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KINGDOM OF ESWATINI Geographic and Programmatic Scoping for Adolescent Girls and Young Women HIV PROGRAMMING IN ESWATINI Design and layout: www.itldesign.co.za Copyright: Eswatini Ministry of Health Publication year: 2019 KINGDOM OF ESWATINI Geographic and Programmatic Scoping for Adolescent Girls and Young Women HIV PROGRAMMING IN ESWATINI Acknowledgments Acknowledgements I would like to express my gratitude to UNICEF staff, especially Leonard Kamugisha, to the Global Fund, specifically Alexandra Plowright, and to Nqobile Tsabedze, Nomathemba, Lungile Tshabalala, and Lungile Nkambule at CANGO for their guidance and support on the development of the Consolidated Report. An appreciation is also extended to the key informants and focus group participants who made time to discuss areas of interest to the scoping exercise. The consultative meetings throughout the document development phase set a good foundation for the geographic and programmatic scoping for adolescent girls and young women, HIV programming in the Kingdom of Eswatini. Lastly, I would like to thank the data collectors who collected data in Mahlangatja, Mhlume and SomntongoTinkhundla. Documentation by: Dr. Nyasha Madzingira Independent Consultant Mobile: +263-773061807 +263-712203745 Skype: dr.nyasha Email: [email protected] Table of Contents CONTENTS Foreword vii Abbreviations and Acronyms vii A. BACKGROUND AND CONTEXT 1 1. Introduction 1 1.1 Purpose 1 1.2 The CANGO Programme 1 1.3 Methodology 3 1.4 Limitations to the Scoping Exercise 4 2. Global and Subregional HIV Situation 5 3. Global, Regional- and Country-Level Policy Environment 7 3.1 Commitments at Global Level 7 3.2 Continental and Regional Policies and Strategies 9 3.3 Eswatini HIV and AIDS Policy Environment 11 B. NATIONAL GEOGRAPHIC AND | PROGRAMMATIC SCOPING OF AGYW 14 4. Statistical Snapshot 14 5. Programme Results 16 6. Intervention Mapping 16 7. Coordination 23 8. Key Global Investments 24 v C. GEOGRAPHIC AND PROGRAMMATIC SCOPING OF AGYW IN 3 TINKHUNDLA 26 9. Statistical Snapshot of the Three Tinkhundla 26 10. Socioeconomic Environment 27 10.1 Living Arrangements for AGYW 27 10.2 HIV and AIDS 28 10.3 SRH and HIV and AIDS Services 31 10.4 Education 34 10.5 Gender-based Violence Response 36 10.6 Civil Society Organizations 37 11. Economic Empowerment Programmes for AGYW 39 12. Community Structures and Systems for HIV Prevention among AGYW 41 D. CHALLENGES 42 13. Challenges/Gaps 42 13.1 Overall 42 13.2 Constraints Faced by AGYW 43 13.3 Challenges Faced by ABYM 44 E. RECOMMENDATIONS 45 ANNEXES 47 Annex 1. Documents Reviewed 47 Annex 2: List of Key Respondents 50 Annex 3: Mahlangatja Clinic Checklist 52 vi BACKGROUND AND CONTEXT A ForewordAbbreviations and Acronyms ABYM Adolescent boys and young men AG Adolescent girls AGYW Adolescent girls and young women AIDS acquired immunodeficiency syndrome ART antiretroviral treatment ASRH adolescent sexual and reproductive health AU Africa Union Commission BSRCS Baphalali Eswatini Red Cross Society CANGO Coordinating Assembly of Non-governmental Organizations CBO Community-based Organization CDC Centers for Disease Control and Prevention CHAPS Centre for HIV and AIDS Prevention Studies CHIPS Children’s Intervention in Swaziland COMM ART Community-centred models of ART COP Country Operational Plan CSE Comprehensive sexuality education CSO Central Statistical Office CSTL Care and support for teaching and learning DHS Demographic and Health Survey DREAMS Determined, Resilient, Empowered, AIDS-free, Mentored and Safe EGPAF Elizabeth Glaser Pediatric AIDS Foundation ESA Eastern and southern Africa ESAR Eastern and southern Africa region FGDs Focus group discussions FLAS Family Life Association of Eswatini GBV Gender-based violence GF Global Fund GKoE Government of the Kingdom of Eswatini HIV human immunodeficiency virus HSS Health system strengthening HTC HIV testing and counselling HTS HIV testing services IEC Information, education and communication IPPF International Planned Parenthood Federation LSE Life-skills education MDR-TB Multi-drug-resistant tuberculosis MICS Multiple Indicator Cluster Survey MITC Manzini Industrial Training Centre MOH Ministry of Health MSF Médecins Sans Frontières MSM Men having sex with men vii NaHSAR National HIV Semi- Annual Review NATICC Nhlangano AIDS Training Information and Counselling Centre NERCHA National Emergency Response Council on HIV and AIDS NFM 1 New Funding Model 1 Cycle from 2014 to 2016 NGO Non-governmental organization NSF National Strategic Framework for HIV and AIDS OVC Orphans and vulnerable children PEP Post-exposure prophylaxis PEPFAR President’s Emergency Plan for AIDS Relief PLHIV People living with HIV PMTCT Prevention of mother-to-child transmission PrEP Pre-exposure prophylaxis PSI Population