The Health and HIV Pillar aims to reduce the number of new infections in intervention sites. Through the Health and HIV initiatives, FACT empowers vulnerable groups such as women, youths, the disabled and children to claim their rights to access treatment, care and support. The pillar will also strengthen women and girls to challenge and reject gender based violence and other harmful cultural and religious practices which contribute to the spread of HIV. More so, the initiatives target the general population, capacitating them to mitigate the spread of HIV and promote sexual reproductive health. FACT’s commitment to a holistic approach to HIV informs its increasing support towards interventions that integrate livelihoods, food and nutrition security. The department also supports the work of the Ministry of Health and Child Care (MOHCC) through offering a variety of health-related social services. FACT’s Health and HIV department works within the three national frameworks namely; The National Health Strategy [2013 – 2015], the Zimbabwe Agenda for Sustainable Socio-Economic Transformation (ZIMASSET) [2013 – 2018) and the Zimbabwe National HIV and AIDS Strategic Plan (ZNASP III) [2015 – 2018].
To attain the general goal of both the department and the organization, the following units are providing support to Health and HIV directly to the various communities where FACT works;
• HIV Testing and Counselling services (New Start)
• ART Program
• Youth Interventions
• Church Communities Programs
• HIV Care and Support to OVC and PLWHIV
• Mobile Populations Road-Wellness Clinic.
• Women’s Rights Interventions. Strategic Goal
Strengthen capacity of communities to respond and cope with HIV, infectious and non-communicable diseases (NCDs), gender based violence (GBV) and other health related issues through delivery of integrated services.
To improve uptake of SRH, HTS and GBV services and products by young people (sex disaggregated) aged 10-24 by 30% by 2018.
2016 - 2018
To increase number of males (10-49 years) by 60% taking up prevention services by 2018.
To increase the uptake of SRH, HTS and GBV services by key populations (sex and KP disaggregated) 25% by 2018.
To increase the number of women & girls participation in leadership and decision making processes at local level by 40% by 2018.
To improve uptake of SRH, HTS and GBV services by 15% of women by 2018
Sexual Reproductive Health uptake and HIV prevention among Youths
With support from UKAID/DFID, FACT reached out to 59 348 young people aged 10-24 (20 011 males and 39 337 females) in Mashonaland West and Manicaland Provinces of Zimbabwe working in nine wards in each of the selected five districts. The goal of the program is to reduce new HIV infections and improve access to SRH services by young people. Below are the key outcomes expected from the SRH project;
i. Youth in selected areas have access to correct information on HIV and SRH
ii. Youth in selected areas accessing HIV testing and counselling and other SRH services
iii. Health service delivery points offering youth friendly integrated HIV and SRH services
iv. Youth friendly environment created in the communities.
To achieve the objectives, the project uses three major approaches which are Join-in-Circuit (JIC) on HIV, Love and Sexuality; Youth Friendly Corners and Sista2Sista clubs. The table below shows the number of young people reached per approach disaggregated by age range.
Youth friendly corners
Achievements worth noting include unlimited access to the following;
a) Opinion leaders actively participating in ASRH awareness
Opinion leaders are important in addressing Sexual Reproductive Health issues for young people and should not be left out. They have the power to influence positive behaviour change if given the platform and recognized in project implementation. FACT therefore, continued to engage opinion leaders in implementation of the SRH and HIV project.
During the reporting period, 227 (that is, 132 females and 95 males) leaders from churches, traditional, professionals like School heads, Nurses, Victim Friendly and Youth Officers and School Development Committees, were engaged in dialogue on SRH issues affecting young people in their communities. Discussions were mainly on progress of the project and how leaders can meaningfully and effectively contribute or influence young people in accessing SRH services at their local clinics. Through discussions, leaders were able to identify SRH issues affecting youths in their communities. These were commonly identified as power relationship issues which make youths unable to freely make their own SRH decisions and choices. Issues such as early marriages, school drop-outs, drug abuse, prostitution, and child headed families and poverty are affecting youths greatly. Leaders identified their role which they saw as important because of the power of influence they have, and could contribute to young people’s access to SRH information and services.
