The impact of the DREAMS partnership on HIV incidence among young women who sell sex in two Zimbabwean cities: results of a non-randomised study

Chabata, Sungai T; Hensen, Bernadette; Chiyaka, Tarisai; Mushati, Phillis; Musemburi, Sithembile; Dirawo, Jeffrey; Busza, Joanna; Floyd, Sian; Birdthistle, Isolde; Hargreaves, James; Cowan, Frances M

doi:10.1136/bmjgh-2020-003892

Cited by 31 publications

(34 citation statements)

References 28 publications

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“…The SHG intervention was delivered as part of Zimbabwe’s nationally scaled HIV prevention and treatment programme for sex workers Sisters with a Voice (Sisters) , which offers a wide range of social and clinical services for high-risk women, including AGYW [ 19 , 22 , 26–29 ]. The intervention was delivered in four high-density communities in Harare, Zimbabwe, characterised by small, clustered houses shared by several families, low education levels of resident adults, low-wage and informal employment, and high turnover of residents.…”

Section: Methodsmentioning

confidence: 99%

‘I was in need of somewhere to release my hurt:’ Addressing the mental health of vulnerable adolescent mothers in Harare, Zimbabwe, through self-help groups

Chingono

Kasese

Miles

et al. 2022

Global Health Action

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Background Adolescents experiencing multiple vulnerabilities, including poverty, curtailed education, transactional sex and early childbearing, are at risk of poor mental health. In Zimbabwe, girls who are pregnant or new mothers and involved in selling sex struggle to cope with the combined pressures of parenthood, financial insecurity, and social stigma. A pilot intervention brought such girls together into self-help groups to increase peer support, resources and skills. Objective This study aimed to explore whether and how participation in a self-help group intervention affected vulnerable young mothers’ experiences and perceptions of mental health stressors. Methods Self-help groups received 12 participatory sessions over 6 months. Eighteen semi-structured interviews and three focus group discussions were held with participants and drop-outs. Before and after the intervention, participants completed the locally validated 14-item Shona Symptom Questionnaire tool to indicate the probable prevalence of common mental health disorders. Results Adolescent girls described mutually reinforcing stressors in their lives and reported low self-esteem and anxiety. Key themes emerging from qualitative data centred around girls’ struggles with adverse life events, the burden of new motherhood, social isolation related to sex work and self-help groups as a source of hope. Participants joined groups to obtain support and felt their mental well-being improved due to new social networks, feelings of solidarity with peers, and increased confidence for positive action, that is, seeking health services for themselves and their babies. Prior to enrolment 16% showed signs of possible common mental disorders falling to 2% at follow-up. Conclusions Participants believed involvement in interactive self-help groups improved their mental health by strengthening peer support and engendering hope for the future. Although reduced mental distress cannot be attributed to the programme, the pilot intervention offers a low-cost approach that could be rigorously tested and adapted to a wide range of community settings.

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Section: Methodsmentioning

confidence: 99%

‘I was in need of somewhere to release my hurt:’ Addressing the mental health of vulnerable adolescent mothers in Harare, Zimbabwe, through self-help groups

Chingono

Kasese

Miles

et al. 2022

Global Health Action

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“…15 We reported a steep rise in HIV prevalence among those aged between 16 and 19 years, suggesting high HIV incidence, consistent with a recent study that reported incidence to be up to 7.1/100 person-years among 18-to 24-year-olds who sell sex in Zimbabwe. 16 In addition to age, we found education (lower level of attainment), marital status (being divorced or separated), and having experienced physical violence/abuse from a client to be associated with being HIV-positive. Young women who sell sex in Zimbabwe have previously been reported as being less able to negotiate safe sex and more likely to have higher risk partners compared with older sex workers.…”

Section: Discussionmentioning

confidence: 76%

Brief Report: Adolescent Girls Who Sell Sex in Zimbabwe: HIV Risk, Behaviours, and Service Engagement

