Traditional leaders are gatekeepers and influncers of opinion, and they play a crucial role in shaping norms and attitudes.
Therefore, their support to community projects is important. No one feels left out, be it key populations (KP).
One leader who stands out is Headman Gandanzara, from Makoni District, Manicaland. Gandanzara and others within the local leadership structures.
Trans Smart, a civil society organisation for the transgender community, strives to cater to the key population, who face challenges in accessing treatment.
Last year, the organisation embarked on Transmartworking with Community Health Advocates (CHAs).
Transmart, led by their Director, Gumisayi Bonzo, a PEPFAR HIV heroine, was among the selected organisations on the first Community Led Monitoring mission in 2022.
She spoke of the challenges encountered by implementing CLM for the first time, including
the limited knowledge among stakeholders regarding the importance of inclusion of Key and Vulnerable Populations in accessing comprehensive HIV services, the lack of treatment literacy in Anti-Retroviral Therapy (ART) amongst the Key and Vulnerable Population users and the negative attitudes of a few health workers hinders access, thus being a barrier to treatment.
“Trans Smart faced challenges in accessing rural clinics. Our CHAs are members of the community and are well known in their home areas. Our programme faced hurdles, and we engaged the Provincial Medical Director, (PMD) and the Provincial Office of the President and Cabinet, (OPC) who provided guidance.
“We got further support from Zimbabwe National Network of People Living with HIV ZNNP+ who facilitated access within different community structures, and since then, our CHAs work very well with the community,” said Bhonzo.
“The challenges faced proved to be an important learning experience in working together with other organisations focusing on different areas of expertise.
“Through engagements in the regions that we were working in, we realised there is more work to be done to ensure that there is effective feedback amongst health service providers, civil society organisations, (CSO’s), local and traditional leadership, which includes the parents of the targeted community,” added Bhonzo.
As the saying goes, if we are to end the HIV pandemic, then everyone should have equal access to treatment,’ this is according to the UNAIDS theme from 2021.
“We encountered sad stories. Stigma and discrimination had become a barrier to the transgender and intersex community. Some nurses would invite fellow workers as if they were consulting to seek clarity or peer support without knowing that they were infringing patients’ rights. This resulted in six people defaulting according to the records we have,” Bhonzo said
Some challenges with access to treatment were also observed with high-risk groups such as artrisanal miners.
Then, one of the main challenges was the distance some had to travel to get ART refills. In the highly mobile small artisanal miners (makorokoza) some were getting resupply from Old Mutare and would have run out of their ART treatment since it is a distance from the areas they are working from, hence they were linked to St Augustine’s Mission Hospital, which is closer to the mining areas.
“We are glad to have brought these few clients who had intermittent treatment,” Gumisayi Bonzo said.
During the implementation of CLM activities, the CHA’s gained some useful insights about the transgender community in the areas of operation. Including the fact that there are some transgender persons who are also sex workers and are therefore at increased risk of contracting HIV.
CHA’s also identified gaps in knowledge on Pre Exposure prophylaxis.
“After identifying gaps in treatment literacy, we, therefore, sat down with them to explain in an interactive manner. It helped as they now understand that as long as one was at risk, they had to continue PrEP and continue using combined prevention measures. PrEP does not prevent sexually transmitted infections,” said Gumisayi Bonzo.
CHA’s further noted that knowledge gaps on PrEP also exist among health care workers.
“We even educated some nurses and village health workers. The health sector keeps losing trained staff as they leave for greener pastures. It is for us as civil society to fill in the treatment literacy gaps, and health care workers alone won’t manage,” added Gumisayi Bonzo.
Health Care Workers pointed out that some of the difficulties with providing accurate information to clients on PrEP could be addressed by providing IEC materials in the local language simplify PrEP.
They made a request.
Due to the capacity building efforts of Transmart for Health Care workers in providing stigma and discrimination free services in their operational areas. Some facilities that were not under their jurisdiction requested to be included in the second phase of the CLM programme.
“Our job was to sensitise the communities, and from the discussions, we found out that stigma was a barrier as transgender people had recoiled into their shells with some missing treatment.”
Through his commitment to ensuring access to rights, treatment, and care services for Key Populations in his area, Headman Gandanzara was singled out as a champion.
The transgender community felt included.
“We, therefore, did not have any challenges coming to his area. We were welcome, and the true sense of leaving no one and no place behind was a lived reality here.
“CLM is not an event. It’s a process, and we were pleased to be in the PEPFAR inaugural cohort. For us, it was a learning curve, and we benefitted in knowledge. The adage , ‘knowledge is power’ rings true. We are an empowered organization now.
Learning does not end, the HIV sector is dynamic, and prevention remains the cornerstone to ending HIV,” said Bhonzo