Adolescents and young people living with HIV (AYPLHIV) have poorer treatment outcomes, face higher HIV risk, inferior access to antiretroviral therapy (ART) and higher loss to follow-up (LTFU) compared with children and adults. Health facilities are often under capacitated to deliver holistic, integrated and comprehensive AFHS for young people. AYPLHIV require specialised and multifaceted support from health providers and communities to remain in care. Such service delivery requires health partnerships at multiple levels between AYPLHIV, peer supporters, health providers and health facilities, national and regional AYPLHIV networks, with all partners equal and important for effective service delivery.
Phakamani Moyo is a young man living with HIV who is engaged as a peer supporter in PATA’s REACH Programme. His role involves providing adherence counselling, health talks, treatment literacy and support groups, alongside health providers at United Bulawayo Hospital (UBH). Through P2Z, he has attended two PATA Youth Summits and one P2Z Local Forum with the national networks of AYPLHIV in Zimbabwe, ZY+. Within P2Z, Phakamani and other peer supporters and health providers jointly designed and implemented a quality improvement plan. This health partnership has encouraged better engagement of peer supporters within the facility as well as supported the facility to provide more AFHS services contributing to improved health outcomes. The work of Phakamani and other peer supporters like him is showing positive results in AYPLHIV adherence and viral suppression, with peer support being associated with an almost seven-fold increase in the likelihood of adolescent viral suppression above that of the UNFPA East and Southern Africa Regional Office (ESARO) rate.
The forums and summits have also served to link Phakamani and his peers with ZY+, both at the events themselves, as well as at ZY+ activities. In creating this linkage and establishing this health partnership, peer supporters are better able to share their service-level issues with networks, which in turn has made the network more representative of and accountable to their constituents. Phakamani has also gained more confidence and skills in communicating key messages and public speaking through strengthening this partnership.
Phakamani was elected as a YAP member at the first youth summit (2016), and again at the PATA 2018 Youth Summit. He was also selected as an IAS Youth Champion (2018-2019), which has supported his participation in the HIV response through focus groups, educational opportunities, and financial support.
He received funding to manage and implement his Friendly Service Delivery (FSD) project, that aims to raise awareness amongst AYPLHIV on HIV-SRH services and improve access and linkage, while building his leadership, advocacy and management capacity. This opportunity has enabled him to engage with and represent his peers’ voices with global stakeholders and policymakers. Phakamani has attended regional and international meetings and conferences (SADC meetings and AIDS 2016 and 2018) and engaged with celebrity advocates in the HIV response including Elton John and Prince Harry.
Phakamani’s story provides a classic case study highlighting the power of partnerships that place young people at the centre. Policy framework changes are not enough to improve services for better treatment outcomes. Change must be affected at all levels, with a focus on creating strong and equal health partnerships. It is the people on the frontline of service delivery and the relationships and partnerships that exist between them at different levels that need to be fostered. Such partnerships are important in the collective HIV response, with increased chance of success and impact when strong partnerships are established at all levels, pooling experiences, resources and skills of peer supporters, health providers, youth networks, programme implementers, policy-makers and communities. Meaningful and constructive health partnerships require clear understanding of different roles and/ or stakeholders, and investments in time to ensure trust is developed on both sides. Such partnerships are essential if we are going to expand access to quality services.