Engaging community structures, results in ownership and sustainability of the intervention. It is viewed as a catalyst for communities to be able to identify and prioritize Adolescent Sexual Reproductive Health. Community dialogues also opened eyes of the opinion and religious leaders on cultural and religious norms that disadvantage girls during their development. Leaders came up with immediate strategies to raise awareness on such practices some of which included inclusion of SRH in community meeting platforms for awareness raising and also strengthening already existing structures for reporting and referral for services.
b) Improving SRH behaviours through Sista2Sista clubs
Sista2Sista club sessions were completed and 12 graduation ceremonies were conducted in December 2016. A total of 54 in Mashonaland West province and 69 in Manicaland Sista2Sista clubs were formed. Young girls appreciated the knowledge they gained from the sessions which they said helped them to make informed decisions. They have become more cautious of their SRH needs and are able to control some bodily demands in a bid to delay early sexual debut.
From their testimonies, it was observed that some girls had already indulged and were in relationships. The knowledge they got emphasized the need to focus on their education which they appreciated as the foundation for their future.
My name is Chipo (Not her real name):
I am 15 years old, doing Form 3 at Chitakatira Secondary School. I used to engage in sexual activities but after attending Sista2Sista sessions, I realised it was all wrong. I stopped immediately and began to focus on my school work. I gained confidence and was tested for HIV. I am a young mother aged 23. I got married in 2011 and have been in marriage for six years. I have four children. Sista2Sista sessions helped me gain information on family planning. I am now on long term method and that enables me to work and raise my children.
c) Promoting uptake of HTS through JIC runs and establishment of youth friendly corners
FACT volunteers using the JIC mobile learning tool. JIC approach is part of the larger behavior change campaign that promotes person to person communication and gives an opportunity for discussion SRH information by young people aged 10 – 24 at JIC runs, establishment of Youth Friendly Corners (18 in Mashonaland West province and 15 in Manicaland) resulted in empowerment of young people to make critical and informed decisions on service uptake which included HIV testing, family planning and Voluntary Medical Male Circumcision (VMMC). Youth friendly service provision at health facilities by trained nurses has promoted uptake of comprehensive SRH and HIV services. The engagement of stakeholders in SRH and HIV issues has enhanced their participation and involvement in creating an enabling environment for young people to access information and services.
Mutare Anti-Retroviral Therapy (ART) Clinic (Treatment and Care Program)
With funding from USAID through PSI, Mutare ART Clinic continued providing services in 2016 with an ultimate goal of preventing mortality and morbidity targeting key populations (KPs) in Mutare urban and Chipinge districts. Key populations who were reached included transactional sex workers. FACT managed to work towards helping adolescent girls and young women to be Determined, Resilient, Empowered, AIDS free, Mentored and be Safe women (DREAMS) through provision of services already cited. The graph below shows achievement versus target on the number of key populations initiated on ART from June to December 2016.
Under the DREAMS initiative which started end of June 2016, Mutare ART clinic managed to initiate clients on ART and Pre-Exposure Prophylaxis. The graphs below shows how the Mutare ART Clinic progressed towards reaching set targets.
Objectives of the ART program
• To prevent new HIV infections.
• To reduce the risk of HIV progression.
• To monitor patients and suppress viral load.
Client Dorothy (not real name) reported to the clinic in a critical condition exhibiting possible signs and symptoms of advanced Cryptococcal meningitis. Cryptococcal meningitis is a serious condition that is characterized by inflammation of the meninges (membranes that covers the brain and spinal cord). The patient also presented with Deep vein thrombosis. DVT which occurs when a blood clot (thrombus) forms in one or more of a person’s deep veins in the body, usually in the legs. This is a serious condition which can be fatal because blood clots in the veins can break loose, travel through the bloodstream and lodge in the lungs, blocking blood flow (pulmonary embolism) and causes death.
The patient’s condition went thorough investigations in order to come up with a correct diagnosis and management. The correct medical management was rendered. She was also referred to Mutare provincial government hospital for admission and close monitoring. There was intensified collaboration between the provincial hospital medical staff and the Mutare ART clinic staff in the management of the patient.
The patient’s condition improved gradually, an indication that she was responding well to the prescribed medication. The patient is now virally suppressed and she verbalizes that she is now feeling better.
Serum Crag [blood test done to exclude Cryptococci (bacteria that causes Cryptococcal meningitis)] results were positive, an indication that there was a possibility that the patient could be having Cryptococcal meningitis. Lumbar puncture (a medical procedure where cerebrospinal fluid is drawn from the spinal cord for examination) results confirmed that the patient had Cryptococcal meningitis.