Rice

Machingura

Maringwa

et al. 2022

JAIDS Journal of Acquired Immune Deficiency Syndromes

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Background:To reduce HIV incidence among adolescent girls who sell sex (AGSS) in Zimbabwe, we need to better understand how vulnerabilities intersect with HIV infection and how those living with HIV engage in care.Methods:In 2017, we conducted social mapping in 4 locations in Zimbabwe and recruited girls aged 16–19 years who sell sex, using respondent-driven sampling or census sampling methods. Participants completed a questionnaire and provided finger prick blood samples for HIV antibody testing.Results:Of 605 AGSS recruited, 74.4% considered themselves sex workers, 24.4% reported experiencing violence in the past year, 91.7% were not in school, and 83.8% had less than a complete secondary education. Prevalence of HIV increased steeply from 2.1% among those aged 16 years to 26.9% among those aged 19 years; overall, 20.2% of AGSS were HIV-positive. In the multivariate analysis, age, education, marital status, and violence from a client were associated with HIV. Among the 605 AGSS, 86.3% had ever tested for HIV, with 64.1% having tested in the past 6 months. Among AGSS living with HIV, half (50.8%) were aware of their status, among whom 83.9% reported taking antiretroviral therapy.Conclusion:The steep rise in HIV prevalence among those aged between 16 and 19 years suggests the window to engage with AGSS before HIV acquisition is short. To accelerate reductions in incidence among AGSS, intensified combination prevention strategies that address structural factors and tailor services to the needs of AGSS are required, particularly ensuring girls enroll and remain in school.

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“…Three major topics were explored: ( 1 ) Prior (before CHIEDZA) family planning experiences ( 2 ) Family planning experiences of attending CHIEDZA, and ( 3 ) Family planning preferences.…”

Section: Resultsmentioning

confidence: 99%

“…Two-thirds of people with HIV globally live in Sub-Saharan Africa (SSA) ( 1 ). In eastern and southern Africa, adolescent girls and young women (AGYW) aged 15–24 years old accounted for 26% of all new infections in 2018 ( 2 ). In Zimbabwe, HIV prevalence among adults in 2020 was estimated at 12.9% and the prevalence is higher among women (15.3%) compared to men (10.2%) ( 3 ).…”

Section: Introductionmentioning

confidence: 99%

Family Planning Experiences and Needs of Young Women Living With and Without HIV Accessing an Integrated HIV and SRH Intervention in Zimbabwe-An Exploratory Qualitative Study

Mavodza

Busza

Mackworth-Young

et al. 2022

Front. Glob. Womens Health

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BackgroundPeople living with HIV have higher unmet family planning needs compared to those without HIV. This is heightened for young people. However, the provision of family planning for young people within HIV programmes is uncommon. We investigated family planning uptake, acceptability of, and engagement with a service offering integrated HIV and sexual and reproductive health services for youth in a community-based setting in Zimbabwe.MethodsCHIEDZA, a community-based intervention offering integrated HIV and sexual and reproductive health services to young people aged 16–24 years, is being trialed in Zimbabwe. This exploratory qualitative study was nested within an ongoing study process evaluation. Data was collected between March-May 2021 with two sets of interviews conducted: I) twelve semi-structured interviews with young women living with HIV aged 17–25 years and II) fifteen interviews conducted with young women without HIV aged between 20 and 25 years who used a contraceptive method. A thematic analysis approach was used.ResultsBefore engaging with CHIEDZA, young women had experienced judgmental providers, on account of their age, and received misinformation about contraceptive use and inadequate information about ART-contraceptive interactions. These presented as barriers to uptake and engagement. Upon attending CHIEDZA, all the young women reported receiving non-judgmental care. For those living with HIV, they were able to access integrated HIV and family planning services that supported them having broader sexual and reproductive needs beyond their HIV diagnosis. The family planning preference of young women living with HIV included medium to long-acting contraceptives to minimize adherence challenges, and desired partner involvement in dual protection to prevent HIV transmission. CHIEDZA's ability to meet these preferences shaped uptake, acceptability, and engagement with integrated HIV and family services.ConclusionsRecommendations for an HIV and family planning integrated service for young people living with HIV include: offering a range of services (including method-mix contraceptives) to choose from; supporting their agency to engage with the services which are most acceptable to them; and providing trained, supportive, knowledgeable, and non-judgmental health providers who can provide accurate information and counsel. We recommend youth-friendly, differentiated, person-centered care that recognize the multiple and intersecting needs of young people living with HIV.

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The impact of the DREAMS partnership on HIV incidence among young women who sell sex in two Zimbabwean cities: results of a non-randomised study

Cited by 31 publications

References 28 publications

‘I was in need of somewhere to release my hurt:’ Addressing the mental health of vulnerable adolescent mothers in Harare, Zimbabwe, through self-help groups

‘I was in need of somewhere to release my hurt:’ Addressing the mental health of vulnerable adolescent mothers in Harare, Zimbabwe, through self-help groups

Brief Report: Adolescent Girls Who Sell Sex in Zimbabwe: HIV Risk, Behaviours, and Service Engagement

Family Planning Experiences and Needs of Young Women Living With and Without HIV Accessing an Integrated HIV and SRH Intervention in Zimbabwe-An Exploratory Qualitative Study

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