Youth Edutainment Services Trust (YES Trust Zimbabwe) is a youth-led CSO who promote youth access to SRHR information through edutainment and multimedia advocacy campaign strategies. The YES Trust Zimbabwe team share how they collaborated with local leaders and community structures to improve HIV prevention for adolescent girls and young women (AGYW) in Zimbabwe.
Plumtree, in the rural Mangwe District of Zimbabwe, is a busy border town. Traffic flows constantly throughout the day as people travel to and from Botswana. There is extensive male migration to South Africa and Botswana in search of new opportunities. In Plumtree, alongside the arrival of travellers, traders, and workers, comes challenges for sexual and reproductive health and rights (SRHR).
In Zimbabwe, AGYW are twice as likely to contract HIV than boys and men. According to the Zimbabwe Population-based HIV Impact Assessment in 2020 (ZIMPHIA 2020), Matabeleland South province – where Plumtree is located – had the highest HIV rates in the country at 17.6%. Here, 22% of women are HIV-positive, compared to 9% of men. A 2020 study conducted by YES Trust Zimbabwe identified five vulnerable groups in Plumtree as being at elevated risk of HIV infection. These are AGYW, including those in sex work; truck drivers; migrant labourers; informal traders; and young people. Girls as young as 14 years old engage in sex work. Young female informal traders are often forced to exchange sex for transport from taxi and truck drivers. Many face daily harassment including physical and verbal abuse. The National AIDS Council of Zimbabwe (NAC) 2022 report revealed that Plumtree has a high rate of new HIV infections among AGYW compared to other border towns and communities.
To address this issue, the Ministry of Health Zimbabwe is rolling out new preventative HIV medications, called pre-exposure prophylaxis (PrEP), for AGYW in Zimbabwe. These are the dapivirine ring, an insertable vaginal ring; cabotegravir (CAB-LA), a long-acting injectable; and oral PrEP tablets. Despite the Ministry of Health’s effort introducing and distributing HIV prevention products, low levels of funding and low uptake due to a lack of information among potential users has hampered rollout. Therefore, there is need to complement the Ministry’s effort by promoting and creating demand for PrEP products and increasing uptake and usage among AGYW at risk of HIV infection.
‘Save Them Young’
In Mangwe rural district, a comprehensive package of public primary health care services are available to ensure access to reproductive choice and health for all AGYW. These include the full range of HIV prevention methods in clinic settings. However, barriers to accessing HIV prevention products include negative healthcare worker attitudes towards AGYW who seek SRHR services and information in communities; social stigma and patriarchal social norms; and long distances to travel to health facilities. The Ministry of Health and National AIDS Council have limited outreach services for AGYW in rural settings. As a result, many AGYW are denied access to the benefits of new HIV prevention products, thereby limiting their reproductive choice.
To support access and uptake, YES Trust Zimbabwe are implementing the ‘AGYW Care+ Save Them Young’ project, focusing on edutainment and multimedia advocacy strategies for improved access to SRHR services and information by AGYW. In partnership with the Ministry of Women Affairs and the Ministry of Youth, YES Trust Zimbabwe mobilise communities with educative messages. At the same time, the National AIDS Council and Ministry of Health offer HIV prevention products and counselling to AGYW through mobile services and outreach.
YES Trust Zimbabwe promote and create demand for PrEP usage among AGYW through an edutainment and multimedia advocacy strategy. This includes sharing messages through radio drama and debates, street theatre, and visual tools like posters. They successfully engaged community leaders and healthcare workers, as well as AGYW, about HIV prevention and where to find products. Through community engagement, YES Trust Zimbabwe are addressing stigma around access to SRHR for young people.
Partners for Choice
YES Trust Zimbabwe used a number of approaches to make sustainable impact:
- Multi-stakeholder approach: YES Trust Zimbabwe identified the different comparative advantages of working with the district-level, ward-level and community-based structures. The project brought together different stakeholders in a one stop approach so communities in rural, remote wards had the chance to receive comprehensive information and services together. This reduced the distances that individuals travel, as on average communities travel more than 10 kilometres to the nearest clinic.
- Deliberate targeting of community stakeholders: The project targeted duty bearers and community-level decisionmakers, including parents, because their roles influence social norms and beliefs that negatively effect AGYW’s access to sexual health services. The project aimed to dispel beliefs that PrEP services promote promiscuity.
- HeForShe campaign: YES Trust Zimbabwe sought to bring men and boys to the forefront of the campaign for PrEP services as partners and as champions. They also deliver key messages on PrEP to other men, reducing stigma and misinformation.
- Radio and community dialogues: An intergenerational forum discussed the different perspectives and views on PrEP services, challenges faced in uptake, and strategies to increase uptake. The dialogues hold different groups accountable and develop context-specific strategies for joint advocacy to increase demand for services.
Looking forward
Already, the project has increased uptake and usage of PrEP among AGYW at risk of HIV infection in rural communities. For example, Empandeni rural ward 1 reported that before the project in 2023, they supported only 2 AGYW to use PrEP. With the introduction of the AGYW Care+ project, in 2024, they engaged over 100 AGYWs, with over 40 showing consistency in use.
Traditional leaders, faith leaders and others who previously viewed the promotion of PrEP as a pathway for early sexual activity and promiscuity are now at the forefront of the campaign for AGYW to take up the services. Through community and one-on-one meetings, these leaders became champions who advocate and support AGYW to take PrEP as their right without fear. These 15 PrEP champions monitor and evaluate health policy implementation, service delivery, and resource allocations for AGYW from the local to national level.
As YES Trust Zimbabwe continues their work, they look forward to building on the current success of their project. They hope to see a reduction in intimate partner violence as partners take the lead to support their partners on PrEP. Additionally, they will continue to improve cooperation among AGYW and service providers through social accountability mechanisms and strengthening evidence-driven advocacy. Finally, they plan to establish Youth Health Centre Committees who would work hand in hand with health care staff in the rural clinics. These came as a result of evidence-based advocacy for youth friendly services.
