Cleopatra Shiella Makura is a 2019 AVAC Advocacy Fellow. This post first appeared CHANGE’s blog.

When I hear the phrase “reproductive health,” I find myself having a flashback to each time I was at a clinic either by myself or with someone else. From that I try to understand how and why I get scared about the whole topic, and to my surprise, sometimes I can’t even understand why I get scared. I ask myself this question: Is it worth it to go to the clinic or hospital to get reproductive health services?

Reproductive health is defined as a state of complete physical, mental, and social well-being in all matters relating to the reproductive system. It implies that people can have a satisfying and safe sex life, the capability to reproduce, and the freedom to decide if, when, and how often to do so.

Sixty-two percent of Zimbabwe’s population is young people below the age of 25. Growing up talking about sex was taboo, and one could only get sex-related information from friends and the theoretical information one gets from school is either too scientific or half-baked. Sex education is mostly delivered by tutors and teachers who are almost your parents’ age and the culture clearly defines every adult taking the parental role in society, and schools and colleges are part of society.

Most young people are aware of basic sexual education, however they lack the realities. It is very difficult for young women and girls to decide when they have sex and how. Zimbabwe’s 2012 Violence Against Children Survey found that seven out of 10 girls did not plan their first sexual encounter. Because our culture hands the decision and initiation of sex to men, young girls and women do not decide when and how to have sex. Usually when we are talking about sex education, it’s that moment of flashback and realising the mistakes which would have already been made.

Nowadays, most young people are afraid of getting pregnant rather than contracting HIV. The first thing on a young girl’s mind after unprotected sex is how to prevent pregnancy rather than HIV and other sexually transmitted infections. This can contribute to young women and girls in Zimbabwe at the age of 15 to 17 having an HIV prevalence of 2.7 percent, a figure that sharply rises to 13.9 percent in the 23 to 24 age range, according to 2017 data. Adolescents in Zimbabwe face challenges such as teenage pregnancy, sexually transmitted infections including HIV, unsafe abortions, child marriage, and lack of access to sexual and reproductive health information services.

The golden question is: Why are young people not accessing services? The main barrier to accessing reproductive health services is a lack of youth-friendly services. It’s very interesting that most health workers are trained on how to treat adolescents by people who are far older than adolescents, and who really do not understand the feelings and thoughts of adolescents. Most meetings and youth-friendly packages are based on speculations about how young people want to be treated. There is little to no involvement of young people on matters that affect them.

It is vital to include young people when designing programs which affect them. However, involvement has been tailored to mean showcasing a young person in a room. What we need is a whole group of young people in the room. Young people have different needs and a one-size-fits-all approach does not work. On top of that, we need young people’s voices to be documented. We are sick and tired of attending meetings and contributing our needs, but when information is documented, our voices are not included. Again, nothing for us without us.

Cultural beliefs heighten the risks and worsen the vulnerabilities of young people. Adolescent girls are often already at a disadvantage due to gender discrimination. Young women and girls must overcome not only the crisis of culture itself, but also potential abuse, violence, and exploitation, which can compromise their development and violate their rights. Because of these vulnerabilities, young women need different HIV prevention options.

As a young woman walks her journey of life, abstinence can work at one moment but then there comes a point when abstinence cannot work, and condoms can protect her instead. However, there may be a point when condoms cannot work due to negotiation issues, and pre-exposure prophylaxis can work. But taking a pill every day when you are not sick can be tiresome, and one might prefer the dapivirine ring as it gives a woman power and control. And still others would prefer an implant or an injection.

There is a need for different HIV prevention methods for young people to use. Because if we acknowledge everyone’s needs together, we can end the HIV epidemic.

AVAC is pleased to announce the next offering of its global Good Participatory Practice Online Training Course! This course offering will run May 29 through August 2, 2019.

Click here to apply. Completed applications are due by May 24th.

The Good Participatory Practice (GPP) Online Course is designed for research implementers, specifically those individuals directly responsible for community engagement in a research or implementation context. (To learn more about GPP, click here.) Learners develop practical GPP plans for their context and those who complete the course receive a GPP Implementer Certificate.

