4. 79 * 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; ARV, antiretroviral; PLHIV, people living with HIV; PrEP, pre-exposure prophylaxis, VMMC, voluntary medical male circumcision. Illustrative Messages • Prevention and treatment are less expensive than missing work • Stay healthy, stay working—prevention is key • Take time to visit your nearest health facility—it is worth the investment • Know your HIV status—it’s the starting point to securing a healthy future • Having more than one sex partners puts you at increased risk of getting HIV—get tested today • Having sex with a partner whose status you do not know puts you at risk—get tested as a couple today • Even if you are HIV+ you can protect your family and have healthy children • I understand that I am at risk of HIV, so I got tested • I am PrEPared—I use PrEP • Reduce the risk of HIV by 60%—get circumcised today • I am in control of my health—I got circumcised • No pain no gain—get the cut for 60% protection against HIV • Be strong and cool—brave the pain like a man and get circumcised • 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 • (for PrePex) You should expect pain on day 2, 3, 4, 6 upon erection, and then again on removal. You will not be bed-ridden • You should expect pain on injection, during erections, day 2, and upon bandage removal • Foreskins are disposed in line with the Human Tissue Act Illustrative Messages for desired change for HIV positive: To get initiated on ART and stay virally suppressed* • Being HIV positive is not the end of the world—take your medication to stay alive and healthy • My family is supportive, so taking my medication is easy • I have HIV and it is undetectable because I take my medicat ion • I found a support group to help me stay on treatment—I feel better • Now I understand why taking my HIV medication is so important —I can live a long, healthy and normal life • I take my HIV medications to keep my viral load low—that reduces the risk of transmission to my partner Illustrative Indicators 1. % of young men who report high self-efficacy for accessing health services 2. % of young men who report increased health risk perception due to unhealthy behaviours 3. # of young men presenting for HIV prevention services 4. % of young men who can name at least two HIV services available for them 5. % of young men who report that they know where to access HIV testing and prevention services 6. % of target audience expressing accepting attitudes to young men accessing (a) VMMC, (b) PrEP and (c) condoms 7. % of young men who report that they know where to access HIV prevention services (a) VMMC, (b) PrEP and (c) condoms

1. 76 COMPREHENSIVE NATIONAL HIV COMMUNICATIONS STRATEGY FOR ZIMBABWE: 2019-2025 “I feel fine—I don’t think I need to go to the doctor. I don’t have time to go. I’m too busy looking for work.” Archetype: Young Man » Community elders, celebrities » Peers/friends » Girlfriend, wife » Social media » Bars » Peer educators » To adopt health-seeking behaviour » To get tested for HIV » To increase use of HIV preventive methods NAME: Lawrence AGE: 24 RELATIONSHIP: Married HIV STATUS: HIV negative GOALS BEST WAY TO REACH ME INFLUENCERS LAWRENCE REPRESENTS A BIGGER POPULATION WHO: » Looks at the appearance of women to determine if they are healthy and their potential HIV risk » Dreams of being permanently employed » Worries most about being able to financially support his family » Feels like it’s important to be healthy so that he can make a living for his family » Spends time at work, at the bar or hanging out with friends » Ignores bulk SMS » Pays attention to group (health) text messages; he has joined WhatsApp and Facebook » Feels that counselling services, support groups and understanding the benefits of HIV treatment could resolve some fears for HIV testing » Trusts health workers for information though he worries about being judged and criticised when he’s at the clinic » Waits to see what happens if he has discharge and an infection. If it gets worse he’ll ask friends or a traditional healer; will go to clinic last Young Man Health Journey Map: Lawrence, 24 years old, HIV negative About this map: This is a theoretical high-level health journey for a young man interacting with three health 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 care workers; Other sources: Radio, TV, internet, friends, clinic Low Risk Perceptions: He is more worried about finding work and sees himself as healthy and strong, so health-seeking behaviours are difficult to justify. He is more likely to seek general health services such as blood pressure or other checks than HIV services, where he perceives himself as low risk Feeling of Control: Feeling in control is the most important thing to him. He does not want to get tested for HIV - he does not se e what the benefit is to him. He worries that if he is HIV positive the n his life will be over; he will have to disclose to his wife that he is b een having sex with other women and possibly recognise that he could have given HIV to her and in turn, his children. Hearing testimonials from men like him who got tested and describe their journey, whether positive or negative, is helpful for him to feel in control. Self-testing and couples testing could improve the feeling of control and acceptability for him Men as Providers: He is preoccupied with providing for his family. He is more worried about finding work than thinking about his health. He wants to stay healthy to support and take care of his family. Celebrities with lived experience and other people, such as brothers and uncles, have influence on his decision to choose HIV prevention methods; he is most likely to be receptive to health information coming from health workers

