SECURING RIGHTS IN THE CONTEXT OF HIV & AIDS PROGRAM (SRP) LET’S TALK DISCLOSURE Hilda Manokore REPSSI PSS FORUM 2015 – VIC FALLS

Page 2 RESEARCH TITLE ASSESSING THE FACTORS INFLUENCING HIV STATUS DISCLOSURE TO AND BY YOUNG PEOPLE (10-24 YEARS) BORN & LIVING WITH HIV AS WELL AS THE EFFECTS OF SUCH DISCLOSURE ON HIV PREVENTION, TREATMENT ADHERENCE & YOUNG PEOPLE’S PSYCHOLOGICAL WELL BEING

Page 3 WHY THE RESEARCH? The study was conducted to generate information to profile and document program interventions in Zimbabwe, particularly the work and program models targeted at YPBLHIV implemented by Oxfam partners, Bethany Project, SAYWHAT and MMPZ under the Securing Rights in the context of HIV Program. The study’s purpose was to examine factors influencing HIV disclosure to and by young people born and living with HIV and how the dynamics of disclosure affect HIV prevention, treatment adherence and the psychosocial wellbeing of young people aged 10–24 years born and living.

Page 4 assess the knowledge, attitudes and practices towards disclosure by both young people living with HIV and their parents/guardians establish the proportion of young people living with HIV in the targeted areas know and have disclosed their HIV status to others understand experiences (social, psychological, emotional, etc.) of young people who have disclosed or not disclosed their HIV status examine the best/preferred ways and developmental appropriate stage to disclose HIV status to young people by their parents/guardians and also self-disclosure to peers understand the benefits of disclosure or lack thereof with regards to adherence and retention to treatment profile and document both the success of programme interventions and the stories of disclosure in Zimbabwe as part of learning, sharing and supporting young people born and living with HIV. Specific Research Objectives

Page 5 METHODOLOGY Qualitative and quantitative data collection techniques and tools were employed within a participatory framework. Separate focus group discussions with young people and their primary caregivers; structured questionnaires were administered with youths. Participatory exercises including the use of dramas (mock gossip), letters about disclosure and life story telling) to share experiences. In–depth interviews were also held with key informants. 200 respondents were selected using purposive and convenience sampling techniques through three Oxfam partners: Bethany Project, MMPZT and SAYWHAT.

Page 6 RESULTS/KEY RESEARCH FINDINGS Those in support groups were more likely to disclose, 73% as opposed to 41%; 53.5% young people had informed someone that they were HIV positive– 44% disclosed to parents, 36% to close associates, 14% to intimate partners and 8% to service providers (school teachers and health workers). Females were more likely to disclose (65%) than males (60%). Young people felt HIV status disclosure was best done on or before 14 years (79%) before sexual debut. However, 69% knew their HIV status before this age. Adults reported adverse consequences when disclosure was delayed, resulting in bitterness with prolonged crying, damage to parent–child relationships and deviant and provocative behavior, loss of hope for the future, withdrawal and depression.

Page 7 RESULTS/KEY FINDINGS CONT. 65% of young people felt positive about life after disclosing their status; 20% felt there was no change, while 7% felt worse. In general, older youths felt more negatively about disclosure than younger, because they are at the key decisions such as finding a marriage partner, bearing children etc. HIV and AIDS knowledge did not translate to positive sexual behaviour as 91% of young men and 78% of young women reported that they would not use condoms in future sexual encounters, due to prior experiences of stigma and discrimination or fear of losing a partner for insisting on using one. Disclosure was associated with receiving positive support; 63% received emotional support and 10% received adherence counselling. However, 27% encountered negative responses, including: stigma & discrimination (17%),discouragement (5%) while 3% experienced rejection, especially by intimate partner; 2% experienced other negative responses. Qualitative techniques revealed that stigma and discrimination are rampant in the form of name calling and isolation in schools and colleagues spousal rejection is also an issue.

Page 8 CONCLUSION The study confirmed that timely disclosure should be before a child becomes a teenager, and the role of support group networks in creating positive young people is important. Attitudes towards HIV status disclosure evolve over time, from worse to better, largely due to psychosocial support, exposure to peers living with HIV, as well as support from civil society organisations. There are benefits to disclosing HIV status: Strengthening of child and primary caregiver relationships Intimate partners are more willing to use condoms Young people improve their health seeking behaviours and adhere to treatment better than those who do not. Young people have more courage to disclose their status to others, especially to adults who can protect them from ridicule by peers. Young people who know their HIV status enjoy increased access to psychosocial and medical support services. Young people are keen to tell other young people and their carers their experiences to support good disclosure and avoid the hurt that results when disclosure is not done well.

Page 9 FOLLOW UP ACTION  As an output to the research the program developed and produced a booklet booklets were produced for those concerned about disclosing right. The program team has engaged with various stakeholders working with the target group….  TALI – Tag A Life  Zvandiri – Africaid  REPSSI  SAYWHAT CONFERENCE  ICASA Platform - November 2015 Zimbabwe (International Conference for AIDS and STIs in Africa)

Page 10 THANK YOU!