4. 85 * For simplicity, all content within this matrix matches the HIV status and journey of the archetype. However, a desired change along with matching illustrative messages have been identified for the alternative HIV status. Abbreviations: ART, antiretroviral therapy; HTS, HIV testing services; PrEP, pre-exposure prophylaxis; STI, sexually transmitted infection; TB, tuberculosis; VMMC, voluntary medical male circumcision. Illustrative Messages • Would you want an older man with your daughter? Then why are you with his? • Protect yourself, protect others, use a condom • My health is my responsibility, I condomise • Knowledge is power. I am in charge of my life—I know my HIV status • HIV services are available near you, get tested today • Your family is important—get tested, know your status, protect yourself and protect them • Start treatment early and avoid getting sick • New medications now available for treatment have fewer side effects—start ART with confidence • I adhere to my treatment, I am at peace and continue to work productively to provide for my family. I do not have to do this alone—I can get support from family and friends to stay on treatment • Want to stop HIV in its tracks? Take your medication and be virally suppressed Illustrative Messages for desired change for HIV negative: To access HIV prevention methods (VMMC, condoms, STI)* • Unprotected sex is risky—use condoms all the time • Make it fun, make it sexy and safe—use a condom • It takes a real man to wear a condom • Protect yourself—use PrEP • If you are having sex without a condom, you are at risk for HIV • Together we can take action to stop the spread of HIV • Reduce the risk of getting HIV by 60%—get circumcised today • I am in control of my health—I got circumcised • There is pain associated with VMMC, but it is manageable with painkillers. You will not be bed-ridden • Prevention is life insurance • More and more people are getting circumcised in the community including famous people like and MPs • Your chief has given us their support to come speak to you about VMMC • You should expect pain on injection, during erections, day 2, and upon bandage removal • This is a government initiative. The doctors performing VMMC have been trained and certified by the MoHCC on how to perform the procedure according to WHO standards • Foreskins are disposed in line with the Human Tissue Act Illustrative Indicators 1. % of community members expressing negative perceptions to relationships between older men and young women 2. % of adult men who report increased HIV health risk perception 3. % of adult men who report high self-efficacy for accessing HTS and HIV prevention, care and treatment services 4. % target audience who recall the benefits of early diagnosis and routine couple testing 5. % increase in the number of people testing for HIV as couples 6. % of adult men who report that they know where to access HTS (including HIV self-testing), HIV prevention and care and treatment services 7. % of target audience with accurate knowledge of HIV services and benefits of ART

1. 82 COMPREHENSIVE HIV COMMUNICATIONS STRATEGY FOR ZIMBABWE: 2019-2025 “I work away from my family. Sex is an escape from being in the mines all day” Archetype: Adult Man » Wife » Peers, friends » Health workers » Sport events » Bars, social/community gatherings » Musical shows » To practice safe sex and reduce relations with younger women » To get tested for HIV » To initiate treatment and become virally suppressed with regular viral load testing NAME: Terrence AGE: 38 RELATIONSHIP: Married, and has a girlfriend HIV STATUS: HIV positive GOALS BEST WAY TO REACH ME INFLUENCERS TERRENCE REPRESENTS A BIGGER POPULATION WHO: » Is more concerned with working to provide for his family (including mother) than to get tested for HIV; stress can make him revert to bad habits – counselling could help him » Thinks being healthy means having decent accommodation, communication and transport means and having money for food and clean water » Values his health because he can prepare for the future » Doesn’t feel comfortable going to the health clinic; is more likely to go the traditional healer first » Feels like going for health screenings is a waste of time because he will lose work wages » Worries about knowing his status because if he is HIV positive it will break down his family; he also worries that others will know his status » Seeks comforts and escape through sex with his girlfriends or sex workers » Has a younger girlfriend to reinforce his feeling of manhood » Enjoys going to watch soccer, musical shows at beer halls » Feels food shortages and lack of money impact his adherence with medications » Has trouble talking with partner about his health Adult Man Health Journey Map: Terrence, 38 years old, HIV positive About this map: This is a theoretical high-level health journey for an adult man interacting with community norms and HIV programmes, which may overlap or be sequential. The journey map reveals his experience and what he might be doing, thinking and feeling along the way that impact his desire and ability to access services The red, dark red and gray dots indicate the highs/positive emotion (motivators) and lows/negative emotion (barriers) of the journey. These help the reader of the map prioritise opportunities for communications interventions and collaboration with service delivery to make the journey easier Trusted information sources: Health workers; Other sources: Brother, celebrities, uncle Social Norms: He has been exposed to older men having relations with younger women for his whole life, so it seems normal and accepted. He likes feeling like a provider to his younger girlfriend – it makes him feel manly. There are no perceived benefits to ending a relationship with a younger woman Proximal Services: He is more concerned with finding consistent work than with taking care of his health and sees little benefit to knowing his HIV status, so do not expect him to go out of his w ay to seek health services. To reach him effectively, meet him where he is already: the bar, sports venues, community functions, even the pharmacy. When he is relaxed, he is more willing to listen and respond to health messages from a peer leader, pastor or health worker Feeling of Control/Feeling Strong: The feeling of control is the most important thing to him. Control has three dynamics: time (takes time for beliefs to form and emotions to rise), preservation (of a man’s healthy status and self-identity), and certainty (of process and outcomes). He does not want people to know his status and heard that getting on medications when still healthy can help him sta y strong so he can work and support his family, which is a big motivator for staying adherent. He worries about what to tell his wife

