SPIDER’s Digital Health programme is based on the premises that when health information is accessible in concise and non-judgemental formats, in the palm of one’s hand through a mobile phone or at a data-lab in a trusted community centre or radio station, it can assist and encourage one to make informed decisions about one’s health. It is on this premise that SPIDER partnered with the International HIV/AIDS Alliance on the READY project proposal. The READY projects focus on young people and adolescents affected by and/or living with HIV and AIDS and their unique health and social needs. The programme is anchored in East, Central and Southern Africa. It is further divided into three streams of focus, READY+, READY Teens, and READY to LEAD. SPIDER has partnered with the Alliance with specific focus on how the READY portfolio utilises digital development in achieving results and providing adolescents and young people with access to quality services, peer support, addressing side effects of medication and adherence, provision of safe spaces and psychosocial services and integrated HIV/SRHR information. SPIDER is contributing to the ongoing activities with support towards digitalising access to information with the view that the key groups will find online platforms as safe spaces to engage with peers and health care providers in their search for psychosocial services and other information needs.
In this partnership, SPIDER and the Alliance label the digitalising process the i-READY projects, and the digitalising initiative is being implemented in Burundi and Mozambique. In Burundi the Alliance implementing partners are Réseau National des jeunes vivant avec le VIH (RNJ+) and Alliance Burundaise Contre le SIDA (ABS). In Mozambique the Alliance implementing partner is Regional Psychosocial Support Initiative (REPSSI). In order to adequately meet the information needs of the key groups in Mozambique and Burundi SPIDER is employing the integrated research approach in making sure that context specific information needs and digital platform access and use trends are thoroughly understood before implementation can commence. The baseline and needs assessment findings have been conducted by independent researchers from Burundi and Mozambique. In this SPIDER Bulletin, we focus on the findings from these studies. In Burundi, the implementing partner RNJ+ has contributed to one of the radio programmes and would like to build on this work in a more systematic way. In Mozambique the i-Ready project is yet to commence. Presentation of the baseline reports from the two countries varies on this basis.
Recent data from Burundi shows a high prevalence rate of HIV among adolescents. Adolescents are vulnerable to contracting HIV due to lack of or limited access to accurate information on drugs-use, sexuality, alcohol use, HIV/AIDS and Sexual and reproductive health and rights (SRHR). Discussions surrounding these issues are hardly brought to light due to lack of open forums for engagements where the adolescents can seek health information and assistance.
In Burundi, the project goal is to ensure availability of accurate HIV and SRHR information and services in the districts of Bujumbura and Makamba. Four strategies are used to achieve the aforementioned goal. These strategies include a radio program called Biratwerekeye which addresses sensitive issues of adolescents and young people via interactive discussions on radio, public services announcements produced for adolescents and young people, podcasts from Biratwerekeye program which are posted on two radio websites and are made public, and lastly, use of social media sites such as Facebook during and following each radio broadcast to engage listeners.
During focus group discussions parents said that use of tobacco and drugs was frequent during and after the 2015 political crisis. The political climate caused psychological stress to the youth.
Awareness and Vulnerability to HIV/AIDS
More than 93% of the adolescents surveyed were aware of HIV and AIDS but only 37.9% had a clear understanding of ways of preventing transmission of HIV.
One year prior to the survey 11.8% of respondents asserted to having used sharp objects such as razorblades shared with peers and 1.9% had shared injections kits such as needles for non-prescribed drugs.
The study also notes high vulnerability associated with having unprotected sex. 29.3% of the young people both girls (37.5% out of the) and boys (24%) who had had sexual intercourse had been paid for it in cash.
The study also found use of other substances such as alcohol and tobacco to be a health threat to young people especially those infected with HIV. 54.7% of adolescents were alcohol consumers, 10.6% were tobacco consumers and 8.7% were consumers of illegal drugs. Some of the respondents were below the age of 16 and to that effect, consuming alcohol and tobacco is illegal.
During focus group discussions parents said that use of tobacco and drugs was frequent during and after the 2015 political crisis. The political climate caused psychological stress to the youth. Parents also highlighted unemployment of the youth which causes them to join idle groups making them susceptible to use of illegal drugs. Some parents do not give children attention due to polygamous marriages; neither do they dialogue with them and provide counselling on topics of sexuality.
