It is almost midday in Tshiyakwakhiwe village, Dlamini in Tsholotsho, the scorching sun’s intense rays’ heat glares down my neck and I quickly break out into more than a little sweat. Loud squeaky voices and cows bellow can be heard from a distance approaching the Gombalume safe space. Tall trees give plenty of shade under the blazing sun and we all rush to take shade while a group of young girls approach us and take shade under the trees next to us.
Among the group of Adolescent girls and young women that arrive one girl with a baby on her back stood out as she confidently greets us and introduces herself. Her name is Lucia Ncube and she is 19years from Tshiyakwakhiwe village ward 2 of Tsholotsho district. Her confidence stuns all of us and we wonder how such a young innocent girl has a 4 month old baby,
“I innocently fell in love with my boyfriend and because of young and immature love we quickly started engaging in sexual activities. He assured me that I was not going to get pregnant if we indulge for the first time and he promised he was not going to impregnate me. I naively believed him and I gave in. A month later, a bomb dropped on me, I was pregnant,” narrated a bright-faced Lucia, you would expect her to sadly share her story but that was not the case with her.
Born and bred in Tsholotsho, one of the most conserved communities in Zimbabwe, Lucia had little to no information on her Sexual Reproductive Health Rights and this was a taboo conversation to be discussed in a family setup,
“Growing up, we never discussed issues to do with practicing safe sex , family planning, and sex in general. As a young girl I was discouraged to talk about such issues. I could have practiced safe sex, avoided pregnancy and being a mother at a young age,” she said.
“Use of any family planning methods was unheard of especially for Adolescent Girls and Young Women who would have never had children. Family planning was attached to myths of possible lifetime infertility yet every woman`s dream is to breastfeed at some point in their life,” shared Lucia.
In January 2022, Lucia enrolled in the Zimbabwe Partnership to Accelerate AIDS Control (ZimPAAC), supported DREAMS program that is being implemented in the Matabeleland North province of Zimbabwe in Lupane, Tsholotsho, Bubi and Nkayi districts.
“The DREAMS program has changed my life for the better. It has opened my eyes. If I had had the information I have now earlier my life would have been different. However there is no need to cry over spilled milk, I have decided to make my life better for me and my son,” said Lucia
“ Now I know how to protect myself while practicing safe sex, I know how to avoid unwanted pregnancies, I have access to family planning methods, HIV self-testing and the use of Pre- Exposure Prophylaxis. Through the Health4Life sessions I have learnt that I have rights to protect myself and my body, I have learnt about financial literacy and how important it is for me to save and start my own business. This is something I had never thought of but now I need to build a bright future for my son.”
“We were trained on ISALS and we have started a group with my friends and we intended to assist each other start a business and build a better future for us,” She said.
Lucia is one of the 27 000 AGYW mentored through the DREAMS program to date to enhance knowledge, strengthen social protection of AGYW, and build social assets. The DREAMS program seeks to reduce new HIV infections among the most vulnerable adolescent girls and young women by 40% in the highest HIV burden districts in Zimbabwe. DREAMS implementing partners (Bantwana and Pangaea Zimbabwe AIDS Trust) under the ZImPAAC consortium prioritize AGYW’s health, wellbeing, and HIV epidemic control through the provision of evidence-based curricular and need-based secondary services.
It is mid-afternoon and the bellowing sound of cows is heard in a distance. The scorching sun’s heat is unbearable and makes it very difficult to walk in the sandy soil of Bubi District in Matabeleland North province of Zimbabwe. Clouds of smoke can be seen from a distance signaling the preparation of midday meals. We walk into Thompson Maseko’s homestead in Vadala village. We go to the neatly thatched kitchen and announce our arrival.
A lean, tall guy walks out followed by two little girls, the resemblance is out of this world, he certainly and without doubt, is the father. Maseko introduces himself to us and lets us know that he is the Padare Enkhundleni Men’s Forum on Gender Male Advocate in Vadala Village. We are excited because he is the one we have come to see.
