4. 63 * 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: ANC, antenatal care; ART, antiretroviral therapy; HTS, HIV testing services; IEC, information, education and communications; PEP, post-exposure prophylaxis; PMTCT, prevention of mother-to- child transmission of HIV; PrEP, pre-exposure prophylaxis; SRH, sexual and reproductive health. Illustrative Messages • I have the right to make informed choices about my health • Book early for ANC (as soon as you know that you are pregnant, at least before 12 weeks) to protect yourself and your baby from HIV • The decisions you make today as a mother will affect your child’s future, so book early for ANC • Book early for ANC, adhere to ARV treatment, practice safer sex and increase chances of delivering an HIV negative, healthy baby • HIV positive? Pregnant? Get HIV medication at your local clinic • HIV-positive women can give birth to an HIV-negative baby—protect your baby by starting HIV medication now • Ensure that you administer the recommended ARV prophylaxis to your new born infant as prescribed and supplied by the health care worker • An HIV exposed infant will be tested for HIV at birth if high risk,6 weeks of age, 9 months of age and 6 weeks post weaning • My family is supportive, so taking my medication is easy • Support your loved ones on HIV treatment for better treatment outcomes • I have HIV and it is undetectable because I take my medication • 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 healthy and normal life • I take my HIV medications to keep my viral load low- that reduces the risk of transmission to my partner • A virally suppressed person is just the same as any other stable person with a chronic illness • I am virally suppressed-I am at peace Illustrative Messages for desired change for HIV negative: To maintain negative HIV status through prevention methods (PrEP, condoms, PEP)* • Book your pregnancy before 12 weeks • Get tested for HIV &syphilis together with your partner • If HIV negative ensure that you get a retest in the third trimester,6 weeks post- delivery and every 6 months during the breast-feeding period • Ensure that you have 8 ANC contacts as recommended by the health facility and also follow recommended postnatal visits • Seek social and family support for ANC and PMTCT services • Deliver at health facility and/or by a skilled birth attendant • Exclusively breast feed your baby for the first six months of life and introduce complementary feeds from six months of life and continue breast feeding for up to 2 years • The baby should receive appropriate immunizations as advised by the health care worker • Use dual family planning methods (family planning method and condoms) to pr event unplanned pregnancy • Ensure that you are screened for cancer of the Cervix at 6 weeks post-delivery Illustrative Indicators 1. % of providers expressing accepting attitudes to clients accessing ANC and HTS services 2. # of providers trained on patient counselling and value clarification 3. # of dialogue meetings held with religious and community leaders 4. % of ANC attendees who report high self-efficacy for accessing ANC and HIV services 5. % of target audience with accurate knowledge of HIV medications (prevention and treatment) to prevent PMTCT 6. % of young women who report that they know where to access information and services for HIV 7. % of target audience who report positive perceptions of the importance of male and family support in sexual and reproductive health 8. % of young women who report that they know (a) where to access viral load services, (b) importance of viral testing and (c) how ART alters disease progression

1. 60 COMPREHENSIVE NATIONAL HIV COMMUNICATIONS STRATEGY FOR ZIMBABWE: 2019-2025 “How can I be sure that my baby isn’t sick, and will I be able to breastfeed like healthy women do?” Archetype: Young Woman » Husband » Mother and sister » Traditional healer » TV » NGO workers » Health care providers Abbreviations: NGO, nongovernmental organisation; ARV, antiretroviral. » To access ANC services and get tested for HIV » To initiate ART and prevent mother-to-child transmission » To become virally suppressed NAME: Anna AGE: 24 RELATIONSHIP: Married, pregnant HIV STATUS: HIV positive GOALS BEST WAY TO REACH ME INFLUENCERS ANNA REPRESENTS A BIGGER POPULATION WHO: » Is worried about getting tested and finding out she’s HIV positive; is worried about whether her husband will kick her out of their home » Wants to live a healthy life and wants her children to be healthy » Thinks being healthy means having a long life, not getting sick and eating good food » Views health and beauty as something that is important to her, especially to have good skin » Talks to her sister about sexual health but doesn’t trust her friends » Spends her time at home, beauty shops and the markets » Seeks general health advice from relatives, then goes to traditional healers; goes to the clinic last » Fears death, sickness, and the unknown » Worries that health care workers will be rude to her » Feels like knowledge is power, but is limited to doing what her husband approves of » Feels that it would be helpful to have information about sexual health for couples » Wishes her husband would go for couples testing, but he refuses; when she was HIV negative, he claimed they shared the same status; she heard that some men prefer HIV self- tests and hopes to convince him to try it » Hides ARVs in her shower cap so that her husband does not find them Young Woman Health Journey Map: Anna, 24 years old, pregnant, HIV positive About this map: This is a theoretical high-level health journey for a young woman interacting with three HIV programmes, which may overlap or be sequential. The journey map reveals her experience and what she might be doing, thinking and feeling along the way that impact her 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: Hospitals, health facility, TV, Dreams programme, NGOs that teach people about health, church; Other sources: radio, friends, family, traditional/faith leaders, village health workers, internet, SMS messages (Econet) Fear of Disclosure: Accessing ANC services is a big barrier because she lacks support from her husband due to social and cultural/religious norms and financial stresses; she needs his permission. If she is HIV positive, she fears being blamed for bringing it into the relationship, which could result in domestic violence. Couples counselling and couples testing are helpful to provide education and promote HIV testing to husbands Knowledge Is Power: She wants to deliver a healthy baby, free from HIV and responds to messages focused on what she can do to protect her baby. Sticking with ARV treatment has great success in preventing mother-to-child transmission, though rates of transmission significantly increase at 18 months to 7% from 6 weeks 3.6% Couples Counselling and Family Support: Getting her husband and family involved in her care can have a big impact on her ability to follow through with ARV treatment. She wants more support from her husband, so getting his involvement through counselling and male role models is a key factor in her ability to keep her viral load low and suppressed

