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Positive living


Volunteers in Zimbabwe are setting the standard for community-based care of people with HIV around the world.


IT is a hot afternoon in Makohliso village, 300 kilometres south of Zimbabwe’s capital, Harare. The land is green but the crops are wilting in a persistent dry, hot spell. It should be the rainy season in this poor country in southern Africa, where everyone hopes the rains will bring good harvests, a source of survival for many people. In Zimbabwe, a difficult climate is not the only struggle.

Three kilometres off the main road, along a narrow and meandering path, is Isaac Masvanike’s homestead. Six graves lie at the entrance to the house. For Isaac, this is a reminder of what the AIDS pandemic can do.

Isaac, a mine worker who had to retire after 22 years because of illness, tested positive for HIV in 2005 after he was admitted to hospital. “I felt sick. The doctor asked my family to pray as he thought I had less than 24 hours to live,” he said. “The doctor was very quick to advise me to go for an HIV test and be prepared to accept my status.”

That was the turning point in Isaac’s life as he was immediately put on antiretroviral treatment to slow the progression of the virus.

Only about 8 per cent of Zimbabwe’s estimated 1.5 million people with HIV take anti-retroviral treatment. Isaac’s nephew pays about ZW$ 5,000 (US$ 21) a month to get the medicines for Isaac from a private medical centre. Today Isaac is a strong man, fit enough to work for his four children and send them to school. Isaac is living example of how knowledge can change lives, says Priscilla Makambe, 36, a Zimbabwe Red Cross Society volunteer care facilitator who visits Isaac every week.

“When I look at Isaac, I see a miracle,” says Priscilla. “I was coming here when he was bedridden. I always shed tears when I looked at his children. Isaac had lost weight, but his ability to face reality and accept his status helped a lot to manage his condition. It was really a touching story.”

Priscilla (pictured right with another client) gives some of the credit for the turnaround in Isaac’s life to an innovative course she took for community volunteers, called HIV Prevention, Care and Support, which is designed to give power back to people living with HIV, their families and caregivers. Launched in 2006, the course was developed by the International Federation, the World Health Organization and the Southern Africa HIV and AIDS Information and Dissemination Service, in consultation with networks of people living with HIV. Zimbabwe’s Ministry of Health and Child Welfare, the National AIDS Council, CONNECT (a welfare organization), the Centre (an HIV project) and the Kenya and Zimbabwe Red Cross Societies field-tested the course.

The course materials are now being translated into 16 languages and the programme will be introduced in nine other southern African countries and around the world.

Priscilla says the course increased her understanding of the needs of people taking anti-retroviral medication, which is supplied by governments, aid organizations or private businesses. “Although we were already encouraging the families to practise proper hygiene and making sure that clients had a balanced diet before we attended the training programme, we realized they need to have adequate food before they take their medicine,” she says.

“Even more important is ensuring your clients enjoy peace of mind and letting them know there is more to be gained by being open about their condition with family members so they get the care and support they deserve.”

Because of pressure on Zimbabwe’s public services, people with HIV must rely on their families and neighbours. But this requires people to be frank about their HIV status. Isaac says the programme helped him be more open with his wife. “It is helpful for the two of us since she is HIV-negative and I am positive. We use condoms without any problems as we now understand our situation. People used to think that condoms were only used by sex workers,” he says.

He adds that it is important for couples to get tested together or at least disclose their status so they can help each other to avoid risk and stay healthy. “When I am very sick it’s my wife who cares for me and this was going to be a problem if she didn’t know the cause of my condition,” he says.

Isaac also says taking his anti-retroviral medication regularly was important to minimize infections and add to his quality of life. “Our Red Cross care facilitator emphasized sticking to the timetable for taking the drugs. Some people were just taking the medicine randomly, while others used to share the drugs with their friends. My wife is very helpful as she always reminds me to take my medicine on time,” says Isaac, adding that this has kept him strong enough to work. “I hope I can live long enough to see my children through their education.”

Priscilla says an eight-part course handbook with information on topics such as treatment, palliative care, care for carers, counselling, nutrition and positive living helps volunteers respond more quickly.

“The package acts as a reference. Whenever we need some questions answered we consult the package instead of waiting for officers from the head offices,” she says.

Evelyn Isaac of the World Health Organization says the training package is unique because it is centred on people living with HIV and their communities, and it links with health services, community programmes and organizations working on HIV.

“It also falls in line with the principle of universal access to prevention, care and treatment as defined in the Millennium Development Goals which will eventually change the dynamics of the epidemic in all countries across the world,” she says. International Federation Southern Africa regional delegation head Françoise Le Goff says the package will complement the increased availability of anti-retroviral medicines.

“The availability of anti-retroviral therapy is changing the shape of home-based care programmes from helping people to die with dignity to positive living,” she explains. “This package couldn’t have come at a better time as it empowers people living with HIV, caregivers and family members who provide care and support and improves backup for their humanitarian work.”

Near to Isaac lives Tendai, 32, a mother-of-two who fell ill in 2003. She tested positive for tuberculosis in 2004. She lives with her parents and ten orphans left by four brothers or sisters who have died. Life has been a struggle for Tendai and her mother, who is 70, who had to sell some of the family’s draught animals to buy food, thus reducing the household’s income from farming.

In the past, Tendai only took her medication when she felt sick. But Tendai’s Red Cross care facilitator told her she needed to continue taking her drugs regularly.

Today she has returned to the market, strong enough to sell mangoes to help support her family.





Home visits, such as this one in Uganda, are an important part of HIV care.









Life in Zimbabwe

13 million population of Zimbabwe
34 / 37 years life expectancy for men and women
83 per cent of people living on less than US$ 2 a day
1.1 million children under 17 orphaned by AIDS
Source: UNAIDS











Tapiwa Gomo
Tapiwa Gomo is International Federation Southern Africa regional information delegate.



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