`It felt like a weight was being taken off my shoulders’: the impact of the Lending a Hand intervention in supporting migrant adolescents and young people in KwaZulu-Natal, South Africa

BACKGROUND: In South Africa, many young people move away from their homes to semi-urban areas for education. They attend day schools while staying in rented accommodation. They may experience alcohol and drug abuse, sexual exploitation, and violence all of which put them at risk of contracting HIV. Our aim was to develop and test the feasibility and acceptability of a support structure for migrant adolescents and young people (MAYP), aged 14-24, and to understand their experiences of the intervention, in KwaZulu-Natal, South Africa. METHODS: Five peer navigators (PNs) were trained on needs assessment (clinical, social, educational, and psychosocial) of MAYP. The PNs enrolled 283 MAYP, aged 14-24, between June 2021 and October 2022. The intervention included 1: using a mobile phone to provide support identified during the needs assessment, 2; facilitating the referral process at a call centre to the study social worker for psychosocial and emotional services, local health facilities for healthcare services and peer support on general issues. We conducted repeat in-depth interviews (IDIs), n=20; and 5 key informant IDIs with PNs, n=5, both face-to-face and telephonically. RESULTS: The majority of MAYP were in grades 11 and 12 at day schools. They rented rooms in an unsafe environment on their own to be closer to their schools. Transitioning from living with their parents or guardians to living on their own in an unfamiliar environment caused physical (e.g. violence), psychological, and mental challenges. In describing the intervention most of them ‘felt like a weight was being taken off of their shoulders’. They also felt that it was beneficial for them as they were linked to treatment for sexually transmitted infections, received psychosocial support from the intervention social worker, and were also supported by PNs in facing general challenges. This helped them develop adaptive coping strategies and avoid risky behaviours. CONCLUSIONS: Interventions targeted for young people are much more effective when they are led by peers who understand young people’s experiences. The intervention was designed for and centred around the needs of MAYP and the short turnaround time during the referral process made it acceptable and they felt respected.