Wednesday, November 7, 2012

Fighting HIV one family at a time

Twenty seven years of HIV and the nation is still buckling under the weight of the pandemic, by December 31 fifty thousand fresh Malawians will have contracted HIV despite the various interventions that are being implemented…there is one intervention, however, that looks like it’s the panacea the nation has been waiting for.
The Kantuwanjes  -  enjoying their hakuna matata married life
 Jonas Kantuwanje, 44, teaches standard three at Mdeka Primary School, some thirty minutes outside Blantyre city, in his spare time he plays technician and fixes radios and televisions that people bring to him, as he works, his young wife Brenda, 22, potters about and the new-born baby in the house serves as an icing to the harmony.

Kantuwanje’s first marriage collapsed years ago and when he thought of remarrying his prime worry was HIV, back in his youth days the pandemic was not as menacing as it is today. He went on to marry Brenda anyway. 

Meanwhile Brenda was also wary of the same worry as her new man. For a man with two children coming to her, she could easily be an innocent victim of HIV.
“There was this silent tension in the house, each one of us silently worried and wondered if the other had HIV,” said Brenda.

Kantuwanje said that he knew that he could get tested at Mdeka Health Centre but the distance, and the fact that sometimes there were no test kits at the health center made him lazy.
Then came the light.
Dapp field officers counsel teens at Mdeka before testing them for HIV.JPG

From the blue, the group village headman, GVH Kabano called a meeting and announced that there would be HIV testers and counselors going round the village to provide what both Brenda and Jonas secretly wanted.

“They came to our house, counseled us and told us of the benefits of knowing our HIV status. We agreed and we were tested. It was a big relief to finally clear the mist between us. You see, after I knew that I was HIV negative I would never dare go out to another woman, I want to keep my status the same so I can say the testing made me responsible,” said the husband.

The wife also beamed and says that the two now live happily because there are no doubts. Well, no wonder a child soon appeared in the family.

The people that tested the Kantuwanjes were field officers from DAPP. Yes you read that correct, DAPP. It stands Development Aid from People to People and not sellers of second hand clothes. Of course, they do sell second-hand clothes but they do many other things too.

The programme that saw the Kantuwanje’s get tested in their backyard is called Total Control of the Epidemic. It is bankrolled by the National Aids Commission (NAC) and the United states Department of Agriculture. 

The field officers go door to door registering people, mobilizing each individual to an individual decision on HIV prevention and ultimately an HIV test.

Madalitso Chimtengo is one of the fifty field officers that DAPP employed for the door to door HIV testing and counseling exercise. He was assigned to test 4000 people in several villages in traditional Authority Chigalu’s area which occurs in Blantyre North. He gallops from one village top another on his mountain bike.

Chimtengo starts by noting that since the programme started three years ago, there is a visible behavioural change as those that have been tested are now responsibly living.  Already out of the about 3600 he has tested only just above 50 have HIV.

I asked him how he manages to beat the strongly held fears about HIV testing and go on to test people in their homes.

“Well, firstly, chiefs rallied the people and told them that we would be going around and again we do not go with the message of testing, we go and ask the people what they know about HIV, if they know little we tell them what they don’t know and then we tell them the benefits of getting tested.

“There is little rejection; the response was actually overwhelming such that it is the HIV test kits that ran out while people still wanted to get tested. If this was a country-wide programme HIV would be contained quickly,” said Chimtengo.

Already at Mdeka Primary School where some field officers had set up a testing booth, children as young as 8 years had to be chased off the queue of those wanting to get tested, its like testing is the new cool thing.
Asked if testing people in the villages is not going to fuel stigma, Chimtengo contests and reckons that it in fact normalizes knowing ones status and bolsters openness on HIV questions.

Chimtengo - There is Behaviour change.JPG
Chimtengo bemoans the lack of condoms in rural areas, the lack of test kits as some of the things that stand in the way of the programme. 

Florence Longwe coordinates the programme for DAPP and reckons that the approach works because of its personal nature.

The HIV and AIDs discussions are taken at a personal level and issues are not generalized. Hence individuals open up on what HIV and AIDS issues are directly affecting their lives.  In a mass media there is no personal dialogue where one can freely open up issues which are affecting them.

“TCE programme sees family as an important entry point for preventions, for stopping stigma and discrimination and rallying support for positive living for those on treatment. It is reaches out to people at their own convenient time and at the same time also those who find it difficult to go for such services due to transports or distance restrictions,” said Longwe.

She said the door to door makes it easy to reach men who usually do not go to clinics to get tested. Out of the tested in the TCE pogramme, 46 percent are men. 

 The project also has potential to reach more married couples who are the main culprits in the spread of HIV today, it difficult to find couple together unless they are at home. Again couples who are HIV negative or think they are because they don’t fall sick will never go to a hospital for HIV testing a gap that the TCE programme effectively fills.

And it is not just testing and counseling.

The project was phased out on October 31 but the Chimtengo said its effects will ring and stick around forever. Each field officer has trained volunteers in the villages who will take over the counseling in prevention, nutrition for the infected and the follow ups on all the rest.

For every HIV positive person, the field officers organised two family members who are supposed to check on the infected making sure that they faithfully adhere to their Anti Retro Viral drug dosage. Some members are trained in vegetable production while some were given heaps of shoes and the returns from the shoe sales are meant to economically help the infected. 

Gift Chitukula another field officer who also has tested over 3000 villagers proudly  declared  that he does not have more than 200 on his list that have HIV and this apparent low prevalence of HIV excited T/A Chigalu.

“I think the fact that we have been speaking and prioritizing HIV and testing has made people start to actually listen and change their behavior, already some bad cultural practices that fueled HIV have been eliminated, we have even banned overnight Kitchen top-ups which were new platforms of immorality,” said Chigalu.

Dapp field officers counsel teens at Mdeka before testing them for HIV.JPG
The programme is also being implemented in the low income areas of Blantyre and Thyolo. It was rolled out in 2007. There are about 25 field officers and each is supposed to test, counsel and follow up on 4000 people in three years. 

That is first to register and know them, then to counsel and or test then check of them later to make sure that those without the virus do not get it and that those with the virus do not spread it and are living healthily.

The Kantuwanjes can now enjoy peaceful sleep and as the Chimtengos and Chitukulas pack their utensils and leave T/A Chigalu’s area, the onus is on the community (over a million reached so far) to keep the sanity that the TCE programme brought.

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