Seven things we’ve learned working with young people

1. Put young people at the centre

READY+ has a holistic approach. One of the programme’s key strengths is how it’s dealing with a range of components that make up a young person’s life. For example, every young person is accessing high quality information on HIV, treatment, and other issues that affect their lives. All too often we find that programmes tend to focus on one area when we know that human beings are far more complex than that.

Peer support is at the centre of the READY+ programme and we’ve adapted the Zvandiri peer support/Community Adolescent Treatment Supporter (CATS) model by taking it further and including advocacy and community sensitisation. We go beyond the individual to also provide information to caregivers, healthcare workers and policymakers. So, when young people enter ‘safe spaces’ such as support groups or health facilities that provide youth-friendly services, they can expect to receive a package of care and responsive services.

2. Work with governments to sustain care

In all four READY+ countries [Mozambique, Zimbabwe, eSwatini and Tanzania] the Ministries of Health have endorsed the CATS model. As a result, young people now play an important role in improving the local health system: providing essential support to their peers to promote good treatment adherence and doing referrals to care including sexual and reproductive health and rights (SRHR) and psychosocial support.

We’re also complementing the government’s approach to health system strengthening by promoting the meaningful engagement of young people in health service design and implementation. This also includes advocating for high-quality youth-friendly health services. As such, in partnership with the ministries, READY+ is contributing to national health targets by making sure these activities are in place for young people even when funding ends.

3. Peer supporters help healthcare workers to deliver

In many health facilities, nurses are overwhelmed with routine health care and promotion, so much that there is often a lag in providing youth-friendly health services. For instance, through READY+, we know that young people, trained as healthcare providers or CATS, provide critical support in health facilities.
In eSwatini, a nurse said the work they’re doing with the CATS has helped them to reach young people who are considered ‘hard-to-reach’. These people weren’t accessing their medicines and  didn’t know they were living with HIV because their caregiver hadn’t disclosed their status. Through some of the CATS sharing their disclosure journeys, the caregivers have understood that, with appropriate support, it is OK to disclose. Now, we see more young people being recruited into the READY+ programme for ongoing care.

We shouldn’t only interact with young people when they are not taking their treatment but follow up with regular check-ins regardless. Moreover, CATS are playing an important role, and the nurses appreciate it. But we must ensure that they are properly supported, not overloaded and given appropriate tasks and responsibilities.

4. Supportive communities are essential

READY+ influences the whole continuum of care and fosters the growth of young people: growth to be able to advocate for their needs and priorities. It’s not just about adherence to treatment, but them being able to speak out as advocates and have a safer community.

We’ve also found there are certain aspects that healthcare workers can’t respond to. For instance, when young people leave the health facility and go home it is important they feel safe. Does their caregiver know how to deal with this young person? How do they talk about dating when a caregiver is asking questions that might make it difficult for the young person to open up? We want to make sure caregivers get to know the person they’re living with and understand that young people living with HIV need support with things beyond just their health. READY+ also contributes to fighting any stigma that may exist against young people living with HIV at home or in the wider community to promote a safer environment.

5. Give young people a future

One of our key challenges has been retaining CATS to stay in READY+ when other programmes offer other peer supporters a financial incentive to reach targets, beyond the stipends that READY+ gives. As such, it is important to come together as partners coordinated by the Ministries of Health and find common ground. For example, several CATS in eSwatini left the programme to do similar work and while one programme gains, another is negatively affected. Some young people regretted their choice and wanted to come back to READY+.

Across the four READY+ countries there is a drive to have para-health workers such as CATS on the front line to encourage them to take on non-clinical tasks. These could include tracking young people who default on their treatment to mitigate the effects of the acute health worker shortages on the health of adolescents and young people living with HIV. CATS also have varied aspirations. Some want to do design or hairdressing, but many look up to clinical staff and are inspired to continue in the health sector, particularly in Zimbabwe. They have the experience and don’t want to waste those skills.

6. Build a new generation of advocates

Networks of young people living with HIV are seeing local advocacy successes and taking global action. But we need to assist them more in how to document their advocacy and the challenges they face. Often, networks will focus on a particular issue and meet with policy makers with an agreed agenda only for the policy makers to focus on issues they wanted to highlight. So, in the end, young people can’t document their action. We need to enable them to guide discussions and better understand the nature of the people they are meeting.

7. Invest in data collection processes

We need high quality data to improve our programming and the lives of young people. Despite the challenges in data collection, if we could invest in strengthening M&E systems at community level – this would give us better information to inform our planning and engagement with partners. And most importantly, real-time data would mean we could respond quickly to the needs of young people.

Chengetai Dziwa is the senior adviser monitoring and evaluation at Frontline AIDS.

READY+ is run by a consortium of partners led by Frontline AIDS with Africaid, CANGO, M&C Saatchi, REPSSI, PATA and Y+. The READY+ Mid-term Review assesses progresses and provides recommendations for future programming.