A Buddy for life

Two trained “buddies” of Million Memory Project Zimbabwe (MMPZ). Photo: terre des hommes schweiz.

The context of Zimbabwe

In Zimbabwe, 22,000 people are still dying of the consequences of AIDS each year despite of the ability to prevent the onset of the disease. The country today has 13.1 million inhabitants. Over 70% of them are living in poverty and the Human Development Index (HDI) of 0.509 ranks the country 155^th in the world. With an HIV prevalence of 15%, Zimbabwe is one of the most highly affected countries in Africa. Over two thirds of Zimbabweans are under 25. The well-being of this key population group is decisive for the country’s future but less than half of these young people have sufficient knowledge and competence to protect themselves from HIV.

HIV prevention and psychosocial support are directly affiliated with the hospital

In 2005, MMPZ was founded to address the consequences of HIV/Aids on adolescents and young adults and to provide a safety net and support young people. The organization works chiefly in Mpilo Hospital, the largest hospital in the region, where around 6,000 young people per year who are HIV-positive or suffering from AIDS pick up their monthly dose of medication. The organization is based in the hospital which undertakes the young people’s medical treatment. MMPZ complements the hospital’s work and has its core competencies in the areas of HIV/AIDS prevention and psychosocial support of young people.

Fiction stories are used to discuss issues of sexuality. Photo: terre des hommes schweiz.

The need to address young people’s issues specifically

“It is vital not only to understand the general context of Zimbabwe but also the personal context of the youth that we work with“, says Trevor Charalambous, the director of MMPZ. As we have entered today a phase in the epidemiology of HIV where children born with the virus have survived into adolescence and young adulthood. Adolescent stage is an important period for mental health development. Adolescents living with perinatally acquired HIV are affected by the normal pressures of adolescence, along with a number of additional complex interacting biological, psychological and social stressors, which are related specifically to living with HIV. Therefore, MMPZ does not only provide comprehensive sexuality education (CSE) but strengthens personal skills and provides psychological support (PSS) for youngsters. HIV-positive young people very frequently suffer from stigmatization and discrimination as well as abuse at school and in their social setting.

MMPZ ensures that young people gain sufficient knowledge and the necessary support to maintain their treatment and protect their health. Gabriela Wichser, Head of Programmes at terre des hommes schweiz, also emphasizes the significance of working with young people: “During puberty, young people go through a key phase in their lives, which is associated with uncertainty and big questions. It is even more important to take these questions seriously and address them in a needs-based way.” This happens in specific sessions, called “memory work”, where MMPZ staff capture some of the thoughts and feelings of young people to best design interventions.

Including parents and caregivers and letting them experience the same outdoor activities as the youths creates their consent, reduces their suspicion and raises their support. Photo: terre des hommes schweiz.

Families and guardians of HIV-positive young people must be included

MMPZ also undertakes sensitizing work in the direct environment of the youngsters. This includes especially (but not only) work with families, classmates, teachers and nursing staff. “This systemic approach is very important and one of the main reasons for MMPZ’s successful work”, Tayson Mudarikiri explains. The National Coordinator for Zimbabwe at terre de hommes schweiz adds: “All our partner organizations here in Zimbabwe work within what is known as an ecological model to improve the young people’s situation as sustainably as possible.”

The family is the closest and most sturdy part of the microsystem for children and adolescents. They are a support system, a safety net that the adolescents can fall on when the rest of the world shuns them. However, several studies in Sub-Saharan Africa show that HIV and AIDS is destructive and erode the family structure resulting in poor family support structures, fragile connections and broken bonds for many adolescents living with HIV, especially those orphaned by the epidemic.“We’ve noted through our programming that a significant number of these youth are single or double orphans and studies have shown that orphanhood is a significant risk factor for treatment failure as youngsters try to come to terms with their status”, says Cinderella Mushambi, social worker at MMPZ. She leads workshops and seminars for the parents and guardians of HIV-positive young people. “Guardians taking in AIDS orphans are often overwhelmed by the situation. They don’t know enough about HIV themselves; they make the subject totally taboo and are unable to cope with raising their grandchildren, nieces and nephews or adopted children.” For this reason, MMPZ has also developed strategies to include the caregivers of HIV-positive youths in their work.

