Maria, 45, learned she was HIV-positive five years ago. Just a few months before her diagnosis, her husband of 17 years passed away. The two never had a son, so Maria lived with her husband and stepsons up until his death, when she was kicked out of the house with only the clothes on her back.
She went to get tested for HIV after a bout of shingles. To access testing services, Maria traveled from her home in Niassa province, a poor region in the north, to Maputo, Mozambique’s capital and largest city. The trip to Maputo added years to Maria’s life, but many others living with HIV in Niassa may never access the treatment they need, an issue International Medical Corps is addressing.
One of the poorest regions in the world, Niassa has a staggeringly high child mortality rate: 206 of every 1,000 children die before their fifth birthday. The province also has the lowest primary school attendance in the country, while 47 percent of children show stunted growth because of a lack of nutrients. These vulnerabilities are coupled with a hard-hitting HIV/AIDS epidemic. The disease spread quickly and now affects 16 percent of adults ages 15 to 49. According to UNAIDS, 140,000 people died of AIDS in Mozambique just last year.
For those in Niassa, access to basic health care, let alone testing and antiretroviral therapy, is rarely available. In an assessment conducted in an under-served district of Niassa province in July, International Medical Corps found that none of Ngauma district’s seven health facilities met the minimum standards, including those for HIV/AIDS services.
For Maria, testing and treatment services were not the only thing Niassa lacked to help its HIV-positive citizens. She felt alone, without a support network to fall back on. According to an International Medical Corps survey of Niassa residents, this isolation is partly a result of little public understanding of HIV/AIDS. International Medical Corps found that many people do not get tested for fear of shame, defamation, and discrimination. In addition, the lack of accurate messaging around HIV/AIDS has left many people confused about the virus and how it is contracted.
These misconceptions greatly increase the risk of HIV/AIDS, particularly among young women. Safe sex practices, like condom use, are rarely followed, and the stigma around the disease discourages people from getting tested. For those like Maria who face testing and find out they are HIV-positive, the lack of community knowledge often makes a normal life difficult, even outside of antiretroviral therapy.
Tired of feeling isolated after her diagnosis, Maria helped establish an association for women living with HIV in Niassa’s capital, Lichinga. “Kumalane association is our small, but important club for women,” says Maria. “It is here where we live and coexist and try to solve our problems. I am proud to be in this association because it’s my step to certifying a positive life for others and saving more lives as a friend saved mine.”
International Medical Corps works with existing community organizations to help HIV-positive people in Niassa find the support they need. For Fernanda, 46, Kumalane gave her a place where she could interact with women with whom to share her life experiences. “In the association we play to distract the memory,” she says. “I have thanked my friend, Maria, who encouraged me to take the test and, today, ties lives [together]…in the same association…to help the other women live [more] positively.”
A widow with six children, Maria encouraged Fernanda to get tested after she began losing weight and came down with a case of shingles. “I have a brother that works in the National System of Health who advised me to go take the HIV test. While I gained courage, a nurse discouraged me, saying that if I made [a positive] test I would die faster,” Fernanda says. “In 2004, a friend appeared who came back to encourage me to take the HIV test. I did not wait longer; my blood analysis had a positive result.”
To help Niassa’s HIV-positive citizens like Maria and Fernanda find better local treatment and community acceptance, International Medical Corps staff, along with the District Director of the Ministry of Health, runs education programs for Niassa’s communities and health professionals. International Medical Corps is now working toward the goal of getting 250 people into a treatment program each month, a goal set by the Ministry of Health.
For community health workers, International Medical Corps provides education on a variety of health topics, including the importance of raising public awareness of HIV/AIDS and on-the-job training to prevent mother-to-child transmission. Traditional birth attendants have also been trained in safe delivery practices and reducing the transmission of HIV during childbirth. In its follow-up, International Medical Corps found a measurable improvement in the delivery of health services, including HIV testing.
International Medical Corps is training health workers and Niassa’s communities at large. To date, International Medical Corps has held four community awareness sessions on HIV/AIDS, voluntary testing and counseling, prevention of mother-to-child transmission (before, during, and after childbirth), sexually transmitted infections and reproductive health. In total, these sessions have increased the knowledge, awareness, and, International Medical Corps anticipates, the behavior of more than 2,500 people.
Going into its second year, International Medical Corps HIV/AIDS outreach will continue to improve the lives of people living with the virus in Niassa. International Medical Corps already has plans to expand, promising continued support for HIV/AIDS, both medically and emotionally. For those living with HIV, the medical and public support that International Medical Corps promotes is a monumental step in their long battle to restore normalcy and acceptance. Encouraging others to follow in their footsteps and get tested, International Medical Corps’ focus on HIV/AIDS helps people in Niassa make healthy choices, for themselves and their communities.
The names of the women interviewed have been changed to protect their identity.