At a glance
As part of HIV prevention efforts in Mozambique and Zambia, CDC initiated a community-based project through which youth leaders can help address stigma associated with HIV and sexuality.
Background
Finding community as a teen can be a challenge. For those struggling to understand sexuality, sexually transmitted infections, and HIV, this 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 helped launch a multi-pronged approach known as the DREAMS initiative. This was done as part of the U.S. President's Emergency Plan for AIDS Relief (PEPFAR). The DREAMS initiative helps 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 project
CDC understands that to be effective in helping girls stay free from HIV, the whole individual must be treated. Issues of poverty, stigma, violence, and other gender inequities must be tackled in tandem. CDC has initiated the STARS (Stopping Adolescent Reproductive Stigma) project in Mozambique and Zambia. This project aims to identify and address how HIV and stigma associated with sexuality impact adolescents' access care, treatment, and prevention.
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. Young leaders foster community leadership in identifying the drivers of stigma and forming solutions that address sexuality-based stigma. They also work to enhance existing DREAMS interventions.
Below, hear directly from DREAMS ambassadors in Mozambique and Zambia. Ambassadors share their hopes for the STARS initiative in combatting stigma in their countries.
STARS in Mozambique
In Mozambique, stigma continues to have a negative impact on adolescents and young people. For adolescents and young people living with HIV. 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, taboo surrounding health services access has made it impossible to get tested. Social barriers and lack of services, dialogue, and safe information have had a significant effect. Many young people have contracted HIV or have had 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 allows us to truly hear the voices of adolescents and young people, positive and negative. Knowing how they feel about access to information and ways of preventing and treating HIV and pregnancy is important. We hope to hear how they feel in the community and in the health facility. Especially when seeking information about sex, sexuality, and HIV. We also hope to learn how we can promote dialogue around sex and sexuality in a safe way, without barriers.
As DREAMS Ambassadors, we hold a deep commitment to promoting health and gender equality. We also aim to combat 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. This also helps as we look for solutions and strategies to tackle these problems.
We continue to stress the importance of community support and the empowerment of young people to challenge stigma and discrimination. We believe in the ability of all to live their lives with dignity, regardless of their health condition or sexual orientation.
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. This allows for teamwork 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
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 long-term goals.
We cannot run away from the fact that HIV and sexuality stigma is highly associated with culture—social and gender norms. These are the dos and don'ts of a community. In certain communities, access to prevention services is a taboo. Adolescents who are seen accessing these services may be tagged as being promiscuous. These types of stigmas can lead to social exclusion, denial of rights, opportunities, harassment, and violence. All of this 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, our role is to stop stigma, educate fellow youths about prevention services, and encourage them to access services. 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. This 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.
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 HIV-positive individuals to continue adhering to medicine. We can also help them 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. This allows 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. This will help young people be free to access health services without judgment.
Looking ahead
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 more.