIV services: We have qualified nurse counsellors at the centre who provide HIV testing, STI screening and treatment, pregnancy testing, provision of short to medium contraception, treatment of minor ailments and counselling and support sessions. Pangaea Zimbabwe links with Population Services Zimbabwe in the community for the provision of long-acting family planning methods provided through contraceptive implants. The hub also offers oral PrEP to adolescents and young people who are HIV negative but at high risk of HIV infection. This includes young key populations (young men who have sex with men (MSM), young girls selling sex, young female sex workers, and transgender youth around Chitungwiza and we collaborate with Population Services International (PSI). The SHAZ! HUB also offers access to voluntary medical male circumcision, and it is linked with the OI/ART clinics at CitiMed and the Chitungwiza Hospital so that young clients living with HIV can access HIV care and treatment while receiving adherence and social support from counsellors and peer supporters at the hub in collaboration with Zvandiri.
This “safe space” model has been scaled up through the opening of the Mazowe SHAZ!HUB at 1068 Westview in Glendale (near Twin Baobab school). The hub offers similar services as the Chitungwiza one. Clients for long-term contraception and OI/ART clinic services are referred mainly to Tsungubvi clinic. The hub also works in collaboration with peer supporters from Zvandiri. and also refers those in need of mental health support to Friendship Bench. Economic strengthening lessons such as the making of pine gel, dishwashing liquid, and so on are also given at the hubs to empower adolescents and youths We have two projects hosted at the Chitungwiza SHAZ!Hub. These are the Combination HIV Prevention (CHIP) project and MOSAIC’S CATALYST Study.
Over and above, we have two projects hosted at the SHAZ! Hub. These are the CHIP project and MOSAIC’S CATALYST Study.
CHIP Project
The Combination HIV Prevention (CHIP) Project is being implemented in two areas namely Chitungwiza and Mazowe. Chitungwiza is a peri urban town situated in the Seke district in the Mashonaland Province. Mazowe is a highly HIV burdened farming/mining district located in Mashonaland Central Province. The CHIP project uses a peer-to-peer model to mobilise clients to seek services at the hubs. CHIP Champions from the respective communities are engaged and capacitated through validated training material to provide peer-to-peer support. They mobilise youths through conducting literacy sessions and community dialogues to raise awareness and link peers to preferred and appropriate SRH and HIV services.
Main Objectives
- To improve access to comprehensive youth-friendly HIV prevention and SRH services to AGYW and ABYM
- To build the capacity of healthcare workers in Seke and Mazowe districts to provide comprehensive and quality youth-friendly HIV/SRH and KP-friendly services
- To enhance knowledge on HIV prevention, care and treatment, and SRHR services among AGYW and ABYM
- To raise awareness, improve availability, and increase uptake and continuation of various HIV prevention methods for AGYW and ABYM
- To improve the livelihoods of AGYW and ABYM through economic empowerment
Scope of work
In Chitungwiza, there is an already existing hub/safe space, and the one in Mazowe is scaling up services, drawing lessons from the Chitungwiza hub. The priority population is adolescent girls and young women (AGYW) (16-24) in their diversity that is including sex workers, lesbians, queer and transgender women. The secondary priority population is adolescent boys and young men (ABYM) (16-24). The intervention uses three themes (biomedical, behavioral, and structural) to provide combination HIV prevention. The biomedical intervention offers HIV testing through differentiated service delivery models, including distribution of HIV self-test kits. The behavioral component delivers a behavior change curriculum to address knowledge gaps and an economic empowerment curriculum. The structural theme advocates for policy changes such as the provision of integrated HIV/SRHR services and the removal of age restrictions in accessing these services.
Target population
AGYW, ABYM in their diversity (16-24)
Geographical areas
Seke and Mazowe districts
Implementation period
2023-2025 – 3-year project
Results
Since 2023, a substantial improvement in service uptake has been achieved among diverse adolescents and young adults. This progress is attributed to youth engagement in literacy sessions and outreach initiatives, which have successfully linked them to a comprehensive suite of health services. These services include HIV testing (HTS), access to modern contraceptive methods, screening for mental health concerns and sexually transmitted infections (STIs), and seamless initiation of PrEP for HIV-negative individuals and antiretroviral therapy (ART) for those testing positive.
Testimonials
In Zimbabwe, where stigma and discrimination create significant barriers to healthcare access for men who have sex with men (MSM), positive testimonials from MSM who value services at the hubs is a milestone:
“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 uncomfortable sharing information, but after she assured me that she would not judge me and wanted to help me, I felt at ease, and 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.
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.
The 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), sex before the age of 15, or forced sex. One AGYW selling sex shared how the project has benefitted her:
“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.