By Kudakwashe Pembere
When some adolescents living with HIV describe their relationship with guardians, it is like they were reading from the same script yet they are different young boys and young girls, in different times, different geographical areas.
Much like Deborah Cox and the late Whitney Houston singing Same script different cast, in this case, it was an expression of their hatred towards their guardians.
Through the writer’s interactions with these Community Adolescent Treatment Supporters (CATS), it was clear they were still agonizing and angry about being HIV positive.
In 2018 in Mashonaland West, at Banket Hospital, Rutendo (not real name) said she was angry at her guardians for not disclosing her HIV status. Her mother died when young to be cared for by her aunt, the mother’s sister.
“I remember my aunt giving me some tablets saying they were paracetamol preventing me to get so many headaches,” she said.
After enduring some bullying at school because of some skin rashes, and having lost her brother, anger overwhelmed her.
She was angry at her caregivers.
“I am angry at my guardians for not telling me my HIV status sooner,” the then 19-year-old said.
In 2022, for Sheila, then 19, seated in a shade, facing away from the media, fielding some questions, she was still bitter about the late disclosure of her HIV status.
“I will never forgive my parents for not telling me my HIV status. I don’t think I can forgive them,” she said.
From Chitungwiza district, Mufarowashe Nyatondo aged 20 said despite learning about HIV in school in South Africa, he was still angry at his father for not disclosing him the HIV status.
He said his mother, now late had HIV and being the only child with HIV, it was a bitter pill to swallow.
“I was angry at my father because he used to tell me that the tablets, he gave me where for the stomach aches and headaches. I wished he had told me at 10 years of age about the reason I took those tablets,” he said.
He said after counselling he forgave his surviving parent.
“The counsellors told me that during the time I was born, governments were still developing the PMTCT program. I have realised that guardians or parents to these adolescents will be secretive about the adolescent’s HIV status fearing to hurt them,” said Mufarowashe.
While anger is not classified as a mental disorder in the Diagnostic and Statistical Manual of Mental Disorders (DSM–5), it is linked to many mental health conditions, including: antisocial personality disorder. Anger is common amongst many adolescents living with HIV.
With Zimbabwe having surpassed the 95-95-95 HIV targets, adolescents particularly adolescent girls are a key population where much needs to be done.
Training these CATS in counselling other adolescents, helping them alongside their adolescents to accept the HIV status, is Zvandiri an organization that has been in existence from 2004 complementing government’s efforts in reducing the HIV burden in Zimbabwe.
At Zvandiri, the counselors are embedded in government clinics under the Ministry of Health, and ensure everyone gets tested, support and empowerment to accept their status. These counselors become their anchor, helping them adhere to treatment and overcome stigma.
“Mental health was a key component right from the beginning in 2004 and I say this because adolescents said to us we’re starting to get antiretroviral medicines but we need more than that if we’re to survive and thrive so taking their ARVs wasn’t enough they wanted safe spaces and skills to learn how to thrive with HIV so how to cope with all the multiple challenges that they face. So the foundation of the model was that we integrate mental health and psychosocial support within HIV care and treatment,” said Zvandiri Executive Director Nicola Willis said.
A Mental Health Psychosocial Support for Community Adolescents Young People Living with HIV (MPSS CAYPLHIV), a study done by Zvandiri found that 65 percent of adolescents are at risk of developing mental health disorders.
“And what you can see looking at the data at Zvandiri, 65 percent have no distress or disorder and I should say that the evidence from young people with HIV shows that up to 65 percent of young people are at risk of a mental health condition. Twenty-one percent have got mental distress, 11 percent have got a mental health problem and only 3 percent have a mental health condition,” she said.
She added that young people even aged 19 years old are still struggling with accepting their status.
“We are finding young people who don’t know about their HIV status as old as 19 years old especially when they find out or they are suspicious themselves. They have a high viral load. They are failing treatment. They are often struggling with their mental health. So its all connected,” she said. “And the new guidelines, in fact they’re not new, it’s been accepted for a while, from 10 years old young people with HIV should be informed of their status. From 16 years old we can start talking about that. So what we have to do is start helping families to actually get to that point of making that decision, which we all understand is difficult. We also have to help clinics, nurses, counsellors, who are phenomenally busy, to help them find the time for a counselling process which we all know can take time.”
International AIDS Society (IAS) Young Champion Paul Mavesere-Ndlovu said it was critical to invest in mental health interventions for adolescents and young people.
“Children and adolescents living with HIV continue to fall behind in UNAIDS 95-95-95 targets. Studies have shown that poor mental health affect adherence and viral suppression outcomes especially among children and adolescents.
“Hence to address the unmet needs we must invest and scale up evidence based mental health peer-led interventions such as the Zvandiri model,” she said.
