BY MUNYARADZI BLESSING DOMA in Mazowe
The Combination Prevention Approach being employed by the National AIDS Council (NAC) and other partners, has gone a long way in terms of reducing new HIV infections in Mashonaland Central Province.
The Province has a total burden of 111 000 people living with HIV, which translates to a 10,35 percent HIV prevalence and is currently on number five nationally.
It was also revealed that new infections used to be very high, but they have since reduced thanks to the Combination Prevention Approach.
According to the Pan American Health Organisation (PAHO), UNAIDS defines combination HIV prevention as rights-, evidence-, and community-based programs that promote a combination of biomedical, behavioural, and structural interventions designed to meet the HIV prevention needs of specific people and communities.
Speaking during a NAC media tour, Edgar Muzulu, Provincial Manager for NAC in Mashonaland Central said the province has eight districts, namely Mazowe, Bindura, Shamva, Mount Darwin, Rushinga, Muzarabani, Guruve and Mbire, where various responses to key drivers of HIV are being carried out.
Some of the key drivers in the province include gender based violence, traditional and religious practices, people with low risk perceptions about themselves and multi concurrent partnerships where there is low condom use.
“In response to these key drivers as a province; we have come up with interventions that are primarily preventative in nature, because our focus is more on prevention so we make use of what we call the Combination Prevention Approach.
“This is a cocktail of interventions or strategies that include Elimination of Mother to Child Transmission.
“Mother to child transmission is one of the major ways that transmission is taking place in our province because most women when they are pregnant, they miss out on getting on ART (anti-retroviral treatment) or in terms of taking the medication that prevents their unborn babies not to get infected.
“Then another intervention that we have when it comes to preventing these problems is the HIV Testing and Counselling Services; that is the entry point of everyone.
“Then we also have Behaviour Change Communication so that people are aware of risks and what ways they can use in terms of reducing risks in terms of new infections,” said Muzulu.
He added that another Combination Prevention Approach is the condom, which is a way of preventing new infections, a way of preventing of unwanted pregnancies and prevention of STIs.
“STIs are one of the major avenues through which people get HIV because if a person gets STIs, they have some wounds which become openings and become easier highways for HIV.
“Then as we do this Combination Prevention Approach; we make use of what we call models, these are community based interventions that are driven by what we call the peer led approach.
“Within each community, they identify each problem and come up with a model suitable to address those problems.
“For example we have gender based violence as one of our key drivers so you see that we make use of what we call the SASA (Start, Awareness, Support and Action) approach which is a model meant to bring about transformation in terms of how people relate, how people view their own norms and values.
“So it is transformative in nature in terms of how people look at what is valuable and in terms of traditional practices.
“You will find out that traditionally in a setting like Shamva, there was actually valuing those traditions like chiramu, kugara nhaka and so forth, which were some of the causes how HIV spreads.
“So you will find that because of the education, it actually focuses on traditional leaders, influential leaders, religious leaders and the approach seeks to make people introspect and relook at how they are living and see which are the practices which are wrong, which are in the negative, which need to be addressed,” said Muzulu.
He added that with the SASA model, people are equipped with skills of trying to raise awareness amongst themselves and they are also given skills of how to respond, how to encourage each other to avoid such practices.
Muzulu further added that they had noticed some positive outcomes as result of the SASA model which is currently being employed in Shamva, in Bindura District under the Global Fund and in Mbire District under a Social Contracting Arrangement.
He also revealed that the Sista-2-Sista Model which is being implemented in Rushinga District under the Global Fund Grant and also from domestic resources, focuses on the adolescent girls and young women, mostly the 15 to 24 year olds.
“With the objective of equipping these young girls with skills of determination, with skills of resilience, skills of financial management, skills of knowing how to manage their own reproductive sexual health.
“In terms of other skills which will prevent them from getting pregnancies early in their lives and prolong getting married and empower them in terms of their livelihoods.
“So it’s a total package that empowers the young girls so that they are able to live and be able to avoid risk behaviours that can lead to them being infected.
“Then the DREAMS (Determined, Resilient, Empowered AIDS-free) Model, we learnt it from our partners, Zimbabwe Health Interventions (ZHI).
“This model also focuses on adolescent girls and young women to inculcate those virtues of determination, resilience, giving the girl child that confidence, so that they are able to realise their dreams. Determined, Resilient, Empowered, AIDS-free, mentored and safe girls.
“If they are mentored, if they are safe, if they are determined, if they are resilient, then they will realise their dreams.”
Muzulu further revealed that for all the models or strategies, they focus on people centeredness, which is why it is community rooted.
He also revealed that train selected volunteers who are known by their own peers so that they are given the skills and once they are given the skills through a trainer of trainers, they then come back to their communities and drive programmes.
Every year a cohort is recruited and they go through trainings from January to December and once they graduate they go back into the communities, while NAC then make follow ups to see if they are using the skills they would have acquired.
Some of the skills that we give them are economic generation programmes, which they are taught to be self-reliant, some do soap making, basket making, while some form groups and lend money to each other.
The Male Engagement is also another strategy whereby boys are engaged at an early stage so as to inculcate a sense of responsibility and a sense of working hard and sense of caring for others and a sense of not being reckless.
Asked why they carry out different interventions in different districts, Muzulu said: “the epidemic is not homogenous, what drives the epidemic in Mazowe is not what drives the epidemic in Muzarabani, so we do what we call problem identification together with stakeholders.
“And we do what we call ranking of problems and we do what we call prioritization. So when you come to Mazowe when they rank their problems, they can tell you that no, we want to focus on adolescents because this is our big problem.
“If you go to Mbire, they can tell you that focus on men because they are causing GBV (Gender Based Violence). So those are the issues now, so the epidemic is dynamic, it differs from one area to another accordingly.”
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