Access to HIV/AIDS services and treatment
The report shows that only 37.3% of all young people who participated in the study had done a HIV test within twelve months prior to the survey. Among those who tested for HIV and obtained test results, 3.2% (representing 1.2% of the total sample) tested positive for HIV.
Despite the awareness of treatment options, 55.9% were not supportive of the idea that one needs to take antiretroviral therapy (ART) unless he or she feels sick. Moreover, 36.6% said they did not see any problems taking a break from medication and yet any interruption to treatment can result on loss of immunity making them vulnerable to AIDs. In addition, the group sampled expressed a need for SRHR information.
Access to Digital platforms
i-Ready Burundi is using ICT tools to engage and reach out to young people who are affected by HIV as well as those who are in need of SRHR services. The baseline therefore investigated how ICTs are used by young people to understand how to better connect with them.
Findings show that 34.8% of the 161 who were surveyed had mobile phones and 11.8% of those with mobile phones have access to internet. 18.6% of Internet users are on social media networks particularly Facebook and WhatsApp and spend 4.9 hours on social media platforms daily. The online activities respondents engage in included communicating with friends, watching movies and listening to music. The study mentions that 23.6% listen to radio while 16.1% watch TV daily.
More than 50% of the Mozambique’s 35million people are below the age of 35 and thus considered as youth. This means that efforts to empower and strengthen their health and well-being are critical for the future of the country.
The i-READY project in Mozambique wanted to know what the information needs of the adolescents and young people living with HIV were, and through which digital platforms/channels they would like to receive the information.
All the research participants lived in poor communities and in the age between 10 and 24, some of them live with HIV and belong to self-support groups and other types of associations.
Research participants highlighted that family was the major source of stigma
When asked what challenges they face in their everyday life the responses they gave have been thematised into the following categories:
Relationships and Family/Community
Research participants highlighted that family was the major source of stigma because parents and other family members rejected young adults who had become parents while having no job prospects and were living with HIV. They experience challenges when it comes to talking to their parents about transformations happening to their bodies, and other social issues related to the matter of sexuality. Some of the communities where the baseline study took place engage in cultural forms of initiating youth to adulthood some of which are sexual and invasive and as such undermine HIV prevention practices. Young women are also in a predicament of being married off by their families.
As noted above, sexuality is not openly discussed in public or private fora. Young people who identified as homosexual did not know who to talk to or where to find information. Youth rely on the local health clinics, HIV clinics and faith-based counselling services available in the community. However, they said that they did not feel safe in these spaces as the counsellors or care givers were often older community members who knew their families. The young people felt that if they could not discuss their HIV status with their parents and then went on to share this information with the counsellor, the likelihood of the counsellor sharing this information with their families was a deterrent to them revealing their status. Besides the lack of trust from their counsellors, the young people also said these same counsellors were from deeply religious backgrounds and therefore extremely judgmental in these exchanges.
In light of the above challenges, poor psychosocial support with mostly unqualified and unfriendly staff was discussed. They struggled with depression and harboured curiosity towards all the changes that their bodies were undergoing. Information and help in acquiring support on how to prevent HIV and STIs, emerged as a top priority. In addition, information and support on adherence to antiretroviral drugs and re-evaluating individual responses/reactions to specific doses was in short supply.
Prevention and treatment
High unemployment rates forced the young people to seek alternative ways to earn money through intergenerational sexual relations that make all parties involved vulnerable to STIs. An appeal for vocational training and employability skills that would address the socioeconomic vulnerability experienced was communicated. Treatment was a challenge when clinics had no antiretroviral drugs which meant going without medication until a new batch of drugs was available. This has severe consequences for risk of developing resistance to the specific regimens and second- and third-line medication may be difficult to obtain
The research team noted the low attendance and response rates from young men, and as such drew the conclusion that digital solutions could be a channel to reach this group. The data also suggests that the digital platforms for the i-READY projects, should take into consideration the social economic positions of young people. Even though they have access to WhatsApp and Facebook and use the social media sites, they do so sparingly to save on costs. The i-READY digital outreach should consider downloadable offline content which can be shared through WhatsApp and Facebook.