While great progress has been made in controlling the HIV epidemic overall, there is still a need to support the mental health of those living with HIV. The Zvandiri intervention provides peer-delivered mental health and psychosocial support services to adolescents living with HIV. It has been identified by the World Health Organization (WHO) as an exemplar of best practice, integrated into Zimbabwean national policy, and adopted in eight other African countries. Webster Mavhu, Deputy Director at Centre for Sexual Health & HIV/AIDS Research (CeSHHAR) Zimbabwe, along with global health expert Sarah Bernays are looking at how and why the Zvandiri intervention works. They are joined by Nicola Willis, Executive Director of Zvandiri.org in this brief Q+A about their Templeton World Charity Foundation (TWCF) supported project.
Can you describe the concept of Zvandiri and how the intervention is helping adolescents living with HIV flourish within their communities by building character strengths related to Zvandiri?
Nicola Willis: Adolescents living with HIV (ALHIV) can now live long and healthy lives with access to effective treatment. However, to sustainably be able to take their treatment, the vast majority need support with their mental health. Zvandiri, a Zimbabwean based organization, was set up in 2004 and has since been developing interventions to support the health and wellbeing of ALHIV.
It began when a support group of ALHIV adopted the name “Zvandiri” to convey the message ‘I may be living with HIV, but accept me as I am’. Zvandiri encapsulates virtues akin to self-acceptance, joy, and perseverance. We hypothesize that the effects of this are to engender, stimulate, and sustain the positive habits of self-responsibility to engage in treatment, to find beneficial purpose in providing and celebrating mutual peer-based support, and to invest in healthy behaviors in anticipation of a positive future. In the practice of peer-support which is a central tenet of the Zvandiri program, the embodied demonstration of the Zvandiri character strength stimulates a reciprocal and reinforcing effect across the peer network, amplifying its impact. Learn more about the scale at which at which Zvandiri is operating and hear how it's making an impact in this recent video.
What is the main focus of your current TWCF-funded project and what were your findings from your earlier study of this intervention?
Webster Mavhu: Our study is examining and measuring how this intervention can sustainably engage ALHIV to develop the character strengths embedded within the indigenous concept of ‘Zvandiri’ (accept me as I am), so that they can flourish and live well within their communities.
Our team conducted a large trial of the Zvandiri intervention (2016-2019) which demonstrated that Zvandiri works. ALHIV receiving the Zvandiri intervention had a significant and clinically important reduction in HIV viral load after 2 years compared to ALHIV receiving standard care. The intervention, delivered at scale, offers a substantial opportunity to redress ALHIV’s poor outcomes. However, although we know that it works, to replicate and potentially improve its effect, we need to understand why, which is the focus of this current study.
How do you envision your research translating into practical tools people might use in their everyday lives and community?
Sarah Bernays: Our research aims to enhance wellness. If we can understand why and how Zvandiri works, then we can support its practical operation by measuring its sustained effect. It is anchored upon the need to improve and evaluate human strengths and capabilities as enshrined in positive outcomes. The evidence from this study will enable us to develop practical tools, such as evaluation measures and enhanced training activities, to inform further cost-efficient and effective scale-up of the intervention across the African continent.
Part of the study is also to pilot a caregiver intervention to amplify the effect of peer-support for ALHIV’s wellbeing. The learning from this component will enable us to develop practical guidance about supporting caregivers to enhance young people’s wellbeing outcomes through the care that they provide in the household environment. We will develop novel operational approaches, as well as the training and support toolkits needed to implement and sustain the caregiver intervention.
What is an insight or learning you found that might affect future study in your area of interest?
Webster Mavhu: We are currently conducting a detailed review of positive psychological outcomes such as self-esteem, resilience, hope, self-worth, and flourishing and how these may be adapted to sub-Saharan Africa. Not much has been written on these concepts in this setting (which justifies our initiative), but it will be challenging to find equivalent indigenous terms that resonate with young people. If we can identify these then this could be transformative in the ways in which we describe, measure and support mental health and wellbeing for young people in this region.
Our own empirical research is suggesting that the relational dimensions in developing character strengths — for example, being encouraged to recalibrate the meaning of living with HIV because you are inspired by seeing others overcome the issue that has overwhelmed you — is vital to the effect of Zvandiri at an individual level. This preliminary work indicates that character strengths, which appear to be concentrated within an individual, can be developed and protected through relational networks between individuals who together are emboldened to give voice to difficult experiences and change the narrative of growing up with HIV.
Please tell us more about the above video.
Nicola Willis, and young people from the Zvandiri community: In the Greatest Showman’s original song ‘This is Me’, a group of people who have been stigmatized and isolated from society fight back, saying I am bruised, I am battered, but I won’t let that get me down, because I am glorious. This is Me.
‘This is Me’ resonates so closely with our own life experiences as young people from Zimbabwe whose lives have been changed by HIV. We have faced so many challenges growing up – stigma, isolation, hopelessness and fear for our future – but we have learned to cope, love and accept ourselves as we are. This is Me.
With the generous permission of the original writers, Benj Pasek and Justin Paul, and Kobalt and Fox Music, we have covered this song in our own unique, Zimbabwean, Zvandirian way. We came together as a group of young people from the Zvandiri program in Zimbabwe, with support from other local singers, dancers and artists. We had never sung, never danced and never performed before. We auditioned and were selected to be part of this production. Zvandiri means ‘as I am – this is me’. Please watch and enjoy as we celebrate who we are!
Dr. Webster Mavhu is Deputy Director at Centre for Sexual Health & HIV/AIDS Research (CeSHHAR) Zimbabwe. He has a keen interest in adolescence and masculinities and leads the CeSHHAR ‘Masculities Research’ portfolio. In 2021, Dr.Mavhu was promoted to Reader at Liverpool School of Tropical Medicine; this is a joint appointment with CeSHHAR.
Dr. Sarah Bernays is a Global Public Health academic at London School of Hygiene & Tropical Medicine and the University of Sydney specializing in infectious diseases, sexual health and community engagement with young people.
Nicola Willis is the Executive Director of Zvandiri. In 2004, together with young people living with HIV and a group of volunteers in Harare, she established Zvandiri. She's Co-Chair of the World Health Organization (WHO)’s Technical Working Group for Adolescent HIV Service Delivery and is a member of WHO’s HIV Guidelines Committee.
