Doctors Without Borders Southern Africa: Schools Health Programme Toolkit
HIV/AIDS

Bending the curves of the HIV epidemic by empowering and engaging youth

Over the last two years, the COVID-19 pandemic has had a devastating impact globally on countries’ national communicable disease programmes, crucially including the response to HIV/AIDS. Disruptions in treatment and prevention services may have contributed to around 1.5 million new HIV infections that occurred last year. A rigorous scale-up of health services by governments needs to go hand in hand with the active involvement of communities to get the global HIV response back on track. 

Drawing on our experience of more than two decades working with HIV and TB in South Africa, Doctors Without Borders (MSF) believes that community-led interventions, such as those involving youth, can significantly improve the uptake of health services and reduce the risk of HIV infection. 
 

MSF, Doctors Without Borders, Tuberculosis, South Africa, Prevalence survey, tb
Health promotion team Jabu Mthimkulu and Nkosinathi Mpongose walk through a school where they were conducting a health promotion excercise to teach students about TB and correct stigmas around the disease.
Tadeu Andre/MSF

Young people can be extremely effective drivers of social change. In the past ten years, there has been a 46% reduction in new HIV infections among youths aged 15–24 years. However, the world is still falling short of achieving the targets set for young people and achieving the goal of ending AIDS by 2030. 

Empowerment of the youth through proactive engagement is key not only for their seeking behaviour of HIV preventive services but also to allay stigma and discrimination against people living with HIV in the wider community. 

In 2019, MSF teams in Eshowe, KwaZulu-Natal, South Africa, achieved the UNAIDS treatment target of 90-90-90 aimed at helping to end AIDS. The achieved results of 90-94-95 meant that 90% of people living with HIV know their status, 94% of those are on antiretroviral treatment, and 95% of those have a suppressed viral load. This achievement is attributed to the strong community involvement in HIV care pioneered by the Eshowe teams. Through these results, MSF demonstrated the possibility of achieving these high targets in KwaZulu-Natal, which has the highest number of people living with HIV in South Africa, accounting for around 18% of the country's infection rates. 

Empowerment of the youth through proactive engagement is key not only for their seeking behaviour of HIV preventive services but also to allay stigma and discrimination against people living with HIV in the wider community. Dr Liesbet Ohler, Project Medical Referent, MSF project in Eshowe

In 2019, MSF teams in Eshowe, KwaZulu-Natal, South Africa, achieved the UNAIDS treatment target of 90-90-90 aimed at helping to end AIDS. The achieved results of 90-94-95 meant that 90% of people living with HIV know their status; 94% of those are on antiretroviral treatment; and 95% of those have a suppressed viral load. This achievement is attributed to the strong community involvement in HIV care pioneered by the Eshowe teams. Through these results, MSF demonstrated the possibility of achieving these high targets in KwaZulu-Natal, which has the highest number of people living with HIV in South Africa, accounting for around 18% of the country's infection rates

Among the various community and patient-centred interventions led by MSF that resulted in this success, engagement with youths in schools and improved recruitment for voluntary medical male circumcision facilitated in normalising HIV as a disease within the community. In the long term, these efforts are expected to reduce HIV incidences.   
 

MSF, Doctors Without Borders, HIV, AIDS, Eshowe
MSF\ Lay Counsellor Nkosinathi Mpungose delivers a HIV health talk to learners of Hhashi High School in ward 1 of Uthungulu District, Umlalzi Municipality Eshowe. The learners will be given the opportunity to sign up for HIV testing at the Mobile 1-Stop Shop (M1SS) parked on the school grounds. MSF’s Mobile 1-Stop Shop has travelled to dozens of schools, colleges and local sporting and cultural events to deliver HIV Counselling and Testing to people of all ages in rural KwaZulu-Natal, the South African province with the highest prevalence of HIV infection.
Greg Lomas

MSF in Eshowe started its school health programmes in 2012, in partnership with local authorities and health facilities. The aim was to reduce new infections and promote prevention methods among high-school students in grades 8 to12. 

In more than 35 schools in Eshowe and Mbongolwane, MSF offered HIV counselling and testing services (HCT) to mobilise high-school students to know their status, increase health-seeking behaviour and offer better support and care for students who test HIV positive. Using the Life Orientation subject in the school curriculum as a platform, our teams shared health education on HIV/AIDS, TB, sexually transmitted diseases and the risk of teenage pregnancies. Youth-friendly ways of providing education through peer educators and youth camps helped in offering them a safe space and developing an understanding of how to protect themselves and their positive peers. 
 

MSF, Doctors Without Borders, HIV prevention drug
Community Health Agent Babongile Luhlongwane conducts an HIV test on Andile (28), who lives in the remote Entumeni District of KwaZulu-Natal, where HIV prevalence in South Africa is among the highest. Image from 2016 
Greg Lomas

HCT in schools provided a valuable opportunity to promote HIV prevention among students by enabling learners to know their status and begin a long-term habit of regular HIV testing. The student's participation in this intervention required consent from parents, teachers, principals and officials and tacit acceptance from institutions like churches and community-based organisations. This led to a substantive rise in the acceptance of the need for health education and in breaking down common misconceptions among these groups of people and institutions. 

Through school health programmes, MSF also successfully recruited male learners for medical male circumcision (MMC) as a lifelong partial prevention strategy for those who tested HIV negative and in supporting HIV-positive learners with medical screening before circumcision. Working closely with the Department of Health and the Department of Education, MSF teams mobilised and recruited boys for MMC camps in 25 schools in Eshowe and 23 schools in Mbongolwane. Voluntary MMC is recommended by WHO in high HIV prevalence settings as an additional strategy for HIV prevention by reducing the transmission among circumcised men by up to 60%.  With 71% of boys between the ages of 15 and 19 years old medically circumcised in 2018 in Eshowe and Mbongolwane as per MSF’s HIV impact population survey, we expect to see a reduction in new HIV infections within the community. 
 

Our teams teaching school kids about TB in Eshowe so that they can take the lessons home
Health promotion team Jabu Mthimkhulu and Nkosinathi Mpungose at a school where they were conducting a health promotion exercise to teach students about TB and correct stigmas around the disease.
Tadeu Andre/MSF
Globally, young people continue to face substantive challenges to accessing HIV and sexual and reproductive health services. This, despite an extensive global call to focus on youth to control the rising number of HIV infections. Dr Liesbet Ohler, Project Medical Referent, MSF project in Eshowe

Our approach of using schools for recruitment for MMC ended up being a remarkable collaborative effort of community engagement across constituent groups: parents, young males, teachers, leaders, school administrators and health officials. 

Since 2019, MSF has used this successful platform, working closely with schools and government officials, also to raise awareness around TB and de-stigmatise the disease that is one of the leading causes of death among people with HIV.   

Globally, young people continue to face substantive challenges to accessing HIV and sexual and reproductive health services. This is despite an extensive global call to focus on youth to control the rising number of HIV infections. MSF’s experience in Eshowe has shown that it is critical to engage with young people in schools at an early stage to discuss HIV prevention and identify the strategies that suit them best to impact their behaviour and support their choices and future. 

Focusing on increasing treatment and care services is not enough. If national health programmes want to deliver on reversing and ending HIV/AIDS, young people must engage and lead the response to this epidemic.