BACKGROUND:The Determined Resilient Empowered AIDS-free Mentored and Safe (DREAMS) program aims at reducing new incidences of HIV among Adolescent Girls and Young Women (AGYW) in the highest HIV burden areas. In sub-Sahara Africa, AGYW are 5 to 14 times more likely to be infected with HIV than their male peers while every day, more than 750 AGYW are infected with HIV. The DREAMS core package aims to empower adolescent girls and young women and reduce HIV risk through youth-friendly reproductive health care and social asset building through mobilizing communities for change with school- and community-based HIV and violence prevention.
CASE STUDY MOTIVATION: Against the background that Gwanda district recorded high rates of linkage to services referred among the AGYW, this documentation exercise for a case study seeks to determine the factors for high service uptake among AGYW on the line list in Gwanda district. In COP 20 PEPFAR expanded AGYW prevention programming to 10 districts in Matabeleland North and South provinces, bringing the successful DREAMS program to a total of 16 districts in Zimbabwe. The 10 new districts were ranked as very high according to the 2019 UNAIDS Incidence Classification for AGYW 15- 24. Gwanda District is one of the expansion districts that started implementing the DREAMS project in October 2020 and is one of most vulnerable districts of Matabeleland south province characterized by perennial El Nino induced droughts leading to high food insecurity and poverty levels. The HIV prevalence rate of the district is 21.9% and there is high mobility of youths including AGYW specially to neighbouring South Africa and Botswana.
IMPACT: Kudzai is a young married woman aged 20, with one child. She is a DREAMS beneficiary who met with the DREAMS Ambassador early this year through DREAMS sensitization meetings. Kudzai was taken through the DREAMS program, and the role of different partners providing services aimed at empowering her, in all facets of life. Kudzai was told about OPHID and MAC the clinical partners offering SRH services at facility and community. Kudzai was informed about the screening process to ascertain eligibility into the DREAMS program done by OPHID and MAC. Kudzai welcomed the idea of being part of the DREAMS beneficiary and she went through the DREAMS eligibility screening process, and she was screened by the DREAMS Ambassador under MAC.by Matabeleland AIDS Council (MAC) as MAC is the screening partner.
Through the screening process, Kudzai was eligible for enrollment to the DREAMS project as per the vulnerabilities listed on the screening form. She was then referred to an OPHID nurse who provides youth friendly services at Phakama clinic. She was tested for HIV, and on further screening she disclosed that she needed family planning services and she preferred access at community level, and she was referred to MAC. Kudzai got to discuss with MAC the types of family planning that they were offering, and she opted for Depo-provera (Depo) as her preferred family planning method. Following the screening process by MAC, Kudzai was referred to Zimbabwe Health Interventions (Z.H.I) who are the DREAMS club partner and Point of Contact (POC) for enrollment into the DREAMS project for the primary package.
Subsequently, Kudzai joined the Phakama Social Asset Building club where she started to attend HIV prevention services training sessions. Through the knowledge gained from attending the HIV prevention sessions, Kudzai decided to get tested for HIV so that she may know her status.
“I was referred by the Out of School Club Facilitator who was responsible for facilitating the HIV prevention services to an OPHID nurse based at Phakama clinic where I was assisted and offered proper counselling prior to receiving HIV testing services” says Kudzai.
Kudzai, is now an Empowered young woman who knows her HIV status, who knows how to keep her sexual life healthy and who knows how to plan her family together with her husband. Kudzai used the knowledge that she gained from the DREAMS project to improve her marital life as she can now openly discuss with her partner on issues pertaining to their sexual life.
“I didn’t have the confidence to discuss our sex life with my husband but after the exposure to the DREAMS program, I am proud to say that I have also managed to encourage my husband to go and get tested for HIV testing and as a community champion I am prepared well on using the knowledge and services received from DREAMS to raise awareness to other Adolescent girls and Young Women in my community”says Kudzai.
Kudzai is also one of the beneficiary who received economic strengthening interventions, through ISAL trainings offered by Zimbabwe Health Interventions at Phakama clinic. She really appreciates the DREAMS project as it empowered her to be a self-reliant young woman who can make informed financial decisions and started her own business of buying and selling.
CONCLUSION: The case study of Kudzai brings out the role played by each DREAMS partner in reaching out to AGYW in Gwanda District as the partners work together to build AGYW who are Determined, Resilient, Empowered, AIDS-free, Mentored, and safe. The role played by DREAMS partners in Gwanda district in reaching out to AGYW with clinical services is well appreciated as most AGYW are not at liberty to receive these services at their local clinics due to quite several dynamics. These dynamics center around unfriendly environment at health centers as well as the long distances that some AGYW will have to travel to get these clinical services at their local health facilities.