Padare Enkhundlen Men’s forum on Gender is a movement of men advocating for gender justice in Zimbabwe and is one of the partners under the Zimbabwe Partnership to Accelerate AIDS Control (ZimPAAC) consortium.
The spicy aroma from the kitchen does not escape our nostrils and we hope to see his wife busy in the kitchen only to find out that he was the one doing the cooking for his young girls,
“My wife has gone to work and I am home with my daughters so I was preparing lunch for them,” he said. The look on his face does not show that he is doing something out of the ordinary, for him cooking for his daughters is as normal as any other house chore.
“As a male advocate in my community, I encourage men to challenge masculinity, there is nothing wrong with sharing house chores and helping around the house,” he sternly said.
While we are still doing the interview, Maseko excuses himself to go and serve his daughters food and we are glad to watch him do so. In 2020, He was crowned the best Male Advocate in Matabeleland North where he works with Zim-TTECH and Padare Enkundleni Men’s forum encouraging men to get circumcised and demystify myths around Patriarchy.
“I mainly do one on one interactions with men in my community and I work with my village traditional leadership to encourage men to get circumcised. So far, I have reached over 600 individuals in and around my community. In just a month I meet with around 60 men with whom I have conversations around male circumcision and HIV testing,”
“Now, I have frequent visitors who come to enquire and get insights, some of them I refer to the local clinic for further assistance. We have HIV self-test kits that we encourage people to use regularly,” highlighted Maseko.
“I have seen significant changes in my community since I started as a Male Advocate. I have seen men accompanying their wives to access health services. I have seen men help out with house chores. A lot of men in my community are now seeking health services. They no longer shun visiting health facilities and that is a good sign.” He said.
Male Advocates in Matabeleland North work with the Ministry of Health and Child Care through the Zimbabwe Partnership to Accelerate AIDS Control (ZimPAAC) consortium. Padare in Matebeleland North addresses social norms that promote patriarchal domination and all forms of abuse by men that leads to poor health-seeking behavior and gender-based violations. Male advocates work with other critical stakeholders such as National Aids Council and gender organizations to ensure a coordinated approach as well as ease of referrals. Padare engages men in the communities through safe space dialogues where men challenge harmful and toxic masculinities in an endeavour to create a gender-just society. Apart from mobilizing men for services such as Voluntary Medical Male Circumcision, sexually transmitted infections, and HIV testing services, Padare also supports health facilities with Anti-Retroviral Therapy defaulter tracking. This includes bringing back to care males that would have defaulted or deferred on ART due to different circumstances.
Through dialogues in COP20, male advocates have reached out to 95,729 men and boys since 2020 to date. These are men and boys that participated in the dialogues that were held in communities on social norms. Male advocates reached out to and referred for HTS services 36,596 men and boys. Under Voluntary Medical Male Circumcision (VMMC) a total of 2,0707 have been referred for VMMC. A total of 7722 males have been referred for STI screening and a total of 2900 male defaulters have been followed by male advocates while a total of 3,946 males were challenged to accompany their intimate partners for ANC visits.
Located approximately 155 kilometres away from the Capital city, Harare, lies Guruve, one of the eight districts in the Mashonaland Central province of Zimbabwe. The district capital is the town of Guruve and around 25 kilometres away is Kachute Clinic where Zim-TTECH offers Technical assistance supporting the Ministry of Health and Child Care.
In a bid to improve viral load coverage, Zim-TTECH supports Quality Improvement initiatives to its DSD and TA sites. The Quality improvement team focuses on processes and systems, use of data to improve services, and use teams to ensure quality.
Kachuta Clinic has proved to be one facility that is doing well since the roll out of Clinic Lab Interface QI initiative, as the team has proved to be a force to reckon, with a well-documented QI corner in place with the run charts well plotted up to date with annotations.
“We have monthly team meetings, where we update each other on any issues arising during the course of that month, we set our targets and we do not work in silos. If one of us is not available then anyone among the team members can assist,” said Sister Zvidzayi Munyaradzi, the OI focal person.
