In Swaziland, supporting adolescents and young women is key to HIV prevention

November 28, 2017

At first, some of them are shy. They look around, waiting to see how much others are willing to share before speaking themselves. But when they break into small groups, they all start to relax. On one side of the room, the boys scrawl an all-caps heading on top of flipchart paper: WAYS OF GETTING HIV FROM A GIRL. On the other side of the room, the girls title their work in all caps as well: POSSIBLE WAYS IN WHICH A GAL CAN GET HIV DURING SEX.

They’re young, between the ages of 15 and 24. But it’s the right time to have this discussion – many in the room are sexually active, and some are already parents. And once they warm up, they’re all candid, which meshes perfectly with Mphikeleli Dlamini’s facilitation style. Mphikeleli, the Prevention Manager for Pact in Swaziland, is facilitating a safe sex training to open the quarterly Youth Advisory Board (YAB) meeting.

YAB members are ambassadors in their communities. They come from the eighteen Tinkhundla, or districts, where the project is implemented. YAB aims to develop a cadre of youth with strong leadership skills, building on the belief that young people shouldn’t simply be passive recipients of interventions, but should be engaged as individuals with the capacity to become empowered agents of change in their own lives and in their schools, families and communities. In Swaziland, developing this group of empowered leaders is a critical part in the fight against HIV and AIDS. While the country has made significant progress in addressing the HIV and AIDS epidemic, it still has the world’s highest prevalence at just over 27 percent. ­­­

Umliba Loya Embili, funded by USAID/PEPFAR with supplemental funding from DREAMS, works to improve the HIV prevention and impact mitigation needs of vulnerable adolescents and young women. The program targets systemic issues that prevent adolescents and young women from thriving, and aims to create a generation that is healthy, resilient and living in environments where families, communities and civil society promote their optimal care, protection and well-being.

The implementation area of Umliba Loya Embili overlaps with several areas of Pact’s Voluntary Medical Male Circumcision (VMMC) program, making an integrated implementation approach possible. Pact works with nine partner organizations to scale up evidence-based HIV services to vulnerable adolescents, increase access to HIV prevention services to young women and strengthen the institutional capacity of local organizations to effectively contribute to an HIV and AIDS-free generation.

YAB is just one piece of this extensive program. During the opening session for the quarterly meeting, Mphikeleli teaches the YAB members about relationship skills, safe sex, HIV prevention, gender and strategies for those living with HIV. The kids are engaged – they want to learn these things. Nonetheless, when Mphikeleli pulls out the condoms, the rubber vagina and the rubber penis, there’s an unmistakable wave of nervous giggling and a flutter of seat shuffling. But Mphikeleli and his colleagues, Ebele and Zwakele, are professionals – they let the kids react the way they need to in order to feel comfortable, and then they start demonstrating: This is how you put a condom on a penis. This is how you put a condom on a vagina. It’s real and it’s graphic – but, for these kids, this level of nuance gives them the knowledge and confidence to handle real-life situations in a way that will keep them safe and, hopefully, healthy.

Listening to YAB members describe their experience, a consistent theme emerges: It’s all about empowerment, opportunity, change, growth and self-confidence.

Mandisa Msibi:

“I have learned a lot. Now I’m beginning to understand more about life. How to use condoms, how to tell kids to use contraceptives, how to be a voice of the adolescents. How to talk to others to know their status, and how to share information with others about circumcision.

I’m becoming too powerful. I’m becoming a mentor for the children to know how life is and to understand more. I’ve learned a lot here at YAB.”

Siphiwayinkhosi Msweli:

“I like YAB because it changed my mind. I didn’t know it was useful to use protection. I didn’t know that HIV really existed. When I was not in YAB, I was scared to go test my blood. When I was in YAB, my mind changed. I went to the clinic and I got tested.

“YAB has made me strong. Before, I was scared to stand in front of people. I got into YAB and my fear of crowds went away. It was easy to stand on the stage in front of people. It makes me feel like I’m in a family. At our homestead, they talk about things related to sex and HIV like they are private. They say it’s for older people. But in YAB, they tell us all.”

Simile Zulu:

“Being part of YAB is challenging sometimes because you have to be an example to other adolescents. You have to represent everyone. And someone who represents others should be a good person. YAB has had a great impact on my life. I have to take care of myself. It’s been a great experience for me, I’ve learned a lot.

“People recognize me. And YAB helps us through school. They advise us. They empower us. They tell us: ‘Apply yourselves.’ They tell us about good universities in the world and in this country. I think it’s important. People are happy about this.” 

Umliba Loya Embili also works closely with local partners to support healthy, resilient adolescents and young women and to create environments for them that are safe and nurturing. One of those partners, Compassionate Swaziland, supports caregivers of HIV-positive children and facilitates support groups for children living with the disease.

For Phum’lakahle, an eighteen-year-old girl who was born with HIV, this support has been life changing. “As far as I can recall, I have been taking anti-retroviral medication since I was in grade 1. I never knew why I was taking these medications. As time went by, I learned that I was the only child in my family who was taking medication. I would ask: ‘Granny, what are the tablets for? Why am I the only one in this family who has to take them?’ Unfortunately, she ignored my questions and I never got a clear explanation.”

In 2016, Phum’lakahle was hospitalized due to illness. In the hospital, she learned the truth about those tablets she always had to take. When she returned to her community, she faced increased stigma, with her classmates whispering: Phum`lakahle is HIV-positive, stay away from her. She lashed out, refusing to take her medication. She was so angry with her parents and her grandmother because she knew they would continue to be silent and leave her to deal with this disease on her own. Crushed and alone, she contemplated death.

But her grandmother surprised her. Once she realized Phum’lakahle knew her status, she wanted to support her…she just didn’t know how. So she went to Compassionate Swaziland to learn how to be a better caregiver and help Phum’lakahle live a positive life. She encouraged Phum’lakahle to attend monthly teen club meetings, and things started to change.

Phum’lakahle studied HIV – she learned what it means to have the disease and how the disease affects her body. This knowledge empowered her to better deal with the stigma she was facing in her community. She became an advocate for HIV testing, encouraging her peers to know their status. Because of her confidence and knowledge, the stigma around her faded and her peers learned how to be supportive of someone living with HIV.

Phum’lakahle credits Compassionate Swaziland for changing her life. “They gave me hope for a better and brighter tomorrow regardless of my HIV status. I am no longer angry at anybody and I continue to take my medication every day.”

Umliba Loya Embili strengthens the ecosystem that vulnerable adolescents and young women live in, providing practical support for caregivers and improving the ability of civil society organizations, such as Compassionate Swaziland, to implement programming that changes lives. But the project also values vulnerable adolescents and young women as individuals, giving them the knowledge and confidence they need to not only navigate their own life, but to support other young people to do the same in a country struggling with HIV and AIDS

Nontokozo Mayaba, a new member of YAB, is one of many young women inspired to support others in her community through Umliba Loya Embili. “So far, YAB is everything. We’ve been sharing things with the other girls. It’s something else – it’s amazing! I just wish every girl in my community could be able to hear my voice when I tell them what YAB means, what YAB is. I just wish I could be something to them, like maybe their map.”