Youth-friendly medical drop-in centers and psychosocial counselling and support networks

Working with the closest environment of the youth means also working with key institutions where youth interact on a frequent basis. MMPZ has designed the hospital reception area and trained its staff to be youth friendly. “It’s essential that young people in a crisis situation are welcomed with a smile and receive help straight away. We mustn’t forget that we’re not dealing with mere services. Every child here has a human right to health,” emphasizes MMPZ youth worker Sandra Chiomvu.

Young people who are undergoing such a crisis are put in contact with MMPZ staff. They receive psychosocial support and counselling and are then assisted in their everyday lives. This means home visits, invitations to youth group meetings and other events ensure that young people are constantly assisted and supported. This everyday assistance is provided by young MMPZ volunteers, called “Buddies”.

Outdoor activities have shown to strengthen team spirit and cohesion, when being used systematically and debriefed in groups. Photo: terre des hommes schweiz.

Have a Buddy, become a Buddy.

Abundance Moyo is 20 years old and one of these “Buddies”. He benefited from MMPZ’s support some years ago and was included in one of its youth groups. “When I first understood that I was HIV-positive, I was literally paralyzed. I did not know how life could ever continue,” he describes his situation when he first met MMPZ’s staff and youth. “This is when I was introduced to my then “Buddy” Watson. Watson helped me understand that my situation was not hopeless and that I could and would live a positive life. Today I am “Buddy” myself and can help others.”

The “Buddy system” is an everyday assistance offered by the Youth facilitators to other young people newly diagnosed with HIV, those who might be facing difficulties in adhering to their medication, and those who might be finding it difficult to fully accept their HIV status. A “Buddy” is a trained (with both skills and knowledge) young volunteer who is paired with someone newly initiated on ART to offer support in terms of their treatment, possible side effects, what to expect and just offer a helping hand throughout the whole process. This approach allows young people living with HIV not to feel like they are all alone in the world. It teaches to use resources within them to solve issues. Regular home visits are also conducted where the “Buddies” get to interact not only with the young person but also with the caregivers and the rest of the family. This allows to identify supportive families or families who are overwhelmed. The “Buddies” also make it a point that they accompany the clients to their review appointments at the clinic, ensure that scheduled blood tests are done on time, and also track viral loads to check on improvements. The “Buddies” also conduct SRHR sessions emphasizing on protected sex to prevent cases of re-infection and discussing emerging and topical issues in youth sexual reproductive health circles. The “Buddy” system takes a minimum of 6 months before the young person graduates into fully autonomous and successful treatment.

Role plays designed by MMPZ youths to strengthen communication skills. Photo: terre des hommes schweiz.

Protect and support the supporter

The volunteers are closely assisted, too, and constantly receive further training. “It’s important that the volunteers recognize their limits and know when they are unable to help any further and need to request professional help from us,” says Ms. Chiomvu. The “Buddy system” has proved to be a very effective system in improving adherence however an effective framework and measures to support the youth facilitators themselves to avoid burn out and compassion fatigue are crucial. The nature of the work done at MMPZ often has traumatic effects. This has brought about the need to set aside provisions for debriefing facilities at varying periods and levels. Staff are debriefing sessions together with the team of volunteers to avoid burn outs and enhance team building.

MMPZs staff is, however, seldomly called for further assistance. And the success rate of MMPZ is impressive and undoubtedly due to its approach of involving young volunteers in the work. During the project phase between 2016 and 2018, around 2,500 adolescents were able to explain treatment methods. In three years only 412 young people defaulted their treatment. 301 of them have been successfully encouraged to return to treatment. 111 have either moved away or died. 122 of the 301 assisted young people no longer require external help; 135 are still being assisted by young people and the day they take control of their own treatment is in sight. Of the remaining 44 extremely difficult cases, MMPZ staff members are working on reaching the children and their families.”