HIV Reimagined podcast: Conversations for change

The first episode of the HIV Reimagined podcast discussed the big and small changes in health service delivery and met service users, programme implementers, and experts from around the world. Our studio guests and contributors are not only highlighting lessons from HIV programmes, but also featuring the insights and innovations that are making health care better for all.

In this first episode, our conversations focused on mental health programming and practice. Dr. Shaffiq Essajee – host of HIV Reimagined and Senior Advisor at the HIV and AIDS Section, Health Programme Group, UNICEF – spoke to Raj Mariwala and Peter Badimak Yaro about how mental health is perceived, the needs and challenges for mental health programmes in their respective regions, and the changes they have seen in the field through their careers.

Raj Mariwala is the Director of the Mariwala Health Initiative, which is an advocacy, capacity-building and grant-making organisation based in India focused on accessible mental health for marginalized communities. Peter Badimak Yaro, a social development worker and public mental health specialist, is the Executive Director of BasicNeeds-Ghana, a mental health and development advocacy organisation.

The studio guests discussed the stigma surrounding mental health and access to mental health care, changes needed in policies and programmes, the impact of community-focused initiatives, the need for integrated physical and mental health services, and much more.

Features

Mary Wadzanai Munetsi, Implementation Manager at the Friendship Bench, Zimbabwe

What if a grandmother in your community was trained to provide talk-based therapy? The Friendship Bench took a page out of peer support models and added the cultural context to train community members, ‘grandmothers’, to provide Cognitive Behavioral Therapy and Problem Solving Therapy. The programme was designed with comprehensive community research and proven interventions in mental health to specifically create safe spaces within a community.

Read more about the Friendship Bench’s impact and evidence. To find more resources and keep up with news about the Friendship Bench, sign up for its online community.

Noor (name protected), a young queer individual from the Middle East and North Africa region

When an individual must lie to a health worker about their identity and mental health needs, they are likely not receiving the support and care they need. This was Noor’s story before reaching a non-stigmatizing mental health provider through the MENA Moves project. The USAID-funded MENA Moves project was implemented by FHI360 in Tunisia, Morocco, and Algeria between September 2021 and October 2022. It sought to address the high unmet need for mental health support for HIV programme providers and beneficiaries by providing free, confidential, mental health care to program implementers and vulnerable groups, including young lesbian, gay, bisexual, transgender, queer, and intersex people and those of other diverse sexual orientations and gender identities.

For Noor, the project was not only personally helpful but also displayed a model to expand quality mental health services to marginalized communities that face many barriers in accessing care. Learn more about MENA Moves at FHI360.

Refilwe Mafojane, Technical Advisor, Anova Health Institute, South Africa

Youth Care Clubs is a group-based model integrating HIV clinical management and psychosocial support for adolescents and youth living with HIV. Youth Care Clubs provide a safe space for young people to connect with peers and interact with trained health workers without facing stigma and discrimination. During the COVID-19 pandemic, these spaces continued to provide psychosocial support and fostered improved health outcomes through virtual delivery. This model has reduced long wait times in clinics and improved the delivery of adolescent-friendly health services, signaling an opportunity for more integrated services.

The episode was hosted by Stephanie Ndlovu, an actress and advocate from South Africa. In addition to acting in the show  MTV Shuga, a series that aims to help young people navigate various health issues including sexual and reproductive health and rights, she is the co-Chair of MTV Staying Alive, an international initiative focused on behavioral change.

She was joined in the studio by our panel of experts to discuss the challenges of mental health services for young people, the promise of peer support models and digital tools, and the critical role young people play in shaping effective health care policies and programs.

Nicholas Kee is an advocate and technology expert serving on the U-Report Youth Council in Jamaica. 

Miriam El-Mahdi, is a global health student interested in sustainability and digital health. 

Viet Minh Trinh is the Health Program Coordinator at Lighthouse Social Enterprise in Vietnam, and an advocate for young key populations and LGBTQ+ youth. 

Mutua Ndereva is an artist and activist from Kenya raising issues in his community through art.