For this upcoming course offering, applicants are encouraged to enroll in pairs as team members who have complementary research and implementation expertise, since clinical trials and rollout of new products have a natural relationship with regard to community outreach and stakeholder engagement. An ideal partnership would include someone from the public health or service delivery arm of an institution and someone currently or about to be working on a clinical trial, but all partnerships will be considered.

The pairing is not required for participation but encouraged. We won’t match those who do not have partners but will try to balance the cohort with a mix of those working on clinical trials and those on service delivery and/or public health projects. Over the years of implementing the GPP Online Course, AVAC has learned that the participants who have worked in teams have enhanced their learning experience by having a thought partner to with whom to brainstorm and advocate for tangible changes that can be made at the institution level.

To date, over 150 learners have been certified through AVAC’s GPP Online Course, and nearly all of them have ranked their learning experience as “excellent” or “very good”. The majority report significant gains in their ability to “develop measurable objectives” and “self-efficacy to identify stakeholders”. These metrics indicate learners are better equipped to measure engagement and identify stakeholders in the community who can help advance engagement goals.

Today, a robust pipeline of products are moving through testing, not only for HIV prevention, but for tuberculosis, emerging pathogens, and other disease areas where GPP is being applied. As products progress through trial phases and beyond, important lessons are being learned about translating research into rollout. GPP can play an important role, not only in preparing communities for results and future implementation, but also in incorporating lessons from rollout back into the clinical trials process. By enrolling the pairs as described, we hope that this course can start to add to that body of knowledge.

Join these learners to strengthen your GPP implementation and to add to this growing global community of practice!

For more information about the program, please contact Jessica Salzwedel ([email protected]).

Please join us on May 21, 9-10:30am EDT for a webinar, Breaking the Cycle of Transmission: Increasing uptake and effective use of HIV prevention among high-risk adolescent girls and young women in South Africa—quantitative findings & segmentation.

This webinar is the second in a series presenting the work of the HIV Prevention Market Manager’s project researching what encourages or discourages the effective use of HIV prevention among adolescent girls and young women. Check out part one for the qualitative results.

Click here to register.

This webinar will review the findings from quantitative research on the needs, desires, and structural elements that impact the effective use of HIV prevention products by adolescent girls and young women (AGYW) in places where they are at high risk of exposure to HIV. Join to learn about the results from a survey of 2,000 girls and women and some of the major drivers they contend with as they make decisions about their sexual and reproductive health.

This research initiative of the HIV Prevention Market Manager (PMM) is conducted in partnership with the behavioral research firm Final Mile, user-centered design firm Upstream Innovation and the market research group Ask AfriKa, with the Surgo Foundation providing strategic guidance. The work is funded by the Bill & Melinda Gates Foundation.

PMM applies behavioral research and human-centered design to generate product-agnostic information that will inform the development of HIV prevention interventions that are the most likely to succeed.

The webinar will be recorded and a link posted—and if you have any questions ahead of time, please let us know!

This post originally published by the Center for Health and Gender Equity (CHANGE).

“We’re the generation to make conversations about HIV prevention with adolescents and youth normal among African families.”

These were the words of young women’s health advocates Maria Kapira, Cleopatra Sheilla Makura, Thandie Msukuma, Dr. Lilian Benjamin Mwakyosi and Hilda Zenda during a COMPASS Africa reverse congressional delegation CHANGE hosted on HIV prevention last week.

Maria, Cleopatra, Thandie, Lilian and Hilda traveled from Malawi, Tanzania and Zimbabwe to Washington, DC as our partners in COMPASS Africa and spent one week exchanging their expertise on sexual and reproductive health and rights (SRHR) in US-funded HIV prevention programs for adolescent girls and young women with policymakers, the media and fellow SRHR experts.

COMPASS Africa stands for Coalition to build Momentum, Power, Activism, Strategy and Solidarity in Africa, and aims to provide a comprehensive, integrated HIV response supported by a robust advocacy system that is Africa-centered, addresses non-HIV issues and is high impact and data-driven. CHANGE’s role in the program, which is an initiative led by AVAC, is to hold the US government accountable to its commitments to HIV and AIDS prevention for adolescent girls and young women in the three countries, and to be a resource to in-country partners on integrating sexual and reproductive health and rights in HIV and AIDS prevention programs.

