Young people transforming the lives of adolescents living with HIV in Zimbabwe.
Community Adolescent Treatment Supporters (CATS) enhancing HIV care and child protection in communities receiving cash transfers
BINGA, Zimbabwe, 3 January 2019 – Thabiso* (22), grew up under difficult circumstances after losing her mother at the age of 6. She lives with her grandmother and four siblings in Siadindi village, a fishing community in Binga district, one of the most underserved areas of the country.
Thabiso never thought that one day she would become an influential force in her community. Leaning on her bicycle, she smiles and speaks proudly of her role as a Community Adolescent Treatment Supporter (CATS), helping to transform the lives of adolescents living with HIV in her community.
“After mum died in 2002, dad remarried [and has a new family] so, many people now look up to him [and] he does not earn enough to cater for all our needs. We hardly had enough money to spend on the most basic needs. School fees were our greatest challenge, that forced my brother who comes after me to drop out of school at form three,” said Thabiso.
I grew up a miserable person with no one willing to be associated with me. At some point I thought I was of no value at all, but through my role as a CATS I am now recognised in our community
The CATS are volunteer counsellors aged 18-24, who are HIV positive themselves. They are trained to provide peer support to young people living with HIV and AIDS in communities affected by poverty, drought, and HIV as part of a ‘cash and care’ model to build the resilience of girls and reduce their vulnerability to HIV/AIDS.
The ‘cash’ component is an unconditional transfer of US$20-50, paid every two months depending on household size under a UNICEF -supported Harmonised Social Cash Transfer (HSCT) programme. Through the pay points of the HSCT, the CATS contribute to the ‘care’: helping to sensitize HSCT beneficiaries on the role and services they provide to children, adolescents and young people living with HIV.
CATS provide support through group meetings, and home and health facility visits. In addition, the volunteers offer counselling services to caregivers to assist them in explaining to minors living with HIV, the nature of their illness and minimise the risk of them defaulting in taking their medication.
Some of the children and adolescents living with HIV have faced stigma, discrimination and sometimes rejection by families as well as abuse leading to failure in adherence to their treatment when issues remain unresolved.
CATS address sexual reproductive health issues, life skills, adherence, and coping skills and are also instrumental in identifying and referring child welfare and child protection cases in the community.
The Zvandiri Programme
Mugove Gonese mentors CATS in Binga district including Thabiso. She works with Zvandiri (‘As I am’ in Shona language), a child HIV sensitive programme implemented by Africaid – a civil society non-governmental organisation supported by UNICEF, the Ministry of Health and Child Care and the Ministry of Public Service, Labour and Social Welfare to keep children, adolescents and young people living with HIV aged between 0 – 24 years, safe and confident. CATS are at the core of the Zvandiri Programme.
“When [CATS] go for home visits, that is when they identify welfare and protection cases through interacting with clients,” says Mugove. “After identifying cases, the CATS then refer them to community childcare workers, village health workers or the Zvandiri mentor, depending on the nature of the case. Those close to Binga are referred directly to Social Welfare.”
Despite her many challenges, Thabiso completed her secondary education and therefore met the minimum qualification to be trained as a CATS. She spends each week travelling long distances, sometimes across difficult terrain, to reach affected young people.
“For those who are on enhanced viral load, I am supposed to do two visits per week but some of the clients stay more than 10km away from my place so sometimes I pushed myself so hard to manage at least one visit. Those on enhanced viral load require frequent monitoring in order to establish whether they are responding to [their medication]. Those who do not respond, I then refer to the clinic where they will be given a different drug,” said Thabiso.
A Holistic approach to multiple deprivations
UNICEF is supporting the Government of Zimbabwe to address holistically, a host of social ills that have manifested in communities because of multiple deprivations for children, adolescents and young people due to ultra-poverty, food insecurity caused by persistent droughts and the impact of HIV through a cash and care model of programming. The Harmonised Social Cash Transfer programme (HSCT) and the National Case Management programme were launched in 2012 with support from UNICEF and the Governments of the UK, Sweden and Switzerland, with complementary funding from the Governments of the Netherlands and Japan, to strengthen care for children and adolescents living with HIV and supporting services for the most vulnerable children in El Nino-affected communities, respectively.
Under the Zvandiri Programme, UNICEF supports training and the procurement of supplies for the CATS including the provision of T-shirts (for visibility and identification), bicycles and mobile phones loaded with a real-time monitoring and reporting application.
Zvandiri Mobile Data Application
Zvandiri Mobile Data Application (ZVAMODA) is the application that facilitates the recording and uploading of each contact by CATS with their clients. The data captured is transmitted to a central point at the district office where the Zvandiri Mentor reviews, responds and make necessary referrals in accordance with social workers.
Having a mobile phone and a bicycle enable Thabiso to visit regularly and connect with her caseload of 30 clients. “The coming of bicycles has brought a great relief to me. [Before] it was not possible to see all [my clients] in a month,” said Thabiso. “The [mobile app] gives me the opportunity to escalate and refer some issues straightaway to the Zvandiri Mentor and get feedback on how to respond, without having to wait for monthly support group discussions to be in contact with the mentor.”
CATS can also refer to other service providers, cases of children in need of birth registration, education assistance, nutritional support or Assisted Medical Treatment Orders (AMTO), through which Government helps vulnerable children receive critical medical attention.
“Clients get antiretroviral medication for free, but when they develop other opportunistic infections for which they need to pay for medication, that is when they use AMTO,” said Thabiso.
CATS experience inspires a new career path
Her successful role as a CATS, has led Thabiso to select a new career path. “When I was growing up, I wanted to be a police officer but now I have set my eyes on a mentor position. I have enjoyed working as a CATS. Seeing people I have helped, getting better, motivated me,” Thabiso said.
The duties of the mentor involve coordinating activities of the CATS as well as offering them refresher training. Thabiso developed soft skills that will help her achieve her dream of becoming a mentor at some point in future. “[Her] confidence is growing by the day. She does not mind speaking in public addressing her peers,” said District Mentor, Mugove.
Before becoming a CATS, Thabiso had an indifferent attitude towards people living with HIV but that has now changed. “I used to think it is better for those who are positive to die than to spend their whole life taking pills. I thought that is burdensome,” said Thabiso,
through the training I received, I realised that one can live a normal life and pursue dreams of choice just like anyone else.
*Name changed to protect identity.