Implementation overview of the SADC Project on HIV Combination Prevention for Youths
Botswana, Namibia and Zimbabwe jointly conceptualized an HIV combination prevention project for Adolescent Girls and Young Women (AGYW). Funded by the Southern Africa Development Community (SADC), the project is being spearheaded by Botswana as the Principal Implementer. The project is geared towards continuing and enhancing the capacities, outputs, outcomes and impact of existing HIV and AIDS programmes in the respective countries. It intends to increase scale and depth of HIV prevention initiatives at the community, local and district, provincial and regional levels thus contributing to national efforts and priorities. The project is being implemented by Botswana Family Welfare Association (BOFWA), Namibia Planned Parenthood Federation (NAPPA) and Zimbabwe National Family Planning Council (ZNFPC) which are leading national SRHR organizations.
By Donald Dube
The project anchors on aspirations of various national, regional and international instruments and frameworks. Prioritization of AGYW programming is articulated in the Global strategy for Women’s, Children’s and Adolescents’ Health (2016-2030), Maputo Plan of Action (MPOA) 2016-2030 and Agenda 2063 among others. According to the Strategy for Sexual Reproductive Health and Rights in the SADC Region (2019-2030), girls and young women continue to bear the brunt of the epidemic, with rates of new infections higher than those for boys of their age. Further, the Strategy notes that interventions ‘will only be effective if they recognize the linkages between HIV and SRHR’, hence the project is taking an integrated approach to deliver combination prevention through an adolescent and Youth Friendly Services (YFS).
ZNPFC is implementing the project in the Matabeleland South province in the Beitbridge district. The province has high incidence rates of HIV, teen pregnancy and school drop outs. ZNFPC service package includes HIV testing services, syndromic management of STIs, PrEP, PEP and VMMC (biomedical), comprehensive sexuality education, parent to child communication (behavioral), sexual and gender based violence (SGBV) (structural) using the already existing youth centres and outreach services. ZNFPC collaborates with multiple sectors including Ministry of Health and Child Care, networking partners and rides on the existing Adolescent Sexual Reproductive Health (ASRH) interventions. The project also targets adolescent boys and young men within the affected areas as secondary beneficiaries. The trained cadres within the districts facilitate involvement and buy-in from the community gate keepers, and ownership from the beneficiaries for sustainability and continuity of care.
The project possess potential benefits to the community. These benefits include;
Reduced number of new HIV incidences among AGYW in the region
Reduced HIV expenditure and care burden at national levels
Strengthened networking and partnership in the fight against HIV
Increased knowledge level on HIV issues among young people especially AGYW
Reduced unintended pregnancies among AGYW
Increased knowledge on sexual and reproductive rights and condom negotiation skills
The implementation model entails service provision by peers in convenient and comfortable locations including youth friendly clinics, home, school and communal spaces such as youth centres, sporting grounds and clubs at convenient hours. Furthermore, services are provided confidentially by trained staff with the right attitude, respect and maintaining adequate time for client-provider interaction HIV testing and counselling services are offered as an entry point and linkages to care occur by HIV positive persons going into treatment and prevention reinforcement for the HIV negative. The project is building capacities for peer led interventions delivered through adolescent and youth friendly service provision model.
Key challenges faced by adolescents and young people include high rates of unplanned pregnancies, early child bearing, early marriages and gender based violence, maternal mortality and STIs including HIV. ZNFPC as an implementing partner is an established, reputable and well recognized provider of family planning and SRHR services. The organization is implementing combination prevention strategies guided by needs assessment, unmet needs and gender based violence trends. The project seeks to ensure that young people have the skills, knowledge and capacity to protect themselves against HIV and assist young people in need to have access to sexual and reproductive health clinical services and combination HIV prevention options.
The varied combination prevention packages comprise of biomedical, behavioral and structural. The biomedical constitute of (HIV testing services, TB and sexually transmitted infections screening, sexual and reproductive health and family planning, condoms and lubricants, antiretroviral therapy, pre-exposure prophylaxis, and voluntary medical male circumcision); behavioral packages constitute of (social behavior communication change, risk reduction programmes, multiple sexual partners, intergenerational and transactional sex, gender based violence, comprehensive sexuality education, peer education and psycho social support) and structural packages include (gender norms and harmful practices, parenting, refer for social protection and economic empowerment programmes). The project also undertakes demand creation and utilize treatment adherence clubs to increase service uptake and provide interventions aimed at addressing issues at personal, family and community levels.