Agness John, Senior Technical Officer, EpiC Tanzania, FHI 360

Eva, age 19, was born into one of the poorest families in Kahama Town in the Shinyanga Region of Tanzania. She is the sixth of seven children. Her family survived by selling local beer. While in school, Eva had to join her mother to help with the business. Eva repeatedly experienced violence from customers, sometimes because she refused to drink alcohol or be inappropriately touched, other times because she pickpocketed the drunk men or inflated their bills, in an effort to boost the family’s income.

At home, Eva observed constant fights between her parents.

“I was very young and living at home. My father could come back so loud late at night and beat our mother so much. This was very disturbing and so hurtful. Thinking back, it was during this time of abuse and violent behaviour that my father learned about his HIV status. Being violent was his escaping mechanism and the way to cope with the situation.”

Eva’s father’s violence led to her mother contracting HIV and becoming pregnant. Because Eva’s mother was unaware of her HIV status, she could not seek available options to protect her baby from becoming infected.

“My father’s health deteriorated as days moved ahead. He did not know about either HIV and AIDS, or HIV care and treatment services. He ended up dying, while my mother remained HIV positive, and transmitted the infection to my young brother who was born HIV positive.”

Due to her parents’ HIV status, Eva was stigmatized and had no friends. She felt alone. She struggled to finish school and continued to work in her family business. She was feeling discouraged about her future when she met a mentor from the DREAMS initiative who exposed her to life-changing lessons.

“I met Paulina who is the DREAMS mentor in my ward. We had a discussion and she asked me about several stuff including my risk behaviors. After our long discussion, she introduced the EpiC project. I received information about HIV prevention, linked to biomedical services from a health care provider, and social behavior change group at the community level. Also, I learned about economic strengthening skills and financial literacy. I was later linked to the economic strengthening hub where I learned about tailoring for three months. Upon the completion of my attachment to the economic strengthening hub, Paulina found a placement for me at the more modern and experienced tailor.”

The DREAMS (Determined, Resilient, Empowered, AIDS-free, Mentored, and Safe) initiative addresses social isolation, poverty, cultural norms, violence, and inadequate schooling to decrease HIV among adolescent girls and young women (AGYW) and help them reach their full potential. The Meeting Targets and Maintaining Epidemic Control (EpiC) project, funded by the United States Agency for International Development (USAID) and the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), started implementing DREAMS programming in two regions of Tanzania in 2020.

Economic strengthening hubs are an innovative strategy used by EpiC to empower and equip vulnerable AGYW with practical skills to reduce vulnerability to HIV exposure. In the hubs in Shinyanga, AGYW learn practical skills in tailoring and computer literacy. In addition to teaching skills, the hubs create a platform for participants to receive integrated HIV services including HIV testing, condoms, pre-exposure prophylaxis (PrEP), and family planning. This approach is to ensure HIV-negative AGYW remain HIV-free while those who test positive are enrolled in care and treatment services early.

In 2022, EpiC established 13 economic strengthening hubs, eight of which are located in government buildings. The hubs have reached a total of 859 AGYW. The EpiC project has been working closely with the government to ensure sustainability of the program. Mbwana Kalata, a community development officer on the Kahama Town Council reflected:

“Government is ensuring smooth implementation of the economic strengthening program focusing on girls due to the high HIV prevalence rate contributed by poverty and gender-based violence causes. On top of providing the rooms to run the economic strengthening hub, we are linking the girls with the district’s woman and youth loan initiative. This enables AGYW to access the loan with the very low interest rate of 3% per year. We are also providing technical assistance in registering the groups and businesses, organizing capacity building on entrepreneurship, and routinely visiting to ensure high quality of the program implementation.”

Through the hubs, AGYW such as Eva can establish and run their business and support their families using safer income-generating activities.

“We were taught about establishing the savings and loan group, where three of us established the tailoring mart. Apart from the tailoring mart, I was able to establish the cassava roasting business. Daily, I get the return of 10,000 Tanzanian shillings, which helps me to support my younger brother and ensure he stays at school without the thought of quitting due to lack of school fees.”

Besides becoming resilient and being able to make her own income, Eva is supporting her peers to become resilient and free from HIV. She provides education on HIV in the community to ensure they do not relate it to witchcraft as they did with her father but rather get tested and enrolled in care and treatment services should any of them be found positive.

With the support of empowered AGYW such as Eva, EpiC’s DREAMS programming in Tanzania reached 215,187 AGYW with HIV prevention services from October 2021 to October 2022, including social and behavior change sessions and biomedical services. In addition, 51,215 received HIV testing services;1,912 tested HIV positive and 1,789 were enrolled in care and treatment services. Eva and other AGYW are finding hope for a future free from HIV, unplanned pregnancy, economic instability, and violence.

Featured image: Eva in the tailoring mart she established as a result of skills she received from the economic strengthening hub. Photo by Agness John.