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The Matabeleland AIDS Council (MAC), a Voice and Choice Southern Africa Fund (VCSAF) grantee in South Western Zimbabwe, realised that certain groups such as artisanal miners, long distance truck drivers and sex workers were not accessing sexual and reproductive health (SRH) and HIV services as they found it difficult to attend health facilities in normal working hours. They were also uncomfortable with stigma and discrimination in many facilities.
MAC therefore extended their mobile integrated SRH and HIV services in all six districts of Matabeleland South and Midlands provinces where they are working, to provide services for these groups. The mobile services visit a point which is conveniently located for the targeted groups, on an appointed day of the month, at convenient times, often in the evening.
Night time services are provided at strategic hotspot locations, such as business centres, where people converge for entertainment and to socialise. MAC either has use of some rooms or sets up a tent to create a safe space which is private and confidential. Accessing services at these locations reduces the stigma associated with seeking health services. Female sex workers comprise about 65% of clients that are served. MAC provides services to approximately 240 clients through once a month moonlight services at six service points.
Through a peer model, where peers from the different target groups give health talks and distribute coupons for free access to services, the organisation reaches large numbers of people with an array of services. These include condoms, lubricants, family planning services, HIV self-testing and provision of Pre-Exposure Prophylaxis (PrEP). The services are all offered at the same place enabling clients to have a “one-stop shop” experience for integrated SRH and HIV services.
MAC providers are experienced and sensitive to the needs of their clients. This helps clients to be more accepting of the services that are being provided. Moonlight service provision is complimented by provision of free service coupons which enable clients to access follow up services at their convenience at any Matabeleland AIDS Council outreach site. This was welcomed by most clients as they are very mobile due to the nature of their jobs.
MAC realises that the Moonlight service provision model is an innovative approach to providing SRH and HIV services to Key Populations, as it provides a safe space for service access, resulting in increased access to services for key populations and diverse groups, contributing to improved health outcomes.
Many of the clients that MAC serves through the Moonlight programme return for regular service provision, at the same or other service points. MAC has noted good uptake of condoms and lubricants. Clients express, through various feedback mechanisms, that they prefer the moonlight service option to regular service provision.
Comment on Zimbabwe: Moonlight services for key populations