Empowering Young People as Experts in Their Communities
Finding community as a teen can be a challenge, and for those struggling to understand sexuality, sexually transmitted infections, and HIV, the challenge can be significant. Community efforts to collectively address stigma can change lives, especially in areas where HIV remains a leading cause of death for teen girls.
To drive down HIV infections in high-burden areas, CDC, as part of the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), helped to launch the DREAMS initiative, a multi-pronged approach to help adolescent girls and young women live Determined, Resilient, Empowered, AIDS-free, Mentored, and Safe lives (DREAMS). This first-of-its-kind program weaves together proven interventions—from clinical to educational—aimed at helping girls stay HIV-free.
STARS in Zambia and Mozambique
CDC understands that to be effective in helping girls stay free from HIV, the whole individual must be treated, and issues of poverty, stigma, violence, and other gender inequities must be tackled in tandem. To identify and address how HIV and stigma associated with sexuality impact adolescents’ ability to access care, treatment, and prevention, CDC has initiated the STARS (Stopping Adolescent Reproductive Stigma) project in Zambia and Mozambique.
This two-year community-based project supports the training of youth investigators and the creation of workshops to facilitate youth-led solutions. DREAMS ambassadors serve as critical project co-leads, from the initial design to analyzing the results. Through STARS, youth leaders work alongside community members, civil society organizations, government bodies, and PEPFAR partners to foster community leadership in identifying the drivers of stigma and forming solutions that address sexuality-based stigma and enhance existing DREAMS interventions.
Below, hear directly from DREAMS ambassadors in Mozambique and Zambia as they share their hopes for the STARS initiative in combatting stigma in their countries.
STARS in Mozambique
Contributions from DREAMS ambassadors in Mozambique: Tânia Mabjeca, Nádia Domingos, Felismina Jaime, Eufrásia Simão, Chaida Tarcísio, Nelucha Alberto, Alima Ibraimao, Salomé Sandramo, Amida Omar, Sada Ally, Sara Tomehiua, Ermelinda Macamo, Marlina Mainato, Neucha Alberto, Samira Remane; compiled and edited by Amida Omar and Ednilsa da Sandra Leonardo Macoca
In Mozambique, stigma continues to have a negative impact on adolescents and young people. For adolescents and young people living with HIV, stigma and fear of social discrimination can lead to young people feeling ashamed to go to health facilities to start or continue treatment. For those who do not know their HIV status, the taboo and stigma surrounding access to health services has made it impossible for them to get tested. Social barriers and lack of services, dialogue, and safe information about sex and sexuality have led many young people to contract HIV or have an unwanted pregnancy. It is critical to reinforce the importance of health services for young people so that we can break down barriers.
As DREAMS ambassadors, we hope STARS will allow us to truly hear the voices of adolescents and young people, both positive and negative, about how they feel about access to information and ways of preventing and treating HIV and pregnancy. We hope to hear how they feel in the community and in the health facility when seeking information about sex, sexuality, and HIV. We also hope to learn how we can promote dialogue around sex and sexuality among young people in a safe way, without barriers or taboos.
As DREAMS Ambassadors, we hold a deep commitment to promoting health and gender equality and combating stigma related to HIV and sexuality in our communities. We each offer valuable perspectives and personal experiences that highlight the challenges faced by adolescents and young people in our regions, as well as solutions and strategies for tackling these problems. We continue to stress the importance of community support and the empowerment of young people to challenge stigma and discrimination. As DREAMS Ambassadors, we believe in the ability of all adolescents and young people to live their lives with dignity, regardless of their health condition or sexual orientation.
As [an] ambassador for youth, I must be their hidden voice, their shadow friend, someone who they can trust to be a source of information, to be a model of their transformation.
As young people in the community, we have already felt the impact of STARS. STARS brings a new form of collaboration between adults, experts, and young people to solve a problem that affects everyone and to work collectively to ease stigma. The initiative also realizes the importance of including young people in solving the problems that affect them.
STARS in Zambia
Contributions from DREAMS ambassadors in Zambia: Angela Bwalya, Gladys Bwalya, Mutale Mutinta Musonda, Chipo Twaambo, Taonga Kamanga, Mainwa Munkombwe, and Mwendalubi Banda; compiled and edited by Angela Bwalya
In Zambia, DREAMS ambassadors reflected on their experiences navigating stigma as youth leaders in HIV prevention. Working directly with provincial health offices throughout Zambia gives them a unique perspective on the need for STARS and the long-term goals.
We cannot run away from the fact that HIV and sexuality stigma is highly associated with culture — social and gender norms, the dos and don’ts of a community. In certain communities, access to prevention services is a taboo, and adolescents who are seen accessing these services are tagged as being promiscuous. These types of stigmas can lead to social exclusion, denial of rights, opportunities, harassment, violence, and may have an impact on the mental health, wellbeing, and quality of life of affected people. This leads to a lack of accurate information on sexual health and can ultimately lead to unsafe sexual behavior.
As DREAMS Ambassadors in our communities, our role is to stop stigma, educate our fellow youths about prevention services, and encourage them to access services in facilities freely. We strive to create a safe space for peers where they can express themselves without fear or judgment. This allows us to engage in meaningful conversations about sexuality and sexual health services, which will help youth take informed steps to enhance their sexual health. Ambassadors advocate and support individuals living with HIV or facing stigma due to their sexual orientation. We offer support, empathy, and understanding, and also advocate for young people’s rights to access health care and equal treatment.
I am hoping that the STARS project will come in and address the myths and misconceptions that our communities may have towards HIV and sexual related services.
Our goal for STARS is to help change the minds of various stakeholders so that together, we can combat HIV. By addressing sexuality and HIV stigma, we can reduce new infections and help those who are HIV-positive to continue adhering to medicine and feel valued and loved by friends, family, and the community at large. STARS can also help fill the gap by increasing HIV and sexuality sensitization programs in schools, allowing young people to have the correct information to make healthy choices. More education and information are needed for communities to understand HIV and sexual rights so that young people will be free to access health services without judgment.
Stories of hope and determination from DREAMS ambassadors are not unique to Mozambique and Zambia. For nearly 10 years, CDC, through PEPFAR, has implemented the DREAMS program in 13 countries – empowering countless young people in their communities. While progress has been made in keeping young people safe, empowered, and free from HIV – the fight is far from over. The data – and the young people around the world – tell us clearly that we must continue to sustain our efforts and do even more.