3. 62 COMPREHENSIVE NATIONAL HIV COMMUNICATIONS STRATEGY FOR ZIMBABWE: 2019-2025 Communications Matrix: Young Women DESIRED CHANGES* TO ACCESS EARLY ANC AND GET TESTED FOR HIV TO INITIATE ART AND PREVENT MOTHER- TO-CHILD TRANSMISSION TO BECOME VIRALLY SUPPRESSED Barriers • Lack of information on HIV and SRH • Provider imposing personal beliefs on clients • Limited power, gender inequality • Lack of basic information on sexual and reproductive health and HIV • Religion • Peer influence • Disclosure of HIV status to partner • Provider not friendly/lack of confidentiality • Shortage of staff/providers • Self-stigma • Fear, denial • Power dynamics in relationships • Lack of comprehensive knowledge on ART • Cost and distance to access ART services • Fear of disclosure to partner • Lack of knowledge on benefits of viral load suppression • Self-stigma • Pill burden and fatigue Facilitating Factors • Empowerment to encourage husband to get tested • ANC as entry point for accessing services, including knowing HIV status • Family planning (child spacing) • Partner testing • Disclosure • Supportive family/community • Active male involvement • Easy access to ART • Integrated services • Positive peer influence • The desire to protect her baby • Partner and family support Communications Objectives 1. To change negative cultural beliefs related to accessing ANC services early 2. To change negative gender norms/roles to improve male involvement in ANC 3. Increase self-efficacy to access ANC and HIV services 4. Improve knowledge, attitudes and perceptions on PMTCT 5. Increase knowledge on where to access treatment services 6. Improve perceptions on the importance of male and family support in female sexual and reproductive health 7. Improve knowledge, attitudes and perceptions about access to viral load monitoring services 8. Improve knowledge, attitudes and perceptions on the importance of viral load testing, disease progression and how ART alters disease progression Illustrative Messages • Get tested today and live long to take care of and protect your family • HIV testing is available at any health centre—get tested now • Do not delay, protect your unborn child, get on treatment now • Disclosing my HIV status is not easy, but protecting my unborn child is more important • Take care of your health, take your medications and get virally suppressed • Being HIV positive is not the end of the world-take your medication to stay alive and healthy

2. 61 Young Woman Health Journey Map: Anna, 24 years old, pregnant, HIV positive About this map: This is a theoretical high-level health journey for a young woman interacting with three HIV programmes, which may overlap or be sequential. The journey map reveals her experience and what she might be doing, thinking and feeling along the way that impact her 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: Hospitals, health facility, TV, Dreams programme, NGOs that teach people about health, church; Other sources: radio, friends, family, traditional/faith leaders, village health workers, internet, SMS messages (Econet) Fear of Disclosure: Accessing ANC services is a big barrier because she lacks support from her husband due to social and cultural/religious norms and financial stresses; she needs his permission. If she is HIV positive, she fears being blamed for bringing it into the relationship, which could result in domestic violence. Couples counselling and couples testing are helpful to provide education and promote HIV testing to husbands Knowledge Is Power: She wants to deliver a healthy baby, free from HIV and responds to messages focused on what she can do to protect her baby. Sticking with ARV treatment has great success in preventing mother-to-child transmission, though rates of transmission significantly increase at 18 months to 7% from 6 weeks 3.6% Couples Counselling and Family Support: Getting her husband and family involved in her care can have a big impact on her ability to follow through with ARV treatment. She wants more support from her husband, so getting his involvement through counselling and male role models is a key factor in her ability to keep her viral load low and suppressed Positive emotion Neutral emotion Negative emotion Anna’s Experience Key Insights Doing: Goes with her husband to talk to the village chief about her pregnancy Thinking: I hope my husband agrees for me to go to the clinic so they can check on the baby Feeling: Hopeful, Optimistic, Nervous Doing: Talks to health worker about ARVs. Learns that she can deliver a healthy baby Thinking: I want my baby to be healthy Feeling: Motivated, Informed Doing: Goes to clinic with her husband and she gets tested; husband does not test Thinking: Why won’t my husband agree to do the test? Feeling: Preoccupied, Optimistic, Overwhelmed Doing: Goes to church; talks to women about what to expect for having her baby Thinking: I feel worried that my baby will be sick, but I can not talk to anyone about it Feeling: Conflicted, Scared Doing: Returns for next ANC visit without husband; receives HIV- positive result Thinking: How did this happen? I’ve only had sex with my husband. I am afraid he will send me back to my village Feeling: Worried, Scared, Betrayed Doing: Delivers a healthy baby Thinking: I am so relieved; do I need to keep taking these medications? Feeling: Relieved, Sleep-deprived, Tired Doing: Takes baby for a check-up. Talks to health worker about ARVs Thinking: My baby is still at risk for HIV if I do not take my medication?! Feeling: Worried, Scared Doing: Takes medications continually, though she tries to hide her medications so her husband does not see Thinking: How do I get my husband to get tested? Feeling: Concerned, Secretive Antenatal Care and HIV Testing Services Prevention of Mother-to-Child Transmission Care and Treatment: Viral Load Abbreviations: ANC, antenatal clinic; ART, antiretroviral therapy; ARV, antiretroviral; NGO, nongovernmental organisation; PMTCT, prevention of mother-to-child transmission of HIV.