The impact of mental health on young people, especially during times of crisis like the COVID-19 pandemic, takes center stage in this episode. The pandemic exacerbated the social, economic, and psychological challenges faced by young populations. Viet Minh Trinh raises issues faced by LGBTQ+ youth in Vietnam who were increasingly isolated in vulnerable situations, and faced further stigma and discrimination during the pandemic. Mutua Ndereva highlights the devastating consequences of pandemic-related job loss among young people in an informal settlement in Nairobi. More people were facing mental health challenges at the same time that barriers to accessing health care services skyrocketed. Miriam El-Mahdi notes that many of these barriers for mental health care had already existed – rather than introducing new tools, including digital interventions, during a crisis, there is an urgent need to build up and sustain avenues for comprehensive mental health support for young people.

They discuss the digital space as holding immense promise for improving health care services for young people, especially by providing another avenue to facilitate peer-to-peer interactions and implement proven models of peer support. Peer-led initiatives and programmes, such as those championed by Lighthouse and MTV Staying Alive, serve as a bridge between young people and the health services they need.

The discussants address the importance of including young people meaningfully in decision-making. For health care systems that are responsive to the needs of young people and especially for young key populations, those individuals must be at the center of programme planning and policy making. Young people should have a central role in designing health care services tailored to their needs – not just for HIV prevention and care but also for broader sexual and reproductive health services as well as mental health care and psychosocial support. Ultimately, improving the health and well-being of young people hinges on giving them governance spaces and compensation to represent their peers, advocate for their needs, and help shape systems.

Features

Vuyokazi Vuyolissa, peer educator from MTV Shuga

MTV Shuga is a series under the MTV Staying Alive Foundation that focuses on sexual and reproductive health, HIV, and other health priorities for young people. In addition to delivering critical health information through the drama series, the campaign supports peer education on the ground, training young people to be sexual health educators in their communities. Vuyokazi Vuyolissa works on a peer education program called Ukulungisa Ubuntu (Mending Humanity) in South Africa. Using videos featuring young individuals sharing their stories and perspectives, the peer educators create a safe space and facilitate open discussions with groups of young people in the community about gender-based violence and sexual health. For many participants, this is one of the first opportunities to express concerns, ask questions, and share their experiences related to sexual and reproductive health with a group of peers.

Jay Shapiro, founder of Usiku Games; Arnold Mwanjila, head writer at Usiku Games

Jay Shapiro is the founder of Usiku Games, a social impact game developer based in Kenya, and chairperson of the Pan Africa Gaming Group (PAGG). Usiku Games combines the evidence on peer support and behavior change with the power of technology and gamification. The games, as head writer Arnold Mwanjila explains, are not preachy or prescriptive but rather provide users with various elements within the games’ stories that reflect real-life behavior. These role-play games often include health-related behaviors and have potential to connect young people with critical prevention and treatment interventions. Notably, Usiku Games strives to center locally relevant stories and situations that are relatable to users in Africa.

Nelma Passe, national volunteer for sexual and reproductive health at Voluntary Services Overseas (VSO International); translated by Kate Sutcliffe from VSO International

 VSO International and Light for the World are the implementers of the EAGLE or ‘Empowering Adolescent Girls to Learn and Earn’ project in Mozambique. The project works with adolescent girls and young women who are out of school to achieve economic independence. As part of this project, Avert developed the Yaya app, a learning tool that aims to provide 3000 adolescent girls and young women with a user-friendly, self-directed set of action, orientated knowledge-based resources on life skills, sexual health, and relationships.

National volunteer Nelma Passe discusses the process of co-creating the Yaya app and shares how the co-creation process made this new digital health intervention more acceptable to the community. Engaging adolescent girls and young women in the app’s development and design became an intervention in itself to boost their confidence and empower them to share knowledge about sexual and reproductive health. The co-creation process showed that many participants already knew of potential solutions to various challenges in the community but lacked confidence and external support. Her experiences highlight that to improve sexual and reproductive health outcomes, creating these spaces to engage the community as partners is as important as sharing health information. Learn more about the Yaya app and watch a demonstration.

As the speakers in this episode overwhelmingly emphasize, young people know what they need from health care systems. Their active involvement in the design and implementation of health care policies and programmes ensures that the services adequately meet those needs. The panelists remind us that we all have more to do to guarantee that young people's voices are heard and prioritized in order to build a more inclusive and compassionate health care system.