These monthly meetings link and allow flow of information within the facility from the Testing area, OI desk and the Laboratory Department as well as allocation of roles and responsibilities.
It is during these meetings that the team, comprising the Nurse in charge, Primary Counsellor, OI Focal person, Primary care nurse and the Microscopist share information, responsibilities, check achievements, go over registers and note areas of collaboration. The NIC appoints one of the nurses to be the focal person of the OI/ART clinic.
Mr Mupezeni, the Microscopist highlighted how the rollout of CLI QI has assisted the facility as they are now able to book the clients in the appointment diary using code3, documentation of the Facility viral load register and transmittal register, identify clients who are due for Viral load sample collection as well use of the Vacutainer system on plasma collection,
“It used to be difficult to track clients due for Viral load, but ever since we rolled out QI and adopted the cohort system it is now easy. We are now able to identify challenges and problems quickly as a team. As I chat to you right now, I can confidently say I can use the Vacutainer system for plasma collection after demonstration during CLI roll out,” said Mupezeni.
“We have clear follow up procedures, and we refer to our registers for any information needed. This is because our documentation in the registers has improved due to QI mentoring and support from the coaches,” he said.
“Drug pick up has also improved, if a client does not show up, we do follow up as this is easy to track in our registers. We have a clear appointment system in place which is very effective and a follow up of missing results tool is in place. For instance, when we send Viral load samples to the District hospital sometimes not all results are sent back to us, so we have a tool that we designed with client details that we will use to follow up on the missing results,” He said.
The Kachute team has proved to be effective as they do not work individually but as a team. This can be evident by the amount of time they have clients at the facility, they work swiftly together as a team and every team member is aware of what needs to be done and how. With walls amassed with charts and graphs, the clinic uses facility-level data to monitor the progress of the QI project using the plotted graphs.
“We do not encourage specialisation at this facility because what happens when the person specialising in a certain area is not around. We do not want to short-change our clients hence we encourage each team member to be and all-rounder,” said Sister Munyaradzi.
It was on the 5th of September 2017, in the evening, when Lucienne (41years) decided to administer an HIV self-test in the comfort of her home together with her husband. Like all the other days, after hectic farm work, Lucienne was tired and wanted to rest but after visiting her best friend who is the Village health worker who gave her an HIV self-test kit, she wanted to do the test that night and get it over and done with.
“I remember the day and time vividly, the 5th of September 2017, around 8 pm in the evening. 20 minutes later the results came in, and we were all HIV positive. We could not believe it at first. How can a self-test kit show that we were both positive? It could not be,” she said.
After a week of deep thinking and chatting to a close friend who advised her to visit the nearest clinic, Lucienne decided to do another test at the local Nyameni clinic in Marondera,
“My husband tagged along, though he was skeptical about it, we were both scared, but we had to be certain and sure of our HIV status. The results came and we were all HIV positive. That is when reality sunk in. We were so angry with each other at that moment,” she said.
“We were quickly initiated on ART. Back home, our Village Health worker who is also a friend stood with us and assisted us with all the information we needed, we forgave each other and started to live positively,” said ever-smiling Lucienne.
Lucienne and her husband are well known at Sambok farm as they live an open life, they do not hide that they are living with HIV and take their medication openly.
“I am not ashamed of my status, my children know our status, and taking our medication is a family business, my children remind us every day of the need to take our medication religiously,”
“Being HIV Positive is not the end of the world. One can live a healthy and normal life if they adhere to taking their medication as prescribed,” she said.
Zim-TTECH, under the Zimbabwe Partnership, to Accelerate AIDS control consortium, strives to reach hard-to-reach communities through Community outreach approaches where clinical services are provided to the community. Services such as Viral Load sample collection, HIV testing, Cervical cancer screening, ART Refill, Condom Distribution, and PrEP initiation and uptake are provided during the outreach.
Lucienne gets her Viral load sample collected, ART Refill, and Cervical cancer screening services all at once.