What a difference an hour can make!

Kate Iorpenda works in the Knowledge Evidence and Innovation Team. Here she shares reflections from  a recent trip to Harare where she saw first hand the work of Zvandiri’s Community Adolescent Treatment Supporters (CATS). 

I have worked with Zvandiri since 2016 and feel I have learnt so much about the role of the peer counsellors known as CATS, who support children and young people living with HIV. However it was only recently that  I had my first opportunity to visit a facility and see their work first hand.

My visit will become the story I will use to describe  the work of the CATS in all my future interactions. I saw for myself what that connection between a Zvandiri CATS and  a young person living with HIV can mean, and what it can achieve.

Adolescent days are often held in the holiday to offer the chance for children and teens to attend the clinic to collect their ART medication, have their viral load tested and  importantly to check in with clinical staff without missing school. It is also the chance for them to connect with their friends and attend a support group meeting with other children and young people. There they discuss important topics such as dealing with stigma, sharing your status with partners or managing medication

Playing cards from the Masas game being laid on the table

When I arrived at the clinic queues had formed at each of the desks as young people booked in, collected their medicines and took the tests the needed. Elizabeth, a tall and smiling CATS, called each person from the front of the line to  sit alongside her and discuss whether they were up to date with their blood tests, screening and ART collections. She shared with each of them the importance of TB preventative therapy or  referred them for additional screening where there were any gaps .

One of the tools used in this interaction is a mental health screening tool which helps the CATS assess if any of the young people visiting the clinic are in need of psychological support. I watched a number of young people talk through the questions on the sheet.

 Towards the back of the line stood a teenage boy dressed in a black t-shirt, he sat down quietly and looked at the floor. He answered the questions without looking up, his eyes tired and sunken, his shoulders hunched. Working through the questions I could tell Elizabeth was concerned with some of his answers as she glanced around for her supervisor between questions. He had been having trouble sleeping, he felt sad and had used substances and at times felt he heard or saw things that others didn’t. Elizabeth reassured him that there was support they could offer him and gestured to her supervisor for support . He appeared with a warm hello and took the young man to a side room to talk and to explore  what was going on. It became clear that despite taking his medication well and having a low viral load things were not right for him, he was struggling, confused and that he was not aware of his HIV status.

The counselling session uncovered a lack of understanding about his medication and confusion about his condition while living in a home where there was little support and nobody to ask questions of. It became clear that his CATS had spoken to his mother who lives away from home, about her struggles to disclose to her child.

As the young man spent time talking to the counsellor, I watched the older group of young people in the support group session in animated discussion about managing stigma and how best to share your status with others. They discussed  the pitfalls, the ways to start the conversation and the reactions to prepare for. Elizabeth had left her paperwork and screening tools and was now up the front of the group, encouraging responses from the group, challenging them on their answers and celebrating their contributions. They laughed and applauded as a confident young woman in a baseball cap shared how she talked to her partner – ‘this is me, this is who I am , take it or leave it’. As the laughter continued  I was guided into a side room where a group of younger children were gathered around a table. They were being led in a game of cards called ‘Masas’ which is used simply and effectively to support disclosure. The cards explain the immune system and how HIV affects the body and it helps children understand how ART treatment works. There in the group was the young man in the black t-shirt, towering above the younger children, he leaned into the discussion tightly holding onto the cards depicting the white blood cells as a soldier, tired from fighting HIV and the germs that cause opportunistic infections.

The CATS finished her explanation and asked a question to the group, and a broad smile crossed his face as he answered her question and laid down one of his cards. That moment was the beginning of the story, the beginning of him understanding HIV and how to live with HIV, possibly the first time in years where things previously unexplained finally made sense. I left deeply touched by the change in his demeanour, his eyes were brighter, a smile creeping over his lips and I left  with immense awe and pride for the young people living with HIV, who take on this work as CATS and have such a profound impact on lives every single day.