Episode 5, the final episode of this season of HIV Reimagined, zoomed in on a service delivery approach that was scaled-up in many regions during the COVID-19 pandemic and has demonstrated impact in decreasing health care costs, reducing barriers to treatment access, and improving health outcomes: multi-month dispensing.

With the multi-month dispensing – or MMD – approach, health care providers dispense medications to clients for an extended period, typically three or six months rather than the conventional one-month supply. In this episode, host Dr. Shaffiq Essajee (Senior HIV Advisor, UNICEF) spoke to a service user, health care workers, a peer educator, programme planners, and a government representative about the implementation of MMD, and the challenges and opportunities presented by this approach.

For studio guest Dr. Nathan Ford, scientific officer leading HIV service delivery at the World Health Organisation, MMD is about empowering people, allowing them to access the needed treatment more conveniently. In this episode, he traced the evolution of MMD from an innovative pilot programme in Mozambique led by Médecins Sans Frontières to the acceptance of the model by the scientific community, its addition to WHO guidelines, and expanded recommendations for implementation for children, adolescents, and pregnant and breastfeeding women living with HIV.

Studio guest Dr. Lydia Mpango discussed how the restrictions added by the COVID-19 pandemic led to scaling up the roll-out of MMD in Eswatini. MMD was adopted in the country over a decade ago with a focus on adults and then expanding to older children; in the last few years, the approach has further expanded to include younger children, and pregnant and breastfeeding women. Dr. Mpango is a clinician as well as the senior clinical services advisor for care and treatment for the Elizabeth Glaser Pediatric AIDS Foundation (EGPAF)'s ASPIRE Project, which provides technical assistance to the National AIDS Program in Eswatini on paediatric and adult care, treatment, and support.

In many countries, the MMD service delivery approach gained speed during the COVID-19 pandemic when lockdown policies prevented people from traveling to clinics. New policies and programs helped scale-up the implementation of MMD models, and expanded guidance to relieve the heightened burden on health care systems and facilitate treatment continuity. 

Features

Paballo ‘Mota, a service user, with Sister Motekoa Monaheng, EGPAF HIV clinical nurse

Paballo, a young mother from Lesotho, shares her experiences in accessing treatment with MMD compared to the previous approach of picking up a one-month dose at a time. She cites the long and difficult transport to the clinic as a barrier each month. With MMD, not only does she have to travel to the clinic less but also spends less time waiting to see a provider at the clinic. Sister Motekoa Monaheng, an HIV clinical nurse in Lesotho, adds that because fewer clients have to attend the clinic each day, providers have more time to attend to each client. In their experience, MMD has helped retain patients more by reducing wait times, frequency of traveling to the clinics, and associated expenses.

Makaletso, mentor mother at mothers2mothers

Makeletso works with mothers2mothers as an HIV testing services mentor, providing HIV and syphilis counseling and testing services in her community. She is a mother and service user who has seen firsthand the impact of MMD in her community. Makeletso describes the long lines and wait times at the clinics before MMD was rolled out, which was difficult for both health care providers and patients. As a mentor mother, she highlighted efforts like phone outreach that connect clients to the care they need in between appointments and ensure other services, such as blood tests, are not missed even as the frequency of clinic visits are reduced.

Dr. Arinatiwe Ivan, Senior Programme Officer, AIDS Control Programme, Ministry of Health, Uganda

Dr. Arinatiwe Ivan is the national coordinator for differentiated service delivery within the Ministry of Health in Uganda. He explains how the expansion of MMD during the COVID-19 pandemic and restrictions in movement were especially useful to some populations, such as young people and adult men who were less likely to seek frequent refills at the clinics. Viral load suppression and retention in treatment improved among these groups. He also emphasizes the importance of trainings and mentorship for health workers as well as the effective monitoring of stocks to facilitate the roll-out of MMD.

All of the speakers in this episode highlight how multi-month prescriptions help both patients and health systems – a seemingly small change in service delivery improves the workload and wait times at clinics, eases the burden on individuals to refill prescriptions, and aligns with broader efforts for decentralised, patient-centred care.

For improvement and expansion, the episode touches on strengthening supply chains and ensuring stock availability to make MMD possible for more individuals. There is also the potential to expand MMD to other disease areas, including common co-morbidities for people living with HIV.