3. 84 COMPREHENSIVE HIV COMMUNICATIONS STRATEGY FOR ZIMBABWE: 2019-2025 Communications Matrix: Adult Men DESIRED CHANGES* TO PRACTICE SAFE SEX AND REDUCE RELATIONS WITH YOUNGER/MULTIPLE WOMEN TO GET TESTED FOR HIV TO INITIATE TREATMENT AND BECOME VIRALLY SUPPRESSED WITH REGULAR VIRAL LOAD TESTING Barriers • Societal and cultural norms that accept and/or promote multiple relations • Proving a sense of manhood by taking on younger sex partners • Low risk perception • Does not want to use condoms or go for VMMC • Access to male-friendly HIV testing services • Financial implications (travel cost, loss of wages to go for testing) • No benefit for knowing status • Increased emotional trauma from knowing status • Low risk perception • Testing by proxy (partner status) • Long wait times for services • Perception of feminine environment at the clinic • Poor adherence • Lack of knowledge about where to access services • Stigma of being seen at the clinic and everyone assuming the reason is for HIV • Loss of time and wages • Worries about money and medication • Limited knowledge about viral load, etc. • Long turnaround time for results Facilitating Factors • Availability of information about risks that adult men pose to younger women • HIV infection rates of men to younger women • Obligation to protect women and not abuse their power as men • Knowledge on HIV reinfections • Positive masculinities, e.g. through religious and cultural institutions • Shift in social norms—unacceptability of older men to be with younger women • Positive peer influence • High risk perception • Availability of male-friendly HIV testing services • Availability of ART at any public facility • Women supporting health-seeking behaviours • Differentiated care model Communications Objectives 1. Increase knowledge about the risks and dangers of relationships between older men and young women 2. Increase perception of HIV risk 3. Increase self-efficacy for accessing HTS and all HIV prevention, care and treatment services 4. Increase awareness, attitudes and perceptions on the benefits of early diagnosis and routine couple testing 5. Increase knowledge, attitudes and perceptions of where to access community HTS, including HIV self-testing 6. Increase knowledge, attitudes and perceptions about viral load, disease progression and how ART interrupts disease progression 7. Increase knowledge about where to access viral load testing services Illustrative Messages • I am a responsible man, I do not abuse my power by having sex with a young woman • Positive African culture promotes protection of women and girls. Child relations is a violation of human rights • I understand my risk, so I get tested for HIV • Your partner’s HIV status is not yours—get tested Responsible men know their status, get tested today • Be adherent to your medications to stay healthy – get virally suppressed and seek information from your health care provider • Staying on medications keeps you healthy and able to work

2. 83 Adult Man Health Journey Map: Terrence, 38 years old, HIV positive About this map: This is a theoretical high-level health journey for an adult man interacting with community norms and HIV programmes, which may overlap or be sequential. The journey map reveals his experience and what he might be doing, thinking and feeling along the way that impact his desire and ability to access services The red, dark red and gray dots indicate the highs/positive emotion (motivators) and lows/negative emotion (barriers) of the journey. These help the reader of the map prioritise opportunities for communications interventions and collaboration with service delivery to make the journey easier Trusted information sources: Health workers; Other sources: Brother, celebrities, uncle Social Norms: He has been exposed to older men having relations with younger women for his whole life, so it seems normal and accepted. He likes feeling like a provider to his younger girlfriend – it makes him feel manly. There are no perceived benefits to ending a relationship with a younger woman Proximal Services: He is more concerned with finding consistent work than with taking care of his health and sees little benefit to knowing his HIV status, so do not expect him to go out of his w ay to seek health services. To reach him effectively, meet him where he is already: the bar, sports venues, community functions, even the pharmacy. When he is relaxed, he is more willing to listen and respond to health messages from a peer leader, pastor or health worker Feeling of Control/Feeling Strong: The feeling of control is the most important thing to him. Control has three dynamics: time (takes time for beliefs to form and emotions to rise), preservation (of a man’s healthy status and self-identity), and certainty (of process and outcomes). He does not want people to know his status and heard that getting on medications when still healthy can help him sta y strong so he can work and support his family, which is a big motivator for staying adherent. He worries about what to tell his wife Positive emotion Neutral emotion Negative emotion Terrence’s Experience Key Insights Doing: Goes to class at university; hooks up with his sugar daddy Thinking: Why should I change what I am doing? I am happy Feeling: Content, Relaxed, Happy Doing: Asks some of his friends about discharge Thinking: I might need to go to the clinic, but I can not take time off work Feeling: Fatigued, Ill Doing: Spends time watching sports after work Thinking: Being with younger women is part of what men do, what’s the big deal? Feeling: Indifferent Doing: Goes to the traditional healer for herbs Thinking: Should I go get tested for STIs? Feeling: Worried, Frustrated Doing: Goes to work. Does not feel well Thinking: I am worried that I am sick; I can not take time off work Feeling: Sick, Worried Doing: Goes to the clinic; gets diagnosed with gonorrhea and tested for HIV. Results are HIV positive Thinking: How am I going to support my family? Feeling: Worried, Depressed Doing: Reads about HIV; talks to the health worker about treatment. Thinking: How did this happen to me? Feeling: Hopeless, Insecure, Angry, Out of control Doing: Takes medications when he remembers Thinking: I can not remember to take all of these medications, but I try when I can Feeling: Indifferent, Annoyed Prevention HIV Testing Services Care and Treatment: ARVs, Viral Load Abbreviations: CD4, cluster of differentiation 4; STI, sexually transmitted infection.