By Rumbidzai Chidora, Africaid Zvandiri, Zimbabwe and Sharon Amongi, YAPS (Young Person and Adolescent Peer Supporter), Uganda
We are young people living with HIV, but our lives do not revolve around HIV. We have busy, exciting lives and we have dreams and plans to attend to. These plans do not involve having to go to the clinic all the time and spending hours in the queue when we get there. We are neither children nor adults; nor are we a homogenous group. Every young person walks into a clinic with different needs and experiences. So we thank the global HIV community for recognizing that services should be tailored to our needs. The concept of DSD recognizes the uniqueness of our lives and experiences and aims for services that are responsive to those needs.
However, DSD models have tended to focus on where and how often we access our HIV treatment. It must not stop there. Multi-month dispensing (MMD) of antiretrovirals (ARVs) is great news for us. It means fewer clinic visits. Fast track means shorter waiting times. But even if we have the tablets in our hands, whether we take them or not is determined by a whole range of issues. Do we understand why we are taking them and why they are important? Do we have others to support us to adhere? What else is happening in our lives that affects our motivation or ability to adhere to ARVs? Our lives are constantly changing – a lot can happen in six months, or even three months. What support is there in between clinic appointments?
As young people living with HIV, we have developed our own response. We are trained as peer counsellors and mentored to support our peers. We are known as community adolescent treatment supporters, or CATS. We support our peers in their homes, through our phones, in support groups and also in the clinics. We plan the level of support we provide for our clients according to their individual needs. One client may be well, attending the clinic and virally suppressed; another may be facing abuse or stigma, depressed and not adhering well.
We work in partnership with the clinics, planning together who needs what, where and when. We are proud that our services have been found to result in high rates of testing, linkage, retention and viral suppression and that the CATS approach is now adopted or adapted in Eswatini, Ghana, Mozambique, Namibia, Nigeria, Rwanda, Tanzania and Uganda.
This same approach is a great platform for other services too. As we grow up, ARVs are just one part of the care we need. Why reduce our ART refill visits if we still have to go to the clinic every month for our contraceptives? We need access to these at the same time as ARV refill visits. But this means that the information and counselling we get should also be differentiated. We are young people who may get involved in sex, but we’re not ready yet for families. Healthcare workers must give us information in a non-judgemental, adolescent-focused way. DSD should also target our caregivers so they support us fully. The same goes for disability, mental health and social protection services.
DSD must go well beyond ART delivery; let’s use this platform to ensure that all adolescents receive a package of services that is responsive to their needs. We have demonstrated that if you put us at the front of service delivery, with mentorship and support from health facilities, this can be done.