2. 77 Young Man Health Journey Map: Lawrence, 24 years old, HIV negative About this map: This is a theoretical high-level health journey for a young man interacting with three health 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 care workers; Other sources: Radio, TV, internet, friends, clinic Low Risk Perceptions: He is more worried about finding work and sees himself as healthy and strong, so health-seeking behaviours are difficult to justify. He is more likely to seek general health services such as blood pressure or other checks than HIV services, where he perceives himself as low risk Feeling of Control: Feeling in control is the most important thing to him. He does not want to get tested for HIV - he does not se e what the benefit is to him. He worries that if he is HIV positive the n his life will be over; he will have to disclose to his wife that he is b een having sex with other women and possibly recognise that he could have given HIV to her and in turn, his children. Hearing testimonials from men like him who got tested and describe their journey, whether positive or negative, is helpful for him to feel in control. Self-testing and couples testing could improve the feeling of control and acceptability for him Men as Providers: He is preoccupied with providing for his family. He is more worried about finding work than thinking about his health. He wants to stay healthy to support and take care of his family. Celebrities with lived experience and other people, such as brothers and uncles, have influence on his decision to choose HIV prevention methods; he is most likely to be receptive to health information coming from health workers Positive emotion Neutral emotion Negative emotion Lawrence’s Experience Key Insights Doing: Talks with community elders about the roles of a man in the household; accompanies his wife to an ANC visit Thinking: If the chief tells me I should go to my wife’s ANC visit, I will go, but I do not have time to go to the doctor for my health Feeling: Indifferent, Supportive, Informed Doing: Returns to clinic for test; result is HIV negative Thinking: What a relief Feeling: Happy, Relieved, Confident, Relaxed Doing: Goes to ANC visit while heading to town to look for work Thinking: I hope I can get work this week. Work can be so unpredictable Feeling: Hopeful, Optimistic, Worried Doing: Talks to health worker about health and HIV Thinking: It seems like everyone is talking about health, but mostly I am worried about finding work Feeling: Indifferent, Ambivalent Doing: Returns to another ANC visit and gets tested for HIV Thinking: I hope I did not get HIV from sleeping with my girlfriend Feeling: Wants to complete his test quickly so he can go find work Doing: Talks with a peer educator at a sporting event about VMMC and condoms Thinking: Why would I need to use condoms? Why would I get circumcised? Feeling: Unsure, Perplexed, Confused Doing: Considers using condoms when he sees his girlfriend in town Thinking: Maybe I could use condoms when I see my girlfriend like the health worker said Feeling: Indifferent Doing: Reads brochures about VMMC and how it can prevent HIV transmission Thinking: How would I explain getting circumcised to my wife? Feeling: Informed, Pensive, Nervous Health Seeking Behaviours HIV Testing Services Prevention: VMMC, Condoms Abbreviations: ANC, antenatal care; ARV, antiretroviral; PrEP, pre-exposure prophylaxis; VMMC, voluntary medical male circumcision.

3. 78 COMPREHENSIVE NATIONAL HIV COMMUNICATIONS STRATEGY FOR ZIMBABWE: 2019-2025 Communications Matrix: Young Men DESIRED CHANGES* TO ADOPT HEALTH-SEEKING BEHAVIOUR TO GET TESTED FOR HIV TO INCREASE USE OF PREVENTIVE METHODS (VMMC, PREP, CONDOMS) Barriers • Feeling of power over health; no need to take action unless very sick • Lack of time and money • Low desire to spend money on health • Competing priorities for income-generation over health-seeking behaviours • Stigma around being seen at a health facility • Low risk perception for any health-related matter • Transport fees • Low cost/benefit for health-seeking services • Low risk perception • Lack of access to male-friendly HIV testing services • Lack of time to access services because services offered during working or school hours • Assuming status based on partner’s status • Fear of knowing status and uncertain future • Fear if HIV positive they might have transmitted it to wife and children • Transport fees • Unaware of PrEP • Fear of stigma • Promiscuity associated with condom use • PrEP associated with positive HIV status / people assume they are ARVs • Lack of male-friendly services • Negative attitude of public-sector service providers • VMMC—worried about the pain of procedure, recovery, concerns from partner as to why he needs it Facilitating Factors • Availability of free and male-friendly services • Supportive women who advocate for seeking services • Peer support • Endorsement from community and religious leaders • Services offered at places where they are hanging out at sports events, bars • Testimonials from PLHIV • Local or national celebrity ambassadors for HIV testing services • HIV self-test kits (targeted distribution) • Comprehensive HIV education • Favorable community norms • Availability of free services • Locally available services • Targeted condom distribution at universities, sports bars • Timely service • Edutainment, sports, arts • Awareness campaigns using mid-media activities, community-level events • Social clubs Communications Objectives 1. Increased self-efficacy to seek health services 2. Increased perception of health risks due to unhealthy behaviours 3. Improved perception of HIV risk 4. Improved awareness, attitudes and perceptions of health services available for young men 5. Increased knowledge of where to access community HIV services, including HIV self-testing 8. Increase knowledge, attitudes and perceptions of all HIV prevention methods available and where to access them 7. Reduced stigma associated with adopting HIV prevention methods Illustrative Messages • I do not take chances with my health—I see a provider before it gets worse • You only live once. See a health care worker when you are not feeling well • Prevention is better than cure—seek medical advice today and protect yourself and family • A dose of prevention is a lifetime of better health— condomise • A dose of prevention is a lifetime of better health— get tested for HIV • I am a responsible man, I know my HIV status • 1 in 5 young men are HIV positive—know your status • HIV testing and counselling are available at your nearest health facility • A dose of prevention is a lifetime of better health—use PrEP and condoms • Unprotected sex is risky—use condoms all the time • Condoms allow you to enjoy safer sex with peace of mind • Do not go ‘downtown’ without a condom