The Ready, Resourceful, Risk-Aware project, locally named Insika ya Kusasa, which means The Pillars of Tomorrow, is a USAID-funded project implemented in Eswatini by Pact, with assistance from the Elizabeth Glaser Pediatric AIDS Foundation and Johns Hopkins Center for Communication Programs. The project is supporting the government of Eswatini to meet the 95-95-95 targets and achieve sustainable HIV epidemic control across this small southern Africa country. The main goal of Insika is to prevent new HIV infections and bolster support and opportunities among two key groups: orphans and vulnerable children (OVC) and adolescent girls and young women (AGYW).
During the five-year project, Pact and its partners are building socio-economic resilience to HIV’s impact and increasing the use of services for HIV, sexual and reproductive health, family planning and gender-based violence. When children and young women enroll in Insika, they gain access to comprehensive, layered services that are specific to their needs. This gives everyone who Insika touches the best chance for a healthy, vibrant life, including participants who are HIV-positive.
Philile Bhembe knew little about HIV when an Insika home visitor began stopping by her house earlier this year. Philile is 29. She lives in Shiselweni with her mother, her siblings and her three children. The oldest is 12 and the youngest is 2.
“One day she asked to talk to me,” Philile says of the home visitor. “I was reluctant and not interested at first, but I just thought I should try what she was talking about.”
The home visitor explained the Insika project to Philile and suggested she join a local Insika-supported group for young women where they discuss HIV prevention and other health topics. The home visitor connected Philile with an Insika mentor, Pinky Ndlovu, who helped her enroll in a group and asked her a series of questions as part of an initial assessment. Pinky noted that Philile had multiple HIV vulnerabilities, including that she was economically vulnerable and had never been tested for HIV. Pinky connected Philile with Insika’s DREAMS on Wheels mobile clinic, where she learned she was HIV-positive.
“It was not easy learning of my HIV status,” Philile says, “but I grew to accept it with support from the clinic nurses.”
Philile was quickly linked to treatment and began antiretroviral therapy, or ART. Insika continued to support her through regular follow-ups, where she gained tools to properly adhere to ART and stay healthy. Insika also supported Philile as she encouraged her boyfriend to get tested. Philile’s youngest child was also referred for HIV testing and was determined to be HIV-negative.
With her family’s health on track, Philile began working through a more comprehensive mentorship plan with Pinky. While discussing her goals for the future, Philile said she hoped to one day become a businesswoman, so Pinky referred her to a specialized Insika business mentor who connected her with business and entrepreneurship training. Soon Philile started a small enterprise selling fruit and snacks at a local school. It became so successful that her profits surpassed what she’d been making at a low-wage job. Philile quit to focus her energy on growing her business.
With more income, Philile is better able to care for her children, which may help lower their HIV risk as they get older. She tells other young women that even when things go wrong in their lives, there are still opportunities for them and a way forward.
“I am now free,” she says. “I am empowered. I can do whatever I want to do.”
Siphetfo Fakudze was born with HIV, but she didn’t learn her status until she was 12. As a child, she missed so much school because of illness that she had to repeat grades. When she finally got tested for HIV, her health issues began to make sense, but her family still didn’t have the information and resources they needed for Siphetfo to thrive.
Now 17, Siphetfo lives in Hosea with her mother and two siblings. Like many participants, Siphetfo got involved with Insika after a home visitor conducted a vulnerability assessment and offered to enroll her and her family in the program. The home visitor worked with Siphetfo’s family to develop a family care plan. Along with other services, it focused on support for Siphetfo to help her adhere to ART, which she’d begun after her diagnosis.
The home visitor suggested that Siphetfo join an Insika-supported ALHIV (Adolescents Living with HIV) Teen Club at a local clinic, where she’d receive treatment adherence, psycho-social and peer support, as well as clinical services including viral load monitoring and ARV refills. Siphetfo soon became a regular.
“Joining Teen Club taught me what HIV is and what it means to live with HIV,” she says. “I was taught how to take my ARVs correctly so that I stopped falling sick frequently.”
Because of her consistent attendance and her commitment to her health, Insika asked Siphetfo to become a teen leader. She enthusiastically accepted and soon began providing peer support to other adolescents living with HIV and co-facilitating ALHIV Teen Club meetings along with a health care worker and an Insika field officer using a set curriculum. She found purpose in supporting other teens facing the same things she was.
Not all adolescents do as well as Siphetfo in adhering to treatment. When Insika noted an increase in the number of teens with low viral load suppression, the project launched a treatment adherence camp to build better treatment literacy focused on understanding the particular challenges of teens. On the last day of the inaugural camp, attendees took part in a treatment adherence celebration, where Siphetfo won the Best Adherence to HIV Treatment Award, as well as a new bicycle donated by World Vision.
In front of 400 other children and teens living with HIV, Siphetfo proudly shared her personal story and how she maintains good treatment adherence and health.
Both young women featured in this story gave Pact permission to share their stories. Philile Bhembe (not her real name) asked that her name be changed here to protect her privacy.
Lead photo: A community health worker speaks with community members in central Eswatini about HIV prevention.