As part of the COMPASS Africa reverse congressional delegation — or reverse co-del — Maria, Cleopatra, Thandie, Lilian and Hilda participated in CHANGE’s signature advocacy tool. We flip the traditional structure of congressional delegations because policymakers need to hear from sources outside of the US government even within the halls of Congress. As such, we bring advocates from countries receiving US global health assistance to the United States to speak truth to power.

The advocates met with Representative Joaquin Castro and Nita Lowey’s staff to discuss HIV prevention programs in US global health assistance. Maria, Cleopatra, Thandie, Lilian and Hilda also met with new members of Congress, including Representatives Andy Levin and Ilhan Omar to educate them on the importance of comprehensive SRHR programs as they onboard in their new roles. They shared compelling stories with policymakers and their staff to provide critical perspectives that are too often missing from the decision making process in Washington.

Maria, Cleopatra, Thandie, Lilian and Hilda also met with staff from Planned Parenthood of Metropolitan Washington to discuss comprehensive sexual and reproductive health care and Whitman-Walker Health to learn about the comprehensive sexual and reproductive health services they provide to the LGBTQ+ community and people living with HIV and AIDS.

The advocates led a media briefing with top-tier media outlets, including Reuters and PBS. To further share their stories, they recorded a podcast episode on the importance of comprehensive HIV prevention in US global health assistance with RePROS Fight Back, a podcast hosted by Jennie Wetter from the Population Institute that features reproductive rights and justice advocates about issues under attack and provides listeners with way to fight back.

We had an exhilarating week exchanging expertise on SRHR, brainstorming solutions for strengthening US global health assistance, and listening to the advocates’ powerful stories. The advocates left us feeling impressed, inspired, informed and invigorated.

As the advocates mentioned during the media briefing last week, we need to work together to change cultural norms so we can have a positive influence on future generations. Our pursuit of SRHR for all the generations to come has never been more critical — and after last week, watching these fierce advocates in Washington, DC, it feels like it might be possible.

Mitchell Warren is Executive Director at AVAC.

It is with an incredibly heavy heart that I share the news that Manasseh Phiri passed away earlier today in Lusaka.

Manasseh was a dear friend and partner: a doctor, writer and radio journalist, activist, advocate, mentor and farmer! Such a long list of roles, each which he managed with passion, courage, wisdom, intelligence and humor.

Many AVACers and partners had the chance to learn from him, enjoy time with him, and be challenged by him at various meetings, workshops and Partners’ Forums. He was also a leading voice in the establishment of AfNHi.

Even when he was diagnosed with prostate cancer and went through many rounds of treatment, he continued to be a passionate AIDS advocate – while also establishing the Prostate Cancer Foundation of Zambia so that he could channel his public health, person-centered commitment to HIV/AIDS and to prostate cancer.

He will be sorely missed on so many levels.

Now up on our Px Pulse page, and available on your favorite podcast platform, is our latest episode of Px Pulse: “The Science of Choice — The future of HIV prevention research”.

This episode features unmissable conversations about some of the challenges associated with today’s HIV prevention options, and analysis about what should be in the research pipeline of the future.

The field of HIV prevention has been buzzing about the US Government’s National Institutes of Health’s (NIH) Funding Opportunity Announcement (FOA) since it was published in January 2019. The FOA is the latest development once again bringing the topic of choice to the lips of advocates, researchers, funders and community members—and hear why in this episode of Px Pulse.

NIH’s Division of AIDS (DAIDS) leader Carl Dieffenbach and his colleague, Director Sheryl Zwerski—speaking at a January meeting of the AIDS Research Advisory Committee meeting—address the portfolio of prevention strategies that sets the stage for this episode. Linda-Gail Bekker, former President of the International AIDS Society and a leader at the Desmond Tutu HIV Foundation, shares her agenda for the “science of choice”. And AVAC’s Manju Chatani-Gada talks to two young women advocates from Zimbabwe, Maximina Jokonya of Africaid, and Audrey Nosenga of Young Positives. These young women explain the limits of prevention today and why more choices will mean greater empowerment.

For the full podcast episode, highlights and resources, visit avac.org/px-pulse. And subscribe on iTunes to catch every episode!