Services International RA Research Assistant REC Research Ethics Committee RSSC Royal Swaziland Sugar Company SADC Southern Africa Development Community SANU Southern Africa Nazarene University SBCC Social behaviour change communication SGBV Sexual and gender-based violence SHIMS 2 Eswatini HIV Incidence Measurement Survey 2 SMS Short message service SNAP Eswatini National AIDS Programme SRH Sexual and reproductive health SRHR Sexual and reproductive health and rights STI Sexually transmitted infections SWAGAA Eswatini Action Group Against Abuse TA Technical assistance TB Tuberculosis TFFC Taiwan Fund for Children TOR Terms of Reference UN United Nations UNAIDS Joint United Nations Programme on HIV and AIDS UNESCO United Nations Educational, Scientific and Cultural Organization UNFPA United Nations Population Fund UNGASS United Nations General Assembly Special Session UNICEF United Nations Children’s Fund USAID United States Agency for International Development VH Viral hepatitis VLS Viral load suppression VMMC Voluntary medical male circumcision WFP World Food Programme WHO World Health Organization YM young men YW young women viii BACKGROUND AND CONTEXT A. 1. Introduction 1.1 Purpose UNICEF Eswatini Country Office commissioned an assignment entitled ‘Geographic and Programmatic Scoping for Adolescent Girls and Young Women HIV Programming in Three Constituencies/Tinkhundla in Eswatini’. The assignment was divided into two main areas of work, the first being a comprehensive literature review to be complemented by key informant interviews on the status of HIV and adolescent girls and young women with respect to: a) policy; b) funding and; c) programming in the country. The second was the scoping of three constituencies (namely Mahlangatja in Manzini Region; Mhlume in Lubombo Region and Somthongo in Shiselweni Region) in support to CANGO (Coordinating Assembly of NGOs) which is a Global Fund Principal Recipient and will be initiating a programme for adolescent girls and young women (AGYW) in the three Tinkhundla from October 2018. The scoping addressed the following objectives: i. Determine HIV, health, education, social services, gender-based violence (GBV) response, justice/police, community-based organizations based in the relevant geographical areas and their scope of work; ii. Assess existence of income-generating projects/initiatives involving AGYW; iii. Determine social/economic engagements of AGYWs (what occupies their time); and iv. Assess the extent to which there is a community support system that enables AGYW to access HIV and sexual and reproductive health- (SRH) related services. This Consolidated Report is the deliverable for the both parts of the assignment. 1.2 The CANGO Programme CANGO has been receiving funding from the Global Fund since 2016 as Principal Recipient representing civil society. This funding is mainly for an HIV prevention programme and is further distributed to sub-recipients who directly implement the programmes while CANGOs role is mainly around the management of the grant and the provision of technical support and guidance. A community programme designed for out-of-school youth is offered in 20 constituencies. The overall goal of the programme is to halt the spread of HIV and reverse its impact in Eswatini society. A special programme for AGYW aged 10–24 years is implemented in three high density, low income constituencies namely; Somntongo, Mahlangatja and Mhlume from the Shiselweni, Manzini and Lubombo regions, respectively. This 1 programme has two layers, the first layer is the Stepping Stone sessions which provide HIV prevention education and distribution of condoms. These sessions also act as basis to identify beneficiaries who qualify and are willing to be a part of the second layer, namely economic strengthening and education support. Through the economic strengthening, beneficiaries are taken through the WORTH Programme which is believed to provide economic freedom to the AGYWs, while the education support comes in the form of secondary education subsidies which are paid directly to the school. The expected immediate outcomes for these programmes are improved knowledge around HIV Testing Services (HTS) and increased service uptake for HTS and Sexual and Reproductive Health (SRH) while the long-term objective is the reduction of new HIV infections among AGYW by 2022. Two sub-recipients (World Vision and Young Heroes) are responsible for the implementation of this programme and the target is to support 500 individuals with the education subsidies throughout the three years (2018−2021), 4000 individuals per year with the Stepping Stone sessions and 420 individuals/members for the WORTH groups. Other innovations include activities i